Sunday, May 12, 2013

It Seems The NEHRS / PCEHR Has Had a Bit Of A Make Over. Interesting Changes In A Couple Of Areas.

After the outage overnight I wandered along to see what changes had been made to the what the user sees.
Here is what the navigation menu down the side now looks like.

Health Record Overview

Clinical Documents
                Shared Health Summary
Medication Records
                Prescription and Dispense View
Personal Health Notes
Personal Health Summary
Advance Care Directive Custodian
Your Personal Details
Emergency Contact Details
Child Development
                Achievement Diary
                Personal Observations
                Child Health Check Schedule
                Child Growth Charts
                Information for Parents
                Medicare Records
Medicare/DVA Benefits Report
                Pharmaceutical Benefits Report
                Medicare Overview
Restricted Settings
                Medicare Information Preferences
                Notification Settings
                Manage Access to this Record
                Manage Document Access
                Restricted Settings
                Audit Log
----- End
The main changes since my last visit are the addition of two sections. First we have the Child Development Section - which is some reference material and some user added records on the nipper’s progress. Seems sensible but the access controls are a little odd with the Achievement Diary not clinically accessible but the Personal Observations - next down - being clinician accessible.
The other big change is the section labelled Medication Records. Despite having lots of records  under the Pharmaceutical Benefits Report none of this seems to have made it to the Medication Records - so it is very unclear what is going on with this. Maybe is it just another work in progress.
Overall the system now has so many tabs and sub-tabs that checking on all of what is there is quite a lengthy process.
What is now clear is that the whole thing was not delivered in July last year and that major additions are still going on. I wonder how much all this is costing? It seems the child Development Section is a late idea from DoHA to try and actually make the record useful. The un-intended consequences of all this might be quite interesting. I wonder is there a plan to have this record sharable like the Shared Health Summary?
All we can do it watch and wait and see what happens next!


Anonymous said...

The child development section is interesting but a bit odd. I have no children, but my record has this section, and invites me to record "my achievements" and my head circumference etc. (Is this my record or my child's record?).
The observations and personal achievements are surely not mine, but my parent's perspective.
Wouldn't it make more sense for this section to be available only in a child's record which is being managed by a parent/carer?

Anonymous said...

To the expert eye it looks very much as though they are designing the record structures on the fly.

How odd it is that Medication Records are not classified as Clinical Documents.

Terry Hannan said...

David, today's posting prompted me to at least try again to register for my PCEHR having failed to achieve this in 2012. Again I have failed to do so (somewhat pig headedly) as I kept comnong across more and more little glitches.
1. It took me 2-3 minutes to actually find the link to set my registration.
2. I managed to get through the 3 secret questions (down from the original 7 or 9).
3. When entering my address details the system does not permit formats for street numbers like 116-118. It will only take one number.
4. I felt a degree of reticence when I saw I would need not only my Medicare number but my BSB/Account bank details. This is an aspect of privacy/security I think I commented upon when making a post on the PCEHR recruiters in the Launceston Hospital.
5. After entering my Medicare number the system recognised who I was then on the next screen asked details of my last doctor's appointment, which doctor, etc. I would have thought that this was default data and information from the Medicare system!!!!! Is not this the details that is recorded under Medicare?
6. Therefore I still have no PCEHR. I have no idea of how the "clinical" stuff will be entered, accessed, updated,etc.
7. I would also like to again state publically that this project defies the logic, knowledge and experiences learnt from implementing complex e-Health systems. Terry

Anonymous said...

I imagine that the system asks about your last appointment as an identity verification step (something known to you and the system which is unlikely to be known by an attacker).

Not sure about bank account details. It would be a poor verification step (bank account numbers are widely known due to direct debits, payroll, etc). Perhaps they are trying to gather bank account details so they can encourage people to receive their benefits via EFT?

Anonymous said...

The system seeks a number of "points" of id during identity verification. These points are similar to, but not the same, as the 100 point identity check when opening a bank account.

It first seeks to establish who you are claiming to be by getting your Medicare number, name, DOB and address.

It then asks you to prove you actually are that person by asking a series of questions that people impersonating you are unlikely to know. Each question individually doesn't have to be impossible for someone else to know, but the combination of questions should be unlikely for a fraudster to know.

This second set of questions use information that Medicare already know about you. The information is never passed to PCEHR, these pages are hosted by Medicare, and they return to PCEHR only "verified" or "not verified".

Information that Medicare may hold about you includes:
- your BSB and bank account if you have your Medicare claims direct credited
- your claiming history
- details of other people on your Medicare card

There are some other lower volume questions.

Paul Fitzgerald said...

I must admit I have been holding out to register because it was so difficult the first time. Today I bit the bullet, and despite still being a bit painful (rejected all my Medicare information for registration, the first time and had to re-enter all fields)I got registered and now have a record. Unfortunately, it has absolutely no data in the record. I don't attend the GP or other services often, but I have had a couple of visits over the last few years, and had PBS scripts once or twice. No sign of any of them.

Bernard Robertson-Dunn said...

In Pulse+IT today:

Incorrect PBS data added to PCEHR
Kate McDonald
13 May 2013.

Incorrect information about two prescription drugs has been added to a Pulse+IT journalist's eHealth record, a situation which the Department of Human Services (DHS) is currently investigating.
End Quote.

I have asked before about the mechanisms for resolving incorrect data in the PCEHR.

Judging by this report there isn't one. Or if there is, they are not equipped to investigate too many at once.

And it also goes to the issue of users identifying themselves to the operators.

Dr David More MB PhD FACHI said...

Sadly this is hardly news. My record has some prescription entries that were for my wife. Clearly what is needed is a quality audit by actually checking a say 1000 patients and checking against the patient information held by doctor.

Then, at least we might know just how bad the problem is. Of course the records are still 2+ months out of date in terms of what is dispensed.


Dr David More MB PhD FACHI said...

"And it also goes to the issue of users identifying themselves to the operators."

This obviously does not cause problems for the white tea-shirt clad team at Launceston General!


Anonymous said...

Haven't they fixed "Restricted Settings" yet? This meaningless heading appears twice in the menu.

As a major heading it should simply be "Settings". They are not restricted, except in the sense that access to any part of the PCEHR is restricted.

As a subheading this should be "Access Restrictions". They are restrictions on access to the record.

Good Australian English is a vital part of effective communication.

(Aside: The robot verification is true ripoff.)

Anonymous said...

"As a subheading this should be "Access Restrictions". They are restrictions on access to the record."

Don't you mean "Accenture Restrictions"? Wouldn't that be nice ....

Anonymous said...

"The child development section is interesting but a bit odd."
I agree. Under child development it encourages you to record your personal achievements, including your head circumference. (Built especially for those whose who are getting a big head?)
This is wrong. It should be under a heading of 'your parents/guardians' record of your personal achievement when you were young'. People will get confused. They may start recording their child's progress under their own record, not their child's record.
Also I am confused: what is the difference between the medications prescription view and the medicare PBS view. Are they based on the same data or different data? Same deal with the immunisations. They can appear under childhood development, and also under the ACIR list in the medicare view.
Very confusing, and not well thought through at all.
Does anyone else find this confusing?

Anonymous said...

It would be better if the 'Child Development' section was called 'your childhood health details', and had an explanation to say that this information was supplied by your guardian in your record?
Is anyone doing useability testing on this system before it is released?

David Glance said...

I would be interested to know from anyone what the algorithm seems to be about whether past MBS and PBS data makes it into the record - like others commenting, I signed up today and there was nothing there - despite me having just checked my MBS data on Medicare Online and verifying that I do indeed have a reasonably extensive claim history.

The Ux on the site is appalling - try pressing the back arrow on the browser and then hit refresh - I got a Server 500 error - plus a blank screen saying that Concerto had started?

Orion must be laughing all the way to the bank on this one.

Anonymous said...

The difference between the Prescription and Dispense View and the Pharmaceutical Benefits Report is that the former is actual dispensing information from eTP enabled pharmacies (PBS and non-PBS items) and the latter is just what information Medicare holds for items dispensed under the PBS.

Anonymous said...

Could anyone provide me guidance as to where the specifications are for this My Child Health Record? There is some interesting omissions noticed since it was launched and I would like to cast these against the specifications. Thus far my searching is making me wonder if this was built by giving a programmer a blue book to develop off with little or no understanding of what the system will need to do going forward or what might be needed in a health setting.