Thursday, April 14, 2011

Another Blog Prediction Seems To be Coming True!

In October last year I wrote - regarding implementation of the HI Service:

“The alleged comment made by a senior NEHTA official that “implementation is not NEHTA’s problem, and that they are there to design perfection’ sure rings true!

Watch this unravel - from their timelines it already seems to be behind. Without a properly resourced and led implementation, backed by appropriate incentives and undertaken with a solid well considered sector wide implementation plan (developed by project managers who know what they are doing) this is a dead duck!”

The full blog is here:

Well late yesterday we had this little gem appear.

Slow start to healthcare identifier service

  • Karen Dearne
  • From: Australian IT
  • April 13, 2011 5:17PM

FEWER than 30,000 people have checked their healthcare identity number since it was issued to all Medicare users on July 1 last year.

The government has automatically allocated identifiers to 23 million people.

It is intended that all healthcare providers apply the number to any medical record associated with an individual.

None of the 400,000 health professionals with provider credentials have accessed the Health Identifiers service as yet, and only 10 of around 80,000 eligible healthcare organisations have registered with the operator, Medicare.

The $90 million service -- intended to reduce medical errors and improve information-sharing by allocating a unique 16-digit identifier to every Australian -- was launched by the Health Minister, Nicola Roxon, but is still not operational due to concerns over the system's safety and licensing arrangements.

In February, the Health Department banned its use in any live IT environment, until outstanding concerns were resolved. These included the need for greater pre-production and software conformance testing to ensure identifiers could be used safely within healthcare providers' systems, and reduce the potential for misidentification of patients or mismatching medical records.

Now, Medicare documents have revealed only 28,456 people have looked up their HI number while visiting their Medicare Online accounts.

Medicare fielded a further 636 enquiries from customers -- 401 via a dedicated phone hotline, 76 in an office setting and 159 by email, fax or post.

Two people queried the date of the creation of the record, and one complained about being assigned an identifier.

More here:

All one can say is that my suggestions have been ignored and the progress has been, as expected, just glacial.

It certainly seems that delivery of ‘perfection’ is a remarkably slow process.

One can on guess how long we will have to wait for the PCEHR implementation.

We are forcefully reminded just how meaningless political deadlines are and how they tend to be totally disconnected from reality. If BHP ran its activities the way this lot do they would go out backwards and quickly but I guess when you are Government delivery is a lesser priority. Politics, not delivery, is what matters.

Just hopeless.



Bruce Farnell said...

Implementation issues such as this are commonplace in an environment where there is a total absence of IT governance and accountability. For NEHTA to be not concerned about implementation and the implications of their decisions on the implementation process speaks volumes about their relevance to eHealth in Australia.

Anonymous said...

I would suggest if BHP ran their company this way then some people would find themselves in jail.

Anonymous said...

There are big problems with the HI services. They have no been designed with any consideration of what is needed for real world messaging. (And messaging is what actually does the heavy lifting in the end)

In real world messaging we need a location specific identifier for providers and organizations and this is not the way the system has been designed and there are huge issues addressing messages using their current IDs. It is vital for privacy that this is addressed. eg. A medical receptionist has a STD check with her GP at a STD clinic and the results arrive at her place of work (where the GP also works) rather than the STD clinic!!

The messages that are used and will be used for a long time provide a single addressing field for this and it works fine now, but will not work without location specific IDs. Practice IDs are a vital piece of infrastructure we need for messaging and yet these have been made "voluntary" with means they will not happen, and if they do may not be location specific either.

One would have thought that $90M would have been enough to discover these issues, as I have been trying to have them addressed for several years, but technical comment appears to be unwelcome. It appears that people in "high" places think that they can design it the way they choose and everyone else will adapt, but that is not the case when you don't understand the problem in the first place. The whole identifiers mess is a solution to a problem in a parallel universe. Perhaps a crack in time space with appear and transport these people to that universe soon?

Grahame Grieve said...

> A medical receptionist has a STD check with her GP at a STD clinic and the results
> arrive at her place of work (where the GP also works) rather than the STD clinic!!

Please explain how this relates to the HI service. It's not obvious that there is a direct relationship.

Andrew McIntyre said...

Well without a location specific ID to send the results and a lack of Organisation ID's (Which may not be location specific) how are you going to ensure you direct the result to the STD clinic??

Currently we use Provider number, which is location specific. You also need to know which other providers have copies, and at which location that copy was sent.

The assertion is correct, its an issue that the Standards Committee has raised and part of the response is that there are legal issues with provider numbers, even though they are used now and the standard says to use them!!

Combining location and provider may work, but thats a minimum of 33 characters and the locations IDs may not be available, and may not be location specific anyway. If so same provider, same organization with multiple locations could still be a problem. Someone understood this when Provider numbers were setup, but that knowledge appears to have been lost. Much experience has been lost as many good people have retired in the 10 years when Healthconnect/Nehta have been "advancing" eHealth.

Grahame Grieve said...

hi Andrew

Looking at the overall way provider numbers work, I rather suspect that it's an accident of history that provider numbers work well for this because of how they were setup.

You say "currently we use provider number". I can't help thinking that this means we haven't actually identified the target correctly, and that that would have to be sorted out in an SMD world anyway. As for copy to - there we have a bigger issue, I think.

In general, I think that it's right, in the long term, to have hpi-i and hpi-o that are location independent. But we do have lots of location dependent workflow...

As you say, the issue isn't that the issues have been undiscovered, but that no one has chosen to be responsible for things like this. This is hardly a new problem in IT, of course.