It has been a really big week for NEHTA in the news.
First we has the recognition in the News Limited press we were all going to get numbered – and it is not clear there was universal comprehension or joy about this.
See here:
Fake patients roll in health numbers game
- Renee Viellaris
- From: The Courier-Mail
- February 17, 2010
Story Summary
- 16-digit health number from July
- Shared electronic health records
- Privacy concerns remain
CONTROVERSIAL guidelines that will allow "well-known personalities" to have fake health ID numbers will be written, starting next week.
Every Australian from July will be automatically issued a new 16-digit health number.
Also known as a "building block", the health number will eventually allow for medical professionals to share patient health files via an electronic health record.
Legislation is now before Federal Parliament to provide for the health number, which will only store names, dates of birth and addresses, but privacy concerns remain.
The Courier-Mail revealed last month that "well-know personalities" and others considered "at-risk" could apply to have two ID numbers.
One of these ID numbers would be a fake to offer another layer of protection.
Commonwealth-funded IT developer the National E-Health Transaction Authority will meet stakeholders next week to begin discussing guidelines on "pseudonymisation".
A NEHTA spokeswoman said yesterday the guidelines would determine who could be granted fake IDs and who could grant them.
She said it was likely the guidelines would heavily restrict who could be eligible.
The ability for "pseudonymisation" was needed because of guiding health principles, the spokeswoman said.
Defending the plan and in a bid to alleviate privacy concerns, Federal Health Minister Nicola Roxon said the identifier numbers would not be abused.
"The Healthcare Identifiers Bill specifically prohibits the use of the Individual Healthcare Identifiers for anything other than the delivery of healthcare services or related services, such as the management of the health service," Ms Roxon said.
"Further, the Bill also provides specific penalties for the use of Individual Healthcare Identifiers for any purpose other than this."
More here with comments from public.
http://www.news.com.au/national/fake-patients-roll-in-numbers-game/story-e6frfkvr-1225831155324
And here:
Patients have no choice - a health number ID for us all
- By Sue Dunlevy
- From: The Daily Telegraph
- February 17, 2010
YOU are going to get a unique 16-digit health ID number on July 1 - whether you want one or not.
This is a despite a Rudd Government promise the new "e-health" system would be on an opt-in basis.
You can opt not to have a tax file number but a spokeswoman for Health Minister Nicola Roxon yesterday confirmed you will not be able to opt out of the new health identity system.
At first the new health ID number will not hold information but eventually the Government wants it as the basis for a new electronic health record.
Patients will be able to decide whether they have an e-health record that will give doctors around the country access to information on medical tests, operations and other health information of a patient.
This will revolutionise the health system, make it faster and easier for doctors to get test results and improve patient safety by making medication mix-ups less likely.
However, there are concerns that future governments may decide to extend the use of the new e-health number beyond its initial purpose.
In l987, the Hawke government scrapped a project for a national identity system called the Australia Card after it proved unpopular.
Independent Senator Nick Xenophon said the new e-health system had benefits but wanted a Senate inquiry to examine any privacy concerns carefully.
"I can see it would be tempting for governments to use it for more than its intended purpose," he said.
More here:
They even noticed in Europe:
Australia to mandate health ID number
17 Feb 2010
The Australian government has said it will mandate a new national e-health number for all citizens.
The move to mandate the unique 16-digit health ID number, to be introduced from July, comes despite an earlier Government promise the new "e-health" system would be on an opt-in basis.
While the new health ID number will not hold information, it is intended to form the basis of a planned new system of electronic health records.
More here:
http://www.ehealtheurope.net/news/5648/australia_to_mandate_health_id_number
Then we had the Fairfax press discovering we were not going to be able to control the sharing of our health information.
Electronic health record takes first tiny step
MARK METHERELL
February 17, 2010
THE promise that patients will control their medical records in the federal government's proposed electronic health system remains uncertain despite the introduction of ''foundation'' e-health legislation.
The first stage of the scheme, to take effect on July 1, will give every Australian a 16-digit identifying number, known as an individual healthcare identifier (IHI).
The goal is to create a single electronic process to allow doctors and others to identify patients and access their medical records.
A patient's control of who could view their records was highlighted as central to the success of the scheme in a report by the National Health and Hospitals Reform Commission last July.
''An electronic health record that can be accessed, with a person's agreement, by health professionals across all settings is arguably the single most important enabler of truly person-centred care,'' the report said.
But the National E-Health Transition Authority, the body responsible for the first stage, said it was still to be decided how access control would work.
Peter Fleming, the authority's chief executive, said that while the broad outline of the scheme was agreed, the Council of Australian Governments was yet to approve how the rules governing the new record would work.
Nathan Pinksier, a clinical adviser to the authority, said it was difficult to enable patients to block certain health providers from seeing sensitive information that others, such as their doctors, should know.
''These are not easy questions,'' Dr Pinskier said.
There were several potential ways of quarantining patient information. Final selection would be part of a gradual process as the new system would take a few years to introduce.
Widespread differences between existing patient identification schemes throughout Australia have led some in the health industry to be sceptical about the time it will take to implement a new system.
A government official said it was possible the Council of Australian Governments would decide on the next stage of the scheme this year.
More here:
http://www.smh.com.au/technology/electronic-health-record-takes-first-tiny-step-20100216-o8zp.html
Here we have two important pieces of information. One is that the HI Service is a prelude in NEHTA’s mind to an EHR service and second is they have yet to work out how health information is going to be segmented, stored and protected.
Next we learn that the software industry has been kept outside the tent as all this has been planned and developed.
Software firms ill-informed on health ID plan
- Karen Dearne
- From: The Australian
- February 16, 2010
SOFTWARE makers are yet to see full technical specifications for the planned healthcare identifier regime due to start on July 1 provided enabling legislation introduced by Health Minister Nicola Roxon last week is passed by parliament.
The Medical Software Industry Association says members are also yet to see a working demonstration of the system, developed by Medicare Australia in conjunction with the National E-Health Transition Authority.
Under the program, to be operated by Medicare, all patients, medical providers and healthcare organisations will be issued with an individual six-digit number.
Unique identifiers are an essential base for greater use of electronic communications across the health sector, and will be a platform for the future development of individual e-health records.
But MSIA president Geoffrey Sayer said software-makers were in the dark about changes they would need to make to their products, beyond knowing to allow for a number in forms and databases.
"No one in the vendor community has actually seen the e-health community model, and no one actually knows what's involved in its set-up, which I find slightly odd given vendors are supposed to be rolling it out," he said.
"We've asked for the technical details several times and we've tried to source the information from what's available in the public domain, but we still haven't got a clear document that shows us what is supposed to happen."
A NEHTA spokeswoman said yesterday a special vendor day would be held at its Model Health Community demonstration site at Medicare's Canberra headquarters on February 26.
NEHTA chief executive Peter Fleming conceded in an interview with The Australian last month that the healthcare identifier system was built without input from local industry, but said engagement with the private sector was now being addressed.
More here:
Against all this we have the Australian Information Industry Association saying – on the basis of some rather uncertain link between broadband rollout and health productivity and apparent prior briefings that have told them what is in the critical regulations that will support the HI Service legislation - that all is wonderful. Maybe they should have a closer look at the details and expert reaction before they sound off.
See here:
February 19 2010
Healthcare bill a positive step
By Ian Birks*
AIIA is a strong supporter of the Healthcare Identifiers Bill, recently tabled in Parliament by Federal Health Minister Nicola Roxon. The aim of the bill is to introduce nationally consistent healthcare identifiers that will improve the accuracy of health records by ensuring that the right information about the right patient goes to the right place.
With a planned implementation date of July 1, the introduction of healthcare identifiers would deliver the foundations for a much wider range of electronic health care initiatives across the sector by supporting information flow between healthcare providers -- creating improvements in planning, co-ordination and decision-making at all levels.
E-health strategies have seen a long process of development in Australia, and it is now very important that we act consistently to implement planned activities. Delays in implementing national e-health strategies will only lead to higher costs as these issues are inevitably addressed in the future.
There are no strong arguments against the implementation of the Healthcare Identifiers Bill. Healthcare identifiers contain no clinical information. Clear mechanisms are in place to address privacy concerns.
In fact, NSW alone currently has 20 separate identifiers in place. Eliminating that level of duplication though a single national program that offers consistency at both the federal and state levels is essential if Australia is serious about improving the productivity of the healthcare sector.
The right technology strategies will be critical to improving the efficiency of healthcare on a national scale. Yet the levels of technology investment found in other parts of the Australian economy have not been seen in healthcare. ICT investment across healthcare industry sits at around 1.5 per cent, compared with an average of 2.5 per cent in the wider economy. Moreover, the health sector will be a critical component of Australia's economic growth in the future as we set out to develop a genuine digital economy.
.....
*Ian Birks is CEO of the Australian Information Industry Association www.aiia.com.au
----- End extract.
In the professional medical literature we also saw a long article on how we are moving towards a personal electronic health record.
All wired up
18-Feb-2010
The Federal Government wants all patients to have a personal electronic health record by 2012 – and it’s GPs who will hold the key to its success or failure. By Sarah Colyer
DR Mukesh Haikerwal is on a mission to convince GPs that it is worth their efforts to make e-health a major part of the health system.
Rarely a week goes by when the former AMA president is not making an impassioned presentation to a gathering of GPs somewhere around the country on how IT is critical to health reform.
As the principal GP adviser to the National E-Health Transition Authority and a commissioner on the Federal Government’s National Health and Hospitals Reform Commission, Dr Haikerwal is one of Australia’s most well-informed GPs when it comes to e-health.
The reform commission recommended that by 2012 every Australian should be able to access a personal electronic record of their own health information.
Most controversially, it said GPs and other health practitioners should be able to send information to the record by 2013 or they could lose access to Medicare benefits for their patients.
It’s tough, but Dr Haikerwal has no doubt it will be better for patients.
Speaking at a GP function in Sydney late last year, he tried to pre-empt the local doctors’ concerns.
He’d heard some were worried the Person-Controlled Electronic Health Record (PEHR) would strip them of control of their own clinical records. Others doubted they could trust a patient-controlled system, and some were concerned about what it would mean for patient privacy.
Dr Haikerwal stressed that GPs would still own their records. The electronic health record would not contain the GP’s clinical notes, just a summary of vital information. There would be an audit trail to show when information was recorded and viewed and by whom, and GPs would be able to upload information to the record “at the push of a button”.
As for how GPs can be sure the record is up to date, Dr Haikerwal said they simply couldn’t. “But even today, health professionals are aware that records may not be complete. That doesn’t mean they are not worthwhile,” he said.
But Dr Hani Bittar, a western Sydney GP, remains unconvinced.
He has seen a similar system fail — the Healthelink pilot in his region. The internet-based system, hosted by NSW Health, was supposed to share patient data among GPs, hospitals, specialists and pathology providers using the internet.
But Dr Bittar says it has been nothing but a waste of time.
“It slowed our computers down dramatically, we got no support and the hospitals didn’t want to be involved,” he says.
Dr Bittar says some information is best shared only among doctors. He recounts the story of a young female patient who spent a weekend worrying she was going to die after opening an envelope containing normal results from a liver function test.
“Patients are not qualified to read the kinds of things that will be open to them in an electronic health record,” he says.
On top of this, he has his own suspicions that the electronic health record will evolve into a national identity card.
However, Dr Haikerwal says in some ways the national electronic health record is not dramatically different to the paper-based systems that are already starting to fade away.
Dr Haikerwal was recently cleaning out his office drawers when he found a paper version of a shared record he created in 1992 to give to patients, containing a summary of past test results, allergies and medications.
“It was a very useful process when the patient went to hospital, and it helped them and me to get feedback, but it took an awfully long time to put together,” he says.
“To be able to get information that is up to date, accurate, and from a trusted source on which I could act — and vice-versa so that the hospital could act on my trusted word — would help the patient on their journey and would stop me beating my head against a wall.”
DEFINING A NATIONAL ELECTRONIC HEALTH RECORD
THE exact nature of the “national electronic health record” is hard to pin down.
It was not long ago that the Federal Government and its e-health taskforce, NEHTA, were talking about building a centralised database containing the health records of all Australians — a prospect that horrified privacy advocates.
But in a media interview a few months ago, NEHTA CEO Peter Fleming said the original vision had been abandoned in favour of “person-controlled records”, which would be quicker to deploy. provider and healthcare organisation.
Much, much more here (if you can access Australian Doctor):
http://www.australiandoctor.com.au/articles/cb/0c066ecb.asp
The key point you find here is in the bold paragraph.
Even journalists covering this story can’t actually work out what is planned. Heavens help the public!
A day or so we then had this after NEHTA tried a sell job on the journalists with a visit to Canberra, some briefings and then a nice meal.
Long road to e-health record rollout
- Karen Dearne
- From: Australian IT
- February 19, 2010
AN updated business case for a national e-health record rollout is being prepared for the Council of Australian Governments, but there is no guarantee the project will be considered this year.
National E-Health Transition Authority chief executive Peter Fleming said the business case for Individual E-Health Records (IEHR) "has been built, and it clearly ties into the government's overall health agenda and recommendations from the National Health and Hospitals Reform Commission".
"But (funding) is a COAG decision, and then obviously it is up to government in terms of timing (for rollout)," Mr Fleming said. "I am optimistic the case will go to COAG at some stage this year, but I cannot give you a timing on that."
The original IEHR business case, completed in October 2008, estimated the set-up cost of a national e-health record system at $1.6 billion over four years, but warned Australians would pay a high price for further delays.
.....
In Canberra this week, NEHTA clinical lead Mukesh Haikerwal said the current business case was aimed at creating shared record summaries, rather than "a complete health record with everything available".
.....
Media representatives were given a tour of the Model Health Community set up by NEHTA and Medicare Australia to demonstrate the potential operation of the planned national Healthcare Identifier service, if enabling legislation is passed by federal Parliament.
Under the proposed law, all Australians will be issued with a 16-digit unique e-health identity number, linked to existing Medicare numbers, while all medical providers and healthcare organisations will be given 16-digit electronic identifiers based on professional accreditation and location registries.
No personal health information is to be associated with the identifier, although the service will maintain name, address, date of birth and certain demographic details.
.....
Dr Haikerwal said provider authentication and audit logs of access to individual records would make the system more secure than current practices.
Much more here:
I hear that sadly the demonstrations were more like foilware and that the general tone of the discussions with the journalists was sceptical in the extreme – reflecting the earlier take from News Limited and Fairfax reported above..
The bottom line is that no-one knows what the new business case is seeking, no one knows where the HI Service is actually up to and we have some quite confusing things being reported.
It would be a very good idea if NEHTA were to actually put out a detailed release that defines just what is going on, where things are up to and what we can all expect over the next year or two. Right now we are in a NEHTA Media created fog.
On a related topic this appeared a few days ago
Commentary
7:25 AM, 15 Feb 2010
Robert Gottliebsen
More than Canberra can chew
The Peter Garrett insulation bungle is a symptom of a deep public service management problem in Canberra. It has already engulfed Penny Wong and Julia Gillard could be the next victim.
I must emphasise that I am not in the business of excusing ministerial mistakes, and Garrett and Wong could have done a lot better in handling their tasks and they have clear responsibilities under the Westminster system.
Nevertheless, the public service in Canberra is being asked to undertake tasks where it has little experience and that inexperience is contributing to the ministerial bungles. Penny Wong is lucky because opposition leader Tony Abbott is concentrating on the big picture in the emissions trading legislation. If he or his Climate Change Shadow Minister Greg Hunt ever begin to tackle the detail of the emissions trading legislation Penny Wong would be exposed.
.....
Julia Gillard is a brilliant performer and she has handled the problems that have so far arisen in her schools building problem with the professionalism you would expect.
.....
Both Kevin Rudd and Tony Abbott are thinking up all sorts of ideas to give the public service in Canberra even more work to do as part of centralisation. Where the public service is operating in areas where it has proven expertise, ministers can look very good. But once the public service moves into new areas, it struggles and so do the ministers.
I know one or two ministers with good departments who regard this as the greatest long-term danger the government faces. What has happened to Peter Garrett – and what would happen to Penny Wong if the opposition focused on the emissions trading legislation detail – is merely a sign-post of what is ahead.
Full article here (registration required)
Never were truer lines written. We are seeing a national government really struggle with implementation of a lot of programs and from the evidence in front of us both NEHTA and DoHA should be pretty nervous they might be next to be found to not be all that good at program delivery.
We mentioned this issue a few days ago and I am hearing more and more on the topic. Insiders on ABC 1 also mentioned the issue.
See here:
http://aushealthit.blogspot.com/2010/02/life-matters-radio-national-18-february.html
Overall, it looks to me like NEHTA has not only lost effective t control of the HI Service implementation but also it has now lost control of the public debate. That will not be easy to recover from.
David.
WHAT !
ReplyDelete* guidelines on "pseudonymisation"
* who could be granted fake IDs
* who could grant fake IDs
* The ability for "pseudonymisation" was needed because of guiding health principles
Have you ever heard so much crap in all your life? Bureaucracy gone completely stir crazy. What a farce.
Hello Doctor I’ve come to see you today but I’m not really who you think I am because I am hiding in your system as someone else. You see doctor, because I am a very important high profile public figure who everyone recognises I have been subjected to this amazing process where I have been pseudonymised so that people who think they know me don’t really know me because I am not who I am.
What’s that funny noise in my ears doctor? A what- a siren. Oh, that’s very kind of you doctor. But I drove here and I will find my own way home thank you.
From what I recall, standards do allow for pseudonymisation to be catered for so its not crazy talk. Its a matter of how they are implemented that is important!
ReplyDeleteISO/TS 25237:2008 Health informatics -- Pseudonymization
ReplyDeleteCurrent project with Standards Australia (Project Title 9002)
Standards do allow for it - no question. The issue is how it is implemented and how well it is explained to a rather skeptical public.
ReplyDeleteHave NEHTA said they are conformant with current Australian Standards? I am not sure but I am sure some one will tell us.
The bigger point is that there are headlines out there that make it difficult to justify to the masses - when it is critical the capability in a sensible form exists.
David.