I had a number of alarmed e-mails yesterday – when the ABC posted the following in their News Justin Section!
Contract signed for national health ID system
Posted
The Federal Government says a new national healthcare identifier service is one step closer, after a contract was signed to develop and test the scheme.
The service is designed to improve the transfer of patient information between health providers.
It will identify a person's name, date of birth, address and the names of their practitioners, and is the first step towards establishing a shared electronic health records system.
The $51 billion contract between Medicare and the National E-Health Transition Authority will take around two years to implement.
Federal Minister for Human Services, Joe Ludwig, says it is not an access card and people can decide whether or not they want to be part of the service.
"Privacy is a great concern to Australians, particularly in relation to the collection and handling of personal health information. A new regulatory framework would be required," he said.
Continue reading here
http://www.abc.net.au/news/stories/2008/01/12/2137148.htm?section=justin
To everyone’s relief the ABC quickly noticed the $51 Billion was a mistake (It’s more like $51 Million) and corrected the web site.
It now reads:
“The contract between Medicare and the National E-Health Transition Authority will take around two years to implement.”
The announcement also got coverage in The Age
http://news.theage.com.au/medicare-to-develop-identifier-service/20080112-1ll8.html
Medicare to develop identifier service
January 12, 2008 - 1:57PM
Medicare has signed a contract to develop a service which electronically identifies patients and healthcare providers, the federal government says.
Known as the unique healthcare identifier (UHI) service, the program is being developed as part of a proposed national system of sharing health records.
The Shared Electronic Health Records system would make an individual's medical details accessible online to doctors and the patient concerned.
Federal Health Minister Nicola Roxon and Human Services Minister Joe Ludwig said UHI will identify people who receive health care and the people and places providing it.
"One of the key building blocks for the establishment of this system is the means for uniquely identifying patients and health professionals, which will ultimately reduce the possibility of information being sent to the wrong health professional or being assigned the wrong patient," Ms Roxon said in a statement.
Under the contract with the National E-Health Transition Authority (NEHTA), Medicare will design, build and test the UHI service.
….
There are some major concerns I have about all this.
First the timing of the announcement (Saturday afternoon) always makes one wonder what is being hidden etc.
Second and much more substantively there seem to be all sorts of important aspects that are not worked out or thought through. One would have imagined that to award a $51 Million contract all this would be totally clear.
It’s amazing just how many issues are yet to be resolved. A review of the V2.0 UHI Concept of Operations for example can find the following selected quotes:
“Editorial note: Policies to safeguard the use of the IHI and HPI within the healthcare sector are still to be determined.”
“Editorial note: Examples of non-clinical and non-identifier contact information essential to providing healthcare might be: next of kin, previous address, emergency contact and authorised representative.”
“Editorial note: Processes will be established to ensure that recognised healthcare systems will conform to NEHTA e-health policies.”
“5.5 Privacy Framework
The privacy framework will determine how privacy rights and responsibilities between UHI participants will be established and maintained, and therefore underpins privacy aspects of the service. It will apply to providers’ access and use of individual personal information, and providers’ use of provider information. Individuals cannot access other individuals’ information.
Trust is critical to the success of the Unique Healthcare Identification Services because the overall benefits of e-health cannot be achieved without a high rate of adoption. That high rate of adoption will not be achieved without an efficient, effective and enforceable privacy framework.
The UHI privacy framework is currently under development.”
End Quotes.
Third – while it is true the e-Health community are keen to see a usable Health Identification System there is no evidence that the sector and e-health providers are in a position to undertake the extra work involved in change to systems, procedures and policies that will be required by all the users of the systems.
Recent experience with the Medicare Medclaims system suggests reception staff are hardly going to be updating patient demographic details without some financial compensation. I bet these ongoing costs are not factored in.
Fourth it is an odd situation where a private company (NEHTA) non-competitively contracts with Medicare Australia to deliver a service that, on the basis of various other projects they have conducted, might not be the best partner. Just how the public can know they are receiving value for money eludes me.
Fifth to commit a sum of this size without a proven working demonstrable implementation of the planned technologies at a sensible scale would seem foolhardy at best and profligate at worst.
Sixth there seems to be a set of strategic assumptions about who is going to do what in e-Health in Australia that have not been properly surfaced and discussed before a large amount of public money is committed. As Sir Humphrey would say – that is pretty ‘courageous’!.
Seventh the lack of a finalised and agreed privacy framework and privacy impact assessment before contract signing is very poor.
Eighth the plan to have gradual adoption of the service over five to ten years seems hopelessly slow.
Ninth there seems to be no evidence I can find that the proposed concept of operations and technologies are indeed the best and most cost effective to address the identifier requirements – again we have NEHTA saying trust us.
Tenth, I cannot find anywhere the NEHTA plan that is going to prevent a few bad eggs among those with access to the identifiers and demographics of 21 million souls from exploiting this access for crime and profit. This service is at risk of becoming the ID theft database of choice for Australia if not carefully managed.
Eleventh there seem to be aspects of all this that will require legislation at possibly both state and federal level – at least the principles of this should have been available before a contract was signed
Last, the total lack of real public consultation on this proposal is really outrageous. All there has been are long and complex documents published in the NEHTA web site and zilch in the way of public discussion and review. I am sure there are many stakeholders in the health system who would like some input into the final shape of all this
This seems to me to be more of the NEHTA ready, fire, aim approach and to flag a continuing failure to learn the lessons of the BCG report.
The public does not have the information to know if it is buying a ‘pig in a poke’ or not!
A national health ID system is badly needed – but there have to be a lot of questions regarding the approach NEHTA is adopting
David.
Note: Because of breaking news the News Update will be published tomorrow.
D.
6 comments:
The official release doesn’t specify the $$ amount but given the ABC’s earlier reporting error it is reasonable to assume $51 million is probably the ‘number’ until officially qualified.
So, let’s have a closer look at this.
Q-1: Why choose Saturday for a media release?
Q-2: Who ‘are’ the movers and shakers?
Q-3. Where is the money coming from?
Q-4. Is there a need for a ‘tender’?
Q-5. Where are the people coming from to develop the UHI's?
A-1: Joe Ludwig and Nicola Roxon are now working 7 days a week and getting on with the job. The new Government is doing what Kevin Rudd promised ‘work, work, work’.
A-2: The bureaucrats in Medicare. It’s Joe and his people who are in charge here. Nicola and DoHA have been effectively sidelined on this one. I would suggest that even NEHTA has been snookered and lost control on this front although a bit of face saving has been put in place to prevent the mirror shattering.
A-3: Some, if not all is probably coming (or going to come) from NEHTA or what was 'earmarked' for NEHTA for UHI's (half by Nicola and half by the States). BCG reported 'NEHTA' had a substantial underpsend.
A-4: Why! The way NEHTA has been set up it can do what it likes.
A-5: Most of them will probably be coming from the ‘now defunct’ Access Card Project. Why they might even be seconded to NEHTA in some way to work from NEHTA’s new Canberra offices.
So, in effect Peter robs Paul, Ned Kelly rides again, and Medicare leads the way.
The involvement of NEHTA with Medicare in developing a UIN system was done by administrative regulation about 4 months ago - no tenders and certainly minimal publicity. Add this one to the role of NEHTA in the AAPP messaging project (the largest secure messaging tender ever let nationally), and it seems clear that NEHTA has a very wide mandate indeed.
NEHTA does have a wide mandate as noted by the BCG. They pointed out that NEHTA's Constitution was such that it is unlikely that any eHealth objective agreed to by the Board could be deemed technically 'out of scope' for NEHTA.
NEHTA’s budget underpsend was reported as being $60 million (ie. approx 40% of its budget not spent). I recall the reviewers said that much of the funding for the UHI work was still available and would need to be allocated to Medicare for both startup and ongoing services.
Wow - the largest secure messaging tender ever let nationally. Are you sure it has been let?
What is NEHTA's role in the AAPP messaging project? I think the RFP was approx 23 April 2007.
And where are the funds coming from? How much? Whose budget? Is Argus and/or Healthlinks involved or have they been sidelined? And who is the lead contractor?
Makes sense. There were lot of people involved with the Access Card. DHS had to do something with them and NEHTA has had trouble finding technical staff.
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