Wednesday, February 22, 2012

Senate Estimates Hearing - NEHTA - Wednesday 15 February 2012. Transcript and Comments.

Here is the relevant part of the transcript with some comments in italics.

Community Affairs Legislation Committee - 15/02/2012 - Estimates - HEALTH AND AGEING PORTFOLIO - National E-Health Transition Authority

National E-Health Transition Authority

CHAIR: I suggest that we move to e-health, outcome 2, and then we will go from there.
Senator BOYCE: Is Mr Fleming here?
CHAIR: I hope he is, because I have a statement to make for Mr Fleming. I will put a statement on the record first with Mr Fleming.
During a recent hearing that we had on the e-health legislation I actually made comments on record which stated that Mr Fleming and NEHTA had not returned questions on notice in time. Mr Fleming, I received your letter, I was incorrect and I want to put it on public record that my statements were incorrect and that your responses were on time. They may not have been to the satisfaction of everybody who was receiving them, but absolutely they were on time and I was wrong. I want to make sure that people know that that has now been retracted publicly.
We will move on to questions. Could we have the officers and NEHTA together? Do we have enough space for the officers and NEHTA to be at the table together?
Ms Halton : Why not start on the questions and then we will decide who can fit.
Senator BOYCE: The questions go to the issue of the standards that are being used by the PCEHR. Perhaps I should also, Mr Fleming, make a short statement pointing out that the error about the timeliness of responses in fact came out of my office. We have looked at this very closely, of course, having received your letter from the chair. It appears to be a process issue where we thought we were asking questions of NEHTA but they were, in fact, transferred over. Our log of answers from NEHTA was different from where, in fact, the answers were coming from.
Ms Halton : So the wrong box was ticked or flicked or crossed?
Senator BOYCE: We were not aware that the questions were being transferred. We were still waiting for responses from you, when in fact they were from elsewhere, as I understand it.
I think we started out with over 500 standards being intended for the PCEHR; is that correct?
Mr Fleming : I have with me Mr David Bunker who heads up our architecture group. That standards team is part of David's, so I might ask David to go into more detail, if required, and also Dr Chris Mitchell, who works in the clinical change and adoption side of the team is here.
The standards are actually grouped into 23 separate bundles. There are a number of components within there, so we tend to talk more in terms of the 23 specific bundles of activity that are attached to the work that we are doing. David, did you want to comment?
Senator BOYCE: I appreciate there are 23 bundles. I understand that we started with a situation where you were expecting up to 500 standards and I think you are down to 17 now; is that correct?
Mr Bunker : I am the head of architecture at NEHTA. I am also responsible for standards and security and also our reference-platform-demonstrator-environment software developers. It is probably worth separating specifications and standards so that we are clear. Certainly, NEHTA wants to make use of standards wherever they exist. During the process of understanding the relationship of standards to the design of the PCEHR, and certainly e-health more broadly, what we have done is identify the standards that we can make use of that exist in the marketplace and that exist and are common in Australia.
Senator BOYCE: How many of those are there?
Mr Bunker : In order to achieve a design for the PCEHR system that was based on standards and that would adopt an approach that would use standards and identify novel standards where required, we conducted an extensive piece of work that identified a number of areas that were specific to certain standards. So there were 140-something areas that were actually used to identify the sets of areas within the PCEHR design where standards would be relevant.
Mr Bunker : Through the process of design we have identified what specific standards can be applied. So there are obviously—
Senator BOYCE: Existing standards?
Mr Bunker : Existing standards that can be applied. In the specifications and standards plan that we put into the market late last year we described the use of those standards where there are existing ones, but importantly, also where there is a requirement for a new standard that actually describes certain components of the PCEHR—for example, the clinical information in an event summary, and how that might be moved around.
The specification bundles that were described in that standards and specification plan describe the specifications that NEHTA is producing to support the market to adopt and build to the PCEHR system.
Senator BOYCE: Is it not true, though, that if you are going to be involved in delivering services to the PCEHR you cannot use one standard and not another standard? You need the suite of standards, don't you?
Mr Bunker : That is correct. There are obviously a number of standards, including very technical standards and standardised information components, that support interactions with the PCEHR.
Senator BOYCE: What is currently in the suite of standards that people seeking to provide services or products to the PCEHR would use?
Mr Fleming : If I understand the question correctly—and tell me if I am off track—we have created a website that has all of the specifications that are involved here. In that context I mentioned that there are 23 bundles. For each bundle there are three separate groups of documents. The first group is the information requirements document, which is a high-level definition of what is required, and generally those documents are about 40 pages in length. So it is 40 by 23. Then there is a structured content series of documents. That goes into the detailed specifications and lists all that information. Generally, they are about 300 pages in length. There is a lot of information in there—and once again by 23.
Then there is a third set of documents, which we call the CDA implementation guide. They are about 450 pages in length each. What we do there is provide examples—for example, example code. So we have talked about the standards and then we provide code that shows how that would work. If I hear your question correctly, for each set of specifications, the 23 sets, there is probably over 1,000 pages of documentation that define, in various levels of detail, all those components. That is up on our website and available for all vendors to use. There are also processes that we have in place to provide education and training in that environment.
So we are talking about of the order of 20,000 pages of documentation. One really wonders how all this can be digested, interpreted and implemented. Quite a challenge!
Senator BOYCE: I will go back and then I will follow up on that. Mr Bunker, just to get this on record, how critical are those standards to the architecture, the functionality, the performance and quality of a PCEHR system?
Mr Bunker : Obviously they are critical. It is very important. Certainly NEHTA is, as I said before, committed to this process of seeing these specifications progress through the Standards Australia process. NEHTA has developed the specifications through consultation and engagement with the sector, and has described the interfaces and the design through those specifications, which make use of existing standards. But for a number of those novel requirements we have identified a number of new standards that we would seek to progress through the Standards Australia process. Obviously, we have been working with Standards Australia. They have been very supportive, as has the IT14 community, to actually help us to develop the specifications and standards plan because they are so critical.
I wonder how the IT-14 Volunteers are going to work through all this in other than geological time.
Senator BOYCE: I would like to go to the answer you gave me to question on notice 465 from the last estimates. You said there were 16 areas of standard specifications that were complete and that had been tested. You go on to say they are available on the website for vendors with guidance material on how to implement the specifications. Where are they on the website?
Mr Bunker : Mr Fleming has described what some of the key components of those specifications are. Those specifications—
Senator BOYCE: You told me there were 23 bundles and we have 16 areas.
Mr Bunker : Those specifications are available on the software development learning centre through the national change and adoption partners portal environment. That environment makes the specifications as well as a number of supporting documents available to support vendors interacting with those specifications. But it is not just the website. Obviously there is a lot of communication we have. We have regular webinars with our vendor community so that they can ask questions and get updates and information on what the development status is of different components.
Senator BOYCE: I have vendors telling me that they are not on the website and they are not in your standards catalogue. Why would that be?
Mr Fleming : I guess the only thing I can say is that if someone can look at the website you will see them there. So the answer that we have provided—
Senator BOYCE: They are openly available to anybody who wants to view them? They are not restricted in any way?
Mr Fleming : No, there is a process for logging on. We do ask people to log on so that we know who is accessing them. The reason is that as things are added and the information is made available, we can then provide prompts to let people know they are there. That information is available. As Mr Bunker mentioned, there is a regular webinar with vendors. They should all be aware of that.
Senator BOYCE: With respect to what is on that website, I will have to go back because when I am stuck or they are not there and they are not complete, as is being told to me by vendors, I have to go backwards and forwards to try and see where the truth is.
Mr Fleming : We would be very happy to sit down and show you. They are there; they are available. Clearly, in that answer, where we referred to the 16, with the information in which we indicated there was a problem with the CDA guides for five of those, that might be what is being referred to there. But that information is there, it is available and we are happy to show anyone.
Senator BOYCE: Does this mean I can use that information today if I were a software developer?
Mr Fleming : Absolutely.
Senator BOYCE: It is fit for practice?
Mr Fleming : Absolutely. I will give a couple of examples. We have a national infrastructure partner, Accenture, who are building the PCEHR system. They have used those specifications; the system is built and is being finished. Components are in test at the moment. They have done it; they are building to that. We have our wave site partners, in wave 1 and 2. They are building to those specifications with us. Clearly, we are going through lessons learnt. But that is happening today, yes.
Senator BOYCE: What about other companies that are looking to become involved in the PCEHR? Are they fit for use for those companies? Are they complete?
Mr Fleming : Absolutely. We have made it very publicly available if people wish to use them. Not only are they available to use but we would like to provide them with help, assistance and processes, if they have questions.
Senator BOYCE: You have told me that there are 23 bundles of specification and yet software vendors and others wanting to use the site say there are only two that are fit for use five months out from the launch of the PCEHR. Can you give me any reason why people would be saying that, Mr Fleming?
Mr Fleming : We have a regular meeting with the ICT forums. One of those occurred yesterday. That was stated to me and I asked if that point could be substantiated and there was no substantiation of the point. So the bundles are there.
Senator BOYCE: Doesn't that comment concern you? Did you go back and verify for yourself that it was wrong?
Mr Fleming : When that statement was made to me I said 'please explain', because as far as we are concerned not only can they be built to, but they are being built to. When I asked for examples, none were forthcoming. I am very happy for people to come to me and say, 'This is our problem', but a statement like that needs to be substantiated and no-one has substantiated it. There are people using it and building to those systems now.
CHAIR: Mr Fleming, was yesterday the first time you heard that comment? You actually said in your response when you heard that—
Mr Fleming : Yesterday was the first time I heard that comment. It was in a meeting.
Senator BOYCE: In terms of the use of the standards to develop product to be used in the PCEHR, I am using really broad terms so that I do not inadvertently narrow my inquiry field because I do not know how broad my inquiry field really should be. Accenture and the wave 1 and wave 2 people have been using these bundles of specifications and standards that you have mentioned. What is the feedback on them? Has there been any evaluation of the use of them et cetera?
Mr Fleming : Yes, there has been. I do not have that detail with me. If you do not mind, I will take it on notice to give you a more substantial discussion than I can provide here. The purpose of the wave sites has been that we can work with them. One of the things we have said quite publicly is that it is one thing for us to sit in an office and write specifications and it is another thing to see how it works in the real world. The purpose of the wave sites is to test them through. Most of the problems have not been in the technical specifications; they have been more things like: 'Okay, that's great; now how do I get that inculcated within my work flows? What does it mean if I have to register an HPIO et cetera?' It has been more in those areas. The things we have learned have been quite interesting and clearly we have adjusted our processes accordingly. But if I could take it on notice, we will provide you with a full list of those learnings.
This is a very strange exchange. I wonder why the Senator is being told information that is at such variance to what Mr Fleming is saying?
There is no doubt that July 1 will see a log-on screen. I wonder why no-one asked what you will be able to do what you have logged on!
Senator BOYCE: Would you say that the testing that has so far gone on constitutes real world testing of the products developed using the standards and specifications that you have on your website?
Mr Fleming : There are multiple components to the testing that we do, as you would expect. That includes fairly basic unit testing right through to systems testing, integrated testing, clinical testing and testing whether it is fit for purpose. The testing we are now doing, particularly with some of the earlier needed products that we are actually implementing in GP practices, is real world testing. That is occurring.
Senator BOYCE: That is the wave 1 and wave 2.
Mr Fleming : Absolutely. That is part of why we are doing this, to see what it means, with obviously a lot of hand holding because there is a learning curve that goes on.
Senator BOYCE: You had a pause there.
Mr Fleming : Absolutely. As we have learnt, there were some issues in the CDA.
Senator BOYCE: Are they back on track now?
Mr Fleming : Yes. The actual problem that was detected has been fixed and we are currently testing that. One of the things that we do, which is part of our testing, is that we build out the system ourselves. So for everything that we write a spec for we actually build. We are testing building that. We also had an external process called CCA, certification, compliance and accreditation, which we run through NATA, not NEHTA; therefore there are test labs, external labs, that are accredited through NATA. So anyone who is implementing these systems needs to go through those conformance checkpoints too. So there are very many tests as part of this process.
Senator BOYCE: The product is being developed by Accenture. Have they been subject to real world testing, Mr Fleming?
Mr Fleming : Accenture is developing the national infrastructure for the PCEHR.
Senator BOYCE: So it has not—
Mr Fleming : That build will be completed and available for registration on 1 July. We are in the process of receiving the first component of that, called 1A. We have detailed tests that we do there. We have invited a number of vendors to come and assist us through that process. It is early days for testing.
Senator BOYCE: What do you mean by that?
Mr Fleming : It is one thing for us to test but it is also another component to get vendors in to test their systems against the specs, their interfaces, to see how that works.
Senator BOYCE: When will that testing be complete?
Mr Fleming : There is a test program that will run through right into late June and it is starting now.
Senator BOYCE: Late June?
Mr Fleming : And it is starting now. As you would expect with any system going live on 1 July, there will be various tests that we will do all the way through.
Senator BOYCE: The end result of this will be that the first real world testing of the Accenture system will be when this scheme becomes operational on the government's current deadline of 1 July.
Mr Fleming : Real world in the context of consumers registering for an electronic health record. However, there will be a huge amount of testing with us and with vendors to test the systems process—with the assistance, wherever possible, of our wave sites et cetera—and to test the various environments and configuration. But it will be 1 July when the system goes live that obviously—
Senator BOYCE: I am not sure that everyone is as confident that it is going to go live on 1 July.
Mr Fleming : Senator, this is a very large program, as you are aware.
Senator BOYCE: I realise that.
Mr Fleming : In that context, the types of issues, for instance, that we saw with the specifications were not good, but you expect problems in a large program. Generally, there is nothing that we see that would indicate that we will not be ready for 1 July. We are on track.
Senator DI NATALE: I suppose the first question relates to something that took up a significant amount of time in the recent inquiry—that is the no-access consumer control issue. Is it true to say that NEHTA took the decision to remove the no-access consumer control from the concept of operations? Was that against the advice of the consumer reference forum?
Ms Halton : That is a departmental issue, Senator.
Senator DI NATALE: What does that mean?
Ms Halton : You will have to ask departmental officers, not NEHTA. I am happy for them to come to the table and answer your question.
CHAIR: We are on NEHTA at the moment Senator, if there is anything particularly for NEHTA, and then we will get the officers from the department to come to the table.
Senator DI NATALE: Has NEHTA set any hard targets for consumer inclusion and adoption? Have you actually got hard targets?
Mr Fleming : There are obviously a number of groups working on this program. NEHTA is managing agent for the Department of Health and Ageing regarding PCEHR, and then you have the COAG component of the program as well. In that context one of our partners is NCAP, the National Change and Adoption Partner. They have produced a number of different scenarios as to what might happen depending on certain environmental triggers. We have not locked in any targets—nothing has been approved—but there have been various scenario mappings that indicate numbers in terms of consumers' conditions that could be achieved over time frames.
Senator DI NATALE: What are some of the assumptions that might change?
Mr Fleming : There are various assumptions. One of the assumptions we have looked at, for instance, is that the market will remain as it currently exists—no incentives et cetera—and what that might mean in terms of uptake of the program. The first assumption is: in that environment what does that mean? There are assumptions in terms of what would happen if there were certain target groups and what that might mean. There are clearly groups that would benefit significantly from this, such as those with chronic disease—
Ms Halton : Diabetes, for example.
Mr Fleming : There has been nothing locked in there. That is a policy decision.
Senator DI NATALE: And incentives? You have done some modelling around incentives?
Mr Fleming : No. Once again they are policy decisions.
Ms Halton : That is not a matter for NEHTA.
Senator DI NATALE: I am happy to move on. The suspension of the pilot e-health sites: is that something I can talk to NEHTA about?
Mr Fleming : Absolutely.
Senator DI NATALE: How long did it take NEHTA to identify the software incompatibilities that related to the suspension?
Mr Fleming : The issue we had, as I mentioned earlier when Senator Boyce was asking some questions, was that there are three types of documents that we produce. The information requirements documents were correct; the structured component documents were correct, so the real specs; it was the CDA implementation guide, so the examples, where we had some issues. What had happened was that because we have work that we are undertaking with wave 1 and wave 2 sites, we provided some early guidance to those sites back in May this year. 'Here's the draft specifications, this is what it looks like,' and then we continued to work to build those specifications out with the rest of the industry. What happened, and it should not have happened, was that we did not fully manage our change control, so that when we published the final November specification, we did not give the full change control log to the wave 1 and 2 sites.
Senator DI NATALE: Can you explain 'change control' to me in English?
Mr Fleming : Change control simply says, 'Here's version 1 and here's version 2 and this is the difference.' The difference could be anything. So we gave them a change log but not with everything in there. That was the gap. We have had to go back and update that change log to reflect those changes. For example, if you are a software builder, you have built to this early draft, you need to know what the differences are with examples so that you can change to the new specification. That was a gap. In terms of fixing that, the problem is fixed but we are going through and testing that at the moment. It has caused, in terms of the wave site, about a six-week delay on where they were at. We work very closely with those groups, as you would expect. Therefore we are working closely with them to see what we can do to continue and minimise the impact of that. It is a large program, as I mentioned, so whereas it impacts that component, it does not impact the delivery of PCEHR and the ability to register on 1 July. That is a separate—
Ms Halton : The national infrastructure, basically.
Mr Fleming : That is a separate component.
Senator DI NATALE: How much do you think the suspension cost the project?
Mr Fleming : This is a high level so we are still dotting the i's here. It does not look like it has cost anything in terms of dollars, because the work that we have to do to transition our wave sites across to the national infrastructure had to happen anyway. We have had to put a slight delay on the work. We have been able to rejig those processes. It does not look like financially it will cost us anything. Time-wise, it is probably about six weeks.
This really tests credibility - surely redoing the work to update and correct the specification must have a cost - or is the staff level so high that the extra load is able to be absorbed painlessly!
Senator DI NATALE: Can you tell me about the basis on which the nine organisations were selected to participate in wave 1 and wave 2? What were the criteria?
Mr Fleming : Twelve organisations were selected. There is a process we went through with the first three. They are groups that have had a very strong involvement in e-health from day one with amazing experience in terms of change management contracts. So they were chosen because of their experience and we knew that, no matter what would happen in terms of tenders et cetera, these were groups that had a huge amount of experience that we needed to use and learn from. They were chosen on the basis of their knowledge. The nine other sites were chosen through a tender process which followed the Commonwealth procurement guidelines. There were separate officers on there evaluating that, so it went through the full Commonwealth procurement process.
What this is saying is the Wave 1 was selected on a nod and a wink and only with Wave 2 was a proper tender process conducted.
Senator DI NATALE: On what basis were the sites chosen? What were some of the criteria that were used?
Mr Fleming : There were a number of different criteria. I will provide that on notice. At a high level, the intention was to be able to drill down into specific areas of interest and also to get a reasonable demographic footprint.
Senator DI NATALE: I have some questions about the Office of the Australian Information Commissioner, which has been nominated to conduct investigations relating to the PCEHR. It seems like a fairly substantial task. What are the additional resources that will be given to that office?
Mr Fleming : That is a policy matter for the department.
Senator DI NATALE: Again, with the intention of the department that the system operator of the PCEHR will notify consumers of breaches. Is that something you want me to put again to the department?
Mr Fleming : Yes.
Senator DI NATALE: Good. I am done.
Senator BOYCE: I have a follow-up question, for the sake of the record. How many patient records do the wave 1 and wave 2 suppliers currently have or are dealing with?
Mr Fleming : I am not sure I fully understand the question.
Senator BOYCE: They are developing EHRs, whether they are PCEHRs or PEHRs, which perhaps is the difference, but how many records have they got?
Mr Fleming : There are some high level targets for each of the groups. Once again, I will provide that on notice. Off the top of my head, as part of the wave 1 sites, there is a requirement for about 400 GP practices. It is probably best if I provide it on notice because I will give the wrong numbers.
Senator BOYCE: It is the individual records that I am after. We are talking about less than a million, aren't we?
Mr Fleming : I will provide those numbers separately, if that is all right. They are fairly significant numbers though.
Senator BOYCE: Fairly insignificant?
Mr Fleming : Significant. We spoke about wave 1 and, as you are aware, that is Brisbane, Melbourne east, Hunter et cetera. But when you start moving then into the wave 2, where you have got Medibank and quite a significant number of records there, such as the FRED project, in terms of medication management, the numbers are actually quite significant. I will provide a table with them.
Senator BOYCE: I was thinking while Senator Di Natale was asking his questions that if you have a glitch like this—which probably affects significantly under 20 per cent of the potential e-health records in Australia—with a much bigger, more complicated system which actually allows for personal control, is the likelihood not far greater for problems, glitches, to emerge?
Mr Fleming : The specifications that we are talking about were not things that are being used—
Senator BOYCE: It was a process problem really, wasn't it?
Mr Fleming : It is not things being used in production. This is early work where we were defining specifications and working through those with a number of vendors. It was not a production system. This was picked up as part of our normal—
Senator BOYCE: As you point out, the wave 1 people were in fact people with strong and lengthy experience in the area.
Mr Fleming : Correct, which is why we are working with them. Once again, in that context, this was working with them. It was not into the GP practices or with the consumers at that point in time.
Senator BOYCE: There was still a process issue which led to a six-week pause.
Mr Fleming : Yes, as we learned lessons, but that is part of a process of development. If the question was: what does that mean in terms—
Senator BOYCE: I as a lay person would have concerns, and I imagine most people would, over a glitch of this sort occurring in a simpler system without personal control with less than 20 per cent of the health records of Australia. This would perhaps send up some warning signals about a more complex, personally controlled, vastly greater system.
Mr Fleming : In this context the problem we had was with the specifications. What we are doing is writing some specifications, then building it ourselves, then building it with vendors and then, once we have got that right and we have tested it, move it into local areas and so on. The specifications were written. We are now testing with the vendors. It is very early days. It is not yet in production. That is the reason why we are doing it in those early wave sites, to pick it up and make sure it is scalable. We are not implementing a component of it; we are doing the full build with them to see how it works in a local environment and therefore how it will scale. That is the very reason why you do those early implementations, to pick that up and make sure it does not scale into—
Senator BOYCE: Thank you, Mr Fleming.
It is hard to make much sense of this also. I wonder why it is so hard to get clarity as to what is really going on and what the plans actually are?
CHAIR: There being no further questions for NEHTA, we will move to the officers of the department on e-health.
Senator DI NATALE: My question was about the no-access consumer control from the concept of operations and the fact that it was removed, against the advice of the consumer reference forum. Is that correct?
Ms Huxtable : The process of developing the concept of operations was subject to significant consultation. There were a range of issues about which there were different views. Those issues were worked through with a variety of organisations. There were a variety of views put on the table. In regard to that particular issue, as we discussed at the inquiry, there were views on both sides and at the end of the day there was a middle road found, I guess. That was the decision of government in terms of the features of the PCEHR. So that is in the addendum to the concept of operations. That issue is resolved. I could not tell you in respect of particular stakeholder groups what their particular views were. There were 165 submissions on the conops. There were targeted discussions with stakeholder organisations in addition to that. Through that process a whole variety of views were put on the table.
Translation: We consulted a few groups and made up our own mind - without providing much in the way or discussion or reasons.
Senator DI NATALE: That is fair enough. The next question relates to the Office of the Australian Information Commissioner. As I said, it sounds like a huge task. What are the additional resources that are going to be given to that position?
Ms Huxtable : That really goes to issues around future funding for the PCEHR and there is still consideration being given by government to the features of that. I do not think I am really in a position to answer that question directly. I do not know if anyone election se has more to add.
Ms Halton : Other than to acknowledge that we know it is an issue.
Senator DI NATALE: Aren't we going live in a few months?
Ms Huxtable : There is a budget between now and then, Senator.
Senator DI NATALE: I realise that. I would have thought there would have been perhaps a little bit of planning around that.
Ms Huxtable : There has been plenty of discussion.
Ms Halton : Certainly planning.
Senator DI NATALE: Are you prepared to say anything else?
Senator BOYCE: Watch this space, Senator Di Natale; that is what I think is being said. It would be fairly unusual, would it not, that the funding to just be cut off? Surely there would be forward estimates for this in normal circumstances, wouldn't there?
Ms Huxtable : The decision in respect of the PCEHR, as you will recall, was a two-year funding decision. When that decision was taken in 2010 there was $466 million allocated over the two years. So that money does end on 30 June 2012. There may be other elements—
Senator BOYCE: No-one was expecting they would need to spend another cent on the PCEHR in the next few years?
Ms Huxtable : As the secretary said, there is ongoing consideration being given to the next stage
Senator BOYCE: Are there any other programs within the department of health where there is no funding in the forward estimates despite the fact that the program is going to continue?
Ms Halton : I will take that on notice, Senator. I think there probably are.
Senator BOYCE: Where they are intended to continue?
Ms Halton : Yes, Senator.
Senator DI NATALE: Would it be fair to say that it is something that the department has given some thought to and actually has some planning in place? You are going to go live in a few months. It is hard to think, particularly initially, that there is not going to be a need for significant resources within the office.
Ms Halton : Lots of thought, Senator. We can promise you lots of thought.
Senator DI NATALE: I will be watching with interest.
Ms Halton : By the bucket load.
We have to read this to suggest that DoHA thinks more money is coming and that it will be in the Budget. Watch this space as they say!
Senator DI NATALE: Is it the intention of the department that the system operator will notify consumers of all breaches?
Ms Huxtable : I probably need to get some support on the detail of the legislation.
Ms Granger : Yes, that is in the approach to the legislation: that we will be notifying breaches.
This sound a little vague but is better than what I recall has been said previously.
Senator BOYCE: I just want to confirm this because I have some questions on telehealth and NBN. I am told it comes under you, Ms Huxtable; is that right?
Ms Huxtable : I believe telehealth would be under outcome 3. It probably depends a bit on the question. The telehealth measures are under outcome 3.
Senator BOYCE: They are around the pilot projects in Townsville, New England and Illawarra.
Ms Halton : That is the department of communications, actually. If it is the money that is being spent on the pilots which comes out of the department of communications—
Senator BOYCE: Can I perhaps flip through my questions? You can tell me 'don't worry' but I would hate to—
Ms Halton : Yes, sure. We might be able to answer some of them. Certainly, with the pilots, we do not control those funds, and they are definitely controlled by communications.
Senator BOYCE: The first question I have is: what number of diabetics must the Townsville study recruit to have sufficient power—credibility—to achieve significant findings? Is that something that the department of communications is going to be able to tell me?
Ms Halton : What I can tell you is that the department of communications has worked with us on their pilots to do with the NBN. I suspect that the best thing to do with those kinds of questions is to take them on notice. We will have a conversation and get you an answer across us and the department of communications.
Ms Huxtable : I have just been told that this is a Broadband measure, not one of our measures. I think the questions would need to be directed to them.
Ms Halton : We will put them on notice.
CHAIR: We will be able to see what engagement Health has had, because I imagine the numbers of diabetic people would have to somehow come back through some area of Health. If not, we will get them to Communications for you.
Senator BOYCE: I wanted to also ask some questions about the $20.6 million fund to conduct the trials using the NBN. Did DOHA contribute any funds to that?
Ms Halton : No. I will correct this if I am wrong, but I am sure I am not. The funding has come through Communications. When they were identifying priorities for these early rollout initiatives, there was quite a lot of dialogue with us on the kinds of things that are relevant to the practice of health: how you connect into the home et cetera, including with the consultants—I am almost loath to say that word—who were advising that department. Those consultants came and talked to a number of people, including me, about those projects. As I said, the measures, the money, is through that department.
Senator BOYCE: Through the department of communications?
Ms Halton : Yes. We will take it on notice.
Senator BOYCE: But I understood you were contributing half the funding for the telehealth trial.
Ms Halton : There is a difference. We have other things on telehealth. I think we need to see the questions in precise detail.
Senator BOYCE: What things have you got on telehealth and the NBN?
Ms Halton : We have telehealth measures.
Ms Huxtable : Incentives.
Senator BOYCE: Does that include the NBN? Are they related to the NBN?
Ms Huxtable : No, not directly.
Ms Halton : No.
Senator BOYCE: It is around the two trials that are being done with telehealth and the NBN that I am interested.
Ms Halton : The officers who can talk about telehealth more broadly are not here because that is not in this area.
Senator BOYCE: When would they be here?
Ms Halton : They should be around shortly.
CHAIR: We will make a note.
Senator BOYCE: I do not necessarily need to ask all the questions now. I just want to be sure where I should be doing this.
Ms Halton : The people from medical benefits at 5.15 can certainly talk about our engagement.
Senator BOYCE: Thank you.
CHAIR: Thank you to the officers from e-health; I think we can say we have covered that area.
----- End Transcript.
It seems like it was a rather wasted hour or so but at least we seem to have confirmation some funding will continue and breaches will be notified. Progress I guess.
It is also useful to see the Greens are taking an interest via their medically trained Senator for Victoria. I hope the Greens are going to be able to take a considered position now their numbers have reached critical mass.


Anonymous said...

All sensible and direct questions which deserved clear answers. If this charade wasn't such a tragic waste of opportunity the obfuscation would be hilarious. One can't help thinking of the classic Lewis Carroll nonsense verse, The Walrus and the Carpenter - To carry the analogy further, lets just hope someone is brave enough and cares enough to ensure that Australians expecting eHealth to improve things don't suffer the fate of the oysters at the hands of the clowns avoiding the questions.

Anonymous said...

I'm thoroughly enjoying the squealing on this blog. It's like the readers have never seen a big government project in action before. They sound positively surprised by how this is playing out. (I offer my congratulations, the righteous zeal almost sounds convincing).

This one does look a little more likely to go bang, but given wider events, it seems like a ruddy chance there'll be much bigger bangs around.

Dr David More MB PhD FACHI said...

"I'm thoroughly enjoying the squealing on this blog. It's like the readers have never seen a big government project in action before."

Oh yes we have and we have also seen how they turn out. Think HealthConnect, HealthSmart, HealtheLink to say nothing of various IT stuff ups in other Federal Department - too many to list.


B said...

Three questions:-

1. How much work and funds are required to go beyond the registration capability expected on 1 July?

2. What are the on-going maintenance and support costs of the system?

3. Where are these funds coming from?

Anonymous said...

Mr Fleming says about the CDA issues "...we did not give the full change control log to the wave 1 and 2 sites." Why, then, has the work of the GP Vendor Panel members in this respect been stopped?

Anonymous said...

Because the change logs had become so long (and because change logs are always vague and hard to understand) that it was no longer reasonable to expect implementations to figure out what was actually a correct implementation, even if a revised change log for what was missing was also issued (many 100s of changes in total, though most were very small). Hence they are asked to re-implement based on the only the latest specifications, with no change logs needed. Only, those very latest specifications were withdrawn for a few weeks to correct a series of (relatively minor) technical errors in them. Hence, everyone waits for these new versions

Anonymous said...

... and because the same issues that affected the wave sites applied to the GP Desktop vendors too

Anonymous said...

in short ..... change management control out of control

Paul Karen said...

I am a GP in The Hunter Region (?? wave 1 site I understand).

I have heard zilch about when the so-called "trial" is going to start.

I therefore invite Mr Fleming and Dr Mitchell to contact me as to when I can expect to see some action!!

Anonymous said...

It will require an additional $1bn at least to get PCEHR completed...

Anonymous said...

This is classic technocrat stuff. We have 20,000 pages of documentation so we must be doing well!!!

I would have thought that should ring alarm bells. They are managing the problem rather than actually solving the problem. If anyone thinks we are going to achieve anything when there is 20000 pages of documentation to digest they are deluded. They started out trying to design a racehorse, but it seems that this is something much worse than the usual camel result, its more like a giant praying mantis. Hopefully now that they have mated with it it will do the usual post coital praying mantis convention and turn around and eat them.

Anonymous said...

Quite frankly the AMA and the RACGP and the AGPN and the PGA and the PSA pay lip service to it and say they support it. By doing so they give it credibility and because they each have limited understanding they do not know that they are simply perpetuating this technocratic nightmare and unwittingly forcing it down upon the rest of us. It's a non win situation for everyone except the technocrats busy writing many more pages of documentation to manage a problem, the essence of which, THEY DO NOT UNDERSTAND. And it will continue in this vein until the money runs out. Then it will stop and everyone will ask SO WHAT? and others will say WHAT NOW?