In a crazy – as we now know – rush of blood to the head Minister Abbott announced a Medicare Smartcard in July 2004. Could have been because an election was due – and was held on October 9, 2004 – and not much had happened e-health wise during the electoral term.
28 July 2004
ABB123/04
Medicare smartcard launched
The new Medicare smartcard was launched in Launceston today.
The Medicare smartcard will give people access to their organ donor records, childhood immunisation records, Medicare safety net status and PBS expenditure data as well as provide access to standard Medicare services in the normal way.
The smartcard will operate in conjunction with HealthConnect - a secure, IT-based integrated health record which will give treating health professionals access to information about procedures, treatments and tests (with patient permission) and which will give patients more control over their health records.
Registration for the new smartcard begins in Tasmania today. Later this year, kiosks equipped with smartcard readers will be available in all Tasmanian Medicare offices. Within 18 months, should they wish, Tasmanians will be able to access their health records from home via a secure internet link.
Registration for the Medicare smartcard will flag an individual’s future participation in HealthConnect. Patients who do not wish to be part of HealthConnect can continue to use their existing Medicare cards and access medical services and Medicare rebates in the normal way.
The Medicare smartcard is the latest demonstration of the Government's commitment to using better information to deliver better quality health services.
About 3600 hospital deaths per year are attributed, in part, to inadequate health information. At least some of those deaths could be avoided if treating health professionals had better access to their patients' records. As well, patients could be spared large numbers of duplicated tests and procedures.
Tasmanians who want to register for the Medicare smartcard can visit their local Medicare office. They will need to take evidence-of-identity documents along with them.
Tasmanians wanting more information about Medicare smartcard can phone 1300 850 155 or visit their local Medicare office.
- end Release.
The idea had a long gestation as can be seen from the following note that “The idea of medical smartcards was first flagged in 1992, but it drew flak from privacy groups, which compared it to the controversial 1980s Australia Card proposal.”
As can be seen from the above release there was a level of expectation set that yet to be even partly delivered – as we all wait for the next election announcement!
Later, of course the whole idea was quietly canned – and of course the Access Card Project – “Medicare Smartcard on Steroids” was initiated.
http://www.australianit.news.com.au/story/0,24897,19298551-15306,00.html
Health smartcard fizzles
Karen Dearne | May 30, 2006
THE Medicare smartcard launched in Tasmania two years ago has been quietly scrapped, a Senate estimates hearing has been told.
More than $4.5 million was spent on developing the card, which featured a microchip with far greater data capacity than the magnetic strips on current Medicare cards.
Federal Health Minister Tony Abbott launched the smartcard in Launceston in 2004 as part of the now stalled HealthConnect electronic patient record program. It is understood only 1 per cent of eligible Tasmanians expressed interest in registering for the card.
….. (see URL above for full article)
Now we have the Access Card on probably permanent hold and we have the admission that the old Medicare Card one of the tools of choice for ID Fraudsters.
Access card 'more secure than Medicare'
September 6, 2007 - 5:34PM
The controversial access card will be more secure than the current Medicare system, the federal government says, despite new reports showing it could be targeted by cyber criminals.
The access card is intended to replace the Medicare card and up to 16 other benefit cards, streamlining access to a wide range of government health and welfare services.
There have been ongoing concerns about the privacy implications of the new card and a new report from the Australian Institute of Criminology warns the card could be targeted by cyber criminals.
The study details concerns about how computer technologies could be infiltrated by criminals or even terrorists.
But Human Services Minister Chris Ellison says the new card will be significantly more secure than the current Medicare system.
"The access card will replace the existing Medicare card, which figures in 70 per cent of serious and organised crime identity investigations and 50 per cent of all fraud investigations," a spokesman for Senator Ellison told AAP.
….. (see URL above for full article)
All this started me thinking about the steady progress that now seems to be underway in Germany – and a number of other countries – using Health Related Smartcards. See the following for details:
http://www.ehealtheurope.net/news/2963/german_smartcard_rollout_brought_forward
German smartcard rollout brought forward
17 Aug 2007
In a surprise move, the German health IT agency Gematik has accelerated the schedule of the German national smartcard project to April 2008.
The nationwide rollout of smartcards for all citizens will now start in the second quarter of 2008. “It could easily be finished by the end of 2009”, says Michael Martinet, head of IT at Germany’s second largest health insurance company 'DAK'.
The decision was taken by the board of directors of Gematik earlier this week. It was not made public until yesterday, though, when state secretary Klaus-Theo Schröder of the national ministry of health announced the new accelerated timetable.
Among the directors of the Gematik are the heads of two medical associations, the head of the national hospital association 'DKG', and the heads of the associations of insurance companies.
The German smartcard project is ultimately planned as an online system. Patients will go to their doctor and identify themselves with their smartcard, the ''elektronische Gesundheitskarte' (electronic health insurance card).
The doctor will then be able to store electronic prescriptions, personal medical data, referrals and discharge letters within a server-based network. To do so, he will use a second smartcard, the “health professional card”.
….. (see URL above for full article)
And for a fuller review of what is happening in Germany go here.
All this got me to start thinking – may be if we in Australia were to adopt the German approach we could use a Health Smartcard (with none of the contentious ID Card like features) to do for health what the NEHTA UHI and the Access Card would do if they ever get going.
This would all fit nicely with what Medicare Australia probably would like to do with e-prescribing and a Patient Health Record. Better still it could all be totally voluntary for the first few years till everyone was happy it worked as desired and public concerns were fully allayed. We know there would be considerable adoption among those who are frequent users of the health system – so the card would get used first where it would make most difference.
We could have pretty secure ID, a basic shared record held by the patient and readable only when the patient authorised it and all sorts of other basic capabilities at reasonable cost and hopefully little public contention through a fully voluntary strategy.
There are even International Standards in place on for such Health Smartcards.
I must be missing something – it really can’t be this easy to get this far, can it?
David.
3 comments:
I have been involved in a number of Canadian health smart card trials since 1988 (Jeez... almost 20 years!). Way back in 1988 we were still engrossed in a mainframe culture. Networking and distributed info storage and processing were but gleams in the eyes of dreamers. Smart cards were seen as a way to have an electronic patient record without developing a mother-of-all-databases with their inherent privacy issues.
As it turned out, the smart card as a storage device for EHRs never panned out. There were too many issues including what would happen if the card was lost. The only practical solution was to back the record up in a central location so that it could be recreated... thereby defeating the purpose of the card in the first place. There were also issues of completeness where patients forgot their cards on their visit to the health facility and were not updated.
While the card failed as a data carrier, there was recognition that it was a more secure ID token. However, Canada has a very good mag stripe card infrastructure in place. The economics of replacing not only the cards, but all of the POS devices and software interfaces didn't justify the added benefit (at least not yet).
There might be some additional use for the card as a "sneakernet" communications device replacing all of those paper prescriptions and lab orders that doctors are always passing out to patients so that they can bring them to their pharmacy or lab of choice. Again, the issue would likely be the cost of upgrading the POS devices and software.
David,
How are the NEHTA UHI and UPI different from the German elektronische Gesundheitskarte (electronic health insurance card) and health professional card? The card is just a physical embodiment of the number, right?
Hi,
The key difference is that the patient has control of their card and how their identifier is used. Not so with the NEHTA proposal as I understand it.
David.
Post a Comment