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H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, November 10, 2011

The Medical Software Industry Association (MSIA) Has Lost Patience With NEHTA. This Is Getting Serious.

The following appeared today.

Medical software group raises e-health safety issues

  • by: Karen Dearne
  • From: Australian IT
  • November 10, 2011 12:00AM
The peak medical software group is concerned about the Healthcare Identifiers service.
THE Medical Industry Software Association has warned unresolved patient safety and liability concerns relating to the year-old Healthcare Identifiers service leave members at risk of liability "for any and all adverse outcomes" arising from use of the service.
"Implementers should take legal advice with respect to potential liability, inform their software indemnity insurers and ensure end-users sign comprehensive waivers," the MSIA says in a white paper adopted by members at its annual CEO Forum last month.
The eight-page white paper -- obtained by The Australian -- was provided to all members of the Healthcare Identifiers (HI) stakeholders working group, including the National e-Health Transition Authority, federal Health department and Medicare, for their consideration.
Members should consider implementing existing Medicare Online patient checks for Medicare and Veterans’ Affairs numbers "as a proven alternative without the risks of fines and criminal liability", the paper said.
"Members have been concerned about the safety and clinical liability aspects of the current service since the specifications were first made publicly available.
"More than six months was spent negotiating with Medicare in an attempt to have it accept liability for system failures or data errors. Medicare refused to do so."
The current HI developer agreement is "restricted solely to accessing Medicare’s development environment, while the use of the live HI service is governed by the HI legislation and associated regulations".
"This leaves software implementers potentially liable for any and all adverse outcomes arising from incorrect functioning of the system or bad data supplied by the service," the paper said.
"Given the failure of the Medicare Online patient verification facility for Medicare numbers two years ago, this is not a theoretical risk."
In February 2010, a serious glitch in Medicare’s systems involved the potential incorrect updating of up to 30,000 patient records held in doctors’ own systems after a coding error during routine maintenance.
Medicare was alerted by software vendors who noticed the problem, but the agency was slow to act. Eventually, it was forced to write to 2700 medical practices, warning them to check for flawed data return messages generated over a three-day period.
"It is known that the Medicare data is not perfect, despite investing a large effort in cleaning its patient data over the past two years," the MSIA said.
"However, it is possible that duplicate and/or replicate IHIs will occur either in its database, or be introduced by operator or system errors in patient management and downstream systems.
"At present, even if Medicare is aware of a problem with an IHI, it has no mechanism for informing anyone."
The MSIA said it had repeatedly requested a copy of a patient safety risk assessment of the HI service apparently conducted a year ago from Medicare, the Health Department and the National e-Health Transition Authority. The information is needed by its members who are tasked with upgrading their products to interface with the system.
Much more here:
I don’t need to comment - the white paper says it all.
Download that from here:


Anonymous said...

I agree David you don't need to comment. The White Paper absolutely says it all.

What an appalling indictment of NEHTA, DOHA and Medicare.

The White Paper is not for skimming. It requires careful reading and in doing so the reader should focus on each issue and contemplate why and how the situation discussed has come about.

It is more than 100 percent clear that Nicola Roxon's PCEHR Wave 1 & 2 sites are going nowhere useful while this amazing stupidity prevails. She might not know that and her Departmental Secretary might not know that either but NEHTA's CEO and his Senior Managers certainly do.

Anonymous said...

The thing to note is the Department Secretary (Halton) is also a director of NEHTA, and arguably the one that should be most on the ball as there's lots of state/territory folks buts only one Commonwealth. Primary care is far more important at this stage than acute (low hanging fruit argument)... at least the states have some redundancy, even if they're all marching to their own drums.

In addition, DOHA has over 60 staff (about the size of three medium sized Australian eheatlh companies) purportedly involved with eHealth, so it's simply not acceptable for Halton to be out of the loop.

Anonymous said...

I thought Halton *was* the loop.

Anonymous said...

Man, what a MESS. Surely these technical foulups with the most fundamental service are going to effectively stall PCEHR? If vendors can't even make use of the HI service properly, what hope is there of being able to do ANYTHING with PCEHR?

There are amendments to the HI legislation as part of the PCEHR legislation. Perhaps a Senate enquiry would discover the extent of disfunction in this space?

Or perhaps 4 Corners or 60 Minutes might be a more effective channel get the attention of government here.

Anonymous said...

The moment they stop trying to solve the problems of the nation for everyone and focus on driving e-health into place using existing technology and one or more proven, established, high priority e-health applications, in collaboration with one or more established e-health vendors the sooner they will get some runs on the board. Now, what was it Deloitte said in its National e-Health Strategy document?

Anonymous said...

Friday, November 11, 2011 9:57:00 PM said "Man, what a MESS." Never was a truer word spoke. The mess cannot be fixed by those running NEHTA today. They have well and truly proven on many occasions they are not up to it. It is time to refocus, to chop at the top, deep and wide. It is time to take a deep breath, to heed the call above and if that means redirecting some dollars so be it - let's do it without delay.

Anonymous said...

The little people of e-health.

Friday, November 11, 2011 10:38:00 AM said "contemplate why and how the situation discussed has come about."

…… .. a multiplex of compounding events and incompetent decisions by ill-informed department officials and high-level NEHTA management can be enumerated to account for the "why and how"

…..... .. but the fundamental underlying reason is because, for almost a decade, the aforementioned have consistently refused to listen to, or acknowledge the skills and expertise of the "little people of e-health".

The little people are the highly skilled, they are the ones that make things work, they are the ones at the coal-face, they are the ones who understand the problems, who understand the users, who understand the technology and what is commercially feasible, practicable and achievable for a viable business to undertake in the highly complex health market environment.

They are the ones who emphasised the need to focus on the primary care sector as a high priority, who consistently appealed to be allowed to be involved in the decision making processes. They are the ones department officials and high-level NEHTA management consistently turned a deaf ear and a blind eye to in preference to embracing the big boys.

They are the ones who could have helped prevent the mess we see today. Is it now all too late?

Anonymous said...

To say [Friday, November 11, 2011 11:37:00 AM] “so it's simply not acceptable for Halton to be out of the loop” is a gross understatement.

Ms Halton not only is responsible for her army of 60+ staff in DOHA she is also directly responsible for establishing NEHTA on her watch (currently 250+ staff), for being a 50% shareholder of NEHTA and a Board Director.

Like it or not, which ever way you cut the cake, Ms Halton effectively is accountable for having 310+ staff working on e-health via DOHA and NEHTA.

To put it bluntly – Ms Halton is accountable.

Anonymous said...

NEHTA’s recently released Annual Report shows its current cash holdings are $44M.

I ask you: What could the ‘little people of e-health’ do with that?

Anonymous said...

Well under $2M has been enough to get 6 vendors to incorporate HI Service functionality, some CDA stuff and other bits of functionality (pulse wrote an article a few months back that explains what) to get their products somewhat ready for the PCEHR. I don't think you'd need anywhere near $10M to further flesh out the same functionality amongst a few other key vendors and, more importantly, get it deployed widely across the whole country (not just where NEHTA wants to throw some cash to old mates).

Sadly $15M is being blown in division/NEHTA/consultant project and change management malarkey for Wave 1 alone....the payment pyramid is upside down and it's no wonder the actual deliverers of ehealth are feeling screwed, yet again.

Anonymous said...

Re anonymous 10:28 Sunday and the NEHTA $44m cash. This may be set aside to wind up the company if it does not receive ongoing funding to carry on beyond Jun 2012. It has always been a feature of the 'transition' that it is supposed to be temporary...

Anonymous said...

Fear not - NEHTA will get another tranche of funding for the next 12 months. Its far too hard for Wayne Swann and Penny Wong to chop it back in their forthcoming mini budget, it's probably not even on their radar.

Anonymous said...

60+ staff alright, closer to 100. NEHTA and DoHA just keep chucking more people at it as the ship sinks.

Anonymous said...

I am mortified to think that between them NEHTA and DOHA employ over 350 staff to work on e-health and they have delivered diddly-squat.

By comparison many e-health software companies in the primary care sector employ on average 10 to 15 staff. Yet, despite their small size, they consistently deliver working software and services to medical practices, aged care facilities, community pharmacies and community health services right across Australia.

The latter provide working systems which help keep Australia's health system ticking over; whilst the former DOHA and NEHTA, spend hundreds of millions of dollars to employ busloads of bureaucrats who it would seem have been unable to deliver anything much of value to anyone except their paypackets.

Surely it's time for those in charge of this fiasco to be held accountable.

Anonymous said...

I fear it will be a little like the Eurozone fiasco really - those that SHOULD be held accountable will just 'resign' like Berlusconi or be shifted sideways, or promoted (if they are public servants). Instead scapegoats will be found amongst the 'little people of e-health' to stick it all to.

Anonymous said...

Well, when the 'little people' of Lybia and Egypt stood up and said 'enough's enough' a revolution began driven by people power. Those in charge refused to stand down, they held on to power, they bluffed, they killed, they remained confident they would survive. They were seduced by their own self-importance until suddenly they were gone taking with them whatever riches they could lay their hands on.

That it could be so ..... but in a democracy we do things a little differently ..... we talk about holding people accountable .... and that's all we seem to do .... talk. The 'little people of e-health are powerless to act' and those in charge of taking e-health forward, of setting policy and distributing the money, know that it is so. Where then is the revolution?