Tuesday, February 07, 2012

The Outcome Of the Senate PCEHR Enquiry Will All Depend on Who The Senate Believes - Bureaucrats or the Informed Expert Citizenry!

The almost six hours that I spent watching the Senate Enquiry was fascinating. We really had two utterly different camps in action as I briefly mentioned yesterday. You can gauge the polarity of the views presented by the reporting we have seen.
In the camp that there are a few minor issues that need to be addressed and that all is pretty much going as expected we have reports like this.

E-health records on track: government

The Department of Health and Ageing and the National E-Health Transition Authority (NEHTA) have rejected claims that NEHTA has mismanaged the national e-health record implementation.
Responding to criticism levelled at the government-owned company by the Medical Software Industry Association (MSIA) that NEHTA staff are not qualified, NEHTA CEO Peter Flemming said that his staff are "very skilled and dedicated", with some being the "world's leading experts in their field".
The MSIA had suggested that specifications around health identifiers would not correct health records when a new identifier was issued to a patient. Flemming denied this, saying that Medicare Australia has a system in place to correct problems with multiple identifiers being used for the one person.
"There is a small possibility that something may be keyed in incorrectly. Medicare, the HI system operator, has very advanced systems to detect that, identify it and rectify it."
More here:
PCEHR on track for 1 July rollout
The e-health record system will be open for registration on 1 July
 The rollout schedule for the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project is currently on track, according to the Department of Health and Ageing (DoHA).
DoHA deputy secretary, Rosemary Huxtable, told a Senate committee examining the PCEHR (Consequential Amendments) Bill 2011 that the “national infrastructure” for the e-health record is currently on track, with Australians being able to register for a PCEHR on 1 July.
“The second release provides the functionality for consumers to register for the PCEHR,” she said. “Design for this release has been substantially completed and is scheduled to be completed prior 1 July 2012.”
Putting a rather different - and to be fair - more news-worthy view we have all this.

Public hearing calls for patient safety file scrutiny

THE Senate inquiry into the Personally Controlled E-Health Records program should subpoena all patient safety documents held by the National E-Health Transition Authority for external scrutiny, a public hearing in Canberra has been told.
Medical Software Industry Association president Jon Hughes said NEHTA's consistent refusal to provide the risk assessments meant the $500 million PCEHR system was "characterised by patient safety issues" even before development had been completed.
"Patient safety, and its impact on consumer confidence, is our most important concern to date," Mr Hughes told the community affairs committee.
"The MSIA recommended several months ago that the program should be paused or significantly reduced in scope until safety and other implementation issues have been addressed.
More here:

E-Health corporation savaged at inquiry

  • From: AAP
  • February 06, 2012 3:08PM
THE private corporation established by the federal and state governments to roll out the proposed electronic health records system has been savaged by the software industry and privacy advocates.
Both the Medical Software Industry Association (MSIA) and the Australian Privacy Foundation have told a Senate inquiry hearing in Canberra that personally controlled e-health records should not go live on July 1 as planned.
MSIA president Jon Hughes says industry has lost confidence in the ability of the National eHealth Transition Authority (NEHTA) to deliver the program.
"There is evidence of a lack of probity, ineffective governance and an inability to deliver targeted programs," he told the inquiry.
"The program risks falling into disuse from the very first day of live operation."
More here:

E-health body lacking in medical expertise

David Ramli
The top body set up by the Labor government to ensure its $467 million electronic health record system gets off the ground is facing mounting criticism for not having any members with healthcare experience.
The concerns add to the growing public outcry faced by Health Minister Tanya Plibersek from consumer, medical and privacy bodies. They used a parliamentary inquiry on Monday to slam the National E-Health Transition Authority (NEHTA), which is tasked with rolling out the program.
A spokeswoman from the Department of Health and Ageing (DHA) said the “program control group” was an oversight body set up late last year. It was designed to control and speed up the rollout of the personally controlled electronic health record (PCEHR) system.
“It’s an administrative group made up of senior public servants run by the deputy secretary,” she said. “There is no doctor on that but all the [groups] underneath have doctors and they feed up to it.”
More here:

E-health records risk patient safety: MSIA

The Medical Software Industry Association (MSIA) has claimed there are systemic problems with the government's e-health identifier specifications that risk patient safety and has called for an overhaul to the National E-Health Transition Authority (NEHTA).
Speaking before a Senate hearing today, MSIA president Dr Jon Hughes said that a fundamental flaw exists with the specification of the Health Identifiers used for e-health records, which surfaced when a person was issued with a new identifier by Medicare to, for example, correct a date of birth or changing the gender. In this case, there is no way for Medicare to inform all health organisations using the e-health record system to update their records accordingly.
More here:

NEHTA admits to errors within its e-health identifiers

Concession follows concerns from the MSIA around the accuracy of the identifier service
The National E-Health Transition Authority (NEHTA) has conceded there have been errors within its Individual Healthcare Identifiers (IHI) service, following claims by industry that the service is flawed.
In a senate hearing into the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, NEHTA chief executive, Peter Fleming, admitted there were occasional instances which produced duplicate identifiers.
“Very occasionally, there is the instance of having two numbers,” Fleming said. “Medicare has a process for identifying that, rectifying it with the individual involved and I stress that is only caused by an occasional manual error.
More here:

Industry wants e-health records delayed

Julian Drape
February 6, 2012 - 2:34PM
The private corporation established by the federal and state governments to roll out the federal government's proposed electronic health records has been savaged by the software industry and privacy advocates.
Both the Medical Software Industry Association (MSIA) and the Australian Privacy Foundation have told a Senate inquiry hearing in Canberra that personally-controlled e-health records should not go live on July 1 as planned.
MSIA president Jon Hughes says industry has lost confidence in the ability of the National eHealth Transition Authority (NEHTA) to deliver the program.
More here

E-Health Records marred by project, governance failures: APF

Australian Privacy Foundation warns of dire project and governance failings in the government's personally controlled electronic health records (PCEHRs) initiative
  • Tim Lohman (Computerworld)
  • 06 February, 2012 14:02
The Australian Government’s approach to managing personally controlled electronic health records (PCEHRs) has resulted in poor governance and repeated project failure, a Senate committee hearing into the PCEHR Bill 2011 has heard.
Speaking at the hearing, Australian Privacy Foundation Health Sub Committee chair, Dr Juanita Fernando, pointed to issues of a accountability, particularly from the National eHealth Transition Authority (NeHTA), the “retrofitting” of governance to the PCEHR, and a lack of independence of the governance of the health records.
“We are also concerned about ongoing project failure,” she said. It seems to us that there has been project failure after project failure.”
Fernando pointed to the Individual Healthcare Identifiers (IHI) project as having failed in its goal of allowing healthcare professionals to identify the right patient at the right time in the right place as an example of this failure.
“Standards are a mish-mash; there is no single standard — national or international — which applies right across the health sector. Rather we have borrowed from standards all over the place,” she said. “There are also issues with ‘informed consent’ as nobody knows precisely what the roles and rights and responsibilities of all the players – patients, clinicians, administrators and so on are.
More here:

MSIA recommends alternative e-health record rollout

The group outlined a plan for simplified records by 1 July in the form of of PDFs or letters, with the more complex data filled records to come by 1 July 2013.
The Medical Software Industry Association (MSIA) has detailed an alternative rollout schedule for the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project, following claims the system will be not even be close to completion by 1 July.
MSIA president, John Hughes, told a Senate committee examining the PCEHR Bill 2011 a reduction in the complexity and scope of the e-health program was required for the program to go live on 1 July.
Hughes outlined a plan for simplified records by 1 July in the form of PDFs or letters, with the more complex data filled records to come by 1 July 2013.
“A much simpler release one program could still deliver an effective valuable solution to the health sector by 1 July but only if the scope of that program is reduced significantly,” Hughes said.
More here:

Reset expectations on e-health: AMA

The Australian Medical Association (AMA) has called on the Federal Government to "reset expectations" that it will deliver e-health records to Australians by July this year.
AMA President Dr Steven Hambleton told a Senate hearing this morning that the government's proposed deadline for the launch of its personally controlled e-health record (PCEHR) system for all Australians by 1 July 2012 is "problematic".
"We have a real problem with the level of expectation that has been set ... and the actual ability for doctors to deliver on that day. Even if the legislation is passed [and] the framework is available, there are many, many practices that will simply not be able to communicate with that piece of software."
He said that many medical practices would also be concerned about their risks in terms of recording who has access to the record and when, stating that much of the software around today doesn't have the ability to do that.
He said that the AMA supports e-health records, but said it will be a few years before it is completely up and running.
"I think we need to reset expectations both in the profession and the public, so we understand that there's not going to be a comprehensive personally controlled electronic health record available, or indeed accessible, by most software on that day," he said.
More here:

E-health stricken with privacy and software lurgies

Analysis: Senate hearings begin.

With less than five months before launch, differences between interest groups in the planning of the Federal Government’s $466.7 million personally controlled electronic health record (PCEHR) will be aired today before a Senate Committee.
Submissions from medical associations, privacy groups, rural and remote services, and the medical software industry collectively raise questions over privacy, standards and the ability to service remote regions.
A common view is that the July 1 launch date is too ambitious.
More here:

Defer e-health record system, says consultant

A LEADING e-health consultant says the government's e-health systems is not complete and the bills establishing it should be deferred.
Ian Colclough, a medical practitioner and health informatician, warns that while privacy, security and confidentiality are important issues, "they pale into insignificance when put against the many hard-nosed questions that have repeatedly been asked by a wide cross-section of health industry experts and technology developers".
"These are questions which those in charge of the PCEHR project seem unwilling or unable to answer," he says in a submission to the inquiry.
Dr Colclough says that in considering the bills, "it seems the (Gillard) government believes that the bulk of the work required to enable the PCEHR to be deployed safely in the marketplace is close to completion".
"I am not alone in believing that the PCEHR is far from being close to completion.
More here:

E-health system flawed, says alliance

THE Consumers e-Health Alliance rejects the "medical interventionist" view reflected in the nation's e-health records program, warning that the current approach is fundamentally flawed, with more than $2 billion wasted on failed projects over the past decade.
"The almost universal view that e-health should focus exclusively on supplying 'the right information about the right person at the right time' is a medical interventionist view," CeHA says.
"Consumers have often different perspectives about the role e-health can play, including the rapid identification of disease outbreaks, information about treatment options, an electronic record of their current health status and medical history, and telehealth services as alternatives to expensive hospitalisation or unnecessary travel.
More here:


For me the key issues raised in order of importance were:
1. Governance and the associated leadership issues.
2. Unrealistic and over inflated expectation setting.
3. Concerns around clinical safety.
4. Transparency and the lack of real consultation with stakeholders.
5. Implementation and Technical skills and competence.
6. Excessive complexity of present plans.
7. The attempts by Government to pass legislation regarding a system that was not well defined and specified.
8. The apparent uncertainty regarding ongoing funding.
Other regulatory and definitional issues are also out there! Of course we still have never seen the Business Case that justifies what is happening!
I think it is fair to say the Senate now understands that it is not just the lunatic fringe that has some concerns. Just what they (the Senate) choose to do with that information will be fascinating to watch!
I wonder will the Senate notice that all that is planned to be on offer on July 1, 2012 is a registration screen rather than a system that will do anything useful?


Anonymous said...

This is an amazing amount of media coverage on the PCEHR. Regardless of which view is the closer to the truth it does seem to me that:

a) unless the 'naysayers' be brought on board to openly support the existing program it does not have a snowball's hope in hell of ever going anywhere

(b) many of those who advise caution are not against the project per se, they are just asking that it be put on hold and forensically reviewed before charging ahead willy nilly. That seems like a very reasonable position to adopt. It is too late to fix some of the problems which are claimed to exist after the horse has bolted.

(c) those who say nothing much is wrong and there is no need to be concerned may well be right. Perhaps it will be all OK if we just keep steaming ahead.

The conclusion I have come to is that, when one weighs up the credentials of those who want to steam ahead against those who recommend pausing and reevaluating where we are at and if we are on the right course, I cannot for the like of me see what is to be gained from steaming ahead in such difficult, turbulent, uncharted waters in the hope that all will be well. On the other hand I can see the downside of doing so from a political, commercial and public safety perspective.

Anonymous said...

So let’s be clear, the capacity to register to access ones own PCEHR is like, what, what does that actually really mean to the punter in the street? Let’s forget the gilding of the lily from the consultants who have won the lucrative work to stand up this piece of national infrastructure ..what the f______ hell does it really mean. I will be given the privilege as an citizen of Australia to fill in an eform – and..there it is a relatively blank repository of data? But the consultants and NEHTA and DOHA can declare victory and we will have numerous press releases that use weasel words to say technically it’s all possible and no our money has not been wasted – this is not another pink batts fiasco. Go on pull the other one!!!!

Paul Fitzgerald said...

"...there it is a relatively blank repository of data?" How can it not be blank, when there are not the systems to "feed" it? Most hospitals don't have electronic records, many specialists have no electronic records, most GPs have a record, but it is so proprietary that it will be difficult to get information from it, and finally, most aged care facilities and community care organisations have no electronic records. At the moment, it seems you will have the right to sign up (opt in, which beggars belief, although I heard the privacy spokesperson yesterday say that the system as it stands couldn't do opt out anyway!) and then add your own data as you wish - and then delete it again if you choose....what is wrong with this picture?

Anonymous said...

Indeed - after all this recent reporting surely those that think it is all going to plan live in a different world than the rest of us. Half a billion and rising for that....... just what would anyone be registering for. Trouble is my guess.

Anonymous said...

Can we have please the $ numbers at stake here:
(a) what has been spent on the PCEHR so far to-date
(b) what has been committed but yet to be spent
(c) how much more, over and above (a) plus (b) will be required

Anonymous said...

There will be no "blank repository", as it will be pre-filled with a patient's MBS data and PBS data, which is why the crafty bureaucrats are as comfortable, confident and bold-faced as they are, and propagating the $467M sham which is the PCEHR! That’s why the laws are being changed as a result of this process to back-fill the PCEHR with PBS and MBS data, and DOHA, Medicare and NEHTA have been very public that that’s what they’re doing yet no one seems to notice or protest its clear futility and redundancy to what’s already there and available.

Everything of course is on track because everything is within DOHA's and Medicare's control, while NEHTA plays the patsy with Academy award winning skill, and the tax payer funded treasury is conveniently raided to the tune of $467M at the same time bureaucratic budgets and empires expand.

It's win, win, win for the Politicians as they cut the ribbon on July 1st, Hon. Plibersek registers for her PCEHR, DOHA and Medicare wring their hands at their skill and expanded budgets and power, and NEHTA pats itself on the pack if the plan goes successfully and takes the fall should the plan go awry in a highly unlikely event.

The senators, our voted representatives, neither have the skill nor interest to hold bureaucratic ehealth powers to account, and Sir Humphrey continues to pull the strings and call the ehealth shots at the expense of public and tax payers interest.

The rest is just a distraction from the main event going on behind closed bureaucratic doors, and the punter knows no difference between his MBS data on Medicare online and his newly skinned and $70M PCEHR ($467M) offering.

DOHA and Medicare reps did not look the slightest bit uncomfortable at the inquiry, and with good reason not to. NEHTA looked as clueless as ever yet the senators were not motivated or informed enough to ask and table follow-up probing or insightful questions to penetrate the lies, damned lies and deceit NEHTA regurgitate in a pathological manner with polished consistency – it’s the rail-gauge problem dummy. And when they can’t lie, they just don’t bother to answer their questions on notice.

A PCEHR will be launched on July 1st, much tax payer money will have been pilfered over the last two budget years and it will not make the slightest bit of difference or benefit to healthcare or patients. Let’s see the metrics for the Key Success criteria of the PCEHR to justify this $467M spend and no doubt we’ll be handed a blank sheet of paper.

And no bureaucrat, senator, representative, Quango employee or high paid consultant will lose a seconds worth of comfortable sleep in the process.

Andrew Shrosbree said...

Peter Fleming is missing the point when he reminds us that his staff are "very skilled and dedicated", with some being the "world's leading experts in their field". On this point, I agree with him.
This does not address the reality that all people make mistakes; the complexity of the health care environment makes it impossible for a closed group to anticipate every potential problem.
Break down the walls of secrecy however, and you have a thousand critical eyes looking for the holes.
Eventually, your solution approaches a state of being watertight.

Anonymous said...

Anonymous Feb 7, 2012 05:41 AM sums it all up rather well. It's not a matter of who believes who or who is more right than wrong. The bottom line is the Senators are pretty well powerless as the bureaucrats can get round them a thousand different ways. It all comes down to politics and whether The Health Minister can be swanned by her Department and whether she "can see the downside of doing so, ie steaming ahead willy nilly, from a political, commercial and public safety perspective", as Anonymous Feb 6, 2012 10:59 PM said.

KH said...

Anonymous Feb 7, 2012 05:41 AM writes: "There will be no "blank repository", as it will be pre-filled with a patient's MBS data and PBS data,.."
MBS and PBS data on their own are pretty useless or downright dangerous. The PBS records will tell you that a prescription for a certain drug was filled on a particular date, but it won't tell you that the drug was subsequently stopped because the patient reacted badly. MBS records can tell you that a person had a Level B consultation with her GP but not what was discussed. MBS records may tell that she had a particular test or procedure, but not the outcome.

Anyway the politicians have been saying for many months that anyone can "register" for a PCEHR after 1st July, not that the system will be functional in any meaningful way.

Anonymous said...

It's all to do with mirrors - now you see it, now you don't. It doesn't matter to Medicare or the Department whether the PBS data is useful and accurate or not. It's to do with trying to convince politicians and the punters that PBS OnLine and MBS OnLine together will form the working foundations for the shared electronic health record leading to the one and only Nehtarised National Health Information Exchange(NHIE) managed and controlled by Medicare.

Anonymous said...

That doesn't make them useless or dangerous unless you don't think a clinical user can exercise the same reasoning you just did (congratulations for being the smartest person in the room?).

What was that medication I was prescribed last year that I was allergic to? gee, I can't remember....

the PBS and MBS data doesn't have high value, but it's not useless, and only dangerous if the users are willfully stupid.

Anonymous said...

yes but this is the PCEHR with the emphasis on the PC bit - personal control - so the 'user' is the person in the street. That is what the big selling point of all of this is supposed to be - that I as an individual can control more of my medical record. So the PBS data won't tell me which medication of all those I was prescribed I was allergic to if I can't remember.

Anonymous said...

Right. But if, like my mother, you remember that it was the antibiotics, but not which ones.... like I said, limited usefulness, but not useless. And while it's personally controlled, it's (supposed to be) the doctors who leverage the data.

Anonymous said...

This is your mother speaking.
I don't think you need to spend 476 million to find out what my prescription was! I can ring my GP surgery - they know, or I can ring my pharmacist - he knows. Or failing that, I could even ring Medicare and ask them.
I don't have a computer anyway, and a phone call costs me just 10 cents. Let your fingers do the walking! For that amount of money each and every australian can make about 50 phone calls a year for 5 years!

Anonymous said...

Actually, there is a simpler solution - get your GP to print out your medications/medical record each time you visit. You have a portable, up-to-date summary that cost nothing to produce, doesn't require an internet connection and most importantly, is authoritative.

If you really, really want an electronic version of it - take a photo or use a scanning app on your phone.

Anonymous said...

Ok so we are all now reasonably knowledgeable that the considerable $$$ being spent is doing nothing much other than line the pockets of those with their noses in the trough. (We know who you are). So we can expect you (that’s right you kiddies from .... you suits from.. etc) to say wonderful things about the value its delivering and how swimmingly well it’s all going (for you that is). But what about the rest of us? What then of the PCEHR – it gets put back in the cupboard/left on the shelf to gather dust?
What happens next?

Anonymous said...

What happens next? you ask. Well, this is what happened last time around and this is what will happen again.

The PCEHR will be put on the back burner/left on the shelf to gather dust with the justification it is too far reaching at this time a more stepwise approach will be taken as per many of the recommendations. This is what happened with HealthConnect which eventually morphed into NEHTA.

Another less ambitious approach will be announced to build on the work already done and linking PBS OnLine and MBS OnLine into the embryonic structure of the PCEHR. This will probably involve dusting off the old MediConnect model and proposing some modified version of MediConnect and online prescribing as DOHAs new survival line.

Dr David More MB PhD FACHI said...

This history is a bit out for those who care about such things.

Tony Abbott - Health Minister Aug 2005 said:

"The work of the National E-Health Transition Authority signals the Government's clearer focus and the increased tempo of change. It is jointly funded by the Commonwealth and the states and territories. Its board comprises the nation's health department secretaries and a CEO with a mandate to make a difference. Its job is not to create an e-health system but to create a framework which allows the market to create one. Since late last year, NEHTA has helped to establish inter-operability protocols plus an agreed national framework for the format of patient records and clinical terminology."

The switch to a "Change Management Strategy" was made public a month or so before! At that point NEHTA had been going - if that is the word - for 6-8 months.

On what happens next - I suspect there is much truth in this - but the exact shape of what will happen is still not at all clear to me at least!

A month or so from now I am sure it will be much clearer! We need to ask NEHTA why it did not stick to its mandate!