Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Saturday, March 13, 2010

All Their Own Work - Comments from The Senate HI Service Enquiry You Really Don’t Want to Miss.

I thought it would be fun to collect up a few highlights from the Senate Enquiry. This lot are from Day 1 – March 9, 2010. Italics show the really fun bits – sorry it is so long but context is important.

The full transcript is here:

http://www.aph.gov.au/hansard/senate/commttee/S12875.pdf

Senators in attendance: Senators Adams, Boyce, Carol Brown, Fierravanti-Wells, Furner, Mason, Moore and Siewert.

Terms of reference for the inquiry:

To inquire into and report on: Healthcare Identifiers Bill 2010.

WITNESSES

BENNETT, Ms Carol, Executive Director, Consumers Health Forum

CURTIS, Ms Karen, Australian Privacy Commissioner

FLEMING, Mr Peter, Chief Executive Officer, National E-Health Transition Authority

GRAVES, Dr Debra, Chief Executive Officer, Royal College of Pathologists of Australasia

HAIKERWAL, Dr Mukesh, Chief Clinical Lead, National E-Health Transition Authority

KEARNEY, Ms Ged, Federal Secretary, Australian Nursing Federation

McCAULEY, Dr Vincent, Treasurer and Immediate Past President, Medical Software Industry Association

McKENZIE, Associate Professor Paul, President, Royal College of Pathologists of Australasia

PESCE, Dr Andrew, President, Australian Medical Association

PETTIGREW, Ms Lisa, Director, Health Services, Computer Sciences Corporation

SAYER, Dr Geoffrey, President, Medical Software Industry Association

SOLOMON, Mr Andrew, Policy Director, Office of the Privacy Commissioner

SULLIVAN, Mr Francis, Secretary-General, Australian Medical Association

WISE, Ms Anna, Senior Policy Director, Consumers Health Forum

Here are a few selected highlights:

Page 9

Senator BOYCE—We have talked about the rollout and you have talked about getting to phase 2. But weare talking about 1 July for a rollout which I think is phrased as being ‘in south-east Australia, with something less than a big bang is how this will start’. Do you think that needs to be more specifically set out? Can you give us the time frame for the rollout.

Mr Fleming—The issue here is not the technology. The technology is the tip of the iceberg. We are talking about a major change management process. Over 800,000 people work in health care in Australia and there are many systems, some large and some small. We need to manage this process in a holistic way. So, when I talk about not operating a big bang, I mean that it will be a series of small-scale projects to start with, leading up to probably the first 18 months, when we would be looking at substantial rollout programs. But the intention in the initial phase is small scale, making sure we have it right and then expanding from there.

Senator BOYCE—When will the timetable for that rollout be?

Mr Fleming—We are working closely with all of the jurisdictions at the moment.

Senator BOYCE—Jurisdictions being the states and territories?

Mr Fleming—Yes. Individual projects have been identified with each, and they are being locked down with the states and territories as we speak.

Senator BOYCE—So will you be starting in several states?

Mr Fleming—Absolutely. I will give a couple of specific examples.

Page 10

Senator BOYCE—That is, again, throughout south-east Australia?

Mr Fleming—All around the country. Rather than ‘pilots’ I should say that they are small-scale initial implementations.

Senator BOYCE—Small scale, sorry?

Mr FlemingThey are small-scale initial implementations. We have the intention of scaling them up once we have trialled them.

Senator BOYCE—Is the initial implementation actually using real patients?

Mr Fleming—Real patients, real data; yes. So from the middle of this year you would expect a program along those lines for about 18 months and then, all things being equal, a ramping up to full scale.

Page 10

Senator BOYCE—Can I ask why you are doing the different pilots in different areas rather than doing the whole program in specific areas?

Mr FlemingIn fact, that is the intention. Phase 1 is running a specific pilot in a specific area and getting it right. Phase 2 would then simply be to say: ‘Okay, in this area we’ve trialled this component. Now, let’s overlay components 2 and 3 and see how that package works.’ Once we have got that right, phase 3 would be a larger-scale implementation that is building up. It is cognisant of just how complex our environment is and it is also cognisant of the fact that we need to think holistically here and make sure, not just from a technology perspective but from a business process perspective, we get the end-to-end processes working effectively.

Page 12

Mr Fleming—We have used the Medicare system as the basis to start building the database, and Medicarewill run this system for us. As I mentioned, when you or I go into a GP practice, the link will be made through the Medicare number. But it is a separate database and it is a separate number.

Senator MASON—The Medicare number is linked to the health identifier number, isn’t it?

Mr Fleming—We have used the Medicare basis as a start to build the database. But the Medicare number is not unique.

Senator MASON—It is not unique, but it is not bad.

Mr Fleming—Yes, absolutely.

Dr Haikerwal—The number is just that—it is the number. Medicare is the mechanism to generate and pull that number into a system and to find out what that number actually is. But it is not actually on the card. Again, neither the Medicare number nor the IHI number directly contains any health information.

Senator MASON—But the Medicare card has a number on it, and that is linked to the other number.

Dr Haikerwal—When you come to a practice, you can, using your card, have your number populate the GP’s system with your IHI. But it will only give you that number if the person putting in the request has all the details right. So, on top of the Medicare number, you actually need a name properly spelt and a date of birth properly put in, so that you know you are getting the right person.

Page 14

Senator FIERRAVANTI-WELLS—Do you have any view on the review of the legislation? It is to be reviewed on 30 June 2013. Do you have any view on whether that should be brought forward?

Mr Fleming—In relation to the discussion we had around the rollout and that this is not a big-bang implementation, 2013 is very appropriate. By that stage we will have a good view of how it is rolling out and how the service providers are delivering.

Comment: Note that the Review Date is over three years away.

Page 15

Senator FIERRAVANTI-WELLS—At what point does your organisation disband? Where is your sunset, if I can put it that way?

Mr Fleming—NEHTA was created in 2006 through COAG funding. In December 2008 there was further funding for NEHTA of some $218 million through the Council of Australian Governments. That takes us through until the 2012 financial year. Clearly, if the larger business case around electronic health records is approved there is a potential life for NEHTA beyond where it is today. But the specific answer to that question is that today our existence goes through to 2012.

Comment – One has to wonder what happens then....

Page 16

Senator ADAMS—Is there a subsidy for general practitioners to actually get the additional equipment or to get their equipment up to the standard that it should be to be able to deal with this system?

Dr Haikerwal—One of the recommendations of the commission was very much that. Obviously there are some structural changes that need to be made to the system, and benefits and so on need to reflect that potentially. On the other side, there is a very clear understanding that the cost of providing the services is actually borne by the providers—the healthcare professionals—and the benefits are actually gained by everybody else. Now, as health professionals, we like our people to get better and we like to make sure we get more effective at what we do, but there is a very real cost which is reflected in the discussions and the reform agenda from the commission and also in the business case that COAG will be looking at. That will be flagged, I believe, as one of the important builders of the health system because this is something that people need to understand. There is a cost to be borne. It is not the full cost but it is some of it.

Page 20

Ms Curtis

.....

Thirdly, it is appropriate to talk about the choice and control individuals will have in relation to the healthcare identifiers. A key underpinning of privacy law generally is the idea of choice and control wherever possible. As the committee is aware, the Council of Australian Governments has decided that a unique healthcare identifier will be created for each person receiving health care in Australia. There is no choice in allocation. But this is a good example where, on balance, there are very good public policy reasons for the allocation, given the expected improved healthcare outcomes and efficiencies. But, while we will not have a choice about whether a health identifier will be created for us, we will have an appropriate level of control about how the identifier will be used. As my office understands it, individuals will be able to gain access to the healthcare identifier. Where access is provided by the HI service operator, this information will include the limited identifying demographic information associated with the healthcare identifier and an audit log of who has accessed their identifier. Also, as we understand it, individuals will not be refused health care because they do not have a healthcare identifier and will still be able to access healthcare services anonymously or by using a pseudonym, as per current Medicare arrangements. In addition, my office’s oversight role under the legislation will cover audits of the HI service operator, compliance activities relating to the handling of healthcare identifiers’ own motion investigations and investigating direct complaints about any misuse of healthcare identifiers. My office will also provide an annual report to the minister and parliament on compliance and enforcement activities.

Finally, in recognising that there is some community concern about the use of healthcare identifiers, I ask that there is a targeted, educational campaign by all Australian governments which includes information on the limited uses for healthcare identifiers and the privacy safeguards that are being put in place. A well informed public will help to build trust and confidence in the scheme and ensure the effectiveness for the community. Thank you.

Senator FIERRAVANTI-WELLS—I asked earlier about the review of the legislation. It is currently to be on 30 June 2013. Are you, from a privacy perspective, happy with that?

Ms Curtis—I am very pleased that the legislation is going to be reviewed. I do think it is appropriate to wait quite a few years for the rollout because, if it does commence on 1 July, not all people will be allocated immediately. It will take a while for the system to be in operation. I would like to have at least a full two years of operation before the legislation is reviewed.

Comment: There is confusion about roll out timing it seems.

Page 32

Dr McKenzie—We feel that the actual identification number probably presents significantly less risk than amalgamating all of the patient’s data. I think the security and access control of electronically stored medical records is absolutely critical and should be of the highest quality. The college believes that implementation and the national healthcare identifier should not be restricted by concerns to the risk of patient privacy if they have been adequately addressed by confidentiality safeguards and strong regulation of access.

Finally, we have a couple of concerns about the implementation phase. We understand that the unique health identifier will not actually be available on the patient’s Medicare card or on the written referral. We are concerned it would break down the identity chain, if you like, for specimens and request forms if we do not have that identification available with the specimen at the time that it is being accessioned into the laboratory.

We would really like the opportunity to work with the people who are developing the policy on that detail in order to consider having some kind of encrypted or bar-coded transmission so that it is not necessarily available except securely through the laboratory. We have 50 million episodes coming in just through Medicare, and transmission of that electronically would be really useful. We are particularly concerned about transcribing a 16-digit number and the potential of that to lead to errors.

CHAIR—Was there a second concern, Dr McKenzie?

Dr McKenzie—That is our main concern. We would like to work with NEHTA and Medicare Australia on those issues. In conclusion, we are very supportive of the identifier. Patient identification errors are the commonest form of laboratory error and can be extremely serious. We believe that a unique patient identifier will save lives and prevent negative patient events. The identifiers have the potential to reduce test duplication and the need for recollecting samples. We do not believe that on its own it is a threat to privacy, as long as stringent protections are put in place to cover the comprehensive e-health record. The only other point is the implementation issue that we want to work through.

Page 40

Dr Pesce—Yes, I will do that if that is okay. Thanks for the opportunity to appear before you today. Firstly, the AMA is very keen to see these bills passed. Healthcare identifiers are a fundamental building block for sharing health information electronically, and as a result we want to go forward with this. We are satisfied with the content of the bills. When we saw the exposure draft of the main bill in January, we were concerned that the way it was drafted would mean that doctors possibly would be in breach of legislation if they passed on a patient identifier with patient records—for example, in response to a Medicare compliance audit or to their medical indemnity insurer. I am happy to advise that the department—

CHAIR—You are actually crossing inquiries there.

Dr Pesce—We always use the opportunity to make certain points. I am happy to advise, however, that the Department of Health and Ageing has clarified that this will not be the case. In that regard, we think the bills adequately deal with the use and potential misuse of healthcare identifiers, but we recognise that there are privacy concerns about sharing patient information electronically which are not covered by these bills. In the e-health context, doctors share patients’ concerns that there must be adequate privacy provisions. We would be concerned if patients were reluctant to share information with their doctor because they thought that somewhere, somehow, sometime the information might be accessed inappropriately, and these concerns will need to be dealt with when there is legislation that covers these arrangements for electronic health records.

Using healthcare identifiers is the first step in protecting patient privacy. Patients and healthcare providers will be correctly identified when patient information is transmitted electronically. While we agree that there needs to be more work done on the privacy arrangements for electronic records, we think that these bills should be passed. What we are concerned about is how medical practices are going to implement the identifiers once the bills are passed and some of the implications there.

We urge that the committee consider making recommendations about the development of an implementation plan. The AMA has looked but cannot find any details that inform medical practices of how they will be advised of their identifiers and what they need to do to obtain patient identifiers. We expect that medical practices will need to upgrade their practice software so that there is a place for the identifier number in the electronic patient file, but we understand that software vendors have not been given specifications to make changes to medical practice software to incorporate the identifiers. We anticipate that, when it does come through, there will be a cost associated with upgrading practice software. We think there needs to be an implementation plan so that medical practices are clear about what they need to do and when. While we understand that nobody is under any obligation to use the identifiers, medical practices must be well informed about how to adopt the identifier and use it as part of routine practice. An implementation plan would, hopefully, lessen the impact on medical practices.

We also think a public information and education campaign is critical to ensure that everyone understands the purpose of the identifiers and how they will be used. This would go a long way to alleviating some of the privacy concerns about the identifiers. It cannot fall to already busy medical practices to explain the identifier system to their patients.

I would also like to take this opportunity to suggest to the committee that the introduction of the healthcare identifier presents the perfect opportunity to also introduce a single Medicare provider number for each doctor.

The Productivity Commission has recommended a single Medicare provider number instead of the current requirement for a number for every location the doctor works in. If we had a single Medicare provider number, this would reduce the red tape for doctors and encourage them to use healthcare identifiers.

The AMA is a strong supporter of e-health, but we cannot see e-health becoming a reality without the healthcare identifiers being established under this legislation. And we cannot see e-health becoming a reality without a subsequent commitment from government to build the overarching infrastructure that is necessary to connect up patient information held across the healthcare sector.

This committee has heard from Department of Health and Ageing officials at Senate estimates that they have developed specifications for a national system that will enable private investment. The minister has been reported as saying that the Commonwealth has high expectations that healthcare providers and hospitals would invest in the e-health system. We are not confident that leaving it to the private sector will see a wide-scale national implementation. To make e-health a reality, there needs to be a strong commitment from all levels of government. Medical practitioners will play their part in bringing about the benefits of e-health by investing within their own practices, but government will need to take strong leadership to invest in and build the overarching infrastructure that is needed to connect up patient information. It is only then that we will make real use of healthcare identifiers. I am happy to take your questions.

Page 42

Mr Sullivan—If you see our submission, it really does not go to the principals of the matter because we are pretty well onside—we want to see the identifier happen. The submission is basically about implementation issues, and they can be broken down into two themes—the first is timing around the whole software upgrade rollout, and the second is information to practices about what is happening, when it is happening and so on.

The AMA is very supportive of the clinical leads program that is inside NEHTA, because through that program we feel we have good input into how e-health can be rolled out both with good timing and with good information. We should press on you in any responses you might make that it is vital that the building blocks on the implementation plan be in place. I think we are onside with the concept—it is a bit of a no-brainer; let’s go there; it is all about how we get there.

Senator FIERRAVANTI-WELLS—And who pays for it.

Mr Sullivan—Of course.

Senator FIERRAVANTI-WELLS—That was really the gist of what Dr Pesce was saying, that nobody has done any costing in terms of the potential cost of rolling out the infrastructure necessary.

Page 48

Dr Sayer

.....

We believe that this will represent a significant improvement in health care in Australia. We want to reiterate: this is about being able to identify the right person and matching up the right information for the right, appropriate care. We believe that it is very important. When you talk about the systems involved—and while we represent 90 organisations there are probably 200 vendors out there who would need to be involved in this process—this is not a trivial exercise. We also fully believe that we need to think seriously about the way that we would implement this. Not only must we do it in a controlled environment and manner but we are fully aware that when you involve that many software systems across that many sectors you have to be mindful of what this will need to be doing to get the true benefits across the whole healthcare system. I think I will leave it at that.

Page 49

Senator FIERRAVANTI-WELLS—I want to pick up a number of points in your submission. You commented in relation to some difficulties in responding to proposed legislation: ‘Supporting documentation cannot be completed until the review of the privacy legislation is completed.’ Obviously, at this point, not having the regulations does impede comment. You make a point about accountability and consistent program management and you raise what appears to be a concern about the structure of NEHTA as a corporation. Do you want to elaborate on that? Are you looking at that in terms in of a time period? What is that about? I did not quite understand what you meant there.

Dr McCauley—I imagine that most of you are aware of NEHTA’s structure. NEHTA is a private corporation, the shareholders of which are the states, the territories and the Commonwealth. There have been a number of reports about NEHTA’s governance structure, which have recommended its board should be expanded. To a small extent, that has occurred with the appointment of an independent chair, I think, last year. However, the focus of NEHTA is still very much jurisdictionally based and that makes its engagement with the private sector, which delivers 60 per cent of the healthcare in our country, much more difficult. You will have noticed that NEHTA’s focus and rollout of this program was around the jurisdictions. In particular, it was looking at rolling out initial implementations in the public hospital sector in some of the states. I believe that is actually where the need for identifiers is least because they already have state identifiers. Most of the patients are well known in public hospitals—the so-called frequent flyers—many of them are regular attendees. They are well identified and already dealt with. It is actually in the private sector where we are not able to have identifiers of that nature, where we are not permitted to use things like the Medicare number because that is deemed to be a breach of privacy. We do not have an identifier program where the national identifier would benefit patient care most. I believe that NEHTA’s focus is not on rolling out in that sector, where the benefits would be greatest, because of its governance structure.

Senator FIERRAVANTI-WELLS—Does that lead on to the next point that you are making about commitment and the seriousness of commitment: nobody is going to invest—you obviously see that as a deficiency in terms of its potential—

Dr McCauley—Let us not take away from the importance of this program. We have recently surveyed our members. We are 100 per cent in support of this legislation and in support of the identifiers’ program. Concerns about the NEHTA rollout are there but are, in fact, quite independent of this legislation.

Dr Sayer—Our basic argument is that this identifier program will help the private sector, GP primary care. A lot of exchange of information is happening where a lot of the mismatching is happening. To invest and to prove that this legislation is working well, and relying on the area where it is probably least going to benefit demonstrates a lack of focus. Our argument is: if you are going to do this you have to do it in a controlled manner where it will benefit the most, so we can all understand and see the most benefit there.

Senator FIERRAVANTI-WELLS—What further changes do you think should be made? Can you articulate those?

Dr Sayer—This is a legislation issue, around the unique identifiers. We are concerned that the governance behind NEHTA may be state hospital based. That is a simple view. It needs to have more representation to look at how you get into that. Sixty per cent of health care happens amongst GPs, amongst specialists and amongst allied health practitioners in the community, who are not part of the state health system—and who do not necessarily see themselves as ever being part of the state health system. So that is a separate issue. Our concern is whether NEHTA is going to follow what its jurisdictions want versus what the broader healthcare system wants. And the initial project in New South Wales hospitals, which was mentioned earlier today, dealing with radiology systems, may not directly benefit the wider New South Wales community in its initial stages. While it is an important project, and we do not belittle it—there is a lot of important work going on there—our argument is that you could fast-track into these other areas. From our vendors’ perspective, the state hospital suppliers represent a significant part of our market and our membership but most of our members deal within the private health sector, so they would be reluctant to invest in something that may be just within a hospital setting. That is a simple view.

Page 51

Senator FIERRAVANTI-WELLS—I am conscious that other senators want to ask questions. I have one last question. Under ‘Standards applicable’ you state:

An understanding of the standards that will apply and how those will be tested and maintained is critical.

Do you want to expand on that, and where you see the deficiencies at the moment?

Dr McCauley—I will try to be brief. Standards are a particular interest of mine. I represent Australia at the ISO health standards organisations and at the HL7 international standards organisations. There are particular standards applicable to healthcare identifiers both in terms of their structure and how they are allocated and accessed. NEHTA has, to a point, used the international standards for the structure of healthcare identifiers, and where that is not entirely the case we have through negotiation been able to reach a point where they are compatible with international standards.

However, they have chosen to ignore the international standards for implementation of the healthcare identifier service. They have implemented basic web standards but the higher level application standards that are available in the international space have not been implemented. They have basically made that up. We have not yet had the opportunity to review that in any detail. We were provided for the first time last week with a basic list of the functions that were to be implemented but they have not implemented those in the standards process. The ramifications of that—and this list was actually brought out with a conversation I had with the CEO of iSoft, which is our biggest Australian software company, with a huge overseas market—are that because the implementation in Australia will be a one-off, it will mean they cannot amortise those costs across their overseas markets and hence the cost to the local market will be significantly higher because they will need to basically charge all of their development costs in the Australian market. It will also act as a barrier not only to the export of Australian software which will not have in place those international standards but also to us bringing in competitive software from overseas, which may in fact produce better quality software. We believe strongly in a competitive environment producing better outcomes.

We have seen with Medicare Online, which is a local Australian implementation, that that acted as a significant barrier to overseas companies entering the marketplace. So failure to implement those international standards does have significant ramifications both in terms of competitiveness and costs.

Page 52

Senator BOYCE—From other organisations such as the Office of the Privacy Commissioner and the Consumers Health Forum we have the view that this is urgent legislation. I did ask earlier why after five years it was urgent. Could you tell me your views on the urgency of it versus what appears to be your concern, which is getting it right?

Dr Sayer—The urgency argument is probably one of the only things that the industry agrees on. We are talking about marketplace competitors who usually do not get on, but they agree that this is the most significant thing that is going to happen to improve health through the better management of health information. Given the scenario where we know there are going to be tangible benefits, we are sitting here saying, ‘Why would you wait?’

From the implementation side of it, you would consider it considerable infrastructure. We are talking about everybody having a number, every provider having a number and every organisation having a number, so you want to make sure you get it right, because you cannot have duplicates, you cannot have people being unassigned for too long, mismatched and all the rest of it. So we have to make sure that the systems are in place to allow that core infrastructure to work properly. That is why there is the urgency side of it—the belief that this is important enough that we should be doing it versus when we do it we have to do it properly to ensure that the benefits are realised. We do not want to be changing code on the fly. You want to make this standard space. You want to have this accredited. You want to have QA processes in place that are very rigorous, because the risk you are trying to offset cannot be created through bad management of the implementation side of it. That is probably our basic point

Page 53

Senator BOYCE—NEHTA talks about a rollout without a ‘great big bang’ in south-east Australia from 1 July. Do we have the software, the standards for the processes and the procedures for the software to do that?

Dr Sayer—We do not have the software today.

Senator BOYCE—We do not have the software to start on 1 July.

Dr Sayer—There is not a product in the market that has the capacity to work with the health identifier service. That is a fact.

Dr McCauley—That is principally because the specification for the HI service has not been released.

Senator BOYCE—That is because a standard has not been developed and because NEHTA have not yet got the regulation. NEHTA say they need this legislation so they can tell you what it should look like. Is thatright?

Dr McCauley—That is one of the stances that they have taken. Clearly we would need the regulation to use it in real life. But it is quite usual in the software development industry, because of the long time frames to develop software, that you would receive a specification long before there is any intention to actually roll software out. This process has been handled unusually from that point of view. If the intention is to have any software out there on 1 July then the specification should have been released quite some time ago. We thought that perhaps that had been done with some of the jurisdictions, and that possibly is the case. But we are not aware of that.

Senator BOYCE—Wouldn’t you expect that some of your members would be, if that were the case?

Dr McCauley—iSoft are the biggest player in the health sector. They had their first meeting with NEHTA

about the identifiers program last week.

Senator BOYCE—You are talking about software being something that is developed long term, and we are talking four months now and there is no software yet.

Dr McCauley—Once again, this reflects a focus that probably is not optimal. The private sector can be extremely agile in terms of software development. They see this as important and they have resources that they can deploy to this. iSoft are mustering resources to deploy this. They have the capacity to roll things out rapidly, given the appropriate support. The public sector traditionally has not been able to do that. We have seen that in a number of areas, including the uptake of Medicare programs in the past. I will give you an example: Medicare Online had a rollout process that was not as well resourced and supported as it might have been. It took upwards of three years to achieve significant market penetration. It is in only the last year or two that the public sector has started to take it up. By contrast, PBS Online was firstly developed in cooperation with the health software industry, it was adequately resourced in terms of its rollout and it achieved 95 per cent market penetration within six months. It was being rolled out principally to the private sector. So it is possible for the private sector to be very agile, given that it has appropriate resourcing and scope.

Senator BOYCE—I have one last question and, if the answer is too long, you could take it on notice. I note your comment that you needed to start five years ago but that HealthConnect and HealthConnect Project, which was probably an early version of an e-health system, started 10 years ago. Can you tell us what the success of that has been?

Dr McCauley—HealthConnect?

Senator BOYCE—Yes.

Dr Sayer—I will try to find whether an aspect of that is continuing or what the benefit has been.

Senator BOYCE—It started 10 years ago. We spent about $50 million or so on it, from memory?

Dr Sayer—I suspect you would have spent more than that.

Dr McCauley—It would probably be best for us to take that on notice, if you wanted some detailed information. It is a long time ago now. We will have to look at that in some detail.

Senator BOYCE—But isn’t it an example of the concerns that we need to look at when we are implementing a new e-health program of any sort?

Dr Sayer—To give you a simple response: HealthConnect was much more ambitious than the unique identifier—if we look at it that way. It had much more ambitious projects. It was looking much more at a possible centralisation of medical records. It even had what you would call a ‘federated local level’. This is not attempting to do any of that. It is far less ambitious, but it could be argued that you will get more tangible benefits more quickly than what HealthConnect tried to achieve.

Senator BOYCE—Will we start to see them on 2 July?

CHAIR—That is No. 4, Senator.

Senator BOYCE—I will stop there.

Page 56

CHAIR—Okay. If you could get that back to us as quickly as possible that would be great.

Dr McCauley—Can I just give a brief summary. I think we would like to emphasise that the benefits of this legislation—despite some misgivings we might have about the implementation and the rollout, which can be addressed in other forums—clearly outweigh any downside that may have been brought up in other areas. We think this legislation is extremely important and that not proceeding with it sooner has already cost our society significantly.

CHAIR—Thank you very much. And thank you for your patience!

As always we learn a lot when the Senators ask questions!

David.

15 comments:

John Johnston said...

I think some very good points were made in this exchange but I wonder what happens to the material now. Does the Senate go back and review what was said in this enquiry with some sort of forensic review and then come up with recommendations for change to the legislation or is it more likely the legislation will be passed with a list of recommendations.
I am puzzled why we have the IHI being considered separately. Its every bit as important to have Providers and their organisations carefully identified in concert with the IHI. Has the legislation for the Provider Identifiers been passed already or is the convential wisdom saying they are "incidental".

On second reading of this material I felt that the submissions from Vince, Geoff and Lisa Pettigrew were pretty much "on the money". I remain a little surprised that Peter Fleming made no reference to "trials in the private sector" when he so vehemently gave his "Absolutely" to this idea at the briefings late last year,

Anonymous said...

"All Their Own Work"!!

Very revealing.

The Senators have precisely and forensically penetrated the issues, peeling back the misty clouds, layer by layer to reveal the truth of the matter.

Anonymous said...

"But, while we will not have a choice about whether a health identifier will be created for us, we will have an appropriate level of control about how the identifier will be used."

Bit of a worry that the privacy commissioner thinks patients will have appropriate control over usage -

Haikerwal also suggests that patients will initiate the process by offering their Medicare card to their GP

Sorry? I thought the identifier would generally be bulk downloaded by practices for all their known patients, or otherwise invisibly assigned. If you have somehow escaped a number, they will assign a temporary one anyway...

So how will I have control over how my identifier is used by all the medical providers I encounter, and any other parties they care to share my information with?

Anonymous said...

John Johnston raises a most important point. Why is the IHI not being considered in concert with the other two key identifiers - Provider Identifiers and Organisation Identifiers? The latter two are far from incidental. All three must operate hand-in-glove with each other.

Do not security and privacy issues apply to them also.
Has that work not been done?
Is that work not relevant to software developers?
Is the system being planned ad hoc, piecemeal?
Do these two identifiers present completely different issues from the IHI?

Whatever the reason it’s a real pity on such an important issue as this is under consideration that the Senators didn’t raise these other identifiers. Perhaps it was an oversight or perhaps with all the focus on IHIs they were unaware of the inter-relationship and inter-dependence of the IHI and the Provider and Organisation Identifiers.

As Senator FIERRAVANTI-WELLS pointed out privacy is the “starting point with the identifier of what, potentially, will be a broader system, it is very important that we understand right from the beginning that the proper gatekeeping is in place”. The same applies equally well in the case of John Johnston’s observation.

Anonymous said...

Trials in the private sector. Be patient. The large vendors are working on that with the jurisdictions.

Anonymous said...

"Sorry? I thought the identifier would generally be bulk downloaded by practices for all their known patients, or otherwise invisibly assigned. If you have somehow escaped a number, they will assign a temporary one anyway..."

No. That would not be a good idea. It is very important the data is carefully checked for cleanliness, accuracy and matching. That should be done for each patient as it is applied to populate the 'record' held in the doctor's practice. Heaven forbid we have a repeat of a pink-bats type scenario in every medical practice - then we will have adverse events ++++. Bulk downloading could be a disaster of untold proportions. Of course, the doctors would no doubt expect some incentive payments(PIPs) to come their way as compensation for the effort expended. Let us hope the 'matching process' will be quick-slick.

Anonymous said...

“Absolutely” rolls easily off the tongue for Peter Flemming - 14 times to be exact. It’s a sales technique to reassure, allay concerns, disarm and hopefully divert the buyer to another concern until all objections have been dealt with and the buyer is primed to make the purchase. Experienced people will recognise the technique.

Anonymous said...

“Trials in the private sector. Be patient. The large vendors are working on that with the jurisdictions.”

Yes. Microsoft has a number of Certified Software Partners and with an alignment between NEHTA and Microsoft it follows that Microsoft’s partners will be pulled through the development tunnel in due course. Other large vendors like iSoft and Cerner (also aligned with Microsoft) in the hospital space will also pull the small vendors through. All this in turn is meant to ubiquitously drive a collaborative environment across the public and private sectors.

Dealing with over 100 or more small developers of 5 to 15 people has proven too hard so NEHTA prefers to leave that to the MSIA to bring its members into line to undertake some trials in the private sector in collaboration with some larger well resourced developers. Not all the small developers will agree with that approach but then, they have difficulty agreeing with each other, and that’s an issue they have to solve amongst themselves. If they can’t work together, or if they won’t, NEHTA doesn't want to be their whipping boy.

Anonymous said...

Batch loading is part of the basic plan. See NEHTA's HI Concept of Operations http://www.nehta.gov.au/connecting-australia/healthcare-identifiers
And yes, healthcare providers and organisations are covered in this current Bill. They will start with GPs and others known to Medicare and gradually move out to cover every possible version of dispenser of medical services.
Dont think the provider registry side is ready, although Peter Fleming has assured us it will be by July 1

Dr David More MB, PhD, FACHI said...

There is no way the provider side will be ready in anything less than 12-18 months. This is because NASH is not finalised and the National Registration System is not even meant to start until July 1 as I understand it.

NASH is being piloted (in Brisbane?) before national roll out if it works.

David.

Anonymous said...

"There is no way the provider side will be ready in anything less than 12-18 months".

If that is so then why is Peter Flemming saying otherwise. He is either telling the truth or he is not.

If the former shouldn't we just accept his word for it?

If the latter is it because he knows no better or is ill informed. And if he has got it wrong or is not telling the truth what else has he said that we should be questioning? A good place to start would be the Senate Enquiry. Another is the assurances John Johnston said he gave. Are these both furphys?

Alternatively has David More got it all wrong?

If I were a Senator I would be asking myself some hard questions. I would most likely come down on the side of caution and suggest the bill be deferred until further work is done and important issues clarified.

Dr David More MB, PhD, FACHI said...

And 2009 was a fabulous 'year of delivery?

Believe what you want but plan for serious roll out of individual provider IDs for 2012.

See if I am wrong! I often am!

David.

Anonymous said...

I believe the consumer reps raised issues with batch loading, namely that any doc/org that does it will retrieve patients who only visited once, or those who decided to leave for various reasons. On the grounds that these parties should not have access to identifiers belonging to non-active patients.

I wonder if the doctor groups, largely falling over themselves to be helpful, have given proper consideration to the wide distribution and potential uses of their own identifiers and personal/professional details.

Doctors may well be used to having provider nos and being under Medicare surveillance, etc, but what information will other parties - those recipient peers/rivals, public and private organisations - garner from collecting provider information linked to patient data? And what uses may they put it to?

That doctor X sees a lot of Y patients and orders 123 tests? Yes, medicare knows that now, but who else will that have access to that information in future?

Has this matter been considered by anybody?

Anonymous said...

Haikerwal and Fleming seemed to be desperately trying to avoid the 'privacy issue' being pursued by Senator Mason.

Dr Haikerwal—That is the next part of the build. Obviously there is no point having a number if it is not
going to do anything, and what Andrew Pesce alluded to was the next stage. If you are going to have electronic
records, what is the privacy response to that? Obviously, that is a different discussion because what we are
talking about here is just a number which gives you the start, to allow the system to be—

Senator MASON—But, Dr Haikerwal, that was what happened last time. The access card was all about
saying, ‘Let us just have the number and then you trust us—it will all be okay.’ When any country’s
government establishes a universal, personal identifier for its citizens, the onus is dead on government to
establish why that has to happen—and you understand why?

These guys churn out a lot of spinnnnnnn - which Senator Mason does not want to swallow. The Senator wants the facts - spelt F A C T S

Anonymous said...

I always worry when people keep responding with the word "absolutely". I don't think Peter Flemming gets it. He keeps contradicting himself eg 4.5 million in NSW is a small-scale initial implementation! Small scale - blimey Dave if the population of NSW is say 6.6 million then 4.5 million is 68%. Small-scale??? What do ya reckon Dad - full bottle?