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PostPosted: Fri Dec 03, 2010 7:57 am 
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Doctors resist plan to give patients control of records

PATIENT control over what goes into their electronic medical records faces resistance from medical leaders, who are calling for a delay to the potentially hazardous patient control feature.

Steve Hambleton, the vice-president of the Australian Medical Association, yesterday said that patient control of records should be held off until the electronic records transfer system was bedded down and won the confidence of doctors and patients. The right of patients to hide elements of their records from some health professionals who do not need to access the information has been hailed by the government as a central element of the e-health plan, due to start in July 2012.

But Dr Hambleton said that patients wanting to hide their treatment for depression, for example, raised the possibility of a dangerous medication interaction if the patient was later prescribed painkillers by a doctor unaware of an earlier anti-depressant prescription. Such information needed to be available to all doctors. ''It should only be able to be changed by doctors who understand the implication of what is recorded - and this can certainly be done in consultation with the patient.''

He was speaking at a Health Department summit conference on e-health in Melbourne yesterday where experts argued that technology was available which would enable the patient's full medical record to be accessible only by doctors. The Health Minister, Nicola Roxon, told the conference that privacy was a key concern and the electronic records would be ''truly personally controlled''.

She played up the potential of e-health. ''Allowing doctors instant access to a patient's health record will mean that any conditions such as allergies can be quickly discovered and that can save lives,'' Ms Roxon said.

Carol Bennett, the chief executive of the Consumers Health Forum, called for consumers to have a central role in developing e-health, pointing to Britain's experience which included a poor public response to such records.

http://www.mooneevalleyweekly.com.au/ne ... 12836.aspx


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PostPosted: Fri Dec 03, 2010 8:00 am 
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Don't Repeat the UK's Electronic Health Records Failure

Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.

But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?

In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.

Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:

Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."

Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.

The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.

If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.

Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".

More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.

How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.

The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.

http://www.huffingtonpost.com/stephen-s ... Technology


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PostPosted: Mon Jan 10, 2011 8:02 am 
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Too few training places for doctors

VICTORIA urgently needs more specialist training places for medical students to ensure there are enough practitioners spread across the health system, doctors say.

As 623 new doctors start work in Victoria's public hospitals today, the Victorian branch of the Australian Medical Association urged the state government to boost training places so the graduates could become surgeons, physicians, GPs, psychiatrists, pathologists and other specialists.

The Victorian government has identified 13 areas that require extra training places this year, including emergency medicine, paediatric surgery and oncology, but would not quantify the shortages.

AMA vice-president Stephen Parnis said extra places were vital in private hospitals, community health centres and Aboriginal health services - not just in public hospitals.

New measures were also needed to attract retired specialists to part-time teaching positions.

"This year we have a record number of new doctors beginning work in our hospitals, and given the current workforce shortages and the state's growing population, there has never been a better time for this boost," Dr Parnis said.

"These doctors will make an extremely valuable contribution to our hospitals and will provide much-needed support to experienced doctors who are working in the over-stretched public hospital system."

Increasing specialist training places was essential to ensure Victoria's health services were adequately staffed, he said.

"If we don't find solutions to the shortage of specialist teachers and mentors, and increase the number of specialist training places, future waits for elective surgery and emergency care will become even longer."

When medical students graduate in Victoria, they must do a one-year internship in the public hospital system.

They are then eligible to apply for a specialist training position or gain further experience in the hospital system.

A spokesman for state Health Minister David Davis said the former Labor government had failed to prepare sufficient training places for the arrival of more graduating medical students, leaving the Baillieu government with a ''significant challenge''.

He said the issue would be a priority in discussions with the federal government in coming months and that a number of new options would be explored.

''The Baillieu government is prepared to work with Victorian public hospitals, the private sector and other healthcare institutions to ensure the maximum number of high quality training places are available to meet the significant growth in numbers that the Brumby government failed to make provision for,'' he said.

http://www.theage.com.au/victoria/too-f ... 19jvj.html

[comment - I'm going to go out on a limb here and say what we actually need are less doctors. This would only be achievable if we eliminate 80% of chronic illness through prevention. I believe that a smaller health system with fewer doctors would lead to better quality service - I guess I can dream]


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PostPosted: Tue Jan 25, 2011 11:16 am 
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System is sick, not dead

FOR those unfamiliar with computer systems in Victoria's public hospitals, you would probably have to cast your mind back to the early 1990s to realise just how poor the information technology networks are in our supposedly world-class health program.

We're talking paper-based records, people queuing to use the available computer terminals and the difficulty sharing information with off-site colleagues. For patients in our public hospitals, the ramifications of poor IT systems are serious.

The problem starts from the time a person is treated in the emergency department and doctors and nurses aren't able to get access to the person's history of care with their general practitioner.

In the absence of a central health database that stores the history of patients' illnesses, treatments and medications, medical staff have to piece together this information from the patient's own memory in a process that requires trial and error.

On a good day, the patient will have a list of their medications and illnesses but typically their memory extends more to the colour of the tablet and a vague recollection that the name of the drug begins with an N.

Once the patient is admitted, staff on the wards have to queue to use a computer so they can access the patient's hospital records and diagnostic information. When staff are finally able to get on a computer, the system is slow and clunky and crashes are all too common.

The lack of connectivity between different areas of the health system means medication lists, tests, scans and other diagnostic tools are often repeated. Health dollars and clinicians' time are wasted chasing results and duplicating services in an already stretched public hospital system.

The quality of care is compromised and patients are at increased risk of mistakes being made in their treatment, diagnosis and prescription of medication.

While not common, prescribing the wrong medication can be extremely serious. In the past five years, nine Victorians have died in public hospitals after being given the wrong medication, and there have been a further 25 near-misses. Medication mistakes also lead to higher hospital readmission rates because the patient is not taking the medication needed to control their illness, or the medication has made their condition worse.

When former premier Steve Bracks announced the HealthSMART project back in 2003, the "whole of health IT system" promised to fix all our hospital information technology problems. With a patient's record available to all their treating health practitioners, including scans, blood tests and doctors' and nurses' notes, HealthSMART would reduce mistakes and allow clinicians to spend more time with patients.

With an initial budget of $323 million and a four-year time frame, the project's objectives were a little too ambitious. By 2007 only 24 per cent of the project had been completed, but 54 per cent of the budget had been spent.

The HealthSMART budget was raised to $360 million and the deadline extended several times, but patients are yet to benefit from this substantial investment.

Also, we are yet to see the most important elements of HealthSMART rolled out to Victoria's hospitals. In theory, HealthSMART's medication management system could allow clinicians to control a patient's medications, generate prescriptions, and importantly, be alerted to potential medication mistakes when patients are allergic to a particular drug, or an incorrect dose has been prescribed.

With the right IT support, medication errors could be virtually eliminated, but currently only four Victorian hospitals are in the early stages of implementing the necessary medication management systems. The rest of the state is missing out on these potentially life-saving systems because the rollout is several years behind schedule.

The Baillieu government has inherited an enormous problem in hospital IT that Health Minister David Davis has described as the myki of health. However, the solution shouldn't be to abandon this failing project. Quite the opposite.

You can't build a health IT system by throwing a few million dollars in here and there. It requires a long-term investment for planned development, implementation and regular updates. Hospitals need to be supported with targeted funding to build their basic IT infrastructure and bring these programs online. One of the biggest challenges will be increasing the basic computer infrastructure so doctors and nurses can quickly and efficiently call up patients' records. Without access to computer terminals, advanced programs are pointless.

Last year the former Victorian government announced it would make 500 iPads available for junior doctors and nurses. This would ensure they could access information when they needed it - at the bedside, for example. Six months later this trial hasn't started. We are a long way off seeing hand-held devices on all public hospital wards.

It's time the Baillieu government stepped up to the challenge and turned the HealthSMART mess around. Most importantly, the Premier should commit to the delivery of medication management systems in all Victorian hospitals by the end of 2012. It's an ambitious target, but the benefits for patient care will be immeasurable. We can't make the necessary increases in efficiency and improve patient care without better IT.

http://www.smh.com.au/opinion/politics/ ... 1a2y4.html


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PostPosted: Sat Jan 29, 2011 7:20 am 
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No consent as med students get intimate

MEDICAL students are being instructed by more senior doctors to conduct intrusive physical examinations - involving inspecting the private parts of both male and female patients - without obtaining the consent of the patients concerned.

Research conducted in Australia and Britain found that while some students went along with the requests willingly, seeing them as a learning opportunity, others obeyed because they feared refusal would get them into trouble.

In only a minority of the cases - 13 out of the 71 examples identified - did students dare to disobey their instructions and decline to perform the examinations, which involved touching or examining the breasts, genitals or rectums of men and women.

The representative body for medical schools and the country's leading patient advocacy group expressed concern at the findings.

Examining patients without consent is considered a breach of basic medical ethics, regardless of whether they are anaesthetised and thus unaware of the procedure.

Even if the patient has previously given their consent to an examination by a particular doctor, it is also considered unethical to expose them to examinations by other staff if the patient has not specifically consented to this.

Although a paper published in 2003 had caused a stir by finding 24 per cent of intimate examinations at one British medical school had been undertaken without valid consent, the authors said the new findings showed the problem persisted, "sometimes in contexts in which multiple students examine one patient".

For the new research, 200 students at two unnamed medical schools in Britain, and one in Australia, were interviewed. The findings were published in the journal Medical Education.

Consumers Health Forum executive director Carol Bennett said patients "have a right to know" that appropriate consents were being obtained.

"We would absolutely want to know that this practice (of unauthorised examinations) is not widespread," Ms Bennett said.

James Angus, dean of medicine at the University of Melbourne and president of Medical Deans Australia New Zealand, said while he had not seen the research, he would be concerned if its findings were confirmed.

"This raises important questions and needs to be considered by medical schools around the world," Professor Angus said.

http://www.theaustralian.com.au/news/na ... 5996391826


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PostPosted: Mon Jan 31, 2011 12:35 pm 
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Stop Googling your symptoms. Doctors are sick of it

DOCTORS have warned they are seeing too many "cyberchondriacs", those patients who misdiagnose their illnesses after Googling their symptoms.

The Australian Medical Association is concerned the plethora of online medical information is doing more harm than good, with patients increasingly referring to the internet for advice before consulting a trained GP.

"You can't make a diagnosis using the internet," AMA vice-president Steve Hambleton said.

"Patients turn up with sheets of paper convinced they have a particular problem.

"Doctors have to explain why patients haven't got something — before explaining what they have got. It certainly increases stress for the patient.

"Medical practitioners go through a minimum of 10 years of training before they can practise independently. You can't match that with an internet search engine."

Over the past 12 months most health-related Google searches in Australia were for information related to "symptoms", "blood" and "cancer".

Additionally, online queries about "hemorrhoids (sic)" and "thyroid symptoms" have doubled since 2009.

Google's user experience researcher, Dan Russell, said the onus to assess the accuracy and credibility of online information was on the individual.

"We now as individuals have access to huge amounts of information and you can pull up thousands and thousands of pages about Alzheimer's or irritable bowel syndrome," Mr Russell said.

"The irony is that people once learned how to look at the page of a book, document or journal and understand roughly how believable it was... but now for basically no money any wacko can write anything and put it on the web.

"As an individual at home looking at all this stuff, you have to constantly ask, 'Can I believe this?'"

Mosman GP Penny Shaw said simple symptoms were often misconstrued by patients using the internet, resulting in severe anxiety.

"I've had patients who have come in with a headache thinking they have a brain tumour and many who've had tingling in their fingers and thought they had multiple sclerosis," Dr Shaw said.

http://www.news.com.au/technology/stop- ... 5997300708

[comment - I agree about the internet diagnosis, but research is invaluable and it is important to making informed choices]


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PostPosted: Wed Feb 02, 2011 7:36 am 
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Whopping 80% Of All Web Users Seek Health Info Online

Health matters. In fact, health is the third most popular topic sought out online. In a national survey, The Pew Internet Project and California HealthCare Foundation measured internet users' interest in health information online and found out some insightful results, including searches related to food safety, drug safety and pregnancy information. Symptoms and treatments continue to dominate internet users' health searches.

The most likely groups to look online for health information include adults between ages 18 and 49 who, in the past 12 months, have provided unpaid care to a parent, child, friend, or other loved one. However, fewer than half of African American and Latino adults in the U.S. look online for health information.

Pointing to the user, adults 65 and older also don't tend to look online for medical advice, nor do those adults with high school education only or less, or have a household income of $30,000 or less. Just 2% of American adults say they have a disability or illness that makes it harder or impossible for them to use the internet. Eight percent of people living with a disability say this is true.

The Pew Internet Project also recently issued a short report noting that people living with disability are less likely than other adults in the U.S. to use the internet: 54%, compared with 81%. Statistically speaking, disability is associated with being older, less educated, and living in a lower-income household. By contrast, internet use is statistically associated with being younger, college-educated, and living in a higher-income household. Thus, it is not surprising that people living with disability report lower rates of internet access than other adults. However, when all of these demographic factors are controlled, living with a disability in and of itself is negatively correlated with someone's likelihood to have internet access.

Curiously, young people, Latinos and African Americans are increasingly likely to use mobile devices to gather information, which could potentially shift the patterns among those groups when it comes to using health information resources.

Here are some of the statistics contained in the full report concerning most researches topics:

- 66% of internet users look online for information about a specific disease or medical problem (perennially in the top spot).
- 56% of internet users look online for information about a certain medical treatment or procedure.
- 44% of internet users look online for information about doctors or other health professionals.
- 36% of internet users look online for information about hospitals or other medical facilities.
- 33% of internet users look online for information related to health insurance, including private insurance, Medicare or Medicaid.
- 29% of internet users look online for information about food safety or recalls.
- 24% of internet users look online for information about drug safety or recalls.
- 19% of internet users look online for information about pregnancy and childbirth.
- 17% of internet users look online for information about memory loss, dementia or Alzheimer's.
- 16% of internet users look online for information about medical test results.

http://www.medicalnewstoday.com/articles/215401.php

[comment - medical conditions should always be diagnosed by a doctor first - second opinion if necessary. Only chronic conditions, for which medicine has no cure, should be investigated further. How do I know which it is? With cancer the answer is easy. Still best to have cancer/ chronic disease diagnosed medically, followed by appropriate acute treatment]


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PostPosted: Mon Feb 07, 2011 7:40 am 
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Hard hit deserve millions: doctors

THE Australian Medical Association has called for the millions of dollars promised for GP Super Clinics on the Sunshine and Gold Coasts to instead be used to rebuild health services devastated by recent floods and cyclones.

AMA Queensland president Dr Gino Pecoraro said the two coastal regions were not areas of need and the $22 million committed by the Department of Health and Ageing for the clinics was desperately needed elsewhere.

The call comes just days after local medicos said the Sunshine Coast should never have been chosen as a location for a $15 million Super Clinic because it was already well catered for.

“It’s a waste of money on the Sunshine Coast,” Local Medical Association president Dr Mason Stevenson said during a consultation meeting in Nambour on Friday night.

“The GP Super Clinic will not be able to service the entire Coast.

“It’s more suited for an outer suburban area, or a small rural town.

“The Sunshine Coast, on the other hand, is well endowed with private, large, multi-disciplinary clinics in Noosa, Nambour, Maroochydore, Kawana and Caloundra.

“What we have is the potential for $15 million of tax payers’ money creating the duplicate of existing services.”

While Dr Stevenson said the money would be more suited for grants to create more substantial multi-disciplinary clinics in multiple locations, the AMA yesterday called for it to go to flood and cyclone-devastated communities.

“Sunshine Coast and Gold Coast have the highest and third highest GP to population ratio respectively,” state president Dr Gino Pecoraro said.

“By the Federal Government’s own measure these areas are not considered Districts of Workforce Shortage where general practitioners are in short supply.

“The $22 million could be much better used to rebuild health services for flood and cyclone affected communities across Queensland.

“Regions such as Tully, Ipswich and Toowoomba are in desperate need of repairs to their health facilities and this money could provide vital support.

“There is no need to build GP Super Clinics on the Sunshine or Gold Coast, however, there is an urgent need to rebuild health services in communities devastated by the floods and the cyclone.

“To spend such a significant amount of money where it is not needed is an obscene level of waste.”

http://www.sunshinecoastdaily.com.au/st ... s-doctors/

[comment - these super clinics are not the answer to the strain on our health system - a newer lifestyle with 80% of disease prevented first is. Sure I am one of those burdens - I hope prevention will mean that I won't be a burden second time :)]


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PostPosted: Wed Feb 09, 2011 7:57 am 
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What if doctor doesn't know best?

When are medical treatments worthwhile and when are they futile? This is a complex and often divisive question. Even experienced doctors sometimes disagree about whether to treat, or not to treat.

Take, for example, the controversy surrounding the former director of The Alfred hospital's trauma centre, Thomas Kossmann. In 2007, colleagues accused Dr Kossmann of providing "excessive treatment" to critically ill patients. In 2008, the Victorian Ombudsman accused him of "harvesting patients" to maximise income, and inappropriate billing.

After extensive investigations by the Australian Tax Office, the Transport Accident Commission, WorkSafe and the Medical Practitioners Board, Dr Kossmann was cleared of wrongdoing. Although many issues about Dr Kossmann's work practices have been put to rest, the question about when to treat a critically ill patient remains ongoing and controversial.

In a busy, modern trauma centre, state-of-the-art technologies and cutting edge surgical interventions are standard fare. In this environment, doctors must not only decide what is technically possible but also what is ethically permissible and economically viable.

Today, trauma specialists must decide when to use life-saving technologies. They must make quick decisions about providing, or withholding, treatment that may, or may not, save a person's life. Trauma specialists also make decisions about the costs of saving an individual's life. These are difficult decisions, often made more difficult by the noise, chaos and urgency of a trauma centre.

Some doctors choose to withhold treatment when they consider a patient's prognosis to be poor. They might justify these decisions with calculations about a patient's quality of life. Other doctors believe that all life is valuable, and that every attempt should be made to prolong it.

It is common for doctors working in a trauma centre to adopt a "let's try it and see what happens" approach. It is during the first 24 hours of care that many of the crucial decisions need to be made. Some trauma specialists describe keeping patients alive, even in the short term, as a win.

This principle of "doing everything" to save lives is developed during medical training, fuelled by the fear of legal action and reinforced by financial considerations. However, many doctors recognise that "doing everything" is not always in a patient's best interest.

There are diverse views among health care professionals, consumers and the public about whether an invasive treatment is justified or excessive, whether treatment is futile or worthwhile. There is rarely a right or wrong answer. In many instances, conflicts can be resolved collaboratively at a patient's bed-side. However, in the high pressure world of a busy trauma centre, life and death decisions are left almost entirely to the discretion of the doctor in charge.

Why do we allow these difficult ethical decisions to be made by an individual doctor? We could instead insist on regular and routine reviews that encourage reflection and give voice to a diversity of views. Few trauma surgeons have the time, resources or training to sort through complex ethical problems on their own. Is it simply assumed that medical expertise is enough to ensure that doctors will make the "right decisions"?

Life-saving technologies are accompanied by the responsibility to use these technologies wisely. Perhaps this responsibility could be shared among health care professionals from a range of disciplines, and consumers. Some doctors might argue that you need expert medical knowledge to be competent to judge the issues. But contemporary health care decisions are as much social, economic, ethical and political as they are medical and scientific.

Rather than finger-pointing after crises like that at The Alfred's trauma centre, responsibility for life and death decisions should be shared. Decisions about providing, withholding or withdrawing treatment are contested and would benefit from ongoing scrutiny by a team of health care professionals. These multidisciplinary reviews should be routine and shared openly with the public. In this way, we can all take some responsibility to ensure that life-saving technologies are used justly.

http://www.smh.com.au/opinion/society-a ... 1abs7.html

[comment - all doctors were not created equal, but most important seems to whether they are motivated and empathetic. After visiting numerous doctors I was amazed how different the service was. Like many on this forum I didn't go again to doctors I believed were not offering an acceptable standard of care]


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PostPosted: Tue Feb 15, 2011 8:16 am 
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Researcher allegedly sent fake invoices, ICAC hears

A FORMER research student accused of having conspired to defraud two Sydney hospitals of more than $680,000 denied to the Independent Commission Against Corruption that the goods and services she and her sister had provided were bogus.

Sandra Lazarus, 32, appearing before ICAC commissioner David Ipp, QC, in his inquiry into her conduct, said that she had been a genuine researcher on the application of a cancer diagnostic tool, a ''Medex'' device, and the invoices sent through companies she controlled had been genuine.

Todd Alexis, SC, counsel assisting the inquiry, painted a different picture of the activities of Ms Lazarus and her sister Michelle, who had allegedly improperly obtained payments of $218,350 from the Royal Hospital for Women and $465,300 from the Royal North Shore Hospital.

He said not only had Ms Lazarus provided false invoices but she appeared to have forged the signatures of medical practitioners on requisition and other forms. Similar reports of improper conduct by Ms Lazarus had come from St Vincent's Hospital.

Mr Alexis said goods had not been provided to the women's and Royal North Shore hospitals nor services provided, in a period from 2007 to 2009, and that it had been ''a rather brazen fraud'' which should have been detected.

Ms Lazarus had invoiced for hundreds of tests on patients at the hospital but nursing specialists at the women's hospital had said that no more than a handful of patients had been referred to her.

As part of what was intended to be a limited pilot study, Ms Lazarus had asked for services from Medical and Clinical Informatics Consultants and Wish Consulting, companies owned and directed by herself and Michelle.

The hearing resumes today.

http://www.smh.com.au/nsw/researcher-al ... 1atqx.html


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PostPosted: Wed Feb 16, 2011 9:10 am 
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Radiologist could have missed cancer

Almost a dozen patients who underwent CT scans at Abbotsford Regional Hospital were originally misdiagnosed, and could have potentially been suffering from cancer, according to the Fraser Health Authority.

In an internal review, the FHA investigated the cases of 170 patients from Abbotsford Regional and Chilliwack General hospitals.

A total of 10 Abbotsford hospital patients' CT scan results were misinterpreted by a part-time practising radiologist, and "three or four" of those patients may have had cancer, said CEO Dr. Nigel Murray at a press conference Friday.

"There are . . . discrepancies that could potentially cause harm," Murray said.

"Just the nature of the diagnosis was inconsistent [with] what was found on review by other radiologists and peer review.

"I have to be very up front and say they could include missed cancers."

All of the errant CT scan results occurred between mid-August and mid-September.

One of the 10 patients has since passed away, but Murray was unable to confirm if the patient had died naturally, or because of a misdiagnosed illness.

"That is currently under investigation," he said.

The review centered around a part-time radiologist who had been working within the FHA.

According to the FHA's investigation, the radiologist was qualified, and it was his performance that was being scrutinized.

He has since moved back to his home province of Ontario, and is no longer practising in B.C.

He also dealt with approximately 200 cases in the Cranbrook area.

However, family doctors linked to those patients were immediately informed and an internal quality review performed by four experienced radiologists confirms patient care was not affected.

It wasn't until the radiologist left for Ontario that the investigation into his qualifications and potential misdiagnosis in both the Fraser Valley and Cranbrook began.

Murray said the authority was notified by the B.C. College of Physicians and Surgeons about potential problems around his analysis in Cranbrook, and that it should investigate his cases in the Fraser Valley.

"That doesn't mean he's not licensed or appropriately qualified," said Murray. The information was revealed during a press conference Friday when Health Services Minister Colin Hansen announced a larger umbrella investigation into CT scans and obstetrical ultrasound readings performed by two radiologists - including the one who practiced at the ARH - after two health authorities reported issues concerning appropriate credentials or experience to analyze scans.

Hansen said the Vancouver Coastal Authority also reported problems.

A total of 3,400 patients in the province have been involved and notified, with 140 people requiring further tests, said Hansen.

Vancouver Coastal Health stated Friday at the same press conference that it was notifying more than 900 patients in the Powell River area who received CT scans and obstetrical ultrasound readings and analysis from a full-time radiologist. Dr. Doug Cochrane, chair of the BC Patient Safety and Quality Council, is leading the independent investigation.

"Part of Dr. Cochrane's review will be an immediate 30-day investigation to ensure all radiologists currently working in B.C. are properly credentialed," said Hansen.

Dr. David Ostrow, president and CEO of Vancouver Coastal Health, said the screening process set up to hire qualified radiologists failed.

"We have a whole series of processes in place that we use to look at the credentialing, and then give people privileges to do certain things, and we thought that all of those processes would work and they did not work in this case," said Ostrow.

Results of the Cochrane's investigation will be made public once it has been completed.

http://www.abbotsfordtimes.com/health/R ... story.html


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PostPosted: Tue Mar 01, 2011 12:52 pm 
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IBM wins $23.6 million e-health deal from Government

IBM has won a $23.6 million contract from the Government’s National E-Health Transition Authority (NEHTA) to design and build the National Authentication Service for Health (NASH) project.

According to an IBM spokesperson, the whole infrastructure project is set to be rolled out by June 30, 2012. It claimed this project would form the cornerstone of any national e-health system.

The system aims to become the first national authentication system for electronic records gathered from various health bodies. The system is needed to make sure all data transferred between departments is secure and genuine.

According to a statement from NEHTA, IBM will use its hardware, software and service capabilities to manage the project delivery of the system for healthcare providers.

“NEHTA is providing a software development kit (SDK) that will allow existing healthcare systems and deployments to quickly and seamlessly integrate with NASH,” the statement added.

IBM managing director, Andrew Stevens, said the project would encourage more widespread acceptance of electronic health records and systems.

“This programme will benefit over 600,000 Australian doctors, nurses and allied health providers and accelerate the delivery of smarter healthcare across the entire healthcare system,” he said in the statement.

In mid 2010, IBM came under fire for allegedly bungling a large payroll service implementation for Queensland Health. The project start date blew out from eight to 26 months and when it finally went online a litany of major problems ensued.

The Government announced $466.7m for the creation of a national electronic medical record system in the most recent Federal Budget. But the Coalition has repeatedly called for its cancellation and claimed the funds should be diverted to other needs.

http://www.arnnet.com.au/article/378223 ... overnment/


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PostPosted: Sun Mar 06, 2011 7:18 am 
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Nurses sacked after horror games with patients revealed

NURSES have been sacked from a nursing home for allegedly depriving a dying man of food and photographing residents' genitals in a game called the "Genital Friday Club".

One of the New South Wales' top nursing homes, William Cape Gardens, on the Central Coast, ran an independent investigation into the atrocities before sacking two nurses, allegedly the ringleaders, on February 16.

A third nurse was suspended and has since been reinstated, while a fourth nurse resigned.

The horrific treatment at William Cape includes claims that three nurses told an elderly woman with dementia that her husband was having an affair with her best friend while she was in care.

A whistleblower told The Sunday Telegraph that when food was withheld from an elderly man, the nurse allegedly said: "He was going to die anyway and this way it would make it quicker."

Staff were forced to sign confidentiality agreements over the scandal.

The whistleblower said the "Genital Friday Club" had been going on "for some months and was known of by quite a few members of staff".

A second staff member said at least one nurse took photographs of elderly residents' private parts on an iPhone and asked colleagues to guess who they belonged to.

William Cape's spokesman Tim Allerton, from a public relations firm, said it was unclear how many residents had their genitals photographed in the game.

He said relatives of a female and male resident were given a full explanation and apology, which they accepted.

"In regards to the allegations (that a dying man was starved), we can't really comment on that. We've reported it to police and it's in their hands," he said.

NSW Police and the Federal Department of Health and Ageing have both launched investigations.

A department spokeswoman said it was treating the allegations "very seriously" and a full investigation had been launched by the Aged Care Complaints Investigation Scheme, with investigators to go to the home tomorrow.

Lynda Saltarelli from the action group, Aged Care Crisis said it was one of the worst cases of abuse at a nursing home she had heard of.

While the home said it was in the process of informing relatives of its residents, families that The Sunday Telegraph spoke to were shocked to learn of the investigations.

Peter Thirgood, whose mother Edna lives in the home, was shocked to hear of the alleged behaviour.

"How disgusting. I know some people are not happy around there," he said.

William Cape's provides care to 121 residents and was a finalist in the Property Council's awards for retirement homes last year.

The allegations come 10 months after The Sunday Telegraph went undercover in two Sydney nursing homes to reveal the routine neglect and abuse of the elderly.

http://www.news.com.au/national/nursing ... 6016507730

[comment - I witnessed great nurses and very poor ones when I was in hospital. The larger our medical systems becomes I believe the more likely these things are to happen. Choosing medical staff is a great advantage if you can, although sometimes there is no choice]


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PostPosted: Mon Mar 07, 2011 7:41 am 
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Errors unreported at Melbourne hospital

A review of intensive care unit staff at Melbourne's Royal Children's Hospital has found catastrophic medical errors going unreported.

The Age reports two doctors from the hospital uncovered hundreds of adverse events from a systematic review of the ICU staff and their management of patients.

The pair of doctors found 405 adverse events across 165 patients at the hospital with 28 per cent of those categorised as either major - requiring significant medical intervention, or catastrophic - an error leading to permanent disability or death.

By contrast the doctors, Reshma Silas and James Tibballs, found only 166 events in 100 patients reported through the hospital's voluntary reporting scheme over the 176 days of research.

The bulk of those events were rated as insignificant.

The report, published in the journal Quality and Safety in Health Care, did not outline whether any children died as a result of the errors.

The doctors concluded that systematic reporting - staff interviews and following patient outcomes - was a more effective method than voluntary reporting.

In a written statement to The Age, the hospital's executive director of medical services, Dr Peter McDougall, said the Royal Children's was committed to systematic evaluation of adverse events in addition to its voluntary system.

http://news.ninemsn.com.au/health/82203 ... e-hospital


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PostPosted: Tue Mar 08, 2011 9:11 am 
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Doctor vacancies 'not affecting care'

ACT Health says it is watching the workload of junior doctors who are doing overtime to cover 15 vacant positions.

Graduate doctors were due to fill the positions in January and rotate across the Canberra Hospital and other ACT health services.

ACT Health deputy chief executive Ian Thompson says 76 junior doctors have been recruited, which is more than in previous years.

He says the health service is advertising in Australia and overseas to fill the remaining roles.

"While we have a number of vacancies, we've also made a number of offers and we are hopeful the situation will improve very soon," he said.

Mr Thompson says junior doctors are working about six hours overtime on top of an average 40 hour week.

"We are providing the same level of care and we believe that it is the shifts that we ask junior doctors to provide are safe and that the junior doctors are able to provide good care while they're on shift," he said.

"We monitor very closely the working patterns of junior doctors and try to balance the need to get coverage across the hospital with the need to ensure junior doctors do not work excessive hours."

Mr Thompson is hopeful it will become easier to fill vacancies in coming years.

"There has been an increase in the number of medical school graduates but we haven't seen the full affect of that coming through yet. So I expect in coming years there will be a greater supply, but as it stands at the moment the supply is still tight," he said.

http://www.abc.net.au/news/stories/2011 ... 157104.htm


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