Tuesday, November 26, 2013

I Really Wonder How These People So Misunderstand What Really Matters In E-Health.

This is the transcript of what went on last Wednesday evening at Senate Estimates. Fun bits bolded.
Here is the link:
The usual cast were present except we had the Opposition now being the Government and so on!
CHAIR: Let us move on now to outcome 10—Health system capacity and quality. Do you have any questions in 10.1? I know there are some questions in eHealth. Are there any questions prior to eHealth.
Senator MOORE: We have some basic questions on eHealth.
CHAIR: We should go straight to eHealth.
Senator McLUCAS: I understand that on 3 November Mr Dutton announced a review into the electronic health records. What is the status of that review?
Ms Powell : Yes, you are correct, the minister has announced the review. The review team consists of Mr Richard Royle, who is the executive director of UnitingCare Health Services in Queensland. Also on the review team is Dr Steve Hambleton, the president of the AMA and Mr Andrew Walduck, who is the chief information officer of Australia Post. That review team has begun its work and has in fact been receiving submissions. The terms of reference have been announced, and I am happy to walk through those, if you like.
Senator McLUCAS: I have the terms of reference. It is interesting that this one has gone ahead pretty quickly, isn't it. This review has gone ahead much more quickly than the other reviews that we are dealing with.
Senator Nash: Given that over $1 billion dollars was spent and only a few hundred signed up, I think it was certainly a matter of urgency—
Senator McLUCAS: I think you might have misread your—
Senator Nash: I do not think so.
Senator McLUCAS: Is the department aware of the Accenture survey of late last year of thousands of doctors in eight countries, which revealed broad resistance by doctors in Australia to patient control. Do not answer that question.
Senator Nash: I could not hear the end of that.
Senator Nash: The acoustics in here are terrible, aren't they? Senator McLucas, could you repeat that, please?
Senator MOORE: Can I ask about the support functions around the review in terms of who is providing the secretariat and how people can know about. I googled it and could not find it—that is just me. The review has a really short time frame, which lots of people have commented about. How is the review committee operating? Who is providing the secretariat? Will there be public hearings? What chance do people have to get their say into the process?
Ms Powell : The review team is supported by a secretariat. It is an independent person, with some offsiders who are working directly to the review team. The department is not involved in managing that side of it at all.
Senator MOORE: The department is not involved in any way. So the secretariat is totally independent?
Ms Powell : We will provide facts and figures and things like that.
Senator MOORE: Who is funding the review? Where does the money for that come from?
Ms Powell : The review is being funded out of the department.
Senator MOORE: So the review is being funded out of the department but the personnel involved have no link with the department?
Ms Powell : They are under contract.
Senator MOORE: What is the budget for the review?
Ms Powell : The contracts are currently being finalised. It is approximately $1,500 per day for the reviewers—there is a little bit of variation—plus some travel expenses.
Senator MOORE: $1,500 each.
Ms Powell : Yes.
Senator MOORE: So it is $1,500 each from the time the review was announced? Was it kicked off because—
Ms Powell : For the days they work on the review.
Senator MOORE: The media around it was very fulsome about who was involved. The budget is $1,500 a day for each of the reviewers and a salary component for the secretariat.
Ms Powell : If I could correct myself. I do not believe we are paying for it. The Australia Post person will just pick up their travel expenses.
Senator MOORE: So another agency is paying for that person. That is fine. We have got the budget allocation. Has there been a global budget announced for this review?
Ms Powell : No budget has been announced.
Senator MOORE: Basically, you have said that they have already got some submissions. How do people know how to submit, who are dumber than me and could not just Google the review?
Ms Powell : The review team has written to those organisations that have previously provided submissions to various processes that the department and the government have run in the past. There are about 210 of those. They have also been provided with details of any other organisation that is contacting us and wishing to participate. They have invited those organisations to provide some kind of a submission and they are having separate conversations with some stakeholders. I know that Mr Royle has been talking about the review at public events. My sense from the stakeholders is that it is pretty widely known.
Senator MOORE: What about individual members of the review?
Ms Powell : I believe that they have only written out to those organisations—
Senator MOORE: So in fact it is a closed review?
Mr Madden : The request for submissions did go to those who have previously provided input and submissions on the personally controlled e-health record and other e-health systems. It does involve the Consumer Health Forum and other consumer representatives. There are other organisations and other people who are coming to us and asking whether they can provide input to the review, and we are connecting them with the review team.
Senator MOORE: People come to the department to find out how to do it, rather than through you?
Mr Madden : What we are finding is that people want to get to the review team, and we are connecting them with the review team. Some are finding the review team by themselves if they have seen that Mr Royle is connected with the review. He has been prominently speaking at public events and people have been connecting directly with him.
Senator MOORE: One of the issues generally is that there is wide interest in this area and certainly every time this committee has had any questions about e-health we have had lots of input, as Senator Boyce knows quite well. I was surprised, not at the review, but that it was not publicised through the e-system. Is it too late to have some form of—
Prof. Halton : We will raise it with them.
CHAIR: Is it also the intention to publish the submissions?
Prof. Halton : We cannot comment on that.
Senator MOORE: If we, as a Senate estimates committee looking at the budget, want to know things such as how the review is going to operate, who do we ask?
Prof. Halton : As I have said, we are happy to go to the reviewers, seek information and then provide it to you. As we are not providing that secretariat I cannot answer from first hand knowledge but I am very happy to facilitate the provision of information.
Senator MOORE: Can we put questions on notice? Mind you, the timeframe is a wee bit tight, as the reporting date seems to be mid-December and we do not questions on notice back until after that.
Prof. Halton : You have raised a particular concern, and we will pass on that concern. Someone will be on the email quickly.
Senator MOORE: It is now on the record, and, Minister, I will rely on you in this area. We would just like to know about the process for the submissions, which people mostly get to see, and we would ask—and we can but ask—whether the review document will then be made public.
CHAIR: Are all the submissions to the review to be made public? Mr Fleming, Have you been involved in the review?
Senator MOORE: Did you get the letter to submit, Mr Fleming?
Mr Fleming : We have been invited to provide a submission, which we will be doing.
Senator McLUCAS: Will the report of the review be made public?
Prof. Halton : We cannot answer that question. That is a matter for the minister. We have undertaken to ask the question.
Senator McLUCAS: Will that come back today?
Senator Nash: I will have to see. We will give it our best endeavours.
CHAIR: What was the total cost of the rapid intervention project that was used to ensure that half of all Australia's public hospitals could interface with the PCEHR by the end of this calendar year?
Mr Fleming : By way of background, there are a number of key components to interfacing to the system that the jurisdictions are delivering for the rapid intervention project. The first is that they are integrating into the identifier system, because every transaction they send back needs to indicate who the patient was, etcetera. Then we are building an interface which allows us not only to receive hospital discharge information but provide the hospitals with the ability to view the PCEHR itself.
CHAIR: Why do we need this? This seems like an extra add-on. Is it to make the systems speak to each other?
Mr Fleming : In the health system there are multiple systems in place. Putting aside the jurisdictions, we are currently dealing with over 70 individual self-feed centres; 33 of them are already fully integrated in terms of our specifications; the others are working on that at the moment. We are actually linking into the systems that exist today. It is part of the change management process to allow people to continue to use the systems they have today, which means that they to build that functionality into them.
CHAIR: What was the total cost?
Mr Fleming : I am relying on memory here. It was a COAG funded expense through the NEHTA program. It was about $13 million. On your question, the expectation is 50 per cent of public hospitals. Certainly we would expect by about the middle of next year to have public hospitals, which probably touch about 75 per cent of the population—
CHAIR: You will have 50 per cent?
Mr Fleming : We will have 50 per cent by February. I would expect, as part of that program, by June or July next year probably about 75 per cent of patients would have access to public hospitals that—
CHAIR: Seventy-five per cent of hospitals or 75 per cent of people?
Mr Fleming : Seventy-five per cent of the Australian population.
CHAIR: How many hospitals will that be, though?
Mr Fleming : That would represent, while I do not have exact figures, well over the 50 per cent mark. Where we are at today is that the public hospital here in the ACT went live some time ago back in March. They are currently working with Calvary, which will also go live. About a month ago now, our friends in South Australia went live with all metropolitan hospitals and one country hospital which is currently piloting that. Approximately two or three weeks ago now New South Wales went live in approximately 17 inner-city hospitals. This week all Queensland hospitals went live with the ability to both view that PCEHR and send that information through.
Senator MOORE: Is that public and private?
Mr Fleming : This is public hospitals.
Senator MOORE: When you said the magic word, that 'all' Queensland hospitals had gone live, I got excited.
Mr Fleming : Sorry—all public.
CHAIR: So how many Australian hospitals can currently view or add to PCEHR records?
Mr Fleming : Today it is all Queensland public hospitals and—between New South Wales, South Australia and the ACT—another 40 hospitals. You will see that number increase as the months progress.
CHAIR: So they can view it?
Mr Fleming : Yes.
CHAIR: And they can—
Mr Fleming : They can send the discharge information, absolutely. Could I also point out that one of the key things that clinicians were telling us from day one of this program was that they needed access to discharge—
CHAIR: That was going to be my next question: who can upload a discharge summary and who cannot?
Mr Fleming : In this context, it is the hospitals providing discharge information. But then anyone who has access to the PCEHR through the systems that are no place in general practice can access that information.
CHAIR: So all the public hospitals you just mentioned can view a PCEHR and they can upload a discharge summary?
Mr Fleming : Correct.
CHAIR: What about private hospitals?
Mr Fleming : There has been very little work with the private hospitals at this stage. There are a few we are working with but, at this stage, because of our relationship with the jurisdictions and as a first step we have been concentrating on the public hospitals. Can I also point out that one of the first states we went live with was South Australia. Through South Australia we built a system called HIPS. That system is being utilised by WA, Queensland and Tasmania, and Victoria are currently looking at it. The reason I mention that is because we are supporting that. The intention is that we will also make it available to the private sector.
CHAIR: But what does it do?
Mr Fleming : It actually acts as some middleware within the hospital systems that helps gather this information from the hospital systems and pass it through.
CHAIR: Is it achieving the same as the Rapid Integration Project?
Mr Fleming : It is part of RIP.
Ms Halton : It is supposed to.
CHAIR: HIPS is part of RIP?
Mr Fleming : HIPS is part of RIP. The way this works is that, instead of making significant changes to systems that are created by offshore companies, they are putting an additional piece of logic on each of those systems which will help it pick up the health identifier and communicate with the PCEHR system and with each state and hospital, creating another system change to their system. This is being deployed across all of the hospitals across—
CHAIR: Who developed HIPS?
Mr Fleming : That was done through South Australia with an external company that they deal with.
CHAIR: An Australian one?
Mr Fleming : Yes, I believe so, but I will put that detail on notice.
CHAIR: That would be good.
Senator MOORE: Is that company owned by NEHTA?
Mr Flemming : It is now owned by NEHTA. We have been through a process with the jurisdictions. Because it is used by more than one, they requested us to take ownership of it and manage the process.
Senator MOORE: But intellectual property-wise it is owned by NEHTA.
Mr Flemming : Yes.
CHAIR: What is the total number of individuals registered as we speak for the PCEHR?
Ms Powell : As of midnight last night 1,129,153 consumers are registered in the system.
CHAIR: What is the total number of shared health summaries that have been uploaded?
Ms Powell : 11,136.
CHAIR: What have we got there? Is that roughly one per cent of people who have registered who have actually uploaded a health summary?
Ms Powell : The shared health summary is uploaded by a clinician. The individuals put in information like their allergies. They may choose to put in personal health notes like their immunisation and other personal health details. They can have a health diary, but the shared health summary is a clinical document.
CHAIR: Is that the target? Is that good?
Ms Powell : The clinical software has been broadly available since about April this year.
Prof. Halton : But not universally. Somewhere I have seen the take-up chart of the Northern Territory record, and I have seen the take-up chart in a couple of other countries. If we look at the numbers and the growth in the numbers—here we go; see, I just have to say it!—we can see that the take-up—except that the print is so rubbish I cannot actually read it—is faster.
Ms Powell : Yes, the take-up is faster.
CHAIR: What do you mean 'the take-up'? It is one per cent, or isn't it one per cent?
Mr Madden : The percentage of consumers who have registered, the percentage of shared health records as a percentage of the population, is running at a sharper take-up than what we had in the Northern Territory. The Northern Territory, across a period of five years, reached a point of 90 per cent saturation of their consumers, and they now have about 40,000 clinical documents added to the system each week. It takes some time for the whole community to embrace and push these things through.
Prof. Halton : In terms of our expectations about what is a reasonable take-up rate, I think the answer is: compared to our domestic experience, yes, it is reasonable; and compared to what I know about international experience, yes, it is reasonable.
CHAIR: What becomes a realistic and sensible target whereby it actually becomes something that is useful to us? There must be a threshold of people who are engaged and using it before it becomes a cost saving to the system.
Prof. Halton : That is putting the question in a different way, and we probably have to think about that and take that question on notice. Again if you take the Northern Territory, over five years we went from having no visibility and little utilisation to the position we are now where—in fact, we have received correspondence from a good number of clinicians in the Northern Territory saying that they do not actually understand it; and a practice manager from the Northern Territory said this to me only about three weeks ago—they cannot conceive of a situation where they could not access an electronic record. This particular woman at a practice managers conference was explaining to me how she often sees patients who are not completely aware of what medications they are on. They have left their medications or they have lost their medications. She said it is just completely automatic now that they expect to just hop onto the record and have a look and fix it.
CHAIR: What is the target?
Prof. Halton : We do not have a target. We do not actually have a numerical target. This is something, obviously, that we would imagine that the review will think about in terms of usability et cetera. At the moment there is no promulgated target in this area.
CHAIR: It just seems to me that at one per cent you have got over $1 billion spent and you are not getting any bang for your buck.
Ms Halton : Let's be clear. The billion dollars is comprised of a number of elements. The large majority of the billion dollars is actually things like the standards that underpinned the use of all IT systems in the health space. So those things are already fundamental to the operation of electronic systems in states and territories. The officers can give the breakdown of what comprises the billion dollars.
CHAIR: It would be good to have a breakdown of what comprises the billion.
Ms Halton : The PCEHR is actually the smaller proportion of that amount. The majority of it is actually creating the things that prevent a 'rail gauge' problem in terms of electronic commerce, communication and clinical information.
CHAIR: But most of that has to be done as a support base for any health system.
Ms Halton : For any health system, yes, that is true, but not just for—this is where we need to be very clear about the distinction between the record—the PCEHR, and e-health writ large. E-health is many, many things, including the PCEHR. It is everything from the patient administration system in a hospital; it is everything from what we are going to do in telehealth. It is much bigger.
CHAIR: Yes. Can I just go back to the HIPS. Is there an issue with having with what has been described to me as 'middleware'? Are we likely to end up with data interpretation errors because of it?
Mr Madden : The way the middleware has been created and is tested ensures that there is no handoff or identity mismatch issues between the system—
CHAIR: There is no what?
Ms Halton : Don't you love a techie!
Mr Madden : It ensures the match of the identity in the clinical system, the match of the health identifier and the match of all of those things all the way through to the personally controlled e-health record are tested and are safe. So we have processes to test that.
CHAIR: How long has it been used in the real world?
Mr Madden : The middleware and the testing system? Probably since about August this year—no, it was probably July when we had the ACT health system tested. In August this year we had all the metropolitan Adelaide hospitals connected to the system using that middleware. Again, regarding the testing processes, the fact that we have a single system interfacing with several clinical systems using the hospital means that those testing processes are repeatable.
CHAIR: And there has been no problems with data interpretation. Thank you.
Ms Halton : Can I just make one point, and I think this has kind of been in some of the answer so far. The big problem everyone has with big IT is every time you go to rewrite a system it costs you a fortune. Let us be clear: there are a limited number of vendors and, love them though we do, if they can charge you every single time they make a change in your particular hospital and then the next hospital, it is going to cost you a lot of money. These are big international companies. The reason we have gone this route is precisely so you are going to leave what you have got in place. This enables that connection. Instead of having to wait until every single person is in a refresh and then building it in, which you wait much longer for, it actually gives you the opportunity to move now.
CHAIR: How many doctors have uploaded shared health summaries—that is the 11,000?
Ms Powell : That is the 11,000, yes.
CHAIR: But wasn't there a mail-out to all GPs under Medicare asking them to do this and to register?
Ms Powell : There was a mail-out to GPs as part of that campaign. I do not remember exactly what they have said but it would have provided them with some information about the PCEHR and would have certainly encouraged them to participate.
CHAIR: But you do not have a view about whether 11,000 is a good figure or a poor figure?
Ms Halton : It is a better figure and the Northern Territory's. I think we use the domestic comparison. That, we can tell you, is an observable fact.
CHAIR: How many specialists have registered to use the PCEHR?
Ms Powell : I do not have that information. I can tell you that 6,040 health care provider organisations have registered. An 'organisation' is quite variable in terms of what it might be: it might be a small general practice with one or probably more GPs but it could also be the entire state health system, as it is in Queensland, in which case it would provide coverage for all of the doctors that work in Queensland hospitals.
Senator MOORE: They only have to register once—as a state?
Ms Powell : They can do that.
CHAIR: So how will you ever know what the take-up rate is?
Ms Powell : I am not sure what you mean by 'the take-up rate'?
CHAIR: If one registration equals the Queensland health system—is that what you are saying?
Ms Powell : We will not be able to tell you the number of specialists who are accessing the system—because we do not measure individuals in that way.
CHAIR: Or the number of GPs or the number of X-ray clinics or the number of pathologists or anything—is that what you are saying?
Ms Granger : Only by healthcare organisation. But we could, for example, tell you that Queensland Health has sent 113 discharge summaries to the PCHR in the last two days—since they registered.
CHAIR: In two days?
Ms Granger : That gives you a sense of the take-up.
Senator McLUCAS: I think that is very good—113 discharge summaries in two days.
CHAIR: Is that what it is telling me—113 patients?
Ms Granger : Yes, 113 patients have been discharged from hospital.
CHAIR: We do not know if that was from one hospital or 10 hospitals?
Ms Granger : We might be able to get a breakdown of that.
Mr Madden : As we accumulate more uses of the system, there are things we can discern from the practitioner who has uploaded the documents—because as well as having an organisation identifier, we will be able to identify the individual practitioner involved. We have not gone through and created those reports yet because there has been, to date, patchy take-up.
CHAIR: Not enough people to be bothered.
Mr Madden : We do know that 4,714 GP practices have enrolled. The GPs within—
CHAIR: Have enrolled?
Mr Madden : They have registered to use the PCHR system. The GPs within those practices would certainly outnumber the 4,000 practices that have registered. But, as we start to look at some of the records climbing to larger numbers we can start to do some analytics about how many of these records have been uploaded by specific practitioners. We will not give out the information about who they are, but we can know whether in fact they are different practitioners. We have not done that yet because the numbers have been relatively low.
Senator MOORE: But you can do it?
Mr Madden : Yes. We will be able to discern because, as part of the authentication in the identity management system to hold intact all of the records, we do capture the identification of the GP—the practitioner—at an individual level for those records that are uploaded.
Prof. Halton : At its crudest, there will come a point, as Mr Madden says—we know how many doctors are registered and we have a fair idea about how many of them are actually practising—at which, numerically, you are going—
CHAIR: Yes. If and when we get to the stage where there are sufficient. That statistic of 113 discharge summaries for Queensland in the last two days—do we have a clue how many people would have been discharged in Queensland in the past two days?
Prof. Halton : We could take that on notice.
CHAIR: It would be thousands, wouldn't it?
Ms Granger : We could take that on notice and find out.
Mr Madden : Going back to your earlier question, Senator: what is the target? It is not as simple as how many shared health summaries we have. It is not as simple as how many discharge summaries we have. It is going to be an amalgam of the percentage of those discharge summaries compared to the population coming through and what that means about individual GPs looking at records for patients who are not their regular patient—it is an amalgam of all that. We are starting to build some of those measures, but we will want to feed some of that through what we are seeing from the review—because there are a lot of different views about what this term 'meaningful use' actually means.
CHAIR: Are you able to tell me how many shared health summaries have been downloaded or viewed more than once—after they were created?
Ms Powell : I can tell you the number of times a clinical document has been viewed by somebody else. That clinical document might be a range of things, so that is not exactly what you asked.
Mr Madden : 'Someone else' means somebody other than the person who uploaded it.
CHAIR: That is not a health summary, is it?
Ms Powell : It would include a health summary.
CHAIR: But it is not just health summaries.
Mr Madden : It would be health care summaries, event summaries and discharge summaries.
Ms Powell : It could be looking at medications. That figure would be $44,383. We are getting just over 11,000 reviews of some sort of a document that is in the system.
Mr Madden : This is a practitioner who is not the practitioner who created that document, so another practitioner is looking at that document on behalf of the patient.
CHAIR: How many PCEHRs have been viewed in an acute care setting, by which I mean a hospital?
Mr Madden : We do not have that.
CHAIR: How many shared health summaries have been viewed at hospitals?
Prof. Halton : It is the same answer. In truth, we do not expect very many just yet because, as we have taken you through the capacity to do that, it has just come live in Queensland—there are a number of places where it is only just happening, so we cannot give you the answer. We know the answer would be not many.
CHAIR: I want to ask about Aspen inducing signups under a contract they had with McKinsey & Co. What was the total number of PCR registrations that Aspen secured as a result of their contract with McKinsey & Co?
Ms Powell : Aspen delivered 580,000 registrations for the time they were on contract to McKinsey through the department. NEHTA now have a similar contract; the health department is no longer doing that. They are under contract to deliver a further 150,000 by the end of December.
CHAIR: So you clearly think that is a beneficial way of doing it. Why?
Ms Powell : We trialled a number of ways of encouraging people to register, from targeted mailouts to working with Medicare Locals and general practices. We trialled the assistant registration process very early on and we found that it was the simplest and most efficient way of engaging with people and getting them to sign up in the early days. A couple of the advantages are that it enables a conversation with individuals, you can provide information and it is their on the spot. They do go to places where you are going to find the target cohorts we are after—hospitals, general practice clinics, outpatient wards and things like that.
CHAIR: Was the cost of that contract?
Ms Powell : The contract is with McKinseys, so it is a commercial arrangement that we would not be able to share without going back through them.
CHAIR: Are you able to distinguish those registrations from other registrations?
Ms Powell : Yes, we are.
CHAIR: Do you measure the activity that occurs around that PCEHR after it occurs to see that these are not simply signups for the sake of signups?
Ms Powell : One of the things that we can look at is that after a person has created their own record we can tell how many records have been accessed by a consumer, but we have not tracked that by how they were registered.
CHAIR: So you would not be able to tell, for example, if someone who had registered because Aspen was paid to get them to register had a shared health summary uploaded?
Mr Madden : No.
CHAIR: So how do you know it is succeeding?
Mr Madden : The numbers of people who are registering as a result of seeing advertising in the GP's clinic, in the hospitals or through some of the Medicare Local activities. Take-up rates for that activity are quite low. I will talk a little bit about the next steps. Trialling the assisted registration in a place where patients would expect that they could do this with somebody who had time to explain it to them and get them into the system was showing much more positive results with people wishing to register that some of the other channels.
The other thing, just beyond Aspen, is that, in the public hospital changes through the states and territories relationship that Mr Fleming mentioned, we have also arranged for the assisted registration process to be available in hospitals, because people on the way into the hospital are being asked if they would like their discharge summary to be added to the PCEHR, and, if they are not registered, that will not happen. So they are actually asking if they can be registered while they are in the hospital. Because the identity information that they have on admission is a pretty close match to what they need to get a PCEHR, we can get that done directly from their system. So that is one channel. The other is that, through the GPs' software, we will add this assisted registration process into that software as well so that, if you have a patient who is identified and the patient consents, it is a simple click of a button and they are registered. So there is almost a tacit demand there: if they cannot get registered when they want to, they will not come back in 12 hours and say, 'I'll do that in another channel.' So Aspen has given us some lessons about information, and the language that is used in those consent forms has been taken up through all of the other assisted registration channels, which are happening through Medicare Locals, hospitals and other places as well.
CHAIR: I would just quote here from an article, called 'Lessons from the coalface: the PCEHR in practice' in PULSE+IT yesterday, 19 November, which quotes a Dr Lim as saying:
One of those limitations is the overall cumbersomeness of the system, which he believes needs to be improved.
He also says:
Certainly the sign-up process was extremely cumbersome. It is still cumbersome now but it is less cumbersome than what it was …
Do you perceive that the sign-up process is a barrier to entry for consumers for the PCEHR?
Mr Madden : When we first started, I think one of the first things we learnt was that the identity process and the online registration process was cumbersome. We went through a usability testing process with real consumers and we came back with some significant changes to simplify it. We have made releases to the system probably on three other occasions since the system's inception to make the process easier.
CHAIR: Three improvements? Or levels of improvement.
Mr Madden : Three improvements to the usabilitity, and the most recent one—
Prof. Halton : And, Senator, there is more that can be done.
CHAIR: And there is more to do?
Prof. Halton : Absolutely.
CHAIR: What is stopping that from being done, then?
Mr Madden : Each time we take breath to listen to all we have heard about usability issues—and we do some proper usability trials with consumers to get an idea of what they are—we will simplify. We will make those changes. Before we make them, we do another test with other consumers to test whether that is likely to give us the simplicity we are looking for. If the answer at that point is yes, we put those changes into the system, yet we still get more feedback saying it could be better. So we just continue to react to that and to make changes to make it better. The more consumers who see it, the more different people with different levels of technological capabilities see it and the more people who go through the consent forms and really challenge the English, the more we will do to improve the system. It is the same with many of these developments. All of these concepts on paper, when we start, are really good—
CHAIR: I was just wondering what would happen to the person who designed the Myer website if they had to have three goes at it and then needed to do some more.
Mr Madden : If you look at electronic banking, some of the banks have got some really, really good electronic banking sites today. But, if you go back to where they were 10 years ago, when they first started, they had the same trouble: they had people who signed up and never came back a second time. But that has all changed. People have jumped the line.
CHAIR: Were you going to say something, Mr Fleming?
Mr Fleming : No, I was just agreeing with Mr Madden; sorry.
Mr Madden : Thank you!
CHAIR: The current monthly payment to Accenture for the ongoing running costs of the PCEHR—how much is that?
Prof. Halton : Senator, we have just done a little back-of-the-envelope calculation in relation to your question about Queensland.
Prof. Halton : We think there are about 8,531 people discharged every day from Queensland hospitals, give or take, depending on the day, depending on the circumstance. If you accept that there are about 1.1-something million people with a registration now for a PCEHR, that is one in 23 million Australians, roughly. If you take one in 23 million Australians times 8,531, give or take, you end up with a number in the order of 400—it is actually a bit less than 400. So what you've actually got is probably 200-something of the probably a fraction under 400 people whom you might be able to send a discharge summary to.
CHAIR: Good!
Prof. Halton : I just thought I'd share!
CHAIR: Thank you.
Prof. Halton : You can't say I'm not trying to help!
Ms Granger : I do not have the exact number with me but it is roughly 1.5 million a month.
CHAIR: How long is that contract going to run?
Ms Granger : At the moment, it runs out on 30 June next year.
CHAIR: Ms Tania Plibersek, as Minister for Health, announced in June 2013 a new my child's e-health record app, which people could use for immunisation records. Was that system actually functioning in June 2013, at the time it was announced?
Mr Madden : Yes. It was operational and in production when it was announced and the launch date was one of the catalysts for drawing some of the take-up for that particular system.
Ms Powell : And it has been downloaded 14,190 times. Sorry, it has been accessed that many times. I am not sure whether that is the same as being downloaded—I am not a technical person.
CHAIR: It is an app, is it not?
Ms Powell : Yes.
CHAIR: We should be able to work out how many times it has been downloaded.
Ms Powell : It is about 23 a day.
Mr Fleming : Over 7,000 people now have that app on their 3G phone or tablet and that is growing at about 23 a day.
Senator MOORE: Ms Halton, has the department been asked to give evidence to the review?
Prof. Halton : I did get a letter, like everybody else.
Senator MOORE: No, like the 200 other people who got a letter; not like everybody else.
Prof. Halton : Sorry—like the other people who got a letter, I got a letter.
Senator MOORE: I am just checking. I should have asked that first. And we did confirm NEHTA got a letter.
Mr Fleming : Yes.
Senator MOORE: Did you get a letter, Senator?
CHAIR: No, I did not get a letter.
Mr Madden : Anybody who wants to be put in touch with the review to get a letter, let me know.
Senator Nash: You have just told a lot of people.
CHAIR: Someone will thank you later for that! The rest of outcome 10—there are health infrastructure questions. There are no questions in health information, international policy engagement, research capacity and quality?
----- Transcript ends.
1. It is hard not to get excited with things like RIP and HIPS being chatted about!
2. I simply do not believe more has been spent on Standards than the PCEHR!
3. Don’t you love the condescension from Prof. Halton.
4. Maybe the system design should have been better worked out rather than now creating all sorts of spaghetti middleware might have been a better plan.
5. The useability issue is simply because the whole thing was rushed - simple as that I reckon.
6. It is a secret just how much it cost to sign up all the PCEHR non-users.
Overall - this is really just a debacle being led by people who really don’t have a clue!


Anonymous said...

The cunning beauty of this incremental delivery strategy is that you never get in trouble for being late with no commitment to a deliverable timetable. There is no failure as there is nothing to fail against!

Not working as expected? Don't worry next release will fix that? Not delivering value for money? Its a journey don't you know and once we reach critical mass you will see a tipping point reached.

Its the manyana strategy.

Anonymous said...

Ms Granger : Only by healthcare organisation. But we could, for example, tell you that Queensland Health has sent 113 discharge summaries to the PCHR in the last two days—since they registered.
CHAIR: In two days?
Ms Granger : That gives you a sense of the take-up.
Senator McLUCAS: I think that is very good—113 discharge summaries in two days.


Prof. Halton : We think there are about 8,531 people discharged every day from Queensland hospitals, give or take, depending on the day, depending on the circumstance. If you accept that there are about 1.1-something million people with a registration now for a PCEHR, that is one in 23 million Australians, roughly. If you take one in 23 million Australians times 8,531, give or take, you end up with a number in the order of 400—it is actually a bit less than 400. So what you've actually got is probably 200-something of the probably a fraction under 400 people whom you might be able to send a discharge summary to.
CHAIR: Good!
Prof. Halton : I just thought I'd share!
CHAIR: Thank you.
Prof. Halton : You can't say I'm not trying to help!


Anonymous said...

Yes I can say Prof Halton that you’re not trying to help, and the biggest Help you could provide would be handing in your resignation poste-haste…

So let’s look at the combined facts and spurious claptrap spewed forth by ”Prof. Halton”!

113 Discharged QLD Patients in “two days”, therefore ~57 patients discharged per day.
~8,531 People Discharged from QLD Public Hospitals ”every day”, therefore ~17,062 patients discharged in ”two days”

Thereby we have a ratio of either ~17,062:113 or ~8531:~57, both equating to ~0.66% penetration rate of QLD’s daily discharge summary volume being sent to the PCEHR. Yes that’s correct, just over half of one miserly percentage point of actual coverage of QLD’s daily discharge summary volume! What is good about this exactly?

So, if we indeed indulge ”Prof. Halton” on her assertion that 1.1 something million people out of 23 million Australians have registered for a PCEHR, that is still only just under ~5% coverage of the potential registered population, at a continually mounting cost of over $1B to Australian Taxpayers! Let’s not discount the fact that PCEHR Registrations are a meaningless measurement of no value or substance whatsoever to Australia’s healthcare system.

If QLD’s population is ~4,638.1K out of Australia’s ~23,032.7K, therefore QLD comprises ~20% of Australia’s population (Mar. 2013), and if the PCEHR registrations are relatively evenly distributed the same as the population, then only ~20% of the 1.1 something million people with a PCEHR Registration are from QLD, making ~220K the more accurate and relevant measure of QLD based PCEHR Registrations. Which means only ~4.7% of the QLD population is registered for the PCEHR.

Forgiving ”Prof. Halton’s” illogical argument here, this still makes ~408 patients could have a probable Discharge Summary in QLD in a given day sent to their registered PCEHR from the ~8,531 volume, of which only ~57/day were transmitted, making the current actual penetration rate of the probable allowances only ~14% coverage. Again, at a cost of $1B thus far and still unfortunately counting the mounting Australian Taxpayer losses attributed to this PCEHR debacle.

QLD is most definitely NOT getting ”200-something of the probably faction under 400 people” sent a discharge summary to in no uncertain terms… If ”Prof. Halton” and her staff believe this, then they are as deluded as they are incompetent!

”Prof. Halton’s” back of the envelope calculations and spurious logic demonstrate her complete incompetence to carry on her role and illustrate her inability to appreciate the magnitude of the situation and the scale of this ehealth debacle carried out under her direction and management.

Enough is enough! The incompetent ”Prof. Halton” needs to be held Accountable sooner rather than later and definitely in no uncertain terms!

Anonymous said...


NEHTA is now buying software companies developing middleware software and owning the IP resulting from their acquisition?

Seems a very odd practice and dubious intervention into Australia's ehealth marketplace from a supposed non-profit Government owned and funded "Transition" Authority!

Where in the script of Abbott, Roxon, Plibersek and now Dutton was this behaviour of NEHTA sanctioned? Surely NEHTA has now gone completely rogue…

Anonymous said...

Submissions invited. Mmmm - I have made submissions under my own name on a number of occasions. NO Invitation was received this time - but then, I am not an organisation. Perhaps it is considered that individuals don't have sufficient expertise to warrant being invited. That's odd - because it's often us individuals that provide organisations with the ehealth skills and knowledge the organisation is so sorely lacking.

Anonymous said...

"Professor" Halton is an Adjunct Professor, an honorary title.

No tenure, little or no pay, it's all for show. It tells you a lot about someone who tries to use it to impress, which she does in spades on the Health website:

Anonymous said...

I spoke with Senator Boyce last week via email exchange about a submission and in fact she encouraged me to do so.. until I told her that it was be invite only..she was not aware of this.. interesting question time next time round .. methinks..

Complete ridiculous joke... and if Dutton does not act then he joins the list of incompetents who have already had their fingers on this failed project..

Anonymous said...

Nonsense, utter nonsense, BS and rubbish all of it. Take us all for fools why don't you!!

"Mr Madden : Yes. We will be able to discern because, as part of the authentication in the identity management system to hold intact all of the records, we do capture the identification of the GP—the practitioner—at an individual level for those records that are uploaded."

What IMS would that be then?

Anonymous said...

Mr Fleming : ….. Can I also point out that one of the first states we went live with was South Australia. Through South Australia we built a system called HIPS. That system is being utilised by WA, Queensland and Tasmania, and Victoria are currently looking at it.

CHAIR: But what does it do?

Mr Fleming : It actually acts as some middleware within the hospital systems that helps gather this information from the hospital systems and pass it through.


Terrific stuff Senators.

..... the HIPS system is being utilised ..... ahh - but is it being used or is this another pie in the sky never never sometime it will be utilised fluff?

Where is the evaluation by independent consultants that quantify and assess HIPS' use? including accuracy, reliability, functionality, ease-of-use, customer satisfaction levels, response times, etc.?

Anonymous said...

You think by now they would turn up to Senate Estimates with some simple facts, instead of doing incorrect back of the envelope guesses. E.g.
• Actual PCEHR discharge summary uploads by state/territory against targets that have been estimated based on population, registration numbers and admission rates. Simple.
Agree about the middleware/spaghetti ware. Makes you wonder what the core PCEHR system that we paid Accenture hundreds of millions of dollars for actually does, sitting there hiding behind the spaghetti. if we need to build and implement HIPS systems around the core to enable uploading and viewing of documents. Perhaps we could replace the whole core PCEHR system with something else, perhaps a couple of large thumb drives , which would be a whole lot cheaper than the $1.5 million per month (that’s 18 million per year) we are paying Accenture, hiding behind the HIPS.

Agree that there has been very little of the money spent on actual Standards. If so, then where are the Standards? I think they mean the PCEHR architecture, the design, the requirements and the integration specifications. Sadly, many in DOHA and NEHTA do not don’t know the difference between a standard and any other technical document. There would have been many millions spent on the so called PCEHR architecture and design documents, and we had to feed and transport the tiger teams in luxury. None of this made any difference because they bought a commercial off the shelf system and there was no traceability back to the design documents. And the integration specifications were released (without testing), withdrawn, re-worked and released again, causing long delays and more expense.

Prof Halton seems to treat the whole deal as a huge joke with her back of the envelope calculations which she has to ‘share’ and comments about ‘techies’. This does not inspire confidence in her important role as the System Operator.

So silly to realize only after you have implemented a system how unusable it is. There was obviously no comprehensive end to end testing, which makes us all very scared about when they start doing something actually clinical.

I don’t see how they can compare with the NT system. The medications example they give for that system is the opposite of the medications mess in the PCEHR system. NT uses a sophisticated eMM system (MedChart) that keeps an integrated, safe and complete record of a patient’s medications, including dosage. The PCEHR has a confusing inconsistent conglomeration of ‘medication information’ sourced from a variety of inconsistent sources, with gaps, and may be more dangerous than having no information at all. And it would be interesting to see how much the NT system cost against the PCEHR. It would be a mere fraction of the cost.

Anonymous said...




Anonymous said...

So what health outcomes have been achieved? Outcomes that were achieved better than before the pcehr?

$1billion buys a lot of health care. Has the pcehr achieved more than that $1billion would have if given to Australia's hospitals to shorten waiting times.

Anonymous said...

for The Alcohol and Other Drugs Council of Australia which has operated since 1966 on an annual budget of $1.6 million provided by the federal Health Department.



Anonymous said...

Can some lucky Organization or Individual who's received a letter of invitation to submit to the PCEHR review please attach as an Appendix a copy of the transcript from Hansard of this DOHA/NEHTA Senate Estimates hearing plus a copy of this BLOG entry inclusive of all submitted comments here by the readership...

It truly needs to be used as evidence of incompetence by the self-evident "Incompetents"!

Anonymous said...

There's none so blind as those who will not see.

This government is not interested in evidence or logic. They have their own agenda, driven by belief and hubris.

Only three things will bring about some sort of change - opinion polls, outsiders (like SBY) and an election.

I bet the chances of a double dissolution are heading south.

Bruce Farnell said...

I think I can express the status of what seems to pass as 'eHealth' in a simple formula:

zero targets + zero outcomes = success

Bernard Robertson-Dunn said...


The AMA and the CHF have diametrically opposing views re "ownership" of the PCEHR "system"

That alone makes it a Wicked Problem. Has the problem been solved? Not in my humble opinion.

So the PCEHR is a non-solution to an ongoing problem.

I do hope the review team understands the difference between problem and solution. Looking only at the solution, won't tell them what the problem is.