Tuesday, June 11, 2013

Senate Estimates Transcript - 5 June 2013 - E-Health Section - 7:36pm - 8:28pm

Here is the transcript - I have put some italics in the more interesting bits.
Key players are -
Abetz, Carol Brown, Crossin, Di Natale, Fawcett,  Fierravanti -Wells, Furner, Heffernan, Lines, McKenzie, Moore, Pratt, Rhiannon, Siewert, Smith, Wright.
The Chair is Senator Moore.
Professor Jane Halton, Secretary
Ms Rosemary  Huxtable, Deputy Secretary
Ms Kerry Flanagan, Deputy Secretary
Professor Chris Baggoley, Chief Medical Officer
Mr David Learmonth, Deputy Secretary
Mr Chris Reid, General Counsel
Dr Rosemary Bryant, Chief Nurse and Midwifery Officer
Mr David Butt, Deputy Secretary
Mr Paul Madden, Chief Information and Knowledge Officer
Mr Peter Fleming - CEO.
CHAIR: The committee will reconvene. We are going into outcome 10, which is the health system capacity and quality.
Senator FIERRAVANTI-WELLS: I have a combination of questions, so I will just ask some of the department and some of the authority. Mr Fleming, usually you have Senator Boyce. Senator Boyce is not here today so I am just going to try my best. It is not an area with which I am as familiar. Can you confirm that the funding for the PCEHR, as announced in the 2012-13 budget, will expire on 30 June 2014.
Mr Fleming : Yes, that is correct.
Senator FIERRAVANTI-WELLS: I do not normally ask a lot of questions in this area, so I will just ask the question, and whoever is the appropriate person can answer. Is there any funding for the PCEHR that extends beyond this point? Can you identify this funding for us?
Ms Huxtable : The PCEHR has been funded in two tranches. The first tranche was the 2010 to 2012 funding which I think, from memory, was around $466 million. Hopefully, I got that right. Then there was a second funding tranche announced in the 2012 budget which was an additional $166 million, I think, or thereabouts.
Senator FIERRAVANTI-WELLS: And that expires?
Ms Huxtable : That was for a further two-year period. We are, at this point in time, working on a business case in respect of future e-health funding with the states and territories. That business case is being managed under the auspices of the Australian Health Ministers' Advisory Council to enable government to consider funding arrangements from July 2014 both for the PCEHR and for the National E-Health Transition Authority.
Senator FIERRAVANTI-WELLS: What are those future funding requirements for the continued development and rollout after 30 June 2014?
Ms Huxtable : The business case, obviously, is going to that issue.
Senator FIERRAVANTI-WELLS: You are developing a business case.
Ms Huxtable : There would be ongoing costs associated with the operation of the PCEHR system. There has been work that has been undertaken in NEHTA, more around the development of specifications and standards. The business case itself will need to work out the detailed elements that will comprise future funding. But, certainly, a core element would be the operation of the PCEHR system.
Senator FIERRAVANTI-WELLS: So, the National Partnership Agreement on E-Health expired on 30 June 2012.
Ms Huxtable : There has been a national partnership agreement which underpins the funding that goes to NEHTA. Basically, in e-health, there are two funding streams: there is the Commonwealth element, which has been around the PCEHR, predominately; and then there has been the cost shared element, which has predominately funded the NEHTA work program. That is underpinned by an agreement between the states and territories and the Commonwealth. The national partnership did expire on the date set, however funding has continued to flow to NEHTA from the Commonwealth, states and territories. There has been in-principle agreement to a memorandum of understanding, which has been signed in most states and territories, but is still going through the final processes in some states and territories.
Senator FIERRAVANTI-WELLS: Can you confirm that the incoming brief provided to Minister Plibersek—and you will probably have to have a look at it—stated that the development of an e-health inter-governmental agreement needed urgent attention, due to the pending expiry of the previous commitment?
Ms Huxtable : That is probably not upper-most in my mind, but certainly the engagement with the states and territories around continued funding for NEHTA was a matter for urgent consideration. There was a lot of work done with the states and territories in developing a memorandum of understanding. That work was done some time ago.
Senator FIERRAVANTI-WELLS: Was the MOU, which was to replace the national partnership agreement, signed at the Standing Council on Health on 9 November 2012?
Ms Huxtable : No, it was agreed in principle. Since that time we have been going through the process of states and territories signing the MOU, because they then have to go through their own government processes to put the final ink on the page. The majority of states and territories have signed, but some are still going through their processes.
Senator FIERRAVANTI-WELLS: Could you provide to me a list of the states and territories which have signed, the states which have not, the dates—
Ms Huxtable : It is only Victoria that has not signed at this point.
Senator FIERRAVANTI-WELLS: If you could take on notice the dates. So Victoria is the only one outstanding?
Ms Huxtable : I will just check. Maybe I should take that on notice
Senator FIERRAVANTI-WELLS: Would you, please. Tell me who has got to sign, when they signed, who is still outstanding, and the reasons.
Ms Huxtable : I can tell you the reason. My understanding, is that it has not gone through their internal process. It is not that there are any issues that are under negotiation, or extant; it is just getting through the process. In some states they need to go through their cabinet process, and it just takes time.
Senator FIERRAVANTI-WELLS: It was known that it would expire on 30 June 2012. So, there has been this period of transition. Should not things have been put into place to go on from 30 June at 1 July 2012?
Ms Huxtable : There have been best efforts to get the agreements signed. The important thing is that the agreement-in-principle occurred at that Standing Council on Health meeting. My understanding is that the absence of that agreement has not meant that money has not flowed to NEHTA. The states have continued to make their payments to NEHTA. We have continued to make our payments to NEHTA. All parties are operating as if the agreement had been signed. We are just still going through the final processes.
Senator FIERRAVANTI-WELLS: Given that NEHTA is owned by COAG, can NEHTA continue operations legally, without the MOU signed by all parties?
Prof. Halton : Yes, absolutely.
Senator FIERRAVANTI-WELLS: Can you legally spend money without the MOU binding on all parties?
Prof. Halton : Yes.
Senator FIERRAVANTI-WELLS: Can you legally enter into contracts without the MOU binding on all parties?
Prof. Halton : Yes.
Senator FIERRAVANTI-WELLS: What are the implications of NEHTA operating without the MOU signed by all parties? Are there implications?
Prof. Halton : No. I suppose the MOU is an expression of intent, but the truth of the matter is we are doing a huge amount of work across all jurisdictions, including with the chief information officers in all the jurisdictions. NEHTA is acting as a contractor to us in the rollout of the PCEHR. Remember that NEHTA was set up by COAG in order to drive consistency, commonality and adoption in relation to a one rail gauge across the country on everything in relation to e-health. Remember that e-health is broader than the PCEHR. It is everything from standards through to the approach we have in terms of moving information around the system. Yes, it can operate.
Senator FIERRAVANTI-WELLS: How many consumers have registered for a PCEHR?
Prof. Halton : What do you reckon?
Senator FIERRAVANTI-WELLS: I do not know. I have not.
Prof. Halton : We think, as of this moment, it is 250,000 people. We can confirm the numbers as of yesterday. At the rate at which we are registering people, we are very confident that, as of now, it is 250,000.
Senator FIERRAVANTI-WELLS: How many of those users have had a shared health summary uploaded?
Ms Huxtable : There have been 1,928 shared health summaries uploaded, as of yesterday.
Senator FIERRAVANTI-WELLS: How many practitioners have uploaded shared health summaries?
Ms Huxtable : I have got the number of shared health summaries loaded, but I have not got the number of practitioners. We certainly have data on the number of practitioners who are PCEHR ready. There are 3,636 health care organisations that are read—sorry, not GPs. We had this discussion before: it is the organisations that registered and not the general practitioners.
Senator FIERRAVANTI-WELLS: Is it true that approximately 20 per cent of the shared health summaries have come from one practitioner?
Ms Huxtable : I do not know the answer to that.
Senator FIERRAVANTI-WELLS: Can you just take that on notice?
Ms Huxtable : I will take that on notice. I do not have it broken down like that.
Senator FIERRAVANTI-WELLS: How many discharge summaries have been uploaded?
Ms Huxtable : There have been 464.
Senator FIERRAVANTI-WELLS: How many individual practitioners have registered from the PCEHR?
Ms Huxtable : This is the issue about organisations versus practitioners. The organisations are at 3,636. As to how—
Prof. Halton : But you could probably multiply that by a multiple, if you think about it.
Ms Huxtable : You could do that if you said that the average size of a practice is Y. But the issue that we talked about last time is that where an organisation is a large organisation, like a hospital, then it can encompass many, many health-care providers.
Senator FIERRAVANTI-WELLS: Yes, but it is just one registration.
Ms Huxtable : It is one registration of medical providers.
Senator FIERRAVANTI-WELLS: There was 3,636. What was the number for the registered organisations? Let me write that down as well.
Ms Huxtable : That was the 3,636.
Senator FIERRAVANTI-WELLS: The practitioner number was less?
Ms Huxtable : No, we do not have a practitioner number.
Prof. Halton : It would be a multiple of that.
Senator FIERRAVANTI-WELLS: It would be more. Okay. Can you take that on notice, Ms Huxtable?
Ms Huxtable : I do not know.
Senator FIERRAVANTI-WELLS: You just multiple it by three; is that what you say? Mr Fleming wants to say something.
Mr Fleming : It is actually 4,319 practitioners that have actually registered for the PCEHR.
Senator FIERRAVANTI-WELLS: Great. On average, how many patient records are being accessed every day?
Prof. Halton : We will be able to get you that number.
Senator FIERRAVANTI-WELLS: I will hand up this copy of an article by Sean Parnell.
Prof. Halton : Oh, yes, I remember this one. This would have been in The Australian, would it, Senator?
Senator FIERRAVANTI-WELLS: Yes. That reported that, in March, only 73,648 consumers had registered for a PCEHR, whereas we are now talking about 250,000. First of all, is what he is asserting there correct, that in March there were—
Prof. Halton : We would have to go back and have a look.
Senator FIERRAVANTI-WELLS: Okay. Assuming that is the case and considering that it took nine months to gain 73,648, how have registrations increased so quickly between March and June?
Ms Huxtable : There are a few elements to that. One is that the functionality around PCEHR continues to grow. We have talked before about the strategy deliberately being a gradual rollout, starting with consumer registration and then moving to providers. It was not until around that time that we had GP software enabled to upload to the system. So that has taken time. We have been doing a number of things to develop people's interest in and understanding of the eHealth record. There has been a change in adoption activity that has been going on through some Medicare Local eHealth sites. We have had a range of eHealth sites that have been operational, really, for the duration of the development of the program. More recently, we have worked to enable people to undertake an assisted registration process—so, where they are in a health setting, actually being told about the PCEHR and being asked about their interest in registering for a PCEHR. I think the combination of all those factors means that we have begun to see a good growth now in registrations. In fact, every day that is now growing, to the extent that yesterday we had 10,000 registrations, which is the highest number we have had on one day.
Senator FIERRAVANTI-WELLS: How do you reconcile such a massive shortfall from the target of half a million listed in the 2012-13 budget papers and reconfirmed in the 2013-14 budget papers?
Ms Huxtable : I think that we are still in sight of that 500,000 figure. If we go back to 2012-13, there was certainly an expectation that we would, through the eHealth sites, have people at a stage of readiness and awareness at that point. The reality is that the development, the underpinning work that we needed to do in a technical sense, was complex and took time. So the eHealth sites were not as far advanced as we expected them to be for that 1 July start. The reality is we did not have the legislation to enable registrations, in any event, not until 1 July. As you would recall, that just got through, before its death knell. If you project through that 10,000 a day figure, we have very strong growth at this point. While 500,000 may be a stretch in that regard, I think we are certainly heading in the right direction.
In addition, there are a range of other things, and I talked before about some of that increased functionality. Recently, we put in place a national prescribe-and-dispense repository, which enables the reconciliation of medicines that are prescribed by the doctor and then dispensed to the patient. It is the first time there is a view of that, which of great benefit to practitioners, and they are quite excited about that. We also stood up the child eHealth record element to enable parents to in-put information about the development of their children—the child eBlue Book, in shorthand. So there is a range of activity that means that the functionality is growing, and so more people are developing an interest. It becomes iterative process, effectively.
Senator FIERRAVANTI-WELLS: While we are on that, what about in the Ageing space?
Ms Huxtable : We have been working with the software vendors that have been involved in aged care. Mr Madden can talk more about some of that work; Peter probably could as well. There are a number of software vendors who are in the aged-care space who NEHTA have been working with very closely to enable them to have the capacity not only to assist the registration of their residents—if we are talking about residential aged care—but also to interact with the PCEHR to enable information to be uploaded. We are very conscious that for older Australians there are very significant benefits. The main one is not having to retell your medical history every time you turn up somewhere.
Senator FIERRAVANTI-WELLS: Tell me about it. We do it for my dad all the time.
Ms Huxtable : Exactly—and remember what pills you are on and all that sort of stuff. So many of the features of the PCEHR, I think, are very complementary to improving health outcomes for older Australians.
Senator FIERRAVANTI-WELLS: Just as an aside, this is probably an elementary question, but is it open for children of older parents to register their parents and go through that process for them?
Ms Huxtable : Yes. There are a number of authorisation levels within the PCEHR. If you, for example, are the guardian for another person then you can basically—
Senator FIERRAVANTI-WELLS: Or have a power of attorney.
Ms Huxtable : step into their shoes and effectively be them and be seen as them by the record. Alternatively they may wish to give you certain access so that you can access the record on their behalf. So there are a number of levels of authorisation. We worked a lot with the sector. This was a big issue for the mental health sector in particular in how that works effectively.
Prof. Halton : And the disability sector.
Ms Huxtable : And the disability sector—that is right.
Senator FIERRAVANTI-WELLS: Yes. I might just ask Mr Madden: in the ageing space, obviously you have 180,000 or so in residential aged care and you have one million people that access care under the aged-care system, so that is a sizable chunk. Is that the intention, Mr Madden?
Ms Huxtable : That is right. It is one of our targets.
Mr Madden : In the aged-care space we have got work going with four of the aged-care software vendors, who have got their systems able to connect to the PCEHR. They will give us access to 75 per cent of aged-care residents with the software they are using. I will just give you the statistics. This is probably about a month old, and in a month we have certainly had a lot more growth. But, of aged-care people registered, 4.6 per cent were above 80 years old, 10.8 per cent between 70 and 79, and 15.7 per cent between 60 and 69 years old. So the 60 to 69 would be the biggest cohort of the registrants, until we get back to there. But I think feedback, from the clinicians and others, is that they are certainly promoting registration and take-up for the chronic, complex and aged-care people in their practices.
Senator FIERRAVANTI-WELLS: Can I just hand up this article, please. It is an article by Sue Dunlevy on 14 April. Ms Halton is smiling, so she knows the article already. It is entitled 'E-health system a costly failure.'
Prof. Halton : Yes, Senator.
Senator FIERRAVANTI-WELLS: And it says that a department of health spokeswoman—I do not know who that was—said that about 12 trained staff had been deployed in hospitals, community clinics and aged-care homes in Tasmania and the ACT to sign up patients. That is the gist of it. Then there is a comment there; I will come to that in a moment. This is obviously in the ACT and Tasmania. Were these staff from the Department of Health and Ageing or staff for NEHTA? Is it true?
Ms Huxtable : No, neither. I talked before about some of the registration activity that has been underway as part of the change and adoption strategy. Part of that activity has been around enabling people to be assisted to register, and the way that process works is obviously that there is a certain ID that is required to be shown—several forms of ID—people are spoken to about the benefits of the e-health record and their interest is ascertained, and then they can be assisted to register for an e-health record and to register, say, their young children as well if they are interested. That basically has been conducted through an existing contract which we have had with the national change and adoption partner, who has been McKinsey. McKinsey has engaged Aspen Medical, which has provided staff and deployed staff into a range of aged-care settings and places where you would expect that people are sort of experiencing the health system and would have an interest in these matters. At the time this article was written that was in its very early stages, but since then that has grown. Currently—I hope it is currently—Aspen is deployed in around 50 hospitals and 200 additional settings, including Aboriginal medical services, aged-care facilities, immunisation clinics, GP settings, Medicare offices et cetera.
Senator FIERRAVANTI-WELLS: So Aspen is on a contract?
Ms Huxtable : On a contract that McKinsey has contracted. McKinsey, who is the change and adoption partner, has contracted Aspen. Can I just be clear that assisted registration has always been part of the plan around change and adoption. It is not something that is new. It could not occur early in the piece because the technical elements of the infrastructure were not available at that time, but one of the releases was to enable the assisted registration function, and so at that time it was possible to support assisted registration. We expect that the future of assisted registration will very much be in the practitioner setting, in a GP setting, where someone presents, is known to the practice and at that time can be registered for a PCEHR. Similarly in a hospital setting, at the point of admission or the point of discharge or at an outpatient clinic, they can be registered with the appropriate capacity and the software for that to be a very easy process to get people registered.
Senator FIERRAVANTI-WELLS: Is that McKinsey health group?
Ms Huxtable : McKinsey the consulting firm.
Senator FIERRAVANTI-WELLS: So they have been contracted to do a set of specific tasks that went to tender? They won the tender to do it?
Ms Huxtable : Quite a while ago.
Senator FIERRAVANTI-WELLS: That was a long time ago?
Ms Huxtable : Early in the piece.
Senator FIERRAVANTI-WELLS: And that included a component of assisted registration when things got up and running?
Ms Huxtable : We have certainly worked with them around change and adoption strategies. As the assisted registration capability became possible, then we contracted them to enable that to be—
Senator FIERRAVANTI-WELLS: So this has been an ongoing contractual arrangement with them. You have obviously started—
Ms Huxtable : Which we have augmented from time to time.
Senator FIERRAVANTI-WELLS: It is augmented form time to time as new things come on board, and now they have contracted Aspen to undertake a specific part of that. As part of that contractual arrangement, did they have targets that they had to meet in terms of—
Ms Huxtable : I am pretty sure that the way in which that contract works is that there is a target or an expectation around the number of registrations that would be achieved, and the amount of funding that is available reflects what you would expect from an individual person who is part of that Aspen Medical workforce, what you would expect about how many people they would register over a period of time. So that is how you basically build up the funding, from the bottom up.
Senator FIERRAVANTI-WELLS: When were Aspen specifically brought on board to do the assisted registration?
Ms Huxtable : March? I might have to take the exact date on notice.
Senator FIERRAVANTI-WELLS: This year, was it?
Ms Huxtable : It was quite recently, yes.
Senator FIERRAVANTI-WELLS: That contract, or that subcontract, to Aspen is for how long?
Ms Huxtable : Through to 30 June.
Senator FIERRAVANTI-WELLS: What is their target by 30 June?
Ms Huxtable : I think their expectation is around 150,000 registrations by 30 June. I think we are probably on track to exceed that, to be honest. That was 150,000 in addition to the other registrations that we get through all those other processes that are on foot.
Senator FIERRAVANTI-WELLS: Can you confirm that incentives such as free zoo tickets and mugs have been offered to those who sign up for a PCEHR?
Ms Huxtable : I am certainly aware that there are promotional materials. I think Calvary has some drink bottles and mugs and stuff.
Prof. Halton : I have seen drink bottles.
Ms Huxtable : But it is not an incentive; it is really promotional material so that there is some visibility of e-health. My son has one of those drink bottles. He takes it to basketball.
Senator FIERRAVANTI-WELLS: So you exclude the zoo tickets?
Ms Huxtable : Sorry; I am not aware of zoo tickets but—
Senator FIERRAVANTI-WELLS: You are not aware? What about mugs?
Ms Huxtable : I have got a mug, that is true.
Prof. Halton : I have got a mug, but it is not out of this particular contract. So I have seen a mug. In fact there might be one on my desk. That was for the e-health site.
Senator FIERRAVANTI-WELLS: But you have not been offered a free zoo ticket, Ms Halton?
Prof. Halton : Do not tempt me to make comments about zoos, Senator!
Ms Huxtable : Or zoo parties!
Prof. Halton : Or zoo anything else. But, no, I am unaware of any extracurricular access to zoos.
Senator FIERRAVANTI-WELLS: All right. Are there any other incentives offered to people to sign up?
Prof. Halton : No, not that we are aware of.
Ms Huxtable : Can I just reinforce again that I do not believe that these things are incentives to sign up. Certainly the material that I have seen is promotional material to raise awareness of the eHealth record, and what people chose to do is a matter for them.
Senator FIERRAVANTI-WELLS: I just take you to the second part of that, which was about the Launceston hospital and Professor Terry Hannan, the second column, and his comments there. Did Aspen staff visit Tasmania's Launceston hospital?
Ms Huxtable : Yes. I believe that this relates to the first week of deployment. There was a trial period where they were operating in Tassie to see how things went before it was more broadly rolled out.
Senator FIERRAVANTI-WELLS: Have you responded to Professor Hannan's comments that this whole process seems like a political stunt to enhance the PCEHR registration numbers for a project that has been costly and doomed to failure, implementation wise and politically?
CHAIR: That seems to be a leading question, Senator!
Senator FIERRAVANTI-WELLS: It is in the article.
CHAIR: I know—I am just joking.
Ms Huxtable : As I said before, assisted registration was always part of the planned approach. It was always an element of registration. I think it is a quite legitimate element to raise awareness of the benefits of an eHealth record to a population who would potentially benefit the most. In terms of the process that he set out here, it is obviously important to verify identities as part of that process, where people have had the benefits of an eHealth record explained to them and have chosen to register for an eHealth record. I think it is a very legitimate part of the process.
Prof. Halton : Could I make a comment about that? I do not know this individual. There is what I consider to be a relatively cheap shot in the article which goes to the point about Africa. I say this given the things that I do in global health, which you are aware of. There are countries that have no records—no written records, no anything. They have, a bit like a number of other countries, jumped across copper wire—they never even had it—and they have gone to the use of mobile devices for health purposes. That is a terrific thing. But to think that in this country, where there is a history of print records and we are trying to migrate an entire series of professions, a series of services and ways of working. We have talked in the past about banking. This is infinitely more complicated than banking and infinitely more complicated in terms of defining even what is your right leg, in terms of nomenclature, let alone medicines or everything else. I think it trivialises, in a very sad way, what in fact is the challenge of, in an orderly fashion, getting our health system, with one rail gauge, to what is really cutting-edge in terms of the globe. Having just been at the WHO, a number of countries came up to me, having watched what we are doing, and said, 'This is genuinely world leading.' We are not small like Norway or another country where you have a unitary system. We have a complex, public, private, vibrant healthcare system which only spends the OECD average and gets more than that in terms of outcomes. To migrate where we are at on the money we are spending, people genuinely think this is fantastic. So I thought that was a particularly cheap shot. I do not dismiss in any way, shape or form the challenge of delivering services in those communities. It is a different challenge to ours.
Senator FIERRAVANTI-WELLS: I might just move on. Is the Launceston hospital fully PCEHR compliant?
Ms Huxtable : There is a rapid integration process being managed through NEHTA which is supporting states and territories to be able to provide discharge summaries into the PCEHR. So the rollout of that is graduated. In the ACT and at St Vincent's Hospital in Sydney, they are able to upload discharge summaries and, in the next little while, which is the rest of this calendar year, most other states and territories will be able to do that across either the whole state or a number of hospitals. So the answer to your question is that Launceston Hospital is not fully PCEHR compliant, but there is a plan to support states and territories in that regard.
Mr Fleming : All Tasmanian hospitals are scheduled to be live on the PCEHR system—in terms of being able to send discharges and using HIs—by the end of this month. They are on track.
Senator FIERRAVANTI-WELLS: By the end of this month?
Mr Fleming : Absolutely.
Senator FIERRAVANTI-WELLS: So, to this point, any people that were signed up were not able to fully use the system, not until, Mr Fleming has said, after—
Ms Huxtable : That depends on their health experience. Obviously, discharge summaries are only relevant to people who are being discharged from hospital—
Senator FIERRAVANTI-WELLS: But for other things?
Ms Huxtable : but highly relevant to people who are visiting their GP, who are visiting their specialist, and for whom a shared health summary is relevant, for whom an event summary is relevant and whose medication history is relevant. So there are many elements of the PCEHR that are not about the acute care interface, but we acknowledge that enabling information to flow between the acute care sector and the primary care sector is a key benefit, and we are working very hard to achieve that benefit in the system very quickly.
Senator FIERRAVANTI-WELLS: So, if I understand correctly, in this instance, where you have a hospital like Launceston where Aspen Medical have been active in signing up, they could sign up to everything except discharge summaries.
Ms Huxtable : Well, they sign up to the PCEHR—
Ms Huxtable : and they then have an eHealth record. Then that eHealth record can be used to support their health and sharing of information, which in future may include hospital events but will include plenty of community based events as well.
Mr Fleming : May I just—
Senator FIERRAVANTI-WELLS: The article also refers to ACT hospitals. Have Aspen been active at the two Canberra hospitals as well?
Ms Huxtable : Calvary hospital has been an eHealth site, so it has been a very active participant in eHealth in any event. I am sorry; I do not have the level of detail around Canberra Hospital, but I can take that on notice.
Senator FIERRAVANTI-WELLS: So it is at Calvary, but you do not know if the other hospital is fully PCEHR compliant?
Ms Huxtable : For the ACT, we do know.
Ms Granger : ACT hospitals are loading discharge summaries now.
Ms Granger : The ACT public hospitals, yes.
CHAIR: Mr Fleming, did you want to say something before? I thought you were about to say something earlier.
Mr Fleming : Thank you. I was just going to point out the reason why Aspen are in the outpatient areas of the hospitals. As you are aware, NEHTA is owned by COAG, and in discussion with the director-generals or secretaries of health from the states and territories—and, indeed, from many of the CEOs from the areas—the request was that we be in the outpatient area because they are the areas where we particularly see people with chronic disease. So getting people signed on in the outpatient area was very much about that long-term journey.
Senator FIERRAVANTI-WELLS: Okay. Can I just confirm that Aspen did sign up users at the Launceston hospital, as referred to, but those patients who were signed up would not be able to receive a discharge summary from that hospital?
Ms Huxtable : Until the end of this month.
Senator FIERRAVANTI-WELLS: The end of this month—okay. Thank you. I have dealt with the questions on Canberra Hospital. Now, there were a couple of articles by a Kate McDonald. Does that—
Ms Huxtable : Yes.
Senator FIERRAVANTI-WELLS: Okay. Do you have both those articles? I have copies of them if you want them.
Ms Huxtable : In my head!
Senator FIERRAVANTI-WELLS: Not yet? I am happy to give them to you. Here you go, and there is another one. Just hang on. No one else does this, Senator Moore!
CHAIR: I know. They will be, though!
Senator FIERRAVANTI-WELLS: Okay. I refer to those two articles published on Pulse+IT, regarding a Pulse+IT journalist that had medications incorrectly added to the PCEHR. So you are aware of both articles?
Ms Granger : Yes.
Senator FIERRAVANTI-WELLS: Can you explain to me how this was allowed to happen.
Ms Granger : I should first say that we cannot discuss details of an individual's records, for privacy reasons. What I can say, however, is that that was not an issue with the PCEHR but with a particular health care provider.
Prof. Halton : The article says:
The pharmacist has made an error.
That can happen in any system.
Senator FIERRAVANTI-WELLS: One of the benefits of PCEHR marketed by the government was that it would reduce transcription errors with medication. Doesn't this show that there is still a weakness in the system?
Ms Granger : It is an opinion, I guess, by in fact I think it shows the opposite, because that error may have never been visible to that patient in any other way, yet would have been in the healthcare providers system and perhaps led to a medication error. So in fact it being visible to the patient and their seeing their record meant that that could be picked up.
Prof. Halton : And let's be clear, when we talk about transcription errors we are actually talking about both doctors' appalling handwriting, and that would take it from doctors' appalling handwriting to doctors' typing. But at least when you are typing into a record you have the ability to review that the medication is exactly as you thought it was. Then there is a question about how you get from one record into another. Where we are going is a seamless connection. So in fact the medication that is actually prescribed is connected to the individual and then is connected to their record. As the article says, this was pharmacist's error. In the world we are going to this will not happen. In fact, as Ms Granger said, in this particular case you probably would not have even known about this, whereas in this world you do and where we are going is one step better.
Senator FIERRAVANTI-WELLS: Are you confident these problems won't happen again.
Prof. Halton : In the medium term, once we get all these things connected—absolutely.
Mr Madden : Part of the functionality that was implemented in May was the National Prescribed Dispense Repository, which Ms Huxtable mentioned. When we have GP systems electronically providing the prescriptions that are connected to the health identifier for the individual all the way through to the pharmacy, and the pharmacy dispenses that, it will take away the possibility that we have pharmacies dispensing from something other than the electronic record. But I guess from end to end our direction is to have the HI service and the identity of the patient for every transaction that is happening here, without being taken out of the system again.
Senator FIERRAVANTI-WELLS: Are you satisfied with the process and time frame in which the situation was handled by the PCEHR help desk and the eHealth team? In terms of an issue that had certain ramifications, Ms Granger, are you satisfied that in the end it was handled well?
Ms Granger : I am satisfied in the end it was handled well. Also, there is clear advice with the patient controls that if someone has something incorrect on their record they can remove that when they see it, while it is being resolved.
Senator FIERRAVANTI-WELLS: Considering the issue was first raised in February and not resolved until late May, do you consider that this was an unreasonable amount of time for the error—
Ms Huxtable : I believe the issue was raised and resolved in a very short period of time.
Ms Granger : Yes, so am I. I am not sure what the February reference is.
Senator FIERRAVANTI-WELLS: If that is incorrect can you, Ms Granger, correct that for me.
Ms Granger : Bearing in mind that I cannot give you details about an individual's records, I can say that it was resolved quite quickly, but we cannot give you—
Senator FIERRAVANTI-WELLS: Considering the case is so openly talked about—
Prof. Halton : Nonetheless we are—
Senator FIERRAVANTI-WELLS: I appreciate that. The article quotes Kate: '… despite providing my full name, date of birth, address, Individual Healthcare Identifier (IHI), Medicare card number and expiry date, and the dates of my 2010 visits to the GP and that GP's name,' it still was not enough to verify the identification with the PCEHR help desk. This seems like an excessive amount of information. Is that reasonable?
Ms Granger : Again, I cannot comment on the details of her case. Having said that, we need to be very careful that the right level of proof of identity has gone through, because we could otherwise do the wrong thing to a patient's record.
Senator FIERRAVANTI-WELLS: Those are all the questions I have. Senator Boyce gave me some questions to ask, but given the time I will put those on notice, insofar as they have not been answered here.
All I can say is that this is worth a read to see just what is going on. I am surprised no one asked just how much Aspen Medical was being paid for being at all these sites. Even 1 person at each site for a few days (low as I believe they work in pairs) would be 250+ man weeks and so be a good few dollars in salaries and mugs.
The chance of seeing the Business Case for the July 2014 continuation of funding for all this I would assume is pretty low - as I suspect is the chance of it happening.


Anonymous said...

…”journalist that had (PBS) medications incorrectly added to the PCEHR…
Ms Granger :”…. What I can say, however, is that that was not an issue with the PCEHR but with a particular health care provider.
Prof. Halton : The article says:
The pharmacist has made an error.
That can happen in any system.”

I think it is very unfair to blame the pharmacist. Yes wrong data can be entered into any system, but a good system validates or audits incoming data to ensure the level of quality for the purpose for which it is being collected.

In my own PCEHR record, I have PBS and MBS items that were for my daughter listed under my name (probably mis-keyed in when I have claimed at the shop front); Dr More has stated that he has PBS items for his wife listed under his name, and Kate McDonald has PBS items from some other unknown person (and the other unknown person has no items where there should be some). It is likely that there will be many more similar ‘errors’ with PBS and MBS data in the PCEHR of the hundreds of thousands of people who have now registered for PCEHRS.

Perhaps a more mature and responsible answer would be:

“This is not the fault of the pharmacist, as the source data is actually PBS claiming data, and we (naively) had hoped it would be useful in the PCEHR. However we now realise that our validation rules for PBS claim data were sufficient for our purposes of claiming, but are not stringent enough for the purpose of including this data against individual consumer records in the PCEHR. Over time, once we have other ehealth initiatives in place (like ETP, health identifiers) we expect the quality of this data would improve to a level where it could be included. In the meantime, we think that it is too risky to include this data in the PCEHR, and so are discontinuing the PBS ad MBS data as a source. And we are now looking at ways of supporting pharmacists and other providers to improve data quality so that it is fit for purpose.”

Terry Hannan said...

In response to Ms Halton’s comments regarding me in the Senate Estimates Committee I would like to make the following comments.

· She must have a short memory or does not read her communications as I have communicated with her and I believe Ms Huxtable in the past (I will put the latter on notice!)

·  Ms Halton does not want to acknowledge that it is the experience and knowledge from DEVELOPED economies and their HIT that we took to Africa (now worldwide) and made it work.

·  In reference to the above statement 30+ years of implementation of eHealth with significant successes allows people like me to understand how damn difficult eHealth is.

·  It is this knowledge and experience that allows people like me to hopefully make INFORMED commentaries on eHealth projects such as the PCEHR and whether they are likely to succeed or not. I have no financial gains to make in this domain. I belong to those who wish to see patient care improved and the current models and the planned PCEHR model for care do not work. In fact the PCEHR implementation defies the logic of successful implementations.

·    Last week I was asked by a Professor of Health Informatics at Johns Hopkins University about eHealth in resource poor vs. developed economies.

· This was my response. His reply Perfect!

·    We know what works (alert/reminders/summarisation) in SOME clinical environments in developed economies

·    We know what does NOT work in some clinical environments (all alert/reminders/etc.) do not work all the time

·    IF these technologies are INSERTED into a resource poor environment WILL they work? These are social-technical issues and are INTEGRATED with the information management issues. We did not know if our intrusions would work or not. It was HOW we did it. This is not too dissimilar to that of developed economies except for the $ that assist sustainability and OWNERSHIP of the systems.

·   OWNERSHIP (a dominant feature of MMRS-AMPATH-OpenMRS) is critical to success.

Terry Hannan

Anonymous said...

I sincerely hope Pulse+IT reproduce the 6/11/2013 10:13:00 PM comment. In the context of reporting on some of the ludicrous rubbish mouthed by the Department's bureaucrats at the Senate Estimates. Ms Halton in particular has remained true to form over in her responses to ehealth questioning at Senate Estimates over many many years.

One can expect nothing will change after September. She will continue as Departmental Secretary even if there is a change of Government as she served Mr Abbot when he was Health Minister in exactly the same way as she is doing today.

Simon James said...

@ 6/12/2013 09:23:00 AM
Hi - it's a good thought but we can't really do much with anonymous anecdote. Always happy to hear from folks, particularly the small subset willing and able to speak on the record.

Anonymous said...

6/11/2013 10:13:00 PM wrote: ..... However we [DoHA] now realise that our validation rules for PBS claim data were sufficient for our purposes of claiming, but are not stringent enough for the purpose of including this data against individual consumer records in the PCEHR.

‘Not stringent enough equates to dangerous in the extreme; life-threatening.”.

This is a message which industry experts have been giving DoHA for some years. It is a message DoHA did not and does not want to hear.

The truth is too painful. The recent Senate Estimates shows ever so clearly "we will do what we do because we are doing it and have been doing it for a long time". "We will not change because we can't change and survive at the same time".

All nicely encapsulated by the Secretary's demeanor and her sharp retort - Do not tempt me to make comments about zoos, Senator.

Anonymous said...

Yes, let's tempt dear Ms Halton and see what insightful comments she may share "about zoos", or most likely she will need the temptation delivered "on notice" before she is capable of making any intelligible comments, let alone insightful ones!

Anonymous said...

I need clarification of what she means by making comments about zoo's? Is this little person accusing elected representatives of the Australian people of being simple beasts gaged up for the amusement and torment of the people and implying that she is some sort of zoo keeper who will dictate when, where and with what they will be feed?
That would seem rather more than offensive, people are sacked for less

Anonymous said...

That would seem rather more than offensive, people are sacked for less ..... hummphh ... she is unsackable