Tuesday, November 29, 2011

This May Be The One And Only Opportunity You Get To Save E-Health In Australia. Take It!

The following report appeared in the Australian today.

Performance of NEHTA to go under Senate spotlight

THE performance of the National E-Health Transition Authority will be scrutinised in a Senate inquiry into the Gillard government's e-health record legislation.
The Community Affairs committee has been instructed to examine the design and capability of the $500 million personally controlled electronic health record system, including its expected functionality on the July 1 launch date next year.
Health Minister Nicola Roxon tabled her PCEHR bill and companion regulations in the lower house last Wednesday.
She needs to shepherd the legislation through parliament quickly to meet her political deadline.
Victorian Liberal senator Mitch Fifield has immediately referred it for a broad-ranging public inquiry.
Its scope includes "any other issues the committee considers appropriate".
The committee will consider the security arrangements, risks to patient privacy, the likelihood of data breaches and the proposed penalties.
It has also been instructed to examine NEHTA's use of consultants, contractors and the tendering process during the development of the PCEHR.
In particular, it will look at the products that NEHTA has designed, made, tested and certified for use in the system.
The Medical Software Industry Association has repeatedly warned that unresolved technical and clinical issues could put patients' safety at risk.
It said the Healthcare Identifiers service -- designed by NEHTA with little industry input -- was flawed and could result in duplicate individual identifiers, while there was no means of correcting operator or system errors in users' downstream systems.
Meanwhile, privacy and consumer advocates have complained about NEHTA's lack of consultation over key concerns.
Lots more here:
You can read the terms of reference for the enquiry.
The details are found in Appendix Six.
While it is very good that the topics cited above are being reviewed my major concern relates to the need to have the appropriate leadership for the whole e-Health program and to have the sort of governance frameworks in place that will ensure there is a sensible balance of all stakeholder’s interests as we move forward.
It goes without saying that for me this involves a fundamental review of the evidence for and business case supporting the PCEHR and a root and branch review and audit of just what NEHTA has been doing over the last 5+ years.
I will be preparing a submission on my own account to try and push the Senate Committee to ask the really hard questions and to not be fobbed off as they can be in a short Senate Estimates hearing.
These two paragraphs found later in the article make it utterly clear that big change is needed.
“Mr Fleming said last month that he was "committed to resolving the matter to the satisfaction of both organisations".
But in a second letter to Dr Clarke last week, he said NEHTA could not "accept a situation" where Dr Clarke continued to use "firm and direct communications" as he saw fit.”
You can read the full letter here:
Mr Fleming, it seems, is not at all comfortable with a little assertiveness on the part of a pretty well respected privacy advocate (Chair of the Australian Privacy Foundation at present) whose job it is to be just that!  He apparently does not agree with the views expressed and he (or his staff) seem to be trying to suppress these views by denying attendance at forums.
It is just this sort of issue that properly a designed governance framework and sensibly respectful leadership would swiftly address and save us all from a great deal of toing and froing.
Indeed in the letter Mr Fleming makes it clear he needs and wants respectful communication and co-operation. This is clearly vital on both sides  - especially when matters are seriously contested in the public space. Again a proper governance framework can assist greatly in getting the right outcome. The bottom line to me is that both sides in a disagreement like this actually need to really listen to each other and understand what is being communicated in terms of concerns and issues.
You can read all the correspondence here:
For this and a whole host of other reasons leadership and governance are top of my list for the enquiry. Bureaucrats need to remember they are ‘public servants’ and we are all the public!
Another point I also intend to make is around the frequently stated fiction from DoHA and NEHTA that implementing the PCEHR is implementing the National E-Health Strategy of 2008. This is just plainly and simply NOT true!
Lastly, on the governance issue, we have this claim from Minister Roxon on the legislation.

E-records legislation to be investigated

29th Nov 2011
THE Senate will investigate new legislation intended to create Australia’s personally controlled e-health record (PCEHR) system after the two relevant bills were referred to the Senate Standing Committees on Community Affairs last week.
The legislation, which includes provision for the merging of MBS and PBS information for the first time, was tabled in the lower house by Health Minister Nicola Roxon last week before being referred to the committee in the Senate on Friday.
.....
Ms Roxon told parliament on Wednesday the legislation was developed through two rounds of public consultation and a draft version of the bill.
“The central theme of our system and this bill is that any Australian will be able to register for an e-health record, and they will be able to choose the settings for who can access their record and the extent of that access,” Ms Roxon said.
.....
Full article here:
With decent governance we would have a digest that shows how the Government responded to the submissions mentioned above and what changes were made. Of course we don’t have a clue and no one knows if their time was utterly wasted in responding!
The details of how to make a submission to the Senate Enquiry are found in this post.
The closing date is January 12, 2012 - so get thinking and writing if we are to see some better e-Health in the years to come!
Feel free to indicate in comments areas you think need to be addressed by the enquiry.
David.

5 comments:

Anonymous said...

NEHTA will go out of their way to suppress any anti-NEHTA comments and use any tactic they can to shut down and/or get rid of the perpetrator making the comment no matter which organisation they belong to.

Anonymous said...

At least you don't have a "HITECH Act" appearing out of nowhere in an economic "stimulus" bill like the U.S. had in 2009....

Anonymous said...

If you are a shit batsman you may not get found out in a one day game, it's a bit harder in a test match.

You may be able to see off Senator Boyce with the ball, a full Senate grilling may be a tad more difficult.

Plus NEHTA's power is certainly on the wane ....rise up good folk for the time is upon us.

Napoleon

Anonymous said...

Just to clarify:
"It said the Healthcare Identifiers service -- designed by NEHTA with little industry input -- was flawed and could result in duplicate individual identifiers, while there was no means of correcting operator or system errors in users' downstream systems."
Designed by NEHTA but implemented extremely badly by Medicare, anyone who read the NEHTA identifier documents when they were published on there website (and I think no longer available), will know the design was actually quite sound, safe and logical (in fact it was probably the best work by NEHTA to date), it is the total balls up by Medicare and there. It services providers such as IBM and Dialog that have totally screwed it up.
NEHTA have a lot to answer for but the current problems with Identifiers are moreso a fault of Medicare than anyone else.

Lagrimas de Luna said...

David,

The correspondence between Ms McMahon and the APF is just the latest in a string of strained relationships between Nehta and other organisations. If Nehta is pissing off the MSIA, APF and a multitude of its own staff (who gladly share their experiences once they escape) we must ask whether Nehta is indeed the wronged party. People are just sick of being ignored, marginalised and even victimised. This evil bunch must go. They are wasting our money like a bunch of spolied aristocrats.