The Australian E-Health Press provided a good serve this week. It included these:
First we have:
E-record lag costs health and cash
Karen Dearne | September 01, 2009
WITH a virulent new drug-resistant form of golden staph beginning to claim lives, the federal Health Department is unable to provide information on any of the estimated 40,000 infections among otherwise healthy young people each year.
Experts say the new, community-acquired methicillin-resistant staphylococcus aureus (CA-MRSA) -- which produces infections ranging from minor skin eruptions to loss of limbs and even death within days -- needs urgent attention from health authorities.
The Health Department has told a senate committee that poor data and a lack of connected technology meant information on the spread of the deadly disease could not be extracted from hospital admission systems.
Canberra Hospital infectious diseases unit director Peter Collignon said if only 1 per cent of incidences went "really bad, that's 400 life-threatening cases per annum".
With no national surveillance of CA-MRSA or the better-known hospital-based form of the bug, MRSA, Professor Collignon said, it was impossible to get a handle on the exact number of deaths or critical cases.
"We can't get the federal government to look at this," he said. "This is a public health problem they don't want to deal with."
Now the Health Department has conceded it has no records on the number of MRSA infections reported anywhere in Australia over the past two years.
"There is no information source at this stage which provides data," it said in response to senate community affairs committee questions. "The classification system used to record information on admissions to hospitals (for the National Hospital Morbidity Database) is a potential source ... however, issues with the quality of this data are still under consideration.
"A comprehensive picture of MRSA-related deaths relies on ICD-10 coding. At this stage, it has not been possible to extract this information from the database. However, work is proceeding ... to allow reporting of this cause of death."
More here:
http://www.australianit.news.com.au/story/0,24897,26006558-24169,00.html
This is a useful article as it makes it clear that in large countries it takes time, money, political will, co-ordination and planning to get e-Health in place. These points should not be ignored by DoHA and NEHTA with this ‘year of delivery’ nonsense.
It would be much better if we sorted out a properly planned implementation rather than the ‘Brownian Motion’ we have for a strategy at present.
http://en.wikipedia.org/wiki/Brownian_Motion
Download the slides from the conference from here:
http://www.health-e-nation.com.au/index.php?page=100
Second we have:
Care system of the future
Karen Dearne | September 01, 2009
POLITICIANS should separate the e-health agenda from the broader plans for healthcare reform to prevent further roadblocks to progress, health leaders say.
NSW Health deputy director-general Tim Smyth said the deadline set by the National Health and Hospitals Reform Commission for doctors to become connected or lose access to Medicare patient rebates was "inspired and achievable".
"But we also need to make it easy for health professionals to use e-health, a carrot as well as the stick," he told the Health-e-Nation conference in Canberra.
"If we provide an environment in which there's no excuse not to participate, then e-health becomes simply the way business is done.
"If you want to work as a doctor here, then you'll have to use these systems."
Dr Smyth said it was still a challenge to get clinicians to enter data for e-medical records, mainly because hospital systems required keyboard input.
"Emergency department doctors and nurses tell me it adds five or six minutes to a consultation with a patient, and they don't like that," he said.
More here:
http://www.australianit.news.com.au/story/0,24897,26006553-24169,00.html
It is a bit of a problem when the ‘out of touch’ bureaucrats who speak like this, fail to grasp what the cost to practitioners would be to have that delay imposed on each patient encounter. That is the key barrier and until it is addressed (either by technology that speeds things up, financial incentives or a mix of both) before much success will be seen.
Third we have:
Rudd health system shake-up calls for 'pay per cure'
The Advertiser
September 01, 2009 12:01am
- Rudd review recommends medical shake-up
- "Doctors paid per cure"
- GPs to take "more pro-active approach"
DOCTORS should be paid on the basis of making their patients healthier rather than just the number they see because the current system is failing.
The Rudd Government's own health review recommends the change as part of the first big shake-up of medical services since the introduction of Medicare in the 1980s, AdelaideNow reports.
The Building a 21st Century Primary Health Care System report was released yesterday by Prime Minister Kevin Rudd.
"The Government is determined to get health reform right," he said.
As well as introducing e-medical records to minimise medical errors and inappropriate treatment decisions, doctors would be rewarded for taking on patients with chronic illnesses and delivering the best treatments in the redesigned system aimed at keeping people out of hospitals.
The GPs would get special supplementary payments to recognise the extra time and effort associated with actively managing long-term illnesses.
But the change is an admission the current system of payment per patient has coaxed doctors into favouring patient through-put over active health delivery and the early intervention of emerging problems.
While only a draft, the report recommends encouraging GPs to take a more pro-active approach to people with conditions such as diabetes, asthma and chronic lung disease.
More here:
http://www.news.com.au/story/0,27574,26009983-421,00.html
A good example of the press reporting of the Draft Primary Healthcare Strategy.
It seems now that all 3 reports are now public (NHHRC, Preventive and Primary Care) the time has come for the rubber to hit the road and the Government to say just what it is actually going to do. It will be fascinating to see how it all works out.
Fourth we have:
National Broadband - Key to the Success of E-Health
By Paul Budde
Patients will have a central role
Government are recognising that healthcare is one of the last paper-based sectors of the economy. It has been estimated that, quite apart from the costs involved, this leads to then of thousands of deaths each year.
There is no doubt that a fully integrated computerised e-health system will bring with it its own challenges, and will undoubtedly on occasions also deliver its share of problems. But, as has been the case with all other sectors of society and the economy, integrated computerisation in this sector will improve the situation. While many healthcare sectors have their own computerised systems they are mostly not integrated with other systems operating in the sector. This leads to a mainly paper-based system operating between these incompatible structures. Furthermore, the real power of the existing computerised systems is not maximised as they are unable to provide a whole-of-patient service.
Inefficiencies and errors occur due to the lack of information, lack of sharing, lack of standard processes and lack of decision support—elements that other knowledge-based industries thrive on.
New national broadband networks not only supplies the infrastructure for national e-health systems—it can also be a catalyst for the standardisation and integration of the various widely dispersed computerised systems that are currently used within the sector.
However, an equally important element of e-health is that it will give the patient/client a central role in the health system. At present the patient is simply a subject, with little or no power in the process. The government has already indicated that the control of e-health information ultimately rests with the patient.
This will completely transform the industry, with patients taking far greater control of their own healthcare. Many healthcare issues will no longer be an abstract concept; linking them with patient data will personalise healthcare and enable personal healthcare management. Caregivers can be integrated into the healthcare system to assist the patients in the process.
Once the broad e-health policy is in place a modular implementation will be required. It will be impossible to apply all these different e-health applications at the same time. When the ground rules are in place the implementation should be paced and prioritised.
More here:
http://www.circleid.com/posts/national_broadband_key_to_the_success_of_e_health/
While not agreeing with all the analysis here it is good to see there is discussion of how the NBN may make a major contribution in enabling e-Health.
There is more commentary here:
http://www.commsday.com/node/493
Budde: Use health budget to pay for fibre
September 4th, 2009
The federal government should re-allocate healthcare funds into NBN applications development, according to telecoms analyst/advocate Paul Budde. Budde believes that e-health applications will generate roughly a quarter of the NBN’s revenue, saying that a trans-sectoral approach to the NBN is the only way to make the economics of the $43b project stack up.
Budde said that funds should be taken from the federal government’s health budget and put into e-health development for the NBN. “Are you going to put this [money] into bricks and mortar? Building more and more hospitals? More retirement villages, things like that? Or are you actually going to utilise part of your budget to do that electronically?” he said.
“It might lead to a situation where the government has to take a very major long term investment role in the network, it’s quite possible,” he later added.
Fifth we have:
The state of affairs in health
- Lesley Russell, Angela Beaton
Angela Beaton and Lesley Russell introduce their analysis of the 2009-10 state and territory health budgets
THE GLOBAL financial crisis has been good for health in the sense that it has provoked the state and territory governments to inject capital into health infrastructure. But this major investment needs to be balanced with provisions to ensure that needed health services are there for the vulnerable and disadvantaged groups that are feeling the pinch in this economic downturn.
Generally speaking, the marked investment in health infrastructure in all state and territory budgets, which includes the development and upgrade of metropolitan and regional hospitals, emergency departments, and the purchase of various bits of high-tech medical equipment, will help to improve health care services for many Australians.
Full article here:
http://apo.org.au/commentary/state-affairs-health
For an analysis of State and Territory health commitments against the National Partnership commitments agreed through the COAG process, visit to the Menzies Centre for Health Policy website.
See just how close we have come to the promises. Not a huge amount of discussion on e-Health sadly. (One mention for ACT Health)
Sixth we have:
At the front line of cancer care
Nurses across the country are able to go online to upgrade their expertise under a bold new program, writes Derek Parker | September 05, 2009
Article from: The Australian
SANCHIA Aranda has been in cancer nursing for 30 years. "I enjoy the people and the work.
Cancer's a challenging disease," says Aranda, professor of cancer nursing research at the Peter MacCallum Cancer Centre and head of the University of Melbourne's school of nursing.
"Nurses are the ones on the front line," she says. "When I was a practising nurse, I was always frustrated when I could not give patients the best care, especially in the oncology field. When I look at nurses now, I often see that same concern, that sense that you are not doing all you can because you have not been given the tools and skills. It is, in fact, a key reason for nurses leaving the profession. It is that sense that we wanted to address in this project."
The project in question is the National Cancer Nursing Education Project, known as EdCaN. It is an online package, centred around 11 extended case-based learning modules using video clips and learning activities that follow the journey of a person affected by cancer. The site is run under the auspices of Cancer Australia, and key support for the project has been provided by the Peter MacCallum Cancer Centre. The need for such a program is so strong that Aranda has attracted two other leading figures in the field: Patsy Yates, director of research at the School of Nursing and Midwifery, Queensland University of Technology, and David Currow, chief executive of Cancer Australia.
According to Aranda, figures suggest that one in three men and one in four women will require treatment for cancer by the age of 75.
"So it's a safe bet that every nurse is going to be in the position of treating cancer patients at some point in their career. But in most cases there is no specialist training provided.
"They have to adapt their general nursing skills, and that is not always appropriate, especially in relation to psychological and social issues," says Aranda, noting that only about 50 to 100 nurses are trained as specialist cancer nurses each year. "There simply aren't enough trained specialist nurses to go around, especially in growing areas such as prostate cancer and lung cancer."
What's more, nurses continue to take on new roles such as care co-ordinators, increasing the demand for specialist cancer nurses. Meanwhile, many cancer patients are cared for in non-specialist environments, such as surgical units. That means nurses in these settings need increased knowledge about cancer care to meet patient needs.
"The aim of the program is to provide a broad base of training, tied in with nurses' contributions at all phases of the cancer continuum," says Aranda.
To that end, EdCaN contains supporting modules on key cancer control concepts, competency assessment tools and resources, and a professional development portfolio template. The aim is to ensure that all nurses can demonstrate knowledge on cancer management. Some participants have developed advanced levels of competence in cancer control and treatment. Significantly, there is no cost to nurses to utilise the package. The $4million project has been funded by the commonwealth government as part of the Strengthening Cancer Care initiative, conducted through Cancer Australia.
Aranda says the recent launch of the project followed four years of research and consultations with stakeholders. There were also 14 pilot projects that tested the resources in a variety of ways, involving regional and metropolitan hospitals as well as university providers of nursing education.
"A message that came out of the pilot programs was the need for flexibility in the design of the materials," she explains.
Much more here:
http://www.theaustralian.news.com.au/story/0,25197,26023737-23289,00.html
What a great use of on-line services to upgrade nursing skills in a specialist area!
Seventh we have:
Broadband to stimulate seniors' grey matter
Andrew Colley | September 03, 2009
THE federal government has launched its $15 million senior citizens internet education program.
Federal Minister for Families, Housing, Community Services and Indigenous Affairs Jenny Macklin today unveiled the first 42 of 2000 internet "kiosks" which will be placed in community sites exclusively for teaching senior citizens how to use the internet.
The kiosks are essentially basic PCs with internet connections.
NEC Australia group manager, David Cooke, said the company was currently processing hundreds of applications from community sites for the kiosks.
The contract for the program was awarded to NEC subsidiary Nextep in November 2008.
Nextep is providing contract management and staff to run the program as well as internet access. Some sites would be provisioned using existing internet connections, Mr Cooke said.
Education and training for seniors will be provided by volunteers through partnerships with Adult Leaning Australia, the Australian Seniors Computer Clubs Association and U3A Online.
More here:
Doing this education will be vital if we are to have most consumers engage in e-Health – well done!
Lastly the slightly more out there article for the week:
New breathalyser can test for cancer
Agence France-Presse
August 31, 2009 05:47am
SCIENTISTS in Israel have devised a portable breath tester that detects lung cancer with 86 per cent accuracy, according to a new study.
The device could provide an early warning system that flags the disease before tumours become visible in X-rays, the researchers reported in the journal Nature Nanotechnology.
"Our results show great promise for fast, easy and cost-effective diagnosis and screening of lung cancer," they said.
The sensor uses gold nanoparticles to detect levels of so-called volatile organic compounds (VOC) - measured in a few parts per billion - that become more elevated in cancer patients.
Early detection of lung cancer dramatically increases the odds of survival. Currently, only 15 per cent of cases are discovered before the disease has begun to spread.
Screening via computerised tomography (CT) or chest x-rays can reduce lung cancer deaths, but is expensive and exposes patients to undesirable radiation.
In the study, a team of researchers lead by Hossam Haick of the Israel Institute of Technology took breath samples from 56 healthy people and 40 lung cancer patients.
To avoid contaminants, participants repeatedly filled their lungs to capacity for five minutes through a filter that removed 99.99 per cent of organic compounds from the air, a process called "lung washout".
Then the scientists hunted for VOCs present only in the cancer patients that could serve as biomarkers for the disease.
They found 33 compounds that appeared in at least 83 per cent of the cancer group, but in fewer than 83 per cent of the control group.
The next step was to design an assembly of chemical sensors using gold nanoparticles measuring five nanometres across. An average strand of human hair is about 100,000 nanometres in width.
More here:
http://www.news.com.au/story/0,27574,26004880-23109,00.html
Not quite information technology but seemed pretty clever to me!
More next week.
David.
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