Monday, August 20, 2012

Now What On Earth Is Going On Here? More Stuffing About It Would Seem. Talk About Tiny Steps Forward.

Just got this when I tried to access my NEHRS:

National eHealth Record System Provider Portal Login

ENTER

Ensure you have a valid NASH Token connected.

The NASH (National Authentication Services for Health) is a digital credential for healthcare professionals.
Here is the link:

Given NASH does not exist - it is clear clicking that did not work. Going back things were back to routine!
As mentioned, later we were back to normal and I got into my NEHRS.

I checked on the integration and got this!

                       22-May-2012 Medicare/DVA Benefits Report DHS Medicare
                       22-May-2012 Medicare/DVA Benefits Report DHS Medicare

                         22-May-2012 Medicare/DVA Benefits Report DHS Medicare

                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare
                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare

                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare
                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare

                       06-May-2012 Pharmaceutical Benefits Report DHS Medicare

Each drug gives you this:

Pharmaceutical Benefit Items

Generic Name        ALLOPURINOL
Brand                     PROGOUT 300
Prescribed             Sat May 05 00:00:00 EST 2012
Supplied                Sun May 06 00:00:00 EST 2012
Form and Strength TABLET 300MG
Quantity                60
Repeat Number     2

At last I found the summary screen and guess what it was 3 months out of date! I filled repeats in June, July and I think August. Of course the times are just nonsense - a date would do!

Medicare Overview

The information below is provided from Medicare and may be incomplete. To find out more or to change your preferences, go to Medicare Information Preferences.

Prescription information - PBS & RPBS

Generic name
Brand
Prescribed
Supplied
Form & Strength
Quantity
Repeats
Code
MELOXICAM
MOXICAM 15
05-May-2012
06-May-2012
TABLET 15MG
30
2
08562P
ALLOPURINOL
PROGOUT 300
05-May-2012
06-May-2012
TABLET 300MG
60
2
02604C
TELMISARTAN
MICARDIS
05-May-2012
06-May-2012
TABLET 80MG
28
5
08356T
MELOXICAM
MOXICAM 15
05-May-2012
06-May-2012
TABLET 15MG
30
3
08562P
OMEPRAZOLE
ACIMAX TABLETS
05-May-2012
06-May-2012
TABLET 20MG (AS MAGNESIUM)
30
5
09110L

Australian Childhood Immunisation Register - ACIR

Immunisations

No information available

Cancelled Vaccinations

No information available

Australian Organ Donor Register - AODR

No information available

Medicare Services - MBS & DVA items

Date
Number
Description
Service Provider
In Hospital?
22-May-2012
66602
Red cell folate + serum B12
DR XXX XXXXX
No
22-May-2012
66608
Vitamin D
DR XXX XXXXX
No
22-May-2012
65129
Coagulation - 4 or 4+ tests
DR XXX XXXXX
No

What to say? We have old, incomplete and very clumsy records that no doctor could love. Given I know the medication records are close to 3 months out of date it is hard to really believe this would hardly help much - some, but not what was needed. Definitely a start but jinx a lot of work is needed on interface, utility and so on.
Personal note: These medications are for hypertension, arthritis, gout (family history) and so on so be not concerned - they are not a secret and many over 60 are on such meds. Seeing what we are being offered in the NEHRS is more vital so people can form a view on what is being done. To anyone who wonders all the meds are working well and all my parameters are fabulous now! e.g My blood pressure is 110/70!

Hope this helps others to set up a record and see for themselves.

It seems to me utterly clear that no clinician was involved in the design of this or we would not see what we have been given. This is incompetent rubbish compared with what was possible with some consultation and effort!

David.

19 comments:

Paul Fitzgerald said...

David, I am sure you just broke about 4 of the new national privacy principles! :-)
Certainly seems to be a very un-user friendly system....

Dr David More MB PhD FACHI said...

All my own data. I can disclose what I like to who I like - can't I?

David.

NK said...

Yes you can - but what is the status of anyone who retweets the link, for instance? gray territory.

Can't believe that Medicare put a date with a time in of 00:00.

Anonymous said...

Hi David
I can't be sure, but I think that your data appears to be 'old' or out of date, because Medicare only becomes aware of your data after the pharmacy has sent their claims for dispensing to Medicare, and this may not be in real time, and is likely to be batched, or may be subject to further processing (e.g. if the batch file is rejected). Medicare only holds information that is the result of a claim. E.g an MBS claim will only appear if the patient has taken the receipt and made a claim to Medicare. If you forget to do this, or have an item that is not claimable, then it will not be lodged with Medicare. So just because a script has been dispensed, does not mean that Medicare will know about the dispense event.

Anonymous said...

David, if they had an online realtime prescription monitoring system deployed they would be able to provide you with an up-to-date list of all your current and past medications - wouldn't they?

Dr David More MB PhD FACHI said...

@8/20/2012 09:43:00 PM

So three months to batch..hardly useful

And obsolete data - useless compared with real time.

And this cost a billion dollars?

David.

Anonymous said...

No it cost more than that because we already paid for it to be built in Medicare. You can see your mbs, organ donor and immunization data in Medicare.gov.au, and now you can see it in nehrs also. Would have been better off providing a link over tO Medicare I reckon- at least it would be contextually meaningful, instead of having to wonder why it is 'old' etc, and having to second guess the processing constraints.
Having out of date prescription data is dangerous, unless the reader is informed.

Bernard Robertson-Dunn said...

Anonymous said...

"Having out of date prescription data is dangerous, unless the reader is informed."

Looks like another information/time issue to me.

Has this been thought through and documented?

Anonymous said...

Out of interest David, is your PBS data in your Medicare Online Services account up to date?

Dr David More MB PhD FACHI said...

Sorry, I tried to access my Medicare Information directly but failed the registration process - lacking recent encounter data etc they seemed to want.

Short answer - I don't know. I hope others can compare and let us all know.

David.

Anonymous said...

The mailout for Medicare Online Services is an easier way to register.

My information matches perfectly.

Anonymous said...

You've visited the provider portal (portal.ehealth.gov.au), not the consumer portal. That is secured with a NASH compliant token.

A (small) number of providers have registered and have access to the provider portal today. They are able to use it to view the records of any patients that have registered for PCEHR.

Bernard Robertson-Dunn said...

Anon said:

"They are able to use it to view the records of any patients that have registered for PCEHR."

Could you clarify that statement. Do you mean the records of ANY patient, or only those they are authorised to see.

Anonymous said...

Bernard: seems a funny question.

In a technical sense, they can see any patient whom:
1. Has set their record to general access and not revoked their access, OR
2. Has a RAC or LDAC (access code) and has provided it to that clinician, OR
3. That clinician has declared an emergency access

AND

In all cases, that clinician has a legitimate clinical reason to access that record.

This is an informal summary, the concept of operations is more clear/specific, so any summarisation errors my own.

Bernard Robertson-Dunn said...

Anon said:

Bernard: seems a funny question.

Funny haha, or funny peculiar? (That was rhetorical)

But invoked a straightforward answer, thank you.

So, just to confirm:

Providers can only see those records they are authorised to see.

Anonymous said...

David. This is a total cluster. Not sure how or by whom this is being managed, but wonder if they have told IBM they got another NASH?

Anonymous said...

Bernard: just surprised that you'd interpret "any" - which I meant as "those who have registered" - as meaning "it's been decided to remove all security controls." I know this site is a bastion of skeptics about PCEHR, but it really hadn't crossed my mind that it could be interpreted that way. I guess the informality of a blog doesn't quite translate well.

Anon: I think you can safely assume that IBM are well aware of the current arrangements around NASH conformant credentials.

Anonymous said...

Even if you have a Nash-compliant token you will still need to declare which organization you are accessing on behalf of. That organization must have formally registered to the nehrs and listed you as a valid clinician to access under their umbrella. And you will need to have the patients name dob and ihi or Medicare number . I think. Has anyone actually accessed in this way yet?

Anonymous said...

Yes, some clinicians have accessed, but I don't think anyone would claim meaningful use yet. It's been available for a relatively short period, and this isn't expected to be the primary means by which clinicians connect - most clinicians over time will connect via their desktop software.

The provider portal does not allow document upload, so it's more about allowing a clinician who is away from their system, or hasn't yet got a system, to access information in PCEHR.