Wednesday, April 27, 2011

Sometimes You Just Have To Weep. This is One of Those Times.

The following appeared at today.

Pseudonym identifier a bit Mickey Mouse

Patients may now apply for an individual healthcare identifiers (IHI) as ‘Michael Mouse’ – or any other pseudonym – but they won’t be eligible for Medicare or PBS rebates.

Medicare Australia has released forms that allow anyone who has concerns about their privacy or safety to apply for an IHI in a fictitious name, so as to conceal their identity.

The IHI service is intended as a gateway to e-health schemes such as the Personally-Controlled E-Health Record (PCEHR) due to start operating in July next year.

People who wish to have an IHI but remain anonymous can select a fictitious first name and surname, and must also give a false date of birth, so long as it is within six months of their real date of birth.

More here:

The forms can be downloaded from the page found here:

The article and the form then have some really amazing revelations!

In the section Important things you should know about Pseudonym IHIs

1.You can only hold one Pseudonym IHI at a time.

2.You can choose to merge the Pseudonym IHI with the IHI in your real name at any time.

3. If you seek treatment using your Pseudonym IHI, you will not be able to claim benefits from Programs administered by Medicare Australia, such as Medicare and the PBS.

----- End Quote

So what this means is you can have a protected identity but no PBS or Medical Benefits for you or you can be identified and claim benefits.

This I do not believe was the intent of the Government. As I understood it the Pseudonym IHI was to allow you to be a ‘full citizen’ and be able to have a PCEHR and claim benefits - but just not to disclose your real name when accessing care. As it is reported and I read, to describe what they seem to have come up with as ‘Mickey Mouse’ really flatters the nit wits who have implemented all this.

What I suspect is an un-intended consequence of what has been done is that various records held by Medicare (PBS, Immunisation and Claims) will not be able to be linked to the ‘fake’ IHI and so will not be accessible while you are in anonymous mode.

It also seems that real IHI linked records will be held separate until you give up the Pseudonym IHI and then who knows what sort of information mess will flow. It is not clear if you can have a ‘live’ Pseudonym IHI as well as a verified IHI simultaneously. It is also not clear what IHI you would use to access the IHI and PCEHR portal (when the latter exists).

The bottom line is that the geniuses at Medicare and NEHTA need to go back to the drawing board and come up with a way to have anonymous care and a continuing link to a verified IHI and payments managed behind the scenes. That is what was intended for those who need to protect their identity and that is what should be delivered.



Anonymous said...

This one made me laugh, David. People came from all over the NEHTA office to see what was so funny.

How about we all go and apply for a mickey mouse IHI on 1st July or 1st Jan and see if we can pull them downa

Anonymous said...

I only hope the special alarm now fitted in every ministerial office (its pink and designed to look like a roofing batt) starts to ring loudly in Roxon's office.

It is also clear from the last post that (at least some of) the folks in NEHTA are as mystified/gob smacked as the rest of us about what Medicare/DOHA are doing, and are just not able to be publicly outraged about it.

So, lets start a book on who in 24 months will be asked to sit on the independent panel that enquirers into this 'saga' (however it will unfold over the next 2 years).

Anonymous said...

I would be more inclined to apply for it on 1 April - much more an apt date really......same for the PCEHR.

Anonymous said...

I accept there probably is a case to be made for the use of Pseudonyms in a few exceptional circumstances. However there is a much stronger case to be made to apply the KISS principle – Keep It Simple Stupid – until the very basics of a system has been introduced and bedded down successfully in the market place.

At present all we have heard year after year is a lot of shallow rhetoric with no real substance behind it. The first step is to implement a base system which works and which can be built upon. This mind numbing mentality of covering every single eventuality such as 'pseudonyms' clutters the discussion, impedes progress, and serves to undermine whatever good work is being done.

Fundamentally the effort today should be to introduce a contained e-health record
which provides accurate, secure identification for an individual which can be relied upon as a source of complete information (in at least one area such as my immunizations, or my operations, or my current medications) that can be used and trusted by me and those from whom I may seek treatment.

It does not have to cover everything to do with my health at the outset. t does not have to cover the tiny minority who may want to be known as Mickey Mouse, Donald Duck or Father Christmas.

It does however need to cover a contained core of important data so that the health IT infrastructure and the interoperable links between users can be proven. Running up and down drainpipes all over the place trying to be all things to all people which seems to reflect NEHTAs modus operandi is futile.

The researchers in NEHTA can research till the cows come home but until some pragmatic software vendors agree to collaborate with each other to deploy the nucleus of a PCEHR all we will ever see is more and more truckloads of money being thrown away on poorly conceived bureaucratically driven fantasies.

Anonymous said...

Anonynmous, 9:48: While the idea of KISS is admirable, at least 90% of the effort in implementing a complex system is consumed by the 10% of cases where KISS doesn't work. Although the notion of the 'mickey mouse' identifier sounds silly, it is a simple solution to requiring an IHI to provide anonymous care.

In a utopian future where 90% of health consumers are using IHI's and systems and processes are streamlined for their use, being able use the mickey mouse option is MUCH better than having to have a second path (and systems etc) for anonymous care.

As tempting as it is to heap scorn on the end results of HI service design, it went through exhaustive analysis by many smart people. This particularly clunky result was the least-bad approach when balanced across all of the technical, process, clinical safety, legislative and privacy considerations.

It is unfortunate that the process of developing this answer was so opaque; it is a curious trait of government service design.

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

I don't recall any input being sought from anyone outside the secret and clearly not very competent design team and there is no excuse for that when designing public infrastructure.

There is no excuse for making such a hash of it!


Anonymous said...

To Anonymous 11:36:00 PM I would simply say - I don't entirely disagree with your comment that KISS does not work in many instances. HOWEVER, let me say this:

- if as you say "at least 90% of the effort in implementing a complex system is consumed by the 10% of cases where KISS doesn't work" then forget about the need to address Mr and Mrs Anonymous (who are far far less than 10%.

You will get a much faster result and Mr and Mrs Anonymous probably won't give a frogs fart about whether they can be accommodated or not.

Just be pragmatic - develop and deliver for Mr and Mrs Real-name and stop wasting time and money fluffing about looking at yourself in the mirror fantasising about whether you are a real person or not.

Anonymous said...

Anonymous 9:15 - unfortunately, anonymous care can't just ignore the processes which 'normal' health uses. Quick example: consider an HIV positive person who wants to be anonymous for an episode of care. If this person requires a pathology test, their IHI number would normally be the primary identifier used for the test. If the person requests to sets up an unverified IHI for this anonymous episode (ie mickey mouse), the test can be done as per normal processes used for identified customers. The unverified IHI lapses after a few months, and the care is as near to anonymous as possible.

If the person does not disclose their IHI number (or doesn't want to set up a temporary one), what identifier should the health org use instead for this consumer? Should all anonymous consumers use the same 'John Doe' IHI number? If so, how would the receiving lab tell records for different anonymous customers apart?

Use another type of identifier? OK, so now every e-health system (organisation, software, clinicians, admin) needs to support a full extra set of identifier processes for the small number of anonymous customers. A major goal of HI services is to get rid of all of these local processes - this is one area which almost all pundits seems to agree.

Just stumble through and hope for the best? A good health system should not offer lower quality care for those who wish to remain anonymous. I'm sure Neil Mitchell or Alan Jones would be hauling health ministers in to grill them on why government has decided that it's fine for people who elect for anonymous care to be treated as second-class healthcare consumers.

As anonymous from thursday night said, it becomes very complex very easily to addresses a minority of users like this. There are still plenty of wrinkles left to work out.