Sunday, June 12, 2011

Senate Estimates Hearing - Community Affairs Committee. May 30 ,2011 E-Health Related Questions and Responses.

It is useful to have this available for reference into the future as we see things progress, or not, according to the claims made here. Certainly this is the first time we have had direct questioning of the NEHTA CEO.

I have italicised a few of the more fun parts for easy identification.

The full Hansard is found here:

Key Cast Members:

Senator Boyce - Senator for Queensland.

DoHA Executive

Ms Jane Halton, Secretary

Ms Rosemary Huxtable, Deputy Secretary

Ms Megan Morris, Acting Deputy Secretary

Mr Paul Madden, Chief Information and Knowledge Officer

Outcome 10–Health system capacity and quality

eHealth Division

Ms Fionna Granger, First Assistant Secretary, eHealth Division

Ms Liz Forman, Assistant Secretary, eHealth Strategy

Ms Sharon McCarter, Assistant Secretary, eHealth Systems


Mr Peter Fleming - CEO NEHTA

At about 5pm.

----- Begin Transcript

CHAIR: No, I am leaving it. We are moving to 10.2, which is e-health, and I call the officers from NEHTA.

Senator BOYCE: Thank you very much, Mr Fleming, for being here.

Mr Fleming: It is a pleasure.

Senator BOYCE: We have discussed at a number of estimates how good it would be to have the opportunity to speak to NEHTA, and it is delightful that you are here.

Ms Halton: Don’t give him a false sense of security.

Senator BOYCE: Beg your pardon?

Ms Halton: 'It is delightful that you are here' implies a false sense of security. I am saying don’t give him a false sense of security.

Senator BOYCE: I am not, I hope. I am pleased that you are here. I wanted to start out by looking at the report on your conference that you had in, I think, November-December, which was published in 2011.

Ms Halton: That was our conference, not his conference.

Senator BOYCE: It is a very long report; isn’t it?

Ms Halton: Is this the report of the conference which was our conference, just so that we can be clear what we are talking about? NEHTA did not organise the e-health conference, if that is the one you are talking about; we did.

Senator BOYCE: Is this NEHTA’s report or the department’s report? That is probably one of the first things we should clear up.

Mr Fleming: I believe that was a department report rather than a NEHTA report.

Senator BOYCE: The key barriers and constraints to the implementation of the PCEHR system included tight implementation time frames, the maturity of what was already happening in technology in the sector, the quality of health information assets, a scarcity of appropriately skilled workers, the existing culture, mindsets and attitudes, and funding in investment for the operation of e-health. There was also uncertainty regarding medical legal responsibilities and risks, and the complexity of the stakeholder landscape. All of this was said in November-December last year and yet we are looking at a 1 July 2012 implementation time frame. Can you make those two statements stand together? How is it that even in a report where you talk about the implementation time frame being extremely tight and acting as a constraint to what could be practically delivered—

Ms Huxtable: We will leave that sort of question for the department. That is in relation to the investment in the Personally Controlled Electronic Health Record.

Senator BOYCE: That is what I just said.

Ms Huxtable: That is Commonwealth funding. NEHTA is under the sourcing strategy for that project operating as our managing agent, but it is under a contractual arrangement to the Commonwealth. The report itself is in respect of a conference which was a critical element of the first phase of the stakeholder engagement strategy. NEHTA worked with us in the preparation for that conference and in fact was responsible—

Senator BOYCE: I know all of that.

Ms Huxtable: I am just trying to give the context for that.

Senator BOYCE: I preface this question by saying in that case I will direct this question to the department. Your report states that the implementation time frame for 1 July 2012 is extremely tight and will act as a constraint to what can be practically delivered and yet you are continuing to say that you will deliver. What will be delivered by July 2012?

Ms Huxtable: It is clear from the minister’s statements that the intention is from July 2012 people will have a capacity to register for a Personally Controlled Electronic Health Record system.

Senator BOYCE: They have that now.

Ms Huxtable: No. There is no capacity to register now. That is not correct.

Senator BOYCE: You can have an IHA now if you want one.

Ms Huxtable: The IHA is an important foundation element of having a Personally Controlled Electronic Health Record system. It is a necessary precondition, but in itself it is not the electronic health record system. It has been clear from the beginning that the timing is tight. We have a two-year period to be able to create that capability to register, to work through the way in which the PCEHR itself is constructed and establish what information would be available on the PCEHR. There is a concept of operations, which I am sure you would have seen, that has been released and goes into much more detail around those elements. The consultation process finishes at the end of this month—tomorrow—in respect of the Conops. There will also be a legislative issues paper which will be released quite soon that will go into the regulatory elements of the PCEHR. Some of the issues that were raised in what you read a moment ago are issues that have been revisited both in the Conops and in the legislative issues paper.

Senator BOYCE: Revisited in the Conops by doing what?

Ms Huxtable: The Conops went to a much greater level of detail in terms of how the PCEHR would be constructed.

Senator BOYCE: Was it basically decided to do less?

Ms Huxtable: No, I do not believe so. In addition, there is another document that is very close to being finalised, which provides yet another layer of detail in terms of the design elements. The reality is that, yes, this is a complex body of work. It has a strong technical element to it.

Senator BOYCE: I do not think anyone is disputing whether it is a complex body of work. It is just that we are continually given deadlines which, in the end, are not realistic or deliver something other than what people understood they would deliver.

Ms Huxtable: I can assure you that everyone in our organisation, in NEHTA and the states and territories are working to achieve the deliverable that has been announced by government. The reality is, yes, it is complex and has a number of streams, including a technical stream, but also a change in adoption stream. We are also doing the work on lead implementation sites. There have been 12 of those announced to date.

Senator BOYCE: I know that. I am going to get around to those. I would like to go back to the Conops. I must admit that I had great difficulty trying to get on to the website to work out how to leave a comment. You are sent from one website to another and then to another. How many comments or submissions have you received?

Ms Huxtable: I would have to get an officer to respond to that question. I am sorry, I do not know that level of detail.

Senator BOYCE: Mr Fleming might know.

Mr Fleming: No, I do not. The comments close tomorrow.

Ms Granger: We have received 11 submissions so far, approximately 2,000 downloads of the document and 3,000 views online. That is approximate, but I can find out the exact figures if you would like.

Ms Huxtable: We are also undertaking bilateral discussions with some of the key stakeholders in regard to the concept of operations. I have personally been involved in several of those and I know the officers—

Senator BOYCE: Which stakeholders are they?

Ms Huxtable: I have personally met with the AMA and the Pharmacy Guild. The officers have met with others as well.

Ms Granger: There are 16 in all.

Senator BOYCE: Is that around the concept of operations?

Ms Huxtable: That is correct.

Ms Granger: I have an updated figure as of today of views online of the Conops, which is at 5,000, and downloads are at 4,000.

Senator BOYCE: Why is there such a discrepancy between the number of downloads and views and the number of submissions?

Ms Granger: The submissions do not close until tomorrow.

Ms Huxtable: That is not unusual.

Senator BOYCE: Are you expecting 1,000 or so tomorrow?

Ms Granger: I doubt that we would get 1,000 submissions. In our consultations people have been quite positive.

Ms Huxtable: It is not unusual to get submissions right on the due date.

Senator BOYCE: I realise that, but to have 5,000 downloads and to only have 11 submissions seems light on, even if there are 24 hours to go.

Ms Huxtable: There have been many avenues for consultation and discussion around this document. Many interested parties have been involved in our conference and also in the consultations that have been occurring under the auspices of NEHTA. Mr Fleming may have more information, but there has been a very large number of roundtables and discussions, so I think it is a heavily consulted document.

Senator BOYCE: Will you be publishing these submissions?

Ms Granger: We are asking for permission to publish them.

Senator BOYCE: From?

Ms Granger: From the people who submit them. We will also publish a summary as well. If people are happy for us to publish them then we will.

Senator BOYCE: Have you asked them already?

Ms Granger: We are asking that as part of the submission process.

Senator BOYCE: When would they be published? You would already know which ones you can publish out of the ones that you have.

Ms Granger: Yes. We are thinking by the end of June.

Senator BOYCE: That will probably cover off on Conops for now. Mr Fleming, we were told that 2009 was going to be the year of delivery for NEHTA. Can you tell me what was delivered?

Mr Fleming: Certainly. The HI service, as you would be aware, has been built and is available.

Senator BOYCE: We are talking 2009. Are you talking about your whole strategic plan from 2009 to 2012?

Mr Fleming: Yes.

Senator BOYCE: Perhaps you could give me a year for when you have done these things?

Mr Fleming: If it is all right with you, we can take it on notice to provide the individual years. Subsequent to making a statement on the year of delivery, the HI service was built and we are going through a process of implementation. Tasmania went live earlier this month with implementation to the acute care sector, where they are updating the HI system within their database as patients admit into acute. That is flowing through to work we are doing with other jurisdictions. Indeed, in the private sector, through wave one and two, once again, the HI system and that NEHTA stack will be implemented. In addition to the HI system there was a lot of work done around standards and secure messaging standards. We went through a process with key stakeholders, including the software industry, and it has been lodged as a technical document before Standards Australia. There are a number of other standards around discharge, referral and medication management. The AMT system, which is part of SNOMED, has now gone live in two hospitals in Victoria.

Senator BOYCE: Which ones are they?

Mr Fleming: Australian Medicines Terminology has gone live in Box Hill Hospital, down in Victoria, and the eye and ear hospital. That will now flow through as part of the Victorian rollout of their smart health system into each of their hospitals over time. AMT takes effect from both PBS and TGA. It has the full set of medicines that are available. It is quite key in terms of achieving quality of care around medication.

Senator BOYCE: Not Medicare, though?

Mr Fleming: No. They are some of the key activities in that area. There has also been a lot of work around the National Product Catalogue. We have been working in particular with Western Australia to introduce the National Product Catalogue. It currently has 130,000 items in there.

Senator BOYCE: What is a product in your terms?

Mr Fleming: Any product that is used within the medical environment would fit into that.

Ms Halton: Swabs, devices or items that you would purchase.

Senator BOYCE: Consumer and professional items?

Mr Fleming: Absolutely.

Ms Halton: That is correct. Everything from a trolley to an ear bud.

Mr Fleming: They are some of the major highlights, but I can take it on notice to provide a list by year.

Senator BOYCE: Yes. My question, though, related to the fact that 2009 was going to be the year of delivery. Did it get started in 2009, in your view?

Mr Fleming: Certainly part of that process was changing the culture of NEHTA to be very delivery orientated. We maintain that delivery orientation, but very much also with a focus on what we are doing around implementation—so continuing on delivery, but the implementation of these systems throughout the health system.

Senator BOYCE: Where are you up to in that sense? Your three-year plan went out to the end of 2012. Where would you say you are in terms of your strategic plan?

Mr Fleming: The three-year plan goes out to where our funding ceases. So, it is COAG and PCEHR funding. It finishes in the middle of June 2012. The plan goes out to there. We are on track with that. Each one of those components is tracking to its critical path.

Senator BOYCE: At the last estimates the department had assessed and accepted progress reports from NEHTA on 52 deliverables. I do not want you to tell me what they are now. You may have told me about some of them already, but could you provide on notice to me the reports on those 52 deliverables?

Mr Fleming: The answer is, yes, but it is 2,000 pages.

Ms Halton: We gave you the list of the documents on notice, but the documents equate to 2,000 pages.

Senator BOYCE: I would like to see them. I thought about that for a minute before I said yes. What is your expected spend on consultants for the year ending 2011?

Mr Fleming: The current spend, as at the end of April, on consultants was $39,714,000, which comprised $16 million for Medicare and $8 million for IBM for the work they are doing with us on NASH. I will have to take the forecast on notice, but that is the spend through to the end of April.

Senator BOYCE: That is fine, thank you. It looks as though this amount has increased every year since 2006. Can you explain why?

Mr Fleming: On consultants?

Senator BOYCE: Yes.

Mr Fleming: NEHTA is the National e-Health Transition Authority. Our job is clearly to implement a series of agreed objectives. As part of that process we use external parties wherever we believe they will add significant value, whether it be in terms of delivering on time, within time frames and quality. We certainly use a number of external companies to do those activities.

Senator BOYCE: As you mentioned before, your funding goes through to the end of 2012. I must admit I have great difficulty getting my head around the idea of an organisation that is functioning now, and I presume will continue to function, but does not know where their funding will be after 30 June 2012. When will you know what the government’s decision will be in that area?

Mr Fleming: We are putting together the details for the next COAG business case.

Senator BOYCE: When will that be presented?

Mr Fleming: It will be presented to our board within the next two months, but I cannot give you an answer on the process post that.

Senator BOYCE: I realise that. Does the fact that you really are not certain about your future affect staff retention at all?

Mr Fleming: The reality is that most of our staff understand that we have a job to do for the long term and are aware of that, but it is fair to say that those sorts of things would be a consideration.

Senator BOYCE: Are you short staffed at the present time? Do you have positions that are vacant?

Mr Fleming: We do.

Senator BOYCE: How many?

Mr Fleming: I can take that on notice.

Senator BOYCE: As a rough proportion is it one per cent or 20 per cent?

Mr Fleming: It would probably be in the order of about 20, but that is an approximation.

Senator BOYCE: Twenty staff?

Mr Fleming: Yes, 20 staff. However, I would like to point out that PCEHR is a relatively new program so, as you would expect, we are ramping up staff numbers to accommodate that.

Senator BOYCE: As this report has pointed out, there is a shortage of sufficiently skilled staff and if I were to apply for a job there, presuming I had the skills, I would have no idea whether my career was going to last 12 months or five years. Surely that would affect your ability to recruit staff.

Mr Fleming: It has not to date. In terms of what we are trying to do, our objectives are well articulated. Our staff and people looking at this regard it as a very exciting opportunity.

Senator BOYCE: On notice, can you give me a quarterly figure of staff vacancies since 2006 at NEHTA as a percentage of the workforce at the time?

Mr Fleming: We will give you what we can. We may not be able to go back to 2006.

Senator BOYCE: Perhaps the last two years or whatever is convenient.

Ms Halton: Mr Fleming should do what he reasonably can without directing resources, because I suspect that it will be hard to recreate.

Senator BOYCE: We are only talking about a five-year history and I did not realise that would be a difficult question. If it is, then it is whatever is conveniently available. How long would a job vacancy last, on average, at NEHTA?

Mr Fleming: I would have to take that on notice. It would depend on the type of role we were discussing.

Senator BOYCE: Perhaps the shortest to the longest.

Ms Halton: Something which does not require people to get out every record and start calculating things but gives you a feel would be what we should be providing.

Senator BOYCE: I referred to the department’s report of their inquiry. You would be very well aware of this report. It is full of comments like stakeholders indicated that it ‘should’ be possible to do something by date X and it ‘may’ be realistic and so on. What is your view of this report and the attitudes taken?

Ms Halton: I have to say that I will advise Mr Fleming that he is not to give you an opinion. You just asked him for an opinion.

Senator BOYCE: He runs an independent authority that is supposed to be implementing e-health.

Ms Halton: The protocol in this committee and every committee is that you do not ask people for opinions.

CHAIR: It is a standard process.

Senator BOYCE: Do you think it will be possible to implement all of the current e-health projects by 1 July 2012?

CHAIR: I am wondering about the first three words in that question.

Senator BOYCE: Will it be possible to implement all of the current plans/projects under e-health that are currently there by July 2012?

Mr Fleming: All of our projects are tracking to their critical path. All activities that we expect to be delivered at certain times are being delivered within those time frames.

Ms Halton: Mr Fleming doesn’t use public service speak, does he? Well done.

Senator BOYCE: The question related to July 2012. Is that the case?

Mr Fleming: Yes.

Senator BOYCE: ‘Critical paths’ means that it will all happen in 2012?

Mr Fleming: All activities to date are tracking to their critical path, and all staff are absolutely committed to doing that.

Senator BOYCE: In 2008 Deloittes came up with an e-health strategy that recommended decommissioning NEHTA and replacing it with a stronger governance body. Are you aware of that report?

Mr Fleming: I am, yes.

Senator BOYCE: What response did NEHTA have to that report?

Mr Fleming: This was slightly before my time. A series of actions was taken.

Senator BOYCE: I have some questions on governance, so that is where we are heading.

Mr Fleming: There was a series of actions taken at the time which included introducing an external chair and another independent director. They were key actions taken as part of that process.

Senator BOYCE: Are you aware of the US Veterans’ Affairs Department’s Blue Button?

Mr Fleming: Absolutely.

Senator BOYCE: Can you tell us about Blue Button?

Mr Fleming: Only at a high level.

Senator BOYCE: That is all I wanted.

Mr Fleming: It is a system that has just been introduced for veterans to effectively access their electronic health record. I believe the uptake of that process has been extremely quick, but I do not have the actual figures in front of me.

Senator BOYCE: I understand it was 100,000 veterans in the first 45 days.

Mr Fleming: Yes.

Senator BOYCE: The reason I asked that is what are the learnings for NEHTA out of that in terms of the personally controlled e-health record?

Mr Fleming: Change management is by far and away the most complex of the activities in front of us. The technology pales into significance in terms of the activities here. The department is appointing an independent party to assist with change management. They are the things that will be looked at. We are continuing to look at international trends and the learnings from those. We will be ensuring that the systems that are built have the propensity to expand to handle volumes.

Senator BOYCE: Is stakeholder engagement not one of the areas that should be beefed up in terms of learning from the Blue Button program?

Mr Fleming: Stakeholder engagement is an area that we are constantly working on, as you would expect. Among other things NEHTA has a group called the SRF, Stakeholder Reference Forum, which consists of a large number of key stakeholders.

Senator BOYCE: How long has it included consumers?

Mr Fleming: Since the day the SRF first started.

Senator BOYCE: Which was?

Mr Fleming: At least three years ago now.

Senator BOYCE: That does not gel with the consumers and healthcare people complaining about their lack of involvement less than six months ago. How do you square those two?

Mr Fleming: Stakeholder involvement is very significant when you think of the fact that this touches every consumer and clinician in one way or another. There are over 800,000 people that work in the medical environment here. It is complex. There are many groups involved here. Part of the process is that the individuals that sit on the SRF go back into their own groups. In terms of the consumer involvement, we are looking for ways that we can increase that, and it is expected that the change management partner will assist in that process.

Senator BOYCE: Can you explain in a bit more detail what you are doing for change management, since we are talking about beefing this up?

Mr Fleming: There was a tender issued for a change management partner.

Senator BOYCE: Is this the IBM one?

Mr Fleming: No. There is a series of tenders at the moment. Change management is one of those. The evaluation has been completed and I believe that is going through the final stages now.

Ms Halton: That is something that you have to ask us about.

Senator BOYCE: DOHA did an evaluation of the tender. DOHA is letting the tender. Is that right?

Ms Halton: We are letting a number of tenders. There is a distinction between the work that is done by NEHTA on the contract to us as part of the electronic health record and the work that we are letting to other parties as part of the tender process.

Senator BOYCE: Who is oversighting the change management program?

Ms Huxtable: The tenderer.

Senator BOYCE: You are oversighting it?

Ms Huxtable: The change and adoption partner tender process is almost complete. The evaluation of the tenders has been conducted by the department and with NEHTA involved in the evaluation process, but we will enter contractual arrangements with the change and adoption partner when they are appointed.

Senator BOYCE: How will that group interact or how will the successful tenderer interact with NEHTA?

Ms Huxtable: We work very closely with NEHTA in regard to all these matters. We want to leverage the opportunities that there are already in NEHTA through their various clinical reference groups and so on. We will continue to work closely with them with the change and adoption partner. The change and adoption partner becomes another resource that can focus very much on individual sectoral readiness on the engagement process with consumers and the like as we get closer to the point of implementation. One of the things to be aware of is that while there has been a lot of consultation occurring already around technical and other issues, as we discussed earlier, as we move more into a level of public engagement we want to time that correctly. We do not want to begin that too early before there is a PCEHR available to people. That effort is focused very much on the wave sites, and then as we get towards 1 July it will change in its nature from a more technical discussion through to a more public discussion.

Senator BOYCE: When you get closer to July?

Ms Huxtable: July of next year. The nature of the engagement changes as you move closer to an implementation point.

Senator BOYCE: Absolutely.

Ms Huxtable: I do not think I am saying anything too radical in that regard. The change and adoption partner will be with us through that process.

Senator BOYCE: When will you be announcing that tender?

Ms Huxtable: It will be quite soon—imminent.

Senator BOYCE: Is that weeks or days? Is it this financial year?

Ms Huxtable: I could not say. I do not think there has been a decision taken as yet as to when an announcement will be made, but I expect it will be very shortly.

Senator BOYCE: I have a department question that relates to NEHTA. Mr Fleming, you have an ongoing court case involving a DIAD patient.

Mr Fleming: Yes.

Senator BOYCE: We have been told by the department that no questions can be answered on that because of legal and professional privilege, but can you tell me how much NEHTA has spent on the case?

Mr Fleming: Can I take that on notice?

Senator BOYCE: Is that because you do not know the figure?

Mr Fleming: I do not have the figure in front of me.

Senator BOYCE: Whose funds is NEHTA using to pursue this case?

Mr Fleming: It is being funded through the COAG funding.

Senator BOYCE: So, it is funded by your regular funding from COAG?

Mr Fleming: Yes.

Senator BOYCE: The other legal case was around legal professional privilege. Again, I understood that the case related to alleged theft of IP. Is that case still proceeding?

Mr Fleming: The DIAD that you mentioned as the first case is one and the same. It is one issue. There is only one legal issue.

Senator BOYCE: Chair, I have more questions.

CHAIR: I will let you go through to quarter to without pulling you up and we will see how you are going then.

Senator BOYCE: I would now like to go to the Personally Controlled Electronic Health Records and where we are heading with those. I attended a palliative care conference last week and there was some confusion about what was going to be initially in a PCEHR. I know what the concept of operation says, but it is even a bit fuzzy in terms of whether pathology, imaging and so forth are included. Could you tell me what we are planning to put in it?

Ms Huxtable: The concept of operations goes through the various elements that would be incorporated into a PCEHR.

Senator BOYCE: Or could be?

Ms Huxtable: Would be. The contention is when. Some sectors are more ready—for example, the health summary review. There is already a RACGP health summary review that is being trialled in the wave sites. There is a level of readiness in some regard. In pathology—and I am not necessarily across all the technical detail with that element—there is work that needs to be done to get that sector to a greater state of readiness. The business case that underpinned the funding of the PCEHR always recognised that there would be a number of release stages. Our aim is to get as much information into the record from 1 July as possible, but there will continue to be both—

Senator BOYCE: If there is additional government funding for it there will be.

Ms Huxtable: Correct.

Senator BOYCE: We do not know that yet.

Ms Huxtable: There will be additional information but also a greater quality of information as time goes by.

Senator BOYCE: One of the other questions that is constantly raised here is the fact that there is currently no funding to incentivise GPs and others to transfer data into a PCEHR rather than use the system that they currently have. I know there have been PIP payments around e-health, but they are not related to the PCEHR. Could you explain how you are intending to incentivise or encourage frontline carers, health professionals, to use the system?

Ms Huxtable: The wave sites are an important part of understanding what the lessons are in terms of how information can be incorporated into the PCEHR, both in terms of the opportunities and barriers that there may be to that. You are right; there has been a significant investment over time in terms of getting up the level of computerisation in general practice. That has been highly successful. There is now a very high level of computerisation. One of the other things to recognise is that the intention is for the practice management systems to be structured in a way that enables information to be provided to the PCEHR. One of the areas to test is what is involved in the process of uplifting information, in this case, from a general practice or existing practice management information system to the record itself. These are the sorts of issues that need to be worked through both in the wave sites and as we work through the concept of operations. Some of it goes to the precise design and what role nominated providers may have, which is talked about in the Conop in terms of probably a general practitioner having a role to create a PCEHR on someone’s behalf. There are a number of issues that still need to be worked through in consultation and we will continue to work with various sectors in that regard.

Senator BOYCE: Mr Fleming, would you have a notional cost for a PIP?

Mr Fleming: No.

Senator BOYCE: Would that be something the department would do? Are the current people involved in wave 1 receiving an incentive? I realise you are using this to test, but how are you incentivising? What assumptions have you made about incentives within the wave 1 trials?

Ms Huxtable: I cannot say that I know the answer to that. I could take it on notice or perhaps one of the officers could answer. The reality is that there is variation across the various wave 1 sites.

Senator BOYCE: Mr Fleming, I am not at all sure that I understand the question of source systems. Could you please tell me how you are going to use IBM, I take it, to turn source systems into a generalised NEHTA system? I can see from the back that I got that completely wrong.

Mr Fleming: Yes.

Senator BOYCE: Can you enlighten me?

Mr Fleming: IBM is working very specifically on a program called NASH, the National Authentication Services for Health.

Senator BOYCE: Which will be part of the IHI and the PCEHR.

Mr Fleming: It is a foundation program. What it means is that when someone in the medical community has a transaction there would be a way of authenticating that they are the correct person. That is where IBM fits into that question.

Senator BOYCE: I understand the source systems are how we are going to get a multiplicity of programs to speak to each other.

Mr Fleming: If I understand the question—as part of wave 1 we have a vendor panel. The vendor panel consists of GP desktop systems. We are working with them to implement the series of NEHTA specifications. That includes a HR system, discharge referral, secure messaging and indeed working with that NASH environment. That is on the GP desktop side. The wave 1 sites are in Hunter in New South Wales; Melbourne down in Victoria and GP Partners in Brisbane. With the three state governments we are putting in place an agreement where they will be amending their systems—at the acute care sector level—so that they can talk to that GP level. For example, where a GP practice software system will implement the ability to take a NEHTA compliant discharge the state government will be amending their systems to be able to send a NEHTA compliant discharge. It is part of an overall process that fits in with what we are doing at wave 1 and wave 2 sites.

Senator BOYCE: Are these being done to a standard that you have developed or an international standard?

Mr Fleming: They start with international standards. We have a process of looking at the international standards, then decomposing down into the Australian standards and, if need be, amending and going through the Standards Australia process to do that.

Senator BOYCE: Have you undertaken a risk assessment of that process?

Mr Fleming: Of the standards process?

Senator BOYCE: Of the source systems process.

Mr Fleming: We have detailed risk registers for our program that lists out the various risk and mitigating actions to address that. Yes, we have risk assessments.

Senator BOYCE: You have done a risk assessment?

Mr Fleming: Absolutely, yes.

Senator BOYCE: Has NEHTA done that risk assessment or are you asking those people to self-report on the risks?

Mr Fleming: No. We have a risk group that looks at risk and does that in conjunction with all of our key stakeholders. It takes information risks that are identified in areas such as concept of operations and flows that through. There is also a NEHTA board subcommittee that reviews all of our risk and the actions being taken.

Senator BOYCE: Let us get on to risk assessment in the last couple of minutes that I have. Has a risk assessment been done on individual health identifiers? I asked this question and received an answer that told me there had not been a risk assessment of the HI system done, but I was looking specifically at individual health identifiers. Has there been a risk assessment of that process?

Mr Fleming: We have had a risk assessment of the HI system for a number of years as we have gone through various stages. Clearly the initial focus was on the development and the issues applied there. The development is done. The focus is very much around the implementation and what we need to do there.

Senator BOYCE: I understand PCEHRs are going to be operating using cloud computing. Is that correct? Is that your intention?

Mr Fleming: The reality of the PCEHR is that we use web-type technology. The intent is not to have a central database but a series of repositories that are available, which is distinct from cloud.

Senator BOYCE: Can you explain the difference?

Ms Halton: Just for general interest so everyone can understand.

Senator BOYCE: What are the repositories that you mean by that?

Mr Fleming: Firstly, there might be multiple electronic health records around the country. If I use myself as an example—and I do travel a bit—the reality is that my health record will be stored in various places around the country, just because of the amount of travel I do.

Senator BOYCE: Absolutely.

Mr Fleming: Within that context my record will basically contain my identifier. The context of the system is that we will have an indexing service and attached to the indexing service there will be a summary health profile for Peter Fleming, but within the indexing service we will know where to go out and get more detailed information from the various repositories that exist around the country as required by the clinician and for me as a patient for what I might need to know.

Ms Halton: That is distinct from cloud computing because?

Mr Fleming: I do not want to go into cloud computing.

Senator BOYCE: I do not think that we need to talk about cloud computing. When you say repositories, do you mean places where you have had a health service?

Mr Fleming: Yes. I can give a very specific example. At the end of last year I had a knee reconstruction. As part of that there was an MRI taken of me, which was down at The Avenue in Melbourne. That would be a repository that could be accessed with the right negotiation.

Senator BOYCE: Will we end up with something like 80,000 repositories?

Mr Fleming: No, not at all. There is a process for what a repository needs to be in order to be compliant with the PCEHR system. There are a few levels of compliance required, but the reality is that there will be a number of repositories around the country. It is nothing like 80,000 at a guess.

Senator BOYCE: Last time I asked how many organisations would have a health care identifier and the answer that came back on notice was about 80,000, in which case there is a potential for 80,000 repositories.

Ms Halton: We think that would be very unlikely. The reality is they will have to meet certain conditions to be a repository. It may be the case with a large radiology provider, but the greater likelihood is that they will send that radiology to your GP or your specialist. It is more likely to be a GP and it is more likely that it will be stored there. You have to meet certain requirements to actually operate a repository.

Senator BOYCE: The clinician will be the gatekeeper of that, so to speak. Is that correct?

Mr Fleming: No, the patient will be the gatekeeper. It will be my personally controlled electronic health record.

Senator BOYCE: I realise that. If every time I have an X-ray, for example, I have to say, ‘Are you a repository?’ or ‘Can you send this to someone who is a repository?’, will that mean in the end that the GPs will be the ones who will control the information?

Mr Fleming: No. The intention here is to have automated processes in place so that it does not need that manual intervention.

Senator BOYCE: I must admit that I am more puzzled than I was before we started. I will consider this issue and put some more on notice. Are we confident that these repositories are being accredited and to what?

Mr Fleming: There is a number of components there. Firstly, we have established a thing called CCA, certification, compliance and accreditation, which we are using NEHTA to help deliver. There is a series of requirements that must be met, starting with the HI system, for utilisation of these systems.

Senator BOYCE: I will stop there.

CHAIR: There being no further questions on e-Health, I thank NEHTA. Are there any questions on 10.3, Health Information?

----- End Extract.

This will be interesting to re-read in 12 months to see just how much that is being promised has actually made it to reality!


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