Sunday, March 04, 2012

What Is The Opposition Up To In E-Health? Right Now The Signals Are Confused. I Wonder What They Really Think?

As reported a day or so ago in the press we had the e-Health PCEHR legislation waved through the Lower House of Federal Parliament.
Here is a report:

E-health bill passes lower house

  • From: AAP
  • February 29, 2012 3:04PM
LEGISLATION to establish a national, personally controlled electronic health system has been passed by the House of Representatives.
The bill, which the federal government says will bring the management of health records into the 21st century, passed with the support of the coalition despite the concerns of some MPs.
Liberal MP Andrew Laming said Australia must learn from the experiences of the US and Britain where similar electronic records systems have been implemented.
"And to go down the same path and make the same mistakes is what makes this (opposition) side of the chamber so determined to ask the right questions about electronic health records," Mr Laming said.
.....
The Personally Controlled Electronic Health Records Bill 2011 and the related Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 were both passed at the third reading on the voices.
The full report is here:
A day or so previously we had Liberal MP Paul Fletcher speak out on the matter:

Fletcher: Governments can't dictate technology adoption

Brett Winterford

Attacks NBN and e-health records.

Liberal MP and former Optus executive Paul Fletcher has delivered a stinging attack on the ambitious technology projects of the Labor Government, arguing Australia has not learned lessons from numerous failed IT projects in the private and public sector.
Fletcher savaged the National Broadband Network (NBN), the Personally Controlled Electronic Health Record (PCEHR) project, and the ‘one PC per student’ Digital Education Revolution in a speech to a conference of technology journalists on the Gold Coast Sunday.
He compared these schemes to – among others – the UK’s failed e-health project, the cash flow problems and subsequent Leighton buyout of Nextgen Networks, SingTel’s write-off of Optus’ HFC Network losses and the collapse of mobile telco One.Tel.
......
Health
Fletcher continued this line of argument to criticise the Government's $467 million PCEHR, an electronic infrastructure for shared health summaries.
He argued that doctors need to be enthusiastic adopters of the system to ensure its take-up by citizens, which has yet to play out.
The Government expect 500,000 trial patients to be signed up for the e-health record by the time the project goes live to the public on July 1 this year. However, it has been hit by concerns around take-up from GPs and patients, as well as numerous setbacks to project timelines.
“The goal [of the PCEHR] is a pretty sensible one," he said. "The question is whether the hardware and software will be used at the degree we want."
His history in the private sector taught him to “beware of the big bang". he said.
“There are plenty of horror stories for new IT billing systems being abandoned after millions of dollars were spent," he said.
The UK Government spent £11 billion on e-health but ultimately failed to deliver a functional system, he said.
“Often an incremental approach is more prudent.
“As you in the industry well know, you can lose a lot of money betting on technology.”
Lots more here - especially on the NBN and the private sector role:
From these links you can review Hansard where a good few opposition members spoke:
Here:
and here:
Here are a few remarks from the Liberal speakers:
Ms Marino - Forrest:
“I also believe that the government is ignoring the broader cyber risk. Cyberattacks cause direct financial losses to consumers and businesses from the theft of information or through extortion. The information in electronic health records has to be protected. It has to protect the rights and privacy of the patient. We know that hackers have been able to breach some of the world's most secure internet sites.”
“Given the collective and individual value of health records, how will the government ensure that the private health records of Australian citizens remain totally secure. What responsibility will the government accept when an inevitable breach occurs? This bill appears to impose all of this responsibility on health organisations and none of it on the government itself.
Breaches will be possible at all stages, both directly through unauthorised access and through sophisticated hacking.”
Mr Fletcher - Bradfield:
“Let me turn to the second serious concern I want to identify, which is that this government is seeking to make a big bang change in information technology applicable to the health system and to do so in a huge rush. The near universal view in the sector is that the timetable for implementing these reforms is absurdly and unbelievably tight. The date which has been specified, 1 July 2012, is widely considered to be ludicrous. We have seen this government make this error in area after area. They impose a deadline so that they can announce it in a media release, without thinking through the complex implementation issues. We have every reason to suspect that the same error is going to be made again. I note, for example, that the Medical Software Industry Association, whose members include Cisco, Microsoft and iSOFT, made a very critical submission to the Senate inquiry, noting that the government's approach on this issue has not followed normal business practices in the IT industry and that the documents issued by the National E-Health Transition Authority to software developers were manifestly inadequate.
So if one issue is the unrealistic timeframe, a second issue which compounds that is the naive belief that we can create here a brand new system which will completely transform everything: 'This is going to be year zero. This new system will solve every problem.' That error has been made time after time when it comes to the application of information technology in both the public sector and the private sector. We are well on the way under the approach embodied in this bill to making the same error again.
Why is it that when the government's consultants, Deloitte—commissioned by the Australian Health Ministers' Advisory Council in 2008 to develop a plan to guide the national approach to e-health—recommended 'an incremental and staged approach', they proposed seeking a specific application which was manageable and achievable and which would deliver early benefits. The one they proposed was an electronic prescriptions transfer service between health carers and pharmacies. In their view, a quick win could be delivered at relatively low risk.
They argued that the first step was to connect the care providers, the next was to enable key information flows and only then to go to the third step of building repositories to accumulate the information contained in those information flows. Unfortunately, this government has chosen to reject that very sound advice.”
Mrs Bishop - Mackellar
“Whilst the idea of utilising electronic data collection can certainly be attractive to one in thinking, it is the examination by people who are involved in this sphere that puts up the sorts of worries that people have about a start date of 1 July 2012. I think this is a major sticking point for the opposition—that the whole process is being rushed. One of the things that seems to be driving that rush is the fact that the funding for it—an agreement under the COAG arrangements—runs out at that date, and there is no certainty about any further funding for it.
There are many issues that are of concern to people on this side of the House. We are a conservative party. We are conservative on this side and therefore we are cautious about the way in which we would go forward in order to bring about change. On the government side there is this overuse and indeed abuse of the word 'reform' when really what they are talking about is change, and sometimes it can be change for change's sake or rushed change without adequate work having been done to prepare for it and to look at what the consequences may be.
It was said in the course of the debate that one can have no confidence to date that the records to be accessed will be complete, that they will be up to date, that they will be reliable. Where are the questions being addressed as to who would be liable for damages for acting on records which are not complete, which are out of date, which have not been properly kept? We all know that in our hospital and health system there are many errors.”
Mr Laming - Bowman
“The holy grail of an electronic health record is something that most developed economies are working towards. In summing up this side of the debate on the Personally Controlled Electronic Health Records Bill 2011 and cognate bill, I just want to make the observation that this nation will have an electronic health record. It is going to happen. There is a graveyard of good intentions in other developed economies, and they are lessons from which we can learn. The minister will be aware that there have been enormous expenditures in the UK and in the US. To go down exactly the same path and make the same mistakes—that is what makes this side of the chamber so determined to ask the right questions about electronic health records.
The contributions to this debate have been effectively divided in two. One is the significant upside of having a functional electronic health record, and there is no doubt about that. There is no doubt that we can see great savings and potential in the idea of having electronic information transmissible between the people who need to know. That is a no-brainer. And we know on the other side as well that there are significant concerns about privacy that have to be met. If I can distil it into a single sentence: we need to make sure that we move this project forward at the speed which current technology allows.
I do not want this to be something in between pink batts and the NBN, but we have genuine experience from around the world that shows that there is every possibility that that can occur. Today's debate really should be about how we prevent that occurring. How do we work carefully? How do we focus on the areas where gains can be made undoubtedly? And how do we acknowledge the areas where we are effectively doing little more than tipping money into some omnivorous money-eating machine that is a concept developed and controlled by public servants, from which politicians have effectively abrogated their responsibility, in the hands of fractured and separated private providers who accept contracts not knowing if they can deliver, at risk of forfeiting, at risk of going broke and at risk of not delivering? That is not made up. Those are direct quotes from what happened in the NHS. We can learn from that, but we do not if we have blind contributions in this chamber that focus on nothing but the upside of an electronic health record.”
There is a lot more in the same vein in the two links above. The question is, for me then, just why did the Coalition wave this Legislation through when a Senate enquiry was due in a couple of week and when they clearly have a large number of reservations about a range of risks.
The answer is that, honestly, I have no idea and I wish I did. It seems very odd indeed to me. My only suggestion is that they feel they have ‘bigger fish to fry’ and have not spent the time to carefully, as a party, consider the matter. It is clear some Liberal members and Senators are interested so I believe it is time for them to work out and announce a clear position - given this will be a decade long project and it is likely that for some of that period they will be in Government.
David.

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