Friday, July 27, 2012

What Do You Notice Is Wrong With This? No Wonder The HI Service Has Very Real Problems With Adoption and Use.

In a presentation in late June (released a few days ago) David Bunker (NEHTA’s Head of Architecture) showed this slide - Slide 6.

Update – national foundations

NEHTA has made significant progress in designing, operationalising and enhancing the essential foundations required to enable eHealth:
·         Built and implemented the Healthcare Identifiers Service. As at December 2011 there are 24,350,000 IHIs, 526,000 HPI-Is and 624 HPI-Os issued.
·         More than 2 million IHIs downloaded into clinical systems, including 1.3 million in the Lead eHealth sites and in the TAS and ACT Patient Administration Systems
·         Built and implemented the National Clinical Terminology and Information Service; including Australian Medicines Terminology and SNOMED CT, the National Product Catalogue, and the Security and Access Framework. The NPC is being used by NSW, WA, SA, VIC, QLD and the ACT. VIC has begun limited AMT rollout.
·         Designed the National Authentication Service for Health – currently being built.
The full presentation is found here:
Referring to the Australian Bureau Of Statistics to population of Australia is - as of today - 22,677,692 souls.
See here for the latest figure:
This means there are 1,672,303 more Individual Health Identifiers than there are people. Even allowing for those who have died between December 2011 and now (say 50,000) and the suggestion that visitors from overseas who get a prescription or service stay on the system for ever it seems to me there is a very big information integrity problem here.
To me the problem is that there has never been the needed money spent to initiate and maintain the IHI system in a way that is really fit for purpose and this claim ‘bells that cat’ well and truly. Basically we have a Health Identifier Service which was started on the cheap and now seems to be drifting.
I wonder what the clinical safety implications of all this are. Can’t be positive.
No wonder NEHTA keeps talking about the number of identifiers issued and not about the number that are actually using their IHI with the service. I wonder what having ‘downloaded’ the identifiers into local systems actually means?
It’s interesting to note that after more than five years we are still only seeing a ‘limited rollout’ of the AMT. Again hardly a strong endorsement of what has been done.
I note, in addition, that NASH is still being built rather than implemented. I wonder when that will actually start and how much it will wind up finally costing?
NEHTA’s record would have to be described as ‘patchy’ at best. Separately the Australian is reporting the forward agreements on NEHTA’s funding have not been signed off and  we do know of considerable job losses - especially among contractors.
See here:
“Meanwhile, the National Partnership Agreement on E-Health, under which COAG funds NEHTA, expired at the end of last month.
Mr Madden (DoHA CIO) said a new intergovernmental agreement was "still being developed".
NEHTA's role was to develop the specifications and standards needed to support e-health systems under a COAG program set more than three years ago, he said.
"They don't develop clinical software and put that in the hands of practitioners to use, but the jurisdictions are using products based on their work," he said.”
Dear oh dear - looks a bit messy.


B said...

re NASH.

I heard a rumour that NASH is in deep trouble. It would appear that there has been a degree of disagreement between Health and the vendor about what is to be delivered. Bits were taken out to get the cost down and now it won't actually work or integrate.

There seems to be a big argument about whose fault it is, but whatever the answer, it ain't going to get finished real soon now.

B said...

re the presentation

I have never seen so many weasel words in one slide pack:

Slide 2
eHealth is one of the most important opportunities ....

Oh goodie, an opportunity, not a thing.

Slide 3
eHealth record system implementation is a partnership between governments, NEHTA and the market

Oh goodie, eHealth is a partnership, not a thing that does anything.

Slide 3
NEHTA’s purpose
[is to] Lead the uptake of eHealth systems ... coordinate the progression and accelerate the adoption of eHealth by delivering urgently needed integration infrastructure and standards for health information.

Oh goodie, Leading, co-ordinating, accelerating adoption...
Not actually doing anything.

Slide 6
NEHTA has made significant progress in designing, operationalising and enhancing the essential foundations required to enable eHealth:

Oh goodie, foundations, not something that delivers anything

Slide 7
NEHTA has co-ordinated the progression of priority eHealth initiatives:

Oh goodie, co-ordinated the progression of priority eHealth initiatives. Management speak of the worst kind.

Slide 9
A national system of eHealth records has the potential to save money, make the health system more efficient and improve care for patients.

Oh goodie, the potential to do something. Not actually do, but has the potential.

What a load of spin.

So who is actually responsible for delivering a PCEHR? From that presentation, not NEHTA or DOHA.

That probably explains a lot. Nobody is responsible for delivering a PCEHR, which is why there is no sign of a workable, acceptable eHealth record, personally controllable or not.

And certainly not a system I would trust.

Cris Kerr said...

NEW 'Australian Health Informatics Certification Program'

I hope credentialed readers with capacity to add value will express interest in contributing their ethically guided health informatics expertise to this new 'Australian Health Informatics Certification Program' in the best interest of all Australians' health futures (news extract follows)...


' ... Health informatics workforce issues will be a strong theme running through HIC this year, culminating in a panel during the final session of the conference entitled ‘Can Australia lead the world in digital healthcare? The role of health informatics and its professionals’. There will also be a specialised workshop on ‘The future role of the health informatics professional — opportunities, training, options and accreditation’. If you are a student, an emerging health informatics professional or interested in mentoring future talent, a meeting will be held during HIC to bring those people together and to further develop a strong network amongst our future professionals.

But most importantly, we will be officially announcing the launch of an Australian Health Informatics Certification Program at HIC. HISA has been working with the Australasian College of Health Informatics (ACHI) and more recently with the Health Information Management Association of Australia (HIMAA) and others to put together a framework for this important initiative.

The Health Informatics Certification Program will contribute greatly to the development of the health informatics workforce and health informatics capability by providing additional ‘currency’ for the recognition of health informatics experience and knowledge.

Becoming a certified health informatics professional will involve the successful completion of an exam, the content of which will cover the breadth and depth of health informatics. The first round of candidates will complete the exam in 2013.

As the development of the certification program progresses, more information will be made available through outlets such as Pulse+IT and the ACHI and HISA websites. Stay tuned for more updates and in the meantime if you would like to contribute to our activities in this arena, please don’t hesitate to contact me.

Author Details
Dr Louise Schaper
CEO: HISA This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Dr Louise Schaper is CEO of the Health Informatics Society of Australia, Australia’s health informatics organisation. Louise has over 10 years of experience in eHealth and health informatics, a degree in occupational therapy and a PhD on technology acceptance in healthcare.

Cris Kerr said...

I just came across a news item re HIC 2012.

Is anyone here attending HIC 2012, and if so, could you please post a report here about how the conference describes Australia's Healthcare Future and 'trusted information'?


Welcome to HIC 2012
30 July - 2 August 2012

"Health Informatics - Building a Healthcare Future through Trusted Information"

HIC is the health conference to attend - the absolute cutting edge in health information.

The Health Informatics Society of Australia (HISA) is pleased to invite you to participate in HIC 2012, Australia's Health Informatics Conference, to be held from 30 July - 2 August 2012 at the Sydney Convention and Exhibition Centre.

With the primary theme of Health Informatics - Building a Healthcare Future through Trusted Information, HIC2012 will focus on consumers, practitioners, researchers and industry.

"Health Informatics is the lifeblood of health care. We need to stand up and be counted."
Dr Louise Schaper, HISA CEO



Regina Holliday, USA Patient Artist Advocate, The Walking Gallery

' ... Regina Holliday, USA; Health Advocacy
On March 27, 2009, Regina's husband, Fred Holliday II was diagnosed with metastatic kidney cancer, after months of escalating pain medication prescribed for symptom relief, without a diagnosis of the cause of the pain. Fred died on June 17, 2009. Regina's response to the shock and anguish of losing her 39 year old husband (plus Fred's urging on his deathbed) was to become an arts advocate for all patients' rights to their own medical data.[1] During his final hospitalization, Regina asked repeatedly to see her husband's medical records, so that she could research his condition and care online, and so that they could make informed decisions together. At the first of five hospitals he was admitted to during this medical ordeal, on April 18, 2009, she was told that copies of his records would cost $.73 per page and would be available after a 21 day wait.[2] That would have been May 9, 2009. Fred Holliday II died at home on June 17, 2009. In Regina's words, her husband's final message inspired her advocacy: "He's got a paper in his hand. It says: 'Go After Them Regina, Love Fred.'"[2] And, from Regina's blog on Sunday August 9, 2009: "I am painting because it is the best way I know that can make a difference. I will paint our sorrow on a wall for all to see. It is hard to look away. It makes you think. It makes you question. The scariest thing to the status-quo is an electorate that is thinking and asking questions. I am as grassroots as it comes. There is just me on a 20 foot ladder donated by my church. I am using paint brushes I have had for 17 years. I am applying acrylic paint (paid for by donations of friends and strangers) on a wall donated by a gas station." ... '

Cris Kerr said...

I'm guessing the sponsorship dollars weren't enough to subsidize costs because attendance is limited to those who have a healthy hip pocket... to the tune of $1100 plus for the conference, plus airfares, plus accom and expenses.


SPONSORS of Health Informatics Conference (HIC) 2012...

NSW Govt eHealth

Australian Govt Dept of (public) Health & Aging


BT Health

Business Events Sydney
Care Innovations

Terry Hannan said...

The excess could be all the "boat people" we have/expect!!!! Or there are many with "dual" personalities (very Tasmanian).
Also more seriously how, when and to where were the IHIs downloaded?

Cris Kerr said...

' ... More than 2 million IHIs downloaded into clinical systems (GP desktop clinical software systems?), including 1.3 million in the Lead eHealth sites (wave 1 & 2 sites?) and in the TAS and ACT Patient Administration Systems (hospitals?). ... '

Just more question marks to add to many others.

Keith said...

In "The Age" today:

"Secret report uncovers e-health patient identity problems

Mark Metherell

GLITCHES in patient identity details for Australia's new e-health system have been found in about a third of cases nationally, according to a report the federal Health Department refuses to release."

Read more:

Because DoHA has refused to release the report it's hard to judge the severity of any problems, or whether there is anything new here. We know that the requirement for exact matching leads to a proportion of "no match found" results, but this is far preferable to getting an apparent match on the wrong person. It's the ongoing secrecy and lack of progress which suggest a project in trouble on many fronts.