NEHTA Fantasises About What it Will Deliver with the HI Service.

The following lobbed today. Comments in italics in the text.

Healthcare Identifiers Bill 2010 marks e-health progress

10 February 2010.

A major step towards the implementation of a national e-health system occurred today with the introduction of the Healthcare Identifiers Bill 2010 into the House of Representatives.

The Governments Bill represents the culmination of more than a decades work in developing a framework for the introduction of e-health in Australia across different jurisdictions and with the assistance of professional bodies.

Comment: What what do we think NEHTA means by the introduction of e-Health? NEHTA has been around for 5 years and what are the changes they have delivered? And what exactly is the “e-Health System” they are talking about? Would be good to see the end state that is planned so we can all decide what we think about it. Is an IEHR involved and how is this to work?

The legislation provides for the introduction of a unique identifier which will allow all Australians to have their confidential medical information transferred electronically between health providers.

Comment: Yes, we all get a compulsory number and as far as I read there is no choice in this. I am not sure I want another identifier and why was I never asked? Non-consent in e-Health has been strongly associated with project failure in my experience.

One of the features of the legislation is a guarantee of patient privacy and doctor-patient confidentiality including audits of access to the system and penalties for breaches of privacy.

Comment: How is doctor patient confidentiality changed by all this? We know it will be years before all health providers (and their staff) will have secure identities issued, so what happens while all this –which is not planned or funded as far as the public knows- happens?

National E-Health Transition Authority chief executive Peter Fleming said the legislation would have the effect of improving the safety of patient records and over time provide significant improvements in treatment of patients, particularly those with chronic illnesses.

Comment: And the evidence for this is? And the evidence that this system will deliver is? There is none that what they plan will work (they have never tried it) and they are just in unproven fantasy mode. A serious pilot and evaluation might help – but this just not planned as far as we know.

“We believe the new system will be a vast improvement on the current system where paper records can be damaged or go missing and practitioners often spend large amounts of time locating, collecting and analysing medical records from other providers,” he said.

Comment: The HI Service is about identifiers, so how is this related to that paragraph unless there in an attached EHR which at present is not planned or funded. Indeed it seems to be denied this is the plan!

“This can lead to huge duplication and added cost to the system and frequently results in unnecessary repetition of tests and procedures.”

Comment: This all assumes comprehensive EHRs are in place everywhere. Not that we have seen this so far. Local systems can provide most of the possible benefits without the huge central infrastructure.

Mr Fleming said privacy was paramount and the new system will have a number of built-in safeguards including the feature that the new healthcare identifiers will not contain any medical information.

“The identifier allows the system to ascertain the identity of a patient, but in itself it carries no medical information,’’ he said.

Comment: So all this has no Health Information attached but will make a dramatic difference to the handling of health information. If you believe this well..

ENDS

The full release is here:

http://www.nehta.gov.au/media-centre/nehta-news/597-hibill

Even now there is no clear discussion as to why any single provider or software provider would adopt all this, given the cost in time and inconvenience.

I believe this project will be DOA without careful piloting and evaluation – and then modification on the basis of the findings. This assumes NEHTA will not review a range of alternatives we know exist to solve the problem without a ‘great big’ centralised ID database.

Fantastic thinking is alive and well at NEHTA if they think this can all roll out and work nationally over the next 6 months! If this is not the plan, maybe they could tell us what the plan actually is?

David.