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Wednesday, April 28, 2010

Senator Boyce Accuses Medicare Australia of An Attempted Cover Up of Issues that Might Have Caused Patient Harm.

The following letter was sent to the Minister for Human Services today – April 28, 2010.

April 28, 2010

Hon Chris Bowen MP

Minister for Human Services

Parliament House

Canberra ACT 2600

Dear Minister

I refer to the serious glitch that affected Medicare's systems in early February and, specifically, your reported statements about it in an article in The Australian of April 22, "Minister not told of Medicare record glitch".

I was surprised that you reportedly confirmed that you had not had this matter brought to your attention by Medicare Australia until Friday, April 16.

I draw your attention to a letter dated April 1, 2010, and signed by Ms Sheila Bird PSM, General Manager, eBusiness Division, of Medicare Australia which was sent to 70 Medicare software vendors.

In that letter, Ms Bird states: "Medicare Australia implemented a maintenance change to patient verification at 10pm on Saturday, 6 February 2010. There was no need for Medicare Australia to close down the system to undertake the maintenance. Following concern from a small number of software vendors as to the way as to the way patient verification was functioning, the maintenance change was withdrawn at approximately 9:00 pm on Tuesday, 9 February 2010, and the system functionality was restored to pre 6 February 2010 operations."

Ms Bird continued: "During the above period, an area of functionality within the OPV, PVM and EPV facilities was changed. Software vendors or sites may have actioned the information supplied in the return patient verification messages in different ways. How this was done may have resulted in some records being incorrectly updated."

After stating that Medicare Australia would arrange for a "suitable time and method to work with each (software vendor) to determine the best way of resolving any potential impacts on your clients", Ms Bird sought to assure the software vendors that she was "putting in place robust procedures to ensure that you will receive prompt notification should there be any problems in the future."

Given the timeline of events, I'm sure you agree that it is an appalling situation that 70 Medicare software vendors were not given any official notification of this event in a timely manner or advised that arrangements would be made to resolve any problems until 8 weeks after the event.

If these software vendors were treated in a cavalier way, the fact that you were not advised until – on your own admission – April 16, speaks volumes about Medicare Australia's corporate culture.

I am advised by people in the medical software industry that one of Medicare's software vendors, McCauley Software, informed Medicare's Online Vendor help desk around midday on February 8 and that the Medicare Online vendor help desk confirmed it as a Medicare problem at about 4pm that day.

My advice is that subsequently, Medicare tried to assert that it was a vendor-related issue.

Further I understand that during February and March, some software vendors pleaded with Medicare to advise all affected vendors and peak medical bodies that there had been a problem. These vendors became so frustrated by what appeared to them to be a lack of concern, inertia or – even worse – an attempt to sweep the matter under the carpet - that they threatened to take the matter to you.

It was only after these threats were made that Medicare Australia issued the letter on April 1, to which I have referred.

I was particularly concerned by the statement in The Australian of April 22 by a Medicare spokesman that: "Medicare will inform (doctors and other health providers) about the issue, and provide details of their practice records where a verification check was undertaken (before the error was fixed). Practices will be asked to check their records and correct any that were incorrectly updated."

The use of the present tense suggested to me that this process had not yet begun by April 21 when the statement would have been provided to The Australian. This was confirmed when I became aware of another letter dated April 27, 2010, by Ms Sheila Bird.

In that letter to Medicare's software vendors, Ms Bird stated: "The Medical Software Industry Association and the Australian Medical Association have advised that the unintended change to patient verification on February 6 may have resulted in clinical records being incorrectly updated with incorrect patient names."

The fact is that there was no "may" about it – records were corrupted.

The letter continued: "As a result of this advice Medicare Australia wrote to approximately 2700 practice sites that were impacted by this issue on 23 April 2010."

I would be glad if you could inform me why Medicare Australia waited from February 9 when the glitch was discovered to April 23 – about 2 and a half months – to write to the 2700 medical practices.

That date was, incidentally, a week after Medicare Australia got around to advising you as Minister.

When you issued your statement after that briefing, you said you had requested "regular updates" about progress on record checking so did those early "regular updates" alert you to the fact that 2700 medical practices hadn't been advised by Medicare Australia of the glitch? Did you, at the time of the initial Medicare Australia briefing, actually ask if any medical practices affected by the glitch had been promptly advised of the possible consequences?

Your advice about why Medicare Australia was so demonstrably slow in advising software vendors, the medical profession and you is requested.

However desultory this unhappy history has proven Medicare Australia to have been, of most concern is this paragraph in Ms Bird's letter of April 27: "This issue has revealed complex issues with how software systems use the information obtained through patient verification. It has highlighted for Medicare Australia that information can be used in a way that wasn't intended. Specifically, the information provided as part of patient verification was only intended for use in claiming purposes and not clinical purposes."

It is astounding that Medicare Australia, almost on the eve of the implementation of the scheduled national e-health scheme on July 1, has discovered this major fault in its software. What guarantees can you give that any other major failures of this nature will not occur in the future?

I noted that your statement to The Australian contained the reassurance that would "not hesitate to take further actions to ensure patient safety" which is welcomed and I would be glad to receive your further advice about what action that is or might be.

Yours sincerely

Sue Boyce

Senator for Queensland

----- End Letter.

Accepting the truth of the quotations provided here, and I have seen the source Medicare Australia letter sent to Software providers, the delay and the failure to recognise the need for rapid action, and the attempt to blame the Software Vendors for the problems are really the most troubling of a range of issues raised by Senator Boyce.

Again we have a situation where non-clinically orientated bureaucrats and technical people are failing to make good judgements about the importance of system failures that could impact the quality and safety of patient care – something the Software Vendors understand very well.

The time for improved governance of the whole e-Health space is well and truly upon us – as is the need for much improved co-operation between government and the industry in delivering safe and workable solutions.

The fact that Medicare Australia initially just implemented a change to their systems with no notification speaks volumes about the e-Health governance we do not have!


1 comment:

Anonymous said...

No-one who has had experience of HIC/Medicare's 10 year saga with implementing Online Claiming, and the issues that participating vendors have had to face, will be surprised.

Medicare has always stuck to, or recycled, failed approaches, vis 'no incentives for uptake or incorporation by vendors. Our public media campaign will force update through patient demand'. This failed with both 'HIC Online' ~2000-2003 and 'Easyclaims' ~2007-2009.

Similarly, dropping individual key dongles for Online Claiming, when it became obvious no-one wanted to use them, but continuing to require them till very recently for provider-provider clinical messaging. An enormous show-stopper for e-Health.

Providers' trust in Medicare has long-since evaporated. Who wants a business partner who is also the regulator and initiator of fraud witch hunts, but will also dud providers if it can.