Thursday, August 25, 2016

So Much For Trust In Shared Health Information Systems To Deliver Benefits And To Be Error Free For The Patient Or Carer!

This amazing yarn appeared a little while ago.

Computer system glitch puts thousands of NT patients at risk

  • The Australian

Amos Aikman

Thousands of Northern Territory patients have been put at risk by a major failure of a crucial computer system that transmits information between hospitals and remote clinics.
The NT Department of Health has established a crisis management team to urgently investigate the glitch, believed to have prevented as many as 5400 referrals and other pieces of information concerning about 2400 patients from reaching their intended destinations.
The problem was discovered by accident last Friday, but may have gone unnoticed for as long as 18 months from 2014 till May this year, when sources said it had been fixed “by accident”.
The failure to transmit patient information only came to light when a clinician rang up to see why his patient’s records had not gone through. The problem is understood to have affected clinics Territory wide, including prisons and some alcohol rehabilitation centres.
The Australian has been told most of the 2400 patients affected are unlikely to have suffered serious health consequences because their ailments were minor or their information was transmitted separately via other means.
However, when reached by phone in Melbourne this morning, Department of Health CEO Len Notaras was not able to rule out that patients had been harmed.
Sources said the department had uncovered at least two cases in which cancer patients may have suffered serious consequences from having their treatment delayed, but that has not been confirmed.
The Australian understands one patient is being contacted after it emerged he had left hospital with a broken jaw before the results of his X-rays had been properly considered.
Part of the fix is understood to involve re-entering the missing records from oldest to most recent.
Once that has been done, remote clinic staff will be asked to sit down with patients 2400 individually and explain the situation and ensure their records do not contain errors.

More here:
I love the planned solution – but I am not sure the order of remediation is the right one!

This is really an interesting story and shows the risks of not having a specific provider recording information for a patient and then the same provider using that information - rather than pretending  information sourced from unknown others can be trusted to be true - or even to be there!

The healthcare provider has a strong interest in the accuracy and completeness of their records for their patients. The further you move from that situation the higher the potential risk of inaccuracy and incompleteness.


Anonymous said...

NT have a history of this sort of 'going unnoticed' I remembered this from a few years ago, for something held up as the national benchmark for greatness and sucked in so much of NeHTA time and money perhaps another royal commission is needed up north

Bernard Robertson-Dunn said...

Looking at:

If you believe the last sentence, it seems both systems contain the same information.

"What is the difference between My eHealth Record (NT) and the national
My Health Record system?

The national My Health Record system provides you with a record that is
accessible anywhere in Australia (unlike My eHealth Record (NT) whose
coverage is limited largely to healthcare providers in the NT). This
means that over time, if you visit a participating hospital or
healthcare provider anywhere in Australia, they will be able to view and
send to your national My Health Record.

My eHealth Record (NT) can only be managed through a participating
healthcare provider in the Northern Territory, Kimberley Region of
Western Australia and South Australia. Having a national My Health
Record means that even if you visit different healthcare providers in
areas not covered by My eHealth Record (NT), they will all have access
to the same healthcare information."

Anonymous said...

Let me start off by saying that I have never worked for NT Health, but have followed what they have achieved for a while now. What I outline below is simply based on my understanding of the situation and may have some inaccuracies. Also, I have not read the article as I do not have a subscription to the Australian.
I generally find the comments on this blog very interesting. They are usually very valid in their critique of what is being delivered in the way of digitised health in Oz, especially when you look at the exorbitant cost. In this case however, I don’t believe that the comments from Bernard and Anonymous are valid and perhaps indicate a lack of a full understanding as to what has actually been achieved in the NT.
Anonymous appears to be inferring that the NT has been the beneficiary of excessive NEHTA largess and that nothing has been delivered as a result. They use as an example the problem that occurred in 2011 with prescribing in remote areas as an example. Bernard questions the similarities between My eHealth Record (NT) and the national My Health Record system.
Let me start with Bernard’s comments first. To my knowledge, the NT has had a territory-wide shared record for over a decade. The driver for this was the distances that needed to be covered and the remote nature of a large number of the indigenous healthcare facilities. When patients had to come into one of the hospitals, getting their records to the treating clinician was not easy. The initial centralized record was just data blobs, not atomised data. Whilst not perfect, it did provide the treating clinician with a record of the patient that they may be seeing, perhaps for the first time. The record has evolved over years and has progressed to a more atomized model (obviously dependent on the systems feeding it).
I believe that NT Health has decided they will migrate their centralized record to the national My Health Record system which will be used as the shared health record in the NT. Therefore, there won’t be two records, just one.
As to the inference made by Anonymous, NEHTA has indeed funded a large number of undertaking by various jurisdictions and organisations. It is my view that without doubt, NT Health has delivered more bang for the NEHTA buck, than any other of the funded projects, so your suggestion of the need for a royal commission is way off the mark (or maybe it was said with tongue in cheek).
To me, the issue raised in the Australian, and the problem mentioned by Anonymous are a result of people actually trying to deliver outcomes from the implementation of digitised health. Sure, processes need to be reviewed to ensure problems don’t happen again, and yes, we are dealing with people health, and so the need for accuracy is even more critical, but the benefits that the NT population have enjoyed as a result of what has been implemented to date are significant, and a couple of problems should not be used to pull down those achievements.
Of course, one sure way to not make a mistake, is to do nothing!!

Bernard Robertson-Dunn said...

re "I don’t believe that the comments from Bernard ..." I don't follow the logic that my comment(s) is/are wrong.

"Bernard questions the similarities between My eHealth Record (NT) and the national My Health Record system."

Yes, that's a question not a comment. And you've answered it:

"Therefore, there won’t be two records, just one."

I'll ask another question:

Is the My Health Record a 24*7, high availability system?

My understanding is that the My Health Record system has scheduled down-times.

This is not characteristic of a 24*7, high availability system, in which case relying on it alone for primary health care purposes would be most unwise.

Which leads to further questions:

How much would it cost to make the My Health Record system 24*7, high availability?

If NT has to keep their parallel system going because the My Health Record system cannot be relied on, where are the savings coming from? Or will they just take the risk?

Bernard Robertson-Dunn said...

Some interesting facts.

First, go to

Search for concept of operations

It returns 6 results, none of which are the Concept of Operations

That's interesting fact #1

Now search for "concept of operations" i.e. with quotes

That's when you get interesting fact #2

It returns:

"Access forbidden!

You don't have permission to access the requested object. It is either read-protected or not readable by the server."

What could this possibly mean?

That they are hiding the only document that describes how the system was intended to work and that states quite categorically that the system is voluntary?

They have accidentally forgotten to put the document up on the new site?

The document is there, but has the wrong permissions?

All we can do is guess.

Anonymous said...

It seems the Department has made an art form out of discrediting its Health Record system every step of the way reflecting a dysfunctional Department, incompetent bureaucrats or just plain stupidity. Their next step will be to duck for cover and sheet home the blame to the ADHA.

Eric Browne said...

Bernard, although NEHTA/ADHA wrote the PCEHR Concept of Operations, I doubt NEHTA/ADHA have ever made it available on their web site. It is copyright 2011 Commonwealth of Australia. NEHTA/ADHA would have had to write to and seek permission to republish. They could, and it is still not too late ADHA, to rectify this either by pointing to a Commonwealth copy, or seeking permission, or even updating/producing a current My Health Record architecture document.

The department, for its part, seemed to hit an existential crisis with its website back in 2014. It used to house the PCEHR Concept of Operations there, but presumably got confused between "your" health and "my" health. Rather than solving it by creating "our" health, they simply shut the website down. Fortunately, the National Library archived it. You can find a copy at

Anonymous said...

Thanks for the pointer to the old PCEHR Con Ops Eric.

Reading it through I was reminded that "Benefits and Evaluation: A Benefits Evaluation Partner has been appointed and it is anticipated that more information around benefits evaluation will be available in time."

Has anyone ever see this work, for which I recall many millions of $ were spent? Love to know.

Bernard Robertson-Dunn said...

Thanks Eric, I was after the public URL, I've had a copy for years.

If anyone is browsing the ConOP, have a look at the access controls you can set for the Shared Health Summary and the Personal Health Summary.

You can set any.

And then have a look at what control you have over what your nominated health provider (probably GP) can put into your Shared Health Summary.

Just about whatever they want.

And then have a look at if they have to ask your opinion, permission or even tell you they have uploaded one.

No, they don't have to.

All that is supported by information on the site.

Then have a look at what it says on its home page:

"My Health Record is a secure online summary of your health information. You can control what goes into it, and who is allowed to access it. You can choose to share your health information with your doctors, hospitals and other healthcare providers."

Does all that sound OK to you?