Really the right and left hands of e-Health in Australia seem to have become totally out of touch and connection with themselves and their clients – the Australian Health System.
First, we have this report from a few days ago.
Health identifier not legal till next year
16 March 2009 02:06 PM
The legislation changes required for the national use of an individual health identifier won't likely be completed until mid next year, and that's only if the federal election doesn't become a hurdle, according to National E-health Transition Authority (NEHTA) CEO Peter Fleming.
"I think realistically by the middle of next year we should have the legislation in place to support this. Pragmatically I understand next year is probably going to be an election year and there's a little bit of difficulty around that. So it's something that we need to monitor very carefully," Fleming said, speaking at the IIR National Telemedicine Summit in Sydney today.
The chief executive has touted this year as the "year of delivery" talking about bringing significant pilots on line in the fields of discharge referral and medication management, and having the technical requirements for an individual health identifier up and running.
There has also been work carried out on how to securely move information from A to B.
However, in order for any systems to be populated with personal data, there needs to be consultation on privacy and information sharing issues.
At a recent conference of Australian health ministers, the ministers said it was "essential" that privacy arrangements meet community expectations, balancing the need to protect personal details with the ability to achieve healthcare benefits through sharing of information and agreed that further consultations were required before an individual health identifier could get off the ground.
Now as reported on the blog a week or so ago here:
We have this from the Senate Estimates of the 25th of February, 2009 we have:
“Senator BOYCE—So by the end of the year we should have the unique identifier?
Ms Halton—Yes, we should.
I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!
This was then followed by this:
“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.”
Seems to me here we have a Secretary of the Commonwealth Department of Health and Ageing being publicly repudiated by the CEO of NEHTA as far issues of credibility of implementation time frames for core NEHTA projects.
Worse still we have NEHTA suggesting it might need to arrange, similar to NSW with HealtheLink, some abrogation of privacy principles to move forward.
“Despite the slow movement of legislation changes, NEHTA is keeping its plans for pilots on a "reasonable scale" and has been talking to various bodies to see what parts of the identifier can be implemented to support the pilots. "So it might be through a series of consent agreements, it could be through some kind of ministerial decree," Fleming said.”
Here we see an example of the problem of the fractured governance of e-Health in the ‘unlucky country’!
We have the Commonwealth Department fantasizing about how quickly things will move and we have NEHTA (a private limited by guarantee company) hoping to use ministerial fiat to ignore established and proposed privacy legislation.
The last thing that is needed is to get the privacy and patient advocacy lobbies wound up and unhappy just because of some artificial time-lines that would not be a problem if NEHTA and DoHA had done a better job of forward planning – knowing as they have for at least the last year that legislation to enable the IHI would be needed.
And in the last week we discover that DoHA has what it thinks is a good idea on ePIP, and with not much more than a week or two’s notice to both NEHTA and the software providers, announces a rushed new program.
And we also have the unseemly lack of co-ordination of e-prescribing as a third example of national governance failure:
This really is a case of once is an accident, twice is a co-incidence and three times is enemy action!
The problem in all these instances is that we lack a single entity planning and delivering e-Health in Australia and until this is created (as recommended in the Deloittes National E-Health Strategy) we will remain in this abysmal mess.