Tuesday, February 08, 2011

The Chickens Are All Coming Home To Roost. It’s Looking Like A Huge Mess!

A couple of really quite astonishing articles appeared in The Australian IT Section today.

First we had this:

Health record identifier held up because of safety concerns

THE Health Department has banned the use of the $90 million Healthcare Identifier service in any live environment due to concerns over the system's safety.

The service, operated by Medicare, was declared live by Health Minister Nicola Roxon in July, but has been sitting idle while software interface specifications, licensing arrangements and compliance issues are thrashed out.

Last week, the department prohibited use of the service until all concerns were resolved.

Despite the fanfare over meeting Ms Roxon's deadline for the start of the service -- Medicare issued every Australian with a 16-digit unique number on July 1-- fears have grown of the potential for mis-identification of patients and mis-matching of medical records.

Only state health departments have tested the service so far. Broader adoption depends on finalisation of Medicare's Notice of Integration and conformance processes that ensure all software interacts correctly with the service.

A department spokeswoman said pre-production testing of related systems was important for privacy and safety reasons.

"In order to obtain identifiers for use in live systems, the software must first pass two types of testing," she said. "Medicare tests the software to make sure the integrity of the HI service system is not compromised when the (external) software obtains the identifiers.

"In addition, independent accredited testing laboratories will test the software to ensure that identifiers are used safely within the healthcare providers' systems.

More is found here if you can bear it:


And then we have this.

No budget for huge health e-record development task

SOFTWARE vendors face 10-15 staff years of development work to meet the complex requirements of the $467 million e-health record program, but there's no plan to pay for it.

Health Communication Network chief executive John Frost said the federal government was spending "obscenely large" sums on the personally controlled e-health record, including $38.5m over the next six months on the National E-Health Transition Authority (Nehta).

"That money, frankly, will be spent on consultants," he said. "The government has allocated $12.5m for the three lead implementation sites, $55m for second-wave sites, and $467m for just the first phase" of the personalised e-health record program.

"But the funding proposed for the people who are really going to make it happen is just laughable."

HCN, which supplies the market-leading GP software Medical Director, is one of five desktop vendors invited to join Nehta's software panel, to help "test and fine-tune" the currently undefined personalised record specifications so they can be used at the three lead sites.

Lots more gruesome details here:


Taking the Health Identifier (HI) Service first, regular readers will know I have been saying for ages there are issues about the data quality of the base HI Service and its fitness for record matching.

See here from back in 2009.


This led me to suggest we need incrementally scaled pilots to prove utility and safety. Now - eight months after the fanfare start - it seems we are not much advanced and even the Department is not sure if what they have is actually viable. Bit late to discover that after 2-3 years of development etc.

The second article just shows how fabulously out of touch Government and NEHTA are about how projects such as this should be planned, managed, funded and delivered.

Taken together these two articles just shout incompetence and stupidity about national program delivery.

Heaven help us! The risk of all this just imploding around us must be amazingly high!



Anonymous said...

This is a slow moving train wreck. The policy backflips and the NEHTA debacle have delivered nothing to date.

This Government's propensity to over-promise and under-deliver is ceaseless. And to think Healthcare is supposed to be their strength.

All I am seeing is wastage. The amount of wastage in the public health system is phenomenal. The payroll costs with no ROI at NEHTA and DOHA is truly astounding.

John Frost, as usual,has hit the nail right on the head. How on earth can a PCEHR System be delivered without due consideration to the source systems that currently contain the lion's share of health record data?

This degree of incompetence should no longer be tolerated.

Dr David More MB, PhD, FACHI said...

And if they fix John's issue - they have these - from my blog of 2 days ago:

"From other sources we know there will be an record indexing service, access control services and a template service (whatever that actually is).

What is not clear to me are the following:

1. Where are the health summaries and discharge summaries going to be sourced from?

2. Who will be accountable - and presumably paid - for keeping them current even after they have been uploaded?

3. Who will be accountable for errors in the summaries?

4. How will other non-government entities be paid for their time and trouble to populate the proposed repositories?

5. Who will fund the update of all the affected systems?

6. Who will train and support all the new e-Health users?

7. What happens if your GP does not want to share his records with the Government?

8. More important has anyone actually thought about any of this?"


Anonymous said...

Is that fact , or an unfounded media statement ? Better not count your chickens too quick.

Dr David More MB, PhD, FACHI said...

Is what fact? Seems to me all the material is direct quotes - from HCN or the Government.


Anonymous said...

Might be possible that John Frost has an agenda here...

Dr David More MB, PhD, FACHI said...

I am sure he has. Its probably around not being expensively messed around by incompetents like NEHTA and DoHA. His quotes make it clear he does not wish to be treated like a charity!


Anonymous said...

Dear Anonymous,

Of course John Frost has an agenda.

He also provides >65% of the online GP population with practice management software that contains all of the summary health record information. Australia is leaps and bounds ahead of any other nation in terms of GP adoption of software and this is mainly due to HCN and more than 10 years of effort / investment.

If you think Australian GPs can be churned to another software program that doesn't exist overnight then you have rocks in your head. There may be other GP software vendors (ie 3-4) with <10% market share each that could potentially compete but that will take years for them to migrate. Even if it is given away.

You obviously don't have a clue about clinicians or software users, or more importantly both to understand that this is one of the biggest issues that will stop the Govt from achieving it's political and strategic goal of a PCEHR system by 1st July 2012.

$280K for HCN to upgrade their software whilst NEHTA receives $38M to p*ss up the wall is a rank disgrace. Let alone the consultants fees with their mouths in the trough.

Wake up to yourself!

Anonymous said...

John Frost "provides >65% of the online GP population with practice management software". He used to claim 85%. Soon I predict it will be 45% as market forces consume him from the edges.

Yes he has an agenda. It is to protect and defend his user base. And this is a major obstacle to the advancement of ehealth in the primary care environment.

HCN (MD) John Frost in my view are one of the root causes why the vendor community has been unable to develop working interfaces with MD that are effective and in support of market development. If ever there was a case for kicking a vendor up the proverbial this is it.

As doctors we can now send our prescriptions with a bard code to a prescription exchange service which the pharmacist can access, pull down the script and dispense it. Many pharmacists in my area say they cannot do this because they cannot access MD scripts because MD won't allow their scripts to be sent to one of the script exchanges.

While this unconscionable, blatantly short sighted, self serving, obstructive stupidity is allowed to prevail against the public interest we the doctors, you the vendors and the government as payor of incentives, will all pay the price.

There is one solution which the doctors in our area have been demanding of the Department for over 12 months but they sit in mute silence with deaf ears staring blankly out the window.

The solution is simple and it doesn't take a rocket scientist to either understand or implement it. The solution is this:

--- the Department of Health should modify the conditions relating to incentive payments of 15 cents per script paid to pharmacists who dispense from an electronic script by making it a condition for payment that the incentive will only be paid for scripts which are generated by prescribing software that can send scripts to any and all of the script exchanges operating in the marketplace where the doctor selects which exchange is to receive the script.