Thursday, June 07, 2012

This Is A Piece Of News That Should Not Be Taken Lightly. This Can Stop The NEHRS Dead In Its Tracks.

The following report appeared a few days ago.

Litigation warning on eve of e-Health

FOUR weeks before the introduction of a $1 billion e-Health scheme, key medical indemnity insurers are warning GPs not to participate as they could be exposed to a new wave of litigation.
There is concern doctors could be sued if patients are harmed because records are not kept up to date or clinical information is omitted. They are also worried by the ability of patients to restrict access to parts of the record.
Insurers are advising doctors not to use the e-Health records until the issues are settled.
President of Medical Defence Australia Julian Rait said his organisation had serious concerns about the legal liabilities doctors would face if they used the Personally Controlled e-Health Record (PCEHR) and would "advise members not to participate until these problems are properly addressed".
David Nathan, Avant Mutual Group Limited chief executive, said his organisation was concerned that key elements of the initiative, including the potential risks assumed by healthcare professionals in accessing the PCEHR, were yet to be finalised, and "they may determine our advice to members as to the risks of signing up to the initiative".
Lots more here:
And if you really want to scare people away this will do it.

Premiums may skyrocket due to e-health

5th Jun 2012
AS THE government continues to bargain with GP groups over the conditions practices must agree to when using the national e-health record system, experts have warned the legal liabilities attached to the records could push premiums up.
The first draft of the agreement caused outrage across the profession by requiring practices to assume all legal liability for the system and grant health department officials unrestricted access to their premises and records.
Department officials were due to meet RACGP representatives today to discuss the latest draft of the agreement, which sources said was the fourth so far, but MO understands the major GP organisations are still unhappy with many of the conditions.
MDA National president Associate Professor Julian Rait said the contentious “search and seizure” powers had been removed from the latest draft but GPs should still treat the system with “extreme caution”.
Lots more here:
What needs to be appreciated here is the power of the Medical Indemnity Insurers. If they say to their members we would advise you to leave the NEHRS / PCEHR alone until we are sure there are essentially zero risks as far as your contributing to and using the NEHRS you can be sure they will be taken very seriously indeed.
To practice all doctors need this sort of insurance - essentially to cover their defence costs where they are wrongly accused and to compensate those patients who have been wronged - and costs can range from a few thousand a year to tens of thousands depending on your risk profile.
The Indemnity insurers are ‘not for profit’ and so if they see an additional risk / possible liability their actuaries will cost it in and adjust premiums accordingly - as well as warn about getting involved - or maybe charge a higher premium if you say you plan to use the NEHRS system. There is lots of precedent for extra premiums depending on the nature and scope of practice.
At present there seem to be two areas of concern. The first is around the conditions the Department wants to put in their agreement with doctors to contribute to / be the custodian of the Shared Record. Right now the AMA and RACGP are not at all happy and a third draft is apparently being prepared - the first two having been rejected.
The second area is around accountability for the use of a NEHRS record and possible liability that may flow from wrong treatment or care based on information found in a NEHRS record. Clearly there have to be clear rules and clear ‘good faith’ use exemptions or the risk of use just will not be worth it.
I guess the Government will be grateful, with the delayed start - to have some more time to sort all this out. If they don’t you can be sure clinical use of the system will approximate zero.


Anonymous said...

Just over 3 weeks to go and they are still "bargaining" with the medical indemnity insurers? This debacle has been in the making for over 2 years - this is real 11th hour stuff. It should stop the NEHRS in its tracks until someone can add some reality to the picture!

Anonymous said...

The Health Minister is looking very, very exposed and in turn, so too is the Gillard Government.

The bigger the train crash the bigger the exposure - 1 billion dollars and rising.

Cris Kerr said...

Doctors don't want to use the PCEHR due to legal liability?

Hasn't that story been featured over and over again... hasn't it been done to death by media?

Consumers' best PCEHR interests and long-term health futures have not been adequately addressed yet most consumers remain unaware due to lack of reporting.

Public interest stories like this have taken a back seat to the trials and tribulations of powerful lobby groups and pseudo consumer groups.

Let me just say this to those who think they will never need a PCEHR or that they will never need to opt in for one at any time in their future...

This is not just an issue for today's chronically or critically ill.

What works today can fail dramatically tomorrow... as every chronically and critically ill person can attest.

And will ill health, the job you have today could be gone tomorrow, and if so, you will need a robust free public health system.

We are all consumers and we're all potential patients or potential public health patients.

We all have a potential PCEHR in our futures and our children's futures.

I'm usually conservative with what post, but I'm so very, very frustrated... We're a few weeks out from launch and the PCEHR is being promoted to consumers who are being encouraged to 'sign up'.

(1) According to documentation read to-date; consumers will not be able to restrict individual healthcare provider access to their PCEHR.

Consumers will only be able to restrict healthcare provider organisations (eg restrict an entire hospitals' staff, an entire pathology providers' staff, an entire clinics' staff, etc).

(2) According to documentation read to-date and a recent letter received from DoHA; no population/public health dataset has been planned relative to the PCEHR or our ehealth system.

This means a unique opportunity to dramatically advance our population/public health outcomes and sustainability through public health and medical research has not been planned, and will not occur.

Due to our country's adoption of US health policies and a market-based health system, the word 'public' was long ago removed from 'health'; (eg Dept of PUBLIC Health and Aging, and National PUBLIC Health and Medical Research Council), so what lies ahead in relation to the PCEHR... with exciting 'applications' being opened up to the market?

(3) According to documentation read to-date; consumers can enter information in their own PCEHR, but only in their own words, with their own version of spelling, within their own understanding.

This will devalue the prospects for this new and potentially valuable source of population/public health data, as it will most definitely impact negatively on the integrity of that data.

The consumer section of the PCEHR could 'mirror' medications in the consumer section, and could provide drop down lists for other descriptors such as allergies, symptoms, adverse reactions, etc; but this is not planned.

If it was, the data could then be de-identified and pooled to provide a valuable data set for research and analysis of public health outcomes with a view to identifying and implementing improvement opportunities that would enhance preventative health and health outcomes, improve national productivity and enhance the sustainability of our free public health system.

It's time for the media to remember their 'public interest' charter, to take an active interest in reporting on the PCEHR from a public health/population health and consumer/personal perspective... and to represent the best interests of all our health futures.

If we don't, we'll get the health futures others are planning for us all.

Dr Ian Colclough said...

The real danger of the PCEHR 'thingummy' is that people will be tempted to rely on it in the misguided belief it is accurate and complete because it is held in a 'computer', but until it is accurate and complete you can't rely on it.

The paradox is that if you tell people they can't rely on it until it is accurate and complete they won't have any confidence in it and they won't use it. Yet if they do use it in its inaccurate and incomplete state they will stop using it.

The dilemma is real which is why a we need to consider a 'different approach' to building confidence.

B said...

Three points:

1) Liability should have been a central issue in the Deloittes National eHealth strategy. It wasn't mentioned.

2) Those who accepted and adopted the National eHealth should have realised that liability is a deal breaker and insisted it was at least raised, if not discussed in detail.

3) This is an IT system built by IT people, not a health system for the community.

None of these should come as a surprise to NEHTA and DoHA. This blog and submissions on the draft ConOp document have already made these points (and others, just as valid and critical).

Anonymous said...

"This is an IT system built by IT people"

it is designed by the clinical leads, not by IT people - as should be clear from reading the specifications

Dr David More MB PhD FACHI said...

My understanding is that an earlier and better system was designed by NEHTA - called the IHER - and that this design was made 'personally controlled - by DoHA Bureaucrats (frightened of the privacy lobby) and that this distortion of the original aims was supported by some on the NHHRC.


Anonymous said...

This liability argument was happening when HI Debate was happening. DOHA have just rolled out the same terms and conditions.

What were the clinical college representatives, clinical associations and NEHTA clinical leads doing for the past number of years to allow it to come to head now? Given the number of stakeholder engagements that NEHTA organised at nice hotels surely between canapes some one might have said medico legal maybe be a problem.

Can they all pay back the tax funded allowances they have received? Given the top NEHTA clinical lead is a former AMA President who also sat on NHHRC, one would have thought tax payers' would have gotten greater value for their money to make sure these things were dealt with much sooner.

The big consultancy houses also may have to pay back the money they have received as clearly they have received funding falsely as they were not qualified or experienced enough to understand the issues properly. Or did DOHA, NEHTA and/or the Minister just ignore advice? Therefore who is accountible?

Given the DOHA secretary wanted the PCEHR governance position resting with her role maybe the buck stops with her. She is the longest serving NEHTA director and has been around the longest in DOHA for this program - clearly she is responsible.

Anonymous said...

There is no one person who can be held responsible, for that is the way big projects evolve under the direction of bureaucrats.

The system has been designed by committees. DOHA and NEHTA have appointed people called 'experts' to sit on these committees to give credence to what the technocrats have been developing.

The experts have nodded and been paid. The Agenda for the committees has been set by DOHA. The Chair of these committees has driven through the required result by getting a maximum number of noddies on each committee to nod in favour.

And, if a problem is raised that is too complex for one committee to answer or solve it is referred to another committee.

Big complex projects designed by committees which are controlled by bureaucrats fail don't they Minister? Yes Humphrey, but they only fail once unless I'm in charge.

B said...

Anonymous said:

"it is designed by the clinical leads, not by IT people - as should be clear from reading the specifications"

If that were true then it is just as bad. What credentials do clinical leads have for designing a complex Information System?

I've looked very closely as the ConOp documents and IMHO it is an IT system.

And whoever designed the system only considered the user functionality, not the broader context in which it is to operate - hence the lack of attention to legal liability.

Anonymous said...

> If that were true then it is just as bad.

that was my point: none. I think we can see that they have't added to their credentials here either.

Anonymous said...

6/08/2012 07:11:00 PM

... and the experts who did not just nod, but attempted to make constructive suggestions in this and other areas, were generally ignored.

Anonymous said...

The fact that the definitional document was in fact a Concept of Operations document following the IEEE standard says to you that those defining the problem concieved the problem to be an IT problem and what was needed as an IT/engineering solution.

It is there for all to see!

ehealth has been an IT (gravy) train solving IT issues.

NO doubt about it!