Sunday, February 10, 2013

Karen Dearne - More Money for PCEHR but Little Oversight and Real Uncertainty over Future e-health Programs.

Karen Dearne
10 February, 2013
THE National E-Health Transition Authority has been awarded almost $10 million to provide services relating to the introduction of the Personally Controlled E-Health Record, according to a newly published contract notice.
The federal Health Department will pay $9.9 million for the work, between December 11, 2012, and June 30, 2014.
It follows a previous $110 million contract to provide similar services from December 31, 2010, to June 30, 2012, in the lead-up to the official launch of the PCEHR system last July 1.
NEHTA's answers to questions on notice from the October Senate Estimates session show that the authority's commonwealth and state owners will provide $69 million in core funding for the current year's operations.
NEHTA told the Community Affairs committee that it has also carried over Council of Australian Government funds totalling $28.4 million.
"In regard to the PCEHR managing agent responsibilities, as contracted to Health, NEHTA has approximately $63 million in carried forward funds against future commitments," NEHTA says.
NEHTA's core operations are described as "the development and maintenance of national e-health foundations including the operation of a Healthcare Identifiers service, the operation of national authentication and clinical terminology services, and maintenance of a national product catalogue", according to Victorian Government's Budget statements.
Victoria allocated $8.3 million to NEHTA as its share of core funding for each of the 2012-13 and 2013-14 financial years.
Among other recent federal government PCEHR-related contracts, consulting firm APIS Group has been awarded $5.3 million for support services from last September to June 2014, and the Australian Commission on Safety and Quality in Health Care received $4 million to build "key national health components of the PCEHR" by June 2014.
The Royal Australian College of General Practitioners was given $2.55 million to assist implementation and rollout of the system until the end of June, while Workstar will receive $1.2 million for hosting support and development of online capabilities for the PCEHR change and adoption strategy until June 2014.
Meanwhile, the Health Department has told the Senate Community Affairs committee that COAG's Standing Council on Health has come to a decision on the future of commonwealth-state funding for e-health.
"The eHealth Memorandum of Understanding, which replaces the National Partnership on E-Health (this expired at the end of June last year), was agreed by SCOH on November 9," the department says.
However, the communique released after that meeting simply states: "Today, Health ministers noted progress on the eHealth MOU."
The MOU is yet to be publicly released.
Briefing papers provided to Health Minister Tanya Plibersek when she took over the portfolio said the "development of an E-Health Intergovernmental Agreement" needed urgent attention, due to the pending expiry of the previous joint commitment.
The Key Decision Brief document, released late last year under Freedom of Information laws, show that the minister's approval was to be sought "to circulate a draft of the eHealth IGA to (state and territory) health ministers in mid-February" for discussion at the next SCOH meeting.
"Subject to decisions of government, an agreement is required to set out and communicate the collaborative funding, governance, legislative and administrative requirements of e-health from July 2012," it states.
The COAG Reform Council (CRC), tasked to report on progress and efficacy of the many recently established National Partnership Agreements in meeting targets, previously signalled its difficulty measuring performance in the e-health space.
In its annual Progress Report, released in September, the CRC rated the timeframe for this reform as "at risk", noting that some milestones had not been met.
The Health Department has told the Senate committee that the scope of the previous NPA "dealt largely with the implementation of the Healthcare Identifiers service".
An interim review conducted to determine the NPA's progress towards achieving its objectives found that the "NPA has proved effective and appropriate in achieving the intentions of all jurisdictions in providing funding for NEHTA and successfully establishing the HI service".
But the performance of NEHTA and the federal Health department were not subject to scrutiny.
"Performance measurement for NEHTA and the department were not addressed through the NPA, because it is a COAG document which sets out roles and responsibilities for all jurisdictions," the department's response says.
"The funding agreement in place between NEHTA and the department specifies the roles and obligations of each agency."


Anonymous said...

Consulting firm APIS Group has been awarded $5.3 million for support services from last September to June 2014.

That is 58,000 dollars per week for 21 months.

Now what exactly are these support services?

Latest operations review newsletter is JULY to DECEMBER 2010

Anonymous said...

Might be this:

Bernard Robertson-Dunn said...

A question:

Does the audit log show when the system operator (in this case it would seem to be DoHA and APIS) accesses a citizen's eHealth record? And that includes the help desk and system admin staff.

Another, related question, which maybe answers the first:
Re the PCEHR Rules 2012 at:

This appears to me to be the legislation under which the PCEHR operates.

Looking at the access rules it says:

4. Default access controls
For the purposes of paragraph 15(b) and (c) and subsection 109(6) of the Act, the System Operator must establish and maintain default access controls that:
(a) permit all registered healthcare provider organisations involved in the care of a registered consumer to access the consumer’s PCEHR;
(b) include an access list of the registered healthcare provider organisations that are permitted to access the consumer’s PCEHR because the organisation is involved in the care of the registered consumer;

The interesting thing is that the rules only apply to registered healthcare provider organisations and the consumer. If you are not in either of these groups, the rules do not apply to you.

The rules do not explicitly state that only these groups should be allowed to access a PCEHR. So, technically it seems that anybody who can get access to the PCEHR system, provided they are not part of a registered healthcare provider organisations, can legally access anybody's PCEHR.

Could someone please tell me if and why I am wrong?

Karen Dearne said...

Hi David

I have submitted an FOI request for the eHealth Memorandum of Understanding between the commonwealth and state governments, as agreed at the Standing Council on Health meeting on November 9.

It replaced the former National Partnership on E-Health which expired at the end of June 2012, and is intended to shape future collaboration and governance arrangements for e-health initiatives Australia-wide.

I am using an FOI request facility created by Right to Know (see ) which aims to provide a straightforward means for members of the public to request information from government authorities.

My request is here:
The website outlines how FOI works, and follows up on responses to requests made.

If you click Follow on any particular request, I understand you will receive an automatic email whenever there is some activity recorded.
Regards, Karen Dearne

Anonymous said...

What an indictment of our system of Government and Democracy that such measures have been resorted to in order to gain access on how "Australian Taxpayers" monies are being spent!

Shame on our elected Government representatives and an even greater shame on our unelected public servant bureaucrats that this information is not freely and widely accessible already to members of the public at large that are even remotely interested in what the government and bureaucracy are doing with "their" taxpayer money.

If the Senate Estimates hearing is streaming and scanning this BLOG in real-time, please someone ask the question "WTF is up with Australia's ehealth governance and complete lack of transparency in this particular instance"??

They are called "public servants" for a reason so when are they actually going to begin "serving" the Australian public?

If they can't clearly and transparently explain what they are doing with Australian Taxpayer money, and what benefits the Taxpayers are getting in return, they probably shouldn't have any access to it in the first place!

Karen Dearne said...

Hi David
A quick update on my FOI request for a copy of the eHealth Memorandum of Understanding which DoHA says has replaced the expired National Partnership on eHealth.
The request has not been denied to date, but the dept is claiming it will take almost 20 hours to locate it and ask each of the state and territory govts if they mind it being released first.
All this at a cost of $279 to me, with a 25pc charge payable upfront.
I am puzzled by this, as these agreements are usually published, and are supposed to be provided under COAG's International Agreement on Federal Financial Relations.
You can read the notification here

Anonymous said...

A failure to be transparent simply creates the impression that there is something to hide, and if there is something to hide, there is something to be embarrassed about, and if there is something to be embarrassed about, somebody did something wrong.

Anonymous said...

So how much did Accenture get from building this new back-end infrastructure for E-Health systems over at DoHA? Just wandering.....