The E-Health Policy Confusion Just Rolls On! It Has Deteriorated into Farce!

Just when you thought you could have a quiet Queen’s Birthday weekend sleep-in you find – on the News Radio review of “What’s in the Papers” - that the Courier Mail is writing about e-Health. Taking your morning coffee down to the computer you quickly notice the following article.

Privacy groups fear 'Medishare' card scheme

Renee Viellaris

June 08, 2009 12:00am

PATIENTS' private medical files will be shared among health professionals under a Rudd Government plan for a contentious healthcare card.

From the middle of next year, the Medicare card will provide doctors, dentists, pharmacists and paramedics with an encyclopedia-like file on patients' medical histories, medications and treatments.

Health Minister Nicola Roxon said patients would receive better treatment, as medical errors and the expense of performing lost tests were slashed.

"We've made a decision that every Australian will be allocated a unique health identity," Ms Roxon told The Courier-Mail in an exclusive interview.

"It would be a card, most likely with a chip that would store your information on it, which you would then provide to health professionals and give them access to it when you wanted them to see it."

While the medical community has given cautious support to the plan, privacy bodies want certain safeguards attached.

.....

Ms Roxon said privacy was a concern for the public, so the model would be patient-controlled and patients would determine who could view their files, with the exception of paramedics.

"I think it would need to make sure there is a mechanism for emergency services staff to be able to access it without your permission, because obviously you may not be able to when the ambulance arrives," she said.

Ms Roxon said she expected the National Health and Hospitals Reform Commission to make strong recommendations for e-health in its final report this month.

.....

The full article – and 57 comments as of 1:30pm – are found here:

http://www.news.com.au/couriermail/story/0,23739,25601319-952,00.html

All the commentary from the AMA, the Privacy Commissioner etc can be read on the Courier Mail and I have concentrated on the Health Minister quotes in this excerpt.

The 57 comments also make for pages of fun reading!

I really wonder if Ms Roxon has the least clue as to what she has just said?

If the quotes are accurate – and I have no reason to think otherwise –the Minister has just re-defined the national E-Health strategic direction in a quite amazing way. She is saying the patient held record will be held on a smartcard that the patient would hand over to their doctor when they wanted to share their health information.

She also seems keen to have paramedics be able to over-ride any access controls, assuming they can find the card of course. Remember many paramedic responses are to people’s homes where it may be no means clear just where the card is to be found.

The answer to the question of what the doctor is to do if the patient refuses access to the card is moot. Back to veterinary medicine I guess – or vastly over-ordering of tests.

This is quite a change from just one year ago when NEHTA said in the IHI FAQ.

Will I need to carry a card as proof of my IHI?

No, you will not need to carry any proof of your IHI on a token, such as a card. Your healthcare provider will be able to retrieve your IHI from the eHealth Services using your demographic information, e.g. name, address, and date of birth. Although proof of your IHI will not need to be carried, healthcare providers may still wish to confirm your identity as they do today.

See:

http://www.nehta.gov.au/component/docman/doc_download/286-individual-healthcare-identifier-faqs

Undefined – as with the NHHRC proposal – is the source of information to be placed on the card. Again it seems the provider community will be expected to load the card with information?

What is overlooked in all this is that there is a whole infrastructure required first to accurately identify patients, issue cards, load cards with relevant information, maintain the information, provide secure card readers etc. The list just goes on and on.

I wonder has Ms Roxon considered the cost of smartcards that can handle a complex medical history with documents, images etc. If that is not what is planned then we are really talking about a massive central database with access controlled from a patient held smartcard.

Large database or slightly smaller one (see below) none of this will be cheap. We are talking $billions here – as we know from even the basic costs of the now dis-guarded Access Card project.

Inevitably there will have to be, at a minimum, a central database to backup the information held on the cards so cards can be re-issued, refreshed and recovered if needed after being lost, eaten by the dog or whatever! Additionally there will need to be a backup the history of the information held on the cards for medico-legal purposes (When I scanned the card it said this not that etc).

Of course, as soon as there is a central database all the various privacy concerns become very live. You only have to read the now 66 comments (more added as I typed) to see all those issues well and truly exercised.

For all the details on NEHTA’s e-Health ID plans go here:

http://www.nehta.gov.au/connecting-australia/e-health-id

The governance and planning of e-Health in Australia has now deteriorated to a total fiasco. We have NEHTA, the Minister, Deloittes and the NHHRC all with different perspectives and plans.

Heaven’s above what a mess.

David.