Here is the Hansard Transcript.
The Departmental Contributors are:
Ms Jane Halton - Secretary - DoHA.
Ms Huxtable - Deputy Secretary - DoHA
Mr Hallett - Role Not Listed That I Could Find
Mr Peter Fleming - CEO NEHTA
Mr Paul Madden - CIO DoHA
[19:58]
Senator FIERRAVANTI-WELLS: I will start with the PCEHR, the electronic health records. Could
you tell me how many people have signed up to date since 1 July?
Mr Morris : As of midnight last night, 13,340 people had signed up.
Senator FIERRAVANTI-WELLS: Does the department stand by the figure in the 2012-13 budget
papers of 500,000 as the number of consumers who will register for a PCEHR?
That was at page 192 of the portfolio budget statement.
Ms Huxtable : The 500,000 figure referred to the expectation that we had on the
basis of international evidence and the like around the rate of consumer
take-up that has been seen in other countries. A number of scenarios sit around
that. The 500,000 relates to the first full year of operation. As I think we
discussed at the last estimates, the PCEHR is being rolled out in a staged way.
The first stage of the rollout was consumer registration, which took effect
from 1 July. Then there was the staging of a provider portal, which took effect
from mid-August—I think 19 August was the date. And we are gradually having
software providers coming on board. A number of software providers have
incorporated the PCEHR into what is called a companion tool, and there are
other software providers that are well advanced in enabling connectivity. So we
will see a gradual upgrading of software into GP practices. That will happen
over a period of time. The first tranche of that will start from around the end
of this month. The 500,000 figure was used for operational planning purposes to
get a sense of where we would be heading in the first full year of operation.
It needs to be read in that context.
Senator FIERRAVANTI-WELLS: Does that mean that 1.5 million, then 2.2 million and then 2.6
million in the forward years is really achievable given where we are at the
moment?
Ms Huxtable : There are a number of processes that will be and have already
been put in place that accompany the staging of the rollout. You would be aware
that there has been clarification provided for GPs in respect of use of MBS
items for their participation in the electronic health record. There have also
been announcements made around the Practice Incentives Program and the
expectations of practices in terms of their engagement with electronic health.
These will all be drivers for adoption. As you would know, this is an opt-in
system for both consumers and providers, but the expectation that we have,
based on international evidence and our own experience, is that providers will
be an important part of driving consumer take-up. We are very focused on the
value of the participation in the PCEHR. Overall numbers is one metric but
equally important is the metric around the types of people who are
participating in the electronic health record. The focus of the development
work has been very much around those cohorts who will benefit the most—people
with chronic disease, mothers and newborns, Indigenous people, older
Australians et cetera. That has been the focus and we are driving toward that.
Ms Huxtable : To register?
Ms Huxtable : Yes, it is actually in the Department of Human Services. So there
are three registration channels, one of which is a phone channel, but there is
also the Medicare shopfront and the online channel.
Ms Halton : And I have to say: I am delighted that we have got 13,000. We are
not even at the point of having the GP software available and yet, despite
that, literally, day on day—we get the numbers everyday of how many people have
registered—I open it and think, 'Goodness me'. People really want this. It is
amazing. Most of those registrations are coming online.
Senator FIERRAVANTI-WELLS: Ms Halton, let me share with you my experience on 4 July.
Mr Hallett : You have tried, yes.
Senator FIERRAVANTI-WELLS: Let me tell you about my experience on 4 July. So I ring up and I
spell my surname—three times. There was a problem with the hyphen—lots of
problems with hyphens. So, after 20 minutes the person at the other end of the
phone says, 'Can you go to a Medicare office?' I said, 'Great, terrific—I'll go
off to a Medicare office to register for something online.' Ms Halton, not good
enough.
Ms Huxtable : Senator, the online registration capability came into effect from
6 July, so the online channel has been opened from 6 July—
Ms Huxtable : It does.
Ms Huxtable : Yes, all of the above. And 90 per cent of registrations are
coming through the online channel.
Ms Halton : Senator, I think it is important to understand here: this is a
huge piece of software—softwares, lots of it. This is a huge change. This
capability was stood up in the time that was actually requested of us to stand
it up. Yes, there are all sorts of things that we are learning as part of this
process. In fact, as we move to roll out the GP software—and my colleagues down
this end of the table can talk to you about the early software we now have
available to the profession. But the main bits of GP software will become
available later this year. The last bit is available early next year.
Essentially we are in the early phases of this. So you actually constitute an
attempted early adopter. This is my point about the 13,000—we have not gone out
and promoted registration to anybody.
Senator FIERRAVANTI-WELLS: Ms Halton, you qualified it by saying, 'as far as the department
is concerned'. Doesn't it smack of an implementation that was rushed without
properly—
Ms Halton : No.
Ms Halton : No. Senator, I actually have to strongly disagree with you.
Ms Halton : It has been done properly.
Senator FIERRAVANTI-WELLS: How many people do you think may have tried and had a problem and
may be put off—
Ms Halton : The thing we know—and it is definitely the case and we are
working on this—is that there are some difficulties for people with online
registration. There are some barriers in terms of what is referred to in the
trade as 'useability'. My colleagues can all talk to you about that issue. My
point is exactly this. Early adopters are giving us a lot of feedback about the
registration process—some of the barriers, some of the issues, some of the
challenges. When the GP software becomes available this is when we actually
expect to see, and when we indeed expect to drive, registration. What we are
doing is working through some of those issues in this early phase. And, yes, it
is freely acknowledged that there are some challenges in people actually
registering, and we tried to deal with some of these issues early on, with
information provided on the website about what you might need to verify your
identity. If you ask people along this table, they can all give you a variety
of experiences about registration. Rosemary registered in about three minutes
flat because she had—
Ms Huxtable : An aus.gov.au account.
Ms Halton : an aus.gov.au account. I did not. Everyone has got different
experiences. The truth is that this is a long-term change. It was delivered, as
we promised registration would be available, from1 July, and the electronic
registration from the 6th. That is exactly what we promised.
Mr Fleming : Yes, it is achievable and yes, it was achieved—absolutely. As Ms
Halton said, registration was available on those dates.
In terms of the software vendors
that Ms Halton mentioned, we are working with four groups of software vendors
at the moment. In terms of GP desktop vendors, there are nine of them; two of
them are in the category of the companion tools, and the others are the
traditional desktop providers. The companion tools have been built out and are
operational in beta sites at the moment, and they will roll out before the end
of the month to other sites. So that is a normal process.
In terms of the GP desktop
vendors, who represent 98 per cent of the market, they have all built the HI
system into there. They have an objective: by the 31st of this month to have
the functionality of the PCEHR finalised, and they will do that. Then they have
another objective for February.
In conjunction with that group, we
are working with the aged-care vendors. Once again, the major vendors in that
market are approximately 90 per cent of the market, and they have a series of
objectives that they are working to. We will make announcements very soon about
the community pharmacy vendors who are also signed up and working. The fourth
group of vendors are ones that are not part of our vendor panel but are working
with us for various reasons and, once again, progressing quite strongly down
that path. So, yes, it is absolutely achievable.
Senator FIERRAVANTI-WELLS: How many shared health summaries have been created and uploaded to
the PCEHR?
Ms Huxtable : I do not know that I know the exact number. With the companion
software, there has been a shared health summary uploaded—that is correct,
isn't it, someone? But it is in the very early stages, so, as Mr Fleming said,
the companion tools are in use. I think there are two practices that have used
those companion tools. It must have been at least a month or six weeks ago.
Mr Madden : Mid-September.
Ms Huxtable : The really important next step is when those software vendors are
rolling out their desktop software, which will be starting later this month.
Senator FIERRAVANTI-WELLS: How many have been created? Do you need to take that on notice? I
would have thought that that would be information Mr Fleming or somebody would
have.
Ms Halton : Mr Fleming is not the operator so he will not have that
information. We can get that information for you, but I just need to remind you
that what we have here is actually ahead of what we were anticipating. It was
not our expectation that there would be any summaries available until the GP
software actually became available. The fact that we have had two software
providers come out early because they are trying to get into the market is
actually a bonus. We were not expecting summaries to be provided until the GP
software started to roll out.
Ms Huxtable : I can tell you that 791,764 Medicare documents have been uploaded
to Personally Controlled Electronic Health Records, however, as at the end of
September 2012.
Ms Huxtable : Yes: information about MBS claims, PBS claims, organ donation
registry records and immunisation records.
Ms Huxtable : Yes, definitely, because, as Ms Halton and I both tried to say,
we are not really at the stage—
Ms Huxtable : where we are getting the roll-out of software to enable the
summaries to be uploaded.
Ms Huxtable : Yes. Certainly the national infrastructure has the capacity to
upload shared health summaries, event summaries and discharge summaries. So
that functionality has been delivered.
Senator FIERRAVANTI-WELLS: Mr Fleming, now that the PCEHR has gone live, what is your focus
over the next 24 months going to be?
Mr Fleming : NEHTA, as you know, is funded through two sources: the Council of
Australian Governments—and within that context there was significant work to do
around infrastructure-type services, the HI service, discharge referral et
cetera—and, through PCEHR, the Commonwealth. We are still completing some of
the COAG activities, and indeed our focus is now very much on supporting
implementation. So we are working very closely with all vendors. One of the
things we have built out within NEHTA is: every time we write a specification,
we write sample code, build it ourselves and then make that available to
vendors and help them implement. So our focus is very much now on helping the
implementation of this throughout the country, whether that be with vendors or
others. On the clinical side we have a group of people who are working with
clinicians and those services on process re-engineering and so on, so it is
very much around implementation. We are also finalising certain aspects.
We are working on medication
management will flow through in the near future, for example.
Mr Fleming : As you are probably aware, we did terminate the contract with
IBM. We have been working with DOHA and DHS. We have implemented a NASH solution
with DHS, which is in operation and rolling out. That is progressing.
Mr Fleming : NASH is doing what we need now. For PCEHRS there is a second
component which will support secure messaging. DHS is working with some final
phases there, and they will make some announcements in the very near future.
Certainly everything we need NASH to do it is capable of and it is doing.
Senator FIERRAVANTI-WELLS: Could I just give you a copy of this article. It is 'Experts brand
e-health audit trail as "gobbledygook"'. Did you see that article?
Mr Fleming : I am aware of it from a little while ago.
Ms Halton : This is the infamous David More, the well-known blogger.
'E-health consultant and medico Dr David More', otherwise known as the
well-known blogger.
Ms Halton : No. I have not seen before.
Senator FIERRAVANTI-WELLS: It is about the audit trail. Are you questioning Dr More just
because he is a serial blogger?
Ms Halton : I was just reading the second paragraph, so I know can what this
is about.
Ms Halton : I have not even got to the next part of the comment.
Ms Halton : We might let the chief information and knowledge officer start
talking while I read.
Mr Madden : I did see that blog some time ago. I cannot remember the exact
date. Ms Halton mentioned earlier there were a range of issues around
usability. We had delivered an audit log. We had expected that there would be
low numbers of registrations, and the intention was to reformat and provide
that information in what I will call a more user-friendly style, which has been
done since. Back at that point what we had set out to do was to make sure that
we were capturing all of the auditable records and the changes and the creation
of things in the PCEHRS. All of the audit logs and all of those activities that
have been undertaken have been recorded. How we format that and put it on a
screen to make it usable has been updated to make more user-friendly.
Senator FIERRAVANTI-WELLS: If you are dismissive of Dr More's comments—he styles himself as
an e-health consultant and medico, and I think he makes some pretty valid
points there—over the page there are some other comments. One is by Carol
Bennett. She makes the comment on page 2 of that article:
… the ability of consumers to
track who had accessed their e-Health record was a "critical
component" …
"For the audit to work it has
to be user friendly and it currently isn't," she said.
What is your response? She also
makes some other comments:
… have to make it a high priority
to make the audit user friendly so it can generate confidence that consumers
have the ability to have control over who accesses their record ...
What is your response to Ms
Bennett?
Mr Madden : The response to Ms Bennett is that the usability and the ability
for users to navigate the audit records is a priority, and we will continue to
work on those usability aspects. I guess the critical aspect is that we have
kept a record of every creation of record, access of record, change to record.
So all of those elements of information are there. How we present them into the
future to make them more useful and usable to the user will continue to be a
focus for us.
Senator FIERRAVANTI-WELLS: What about the comments by the Australian Privacy Foundation in
that article that the audit trail data was 'absolutely meaningless'? The quote
continues: 'How the heck is a consumer expected to interpret machine addresses,
that's all they've got to track their record.' And you have comments there.
What is your response to those comments?
Mr Madden : Again, the feedback we got when the blog was first published was
a very important set of feedback that has actually turned our focus to how we
present that information in a more user-friendly style. Again, the information
we have collected and will maintain is the audit trails and logs of all of the
activities in the PCHR, and we are turning that into a user-friendly log that
is more usable and easier for people to read.
Mr Madden : The first part of turning that into a user-friendly audit log has
already occurred.
Senator FIERRAVANTI-WELLS: In relation to the glitches, I mentioned hyphens and commas. Have
apostrophes been sorted out.
Ms Halton : There is no issue there.
Mr Madden : No. We only ever had issues with the apostrophes. We did not have
issues with the hyphens.
Mr Madden : Okay.
Senator FIERRAVANTI-WELLS: I have a long name with a hyphen. I was told 'Can't do hyphens.'
If you tell me there is no problem—
Ms Halton : I can guarantee you that you can do hyphens.
Ms Halton : When you try—and this is important—because of the aus.gov.au
front end, there are a series of questions you are asked that enable Medicare
Australia database to confirm that you are you. We put this information on the
website, but as I said there are still some useability issues about it, which
is why we are not out promoting this very hard at the moment as we try to sort
through those. When you try, have with you the information about the last time
you went to the doctor—so, the last time you claimed a Medicare benefit. If you
have that kind of information—where it was, when it was and how much it
was—that will help you verify your identity to the Medicare database. It
basically says that, if you know that, that is really who you are. That is a
little hint.
Senator FIERRAVANTI-WELLS: I will try again. I now have questions in 10.4 and 10.5 and that
will complete my questions.
CHAIR: As there are no further questions in 10.2 or NEHTA, thank you for
your evidence. Are there questions on 10.3?
[10:22]
Here is the direct link to the relevant - very long segment.
Here is the link to the offending blog on the Audit Trail.
I just had another look at the Audit Trail and it is better
spaced out but I still think it just needs a ½ page description of what you are
looking at. I have to say it is great that the Department is actually listening
and trying to fix the more obvious issues.
I will leave it to others to reflect on the take-up rates
and what it means.
As far as the claims of progress in all the various areas
traversed in this rather short session I am sure readers will feel free to
clarify just what is happening as far as they are seeing things on the ground.
Re: NASH Mr Fleming has told us the contract with IBM has
been cancelled but what is not clear is just what has been delivered for how
much, what is still to be done and who owes whom at the end of the day. We also
note from the NEHTA comments that the NASH saga is still not over. It also is,
of course, hardly widely implemented as yet. Another ‘time will tell’ situation
I would suggest.
I also note the 'using the early users as testers' approach seems to be very much alive and well!
David.
That's funny, I wonder why those 13000 people have registered for a record - since there is not much in any record at this point.
ReplyDeleteI reckon it is all the DOHA, Nehta, Vendor, lead sites and people working in state health systems/industry that have something to do with their work - just curious so they can see how it works. Would be nice to see how many of those 13000 work in eHealth. And how many of them are actual consumers (aged, mothers and newborns, etc).
Now I have seen it, I am looking hard for the 'opt-out' button - is there one?
"Yes. Certainly the national infrastructure has the capacity to upload shared health summaries, event summaries and discharge summaries. So that functionality has been delivered."
ReplyDeleteWell yes - but this is only one part of the interface, and the other parts are to be delivered by the vendors and DHS and implemented by health service providers. There is a long way to go yet - this next stage will be the most difficult and risky part of the system, and will need to be thoroughly tested before it goes live. The HI Service, and the NewNASH will also have to work correctly. No live testing this time I hope. It was one thing to struggle with hyphens and apostrophes when resgitering, and incorrect age calculations, but an entirely different kettle of fish to get a clinical aspect wrong. They will probably find that 'that functionality that has been delivered' in the core system will need some more delivering. This is always the case with interfaces, and especially for new interfaces, and this system has many new interfaces, between many new components. Anticipate problems with dates, sorting of records, and any view that combines data from more than one document. There are likely to be a lot of ' reject messages' coming from the core system - e.g. IHI unknown, template error, etc - and this will be a nightmare for software vendors and their sites. But yes...
" Certainly the national infrastructure has the capacity to upload shared health summaries, event summaries and discharge summaries. So that functionality has been delivered." So if it doesn't work - it must be the fault of all of you out there - not the national infrastructure!
Right, the National Infrastructure has been delivered. And clearly, DOHA didn't rush it towards the appointed date, so clearly there is and can be nothing incomplete about it. Further, the specifications were already withdrawn once to get them correct, so clearly there is nothing wrong with them either.
ReplyDeleteSo DOHA can go full stream ahead scure in the knowledge that while there is a little ill-founded and crassly venal resistance to e-Health and/or the pcEHR, the design and delivery are good and right and all that remains is a little change and adoption stuff to work through.
And, of course, the fact that DOHA has adopted the user-unfriendliness of the audit trail is a priority for them to work on is *not* indicative of a micro-managed process where the project managers strain at a gnat and swallow a camel.
Live testing on vulnerable consumers with chronic disease, the aged, etc, is unconscionable.
ReplyDeleteIt would be good to know how many sign-ups to the PCEHR have been assisted sign-ups and to what degree patients or the aged have put their hand up and asked for it or have been approached or coerced by others to sign up, the degree of transparency, the degree of understanding of what they were signing up to, etc.
Live testing, where it might involve risk, without informed consent, I would say is illegal. Any journalists out there paying attention?
ReplyDeleteAll the good healthIT journalists have been given the flick - the news media is in turmoil as revenues spiral downwards. This means the 4th estate is no longer watching DOHA and NEHTAs stuffups - so its open slather for them with no holds barred.
ReplyDeleteAll I can say is we know Government at all levels and NEHTA read here so if you have something to say a comment or e-mail (confidential) can get the ball rolling. Additionally the specialist medical and IT press are still watching and publishing and you can expect some more mainstream coverage soon!
ReplyDeleteDavid.
Well then thank goodness for the infamous serial blogger!
ReplyDeleteDear Jane 10/25/2012 02:55:00 PM you know you shouldn't talk about David like that, it doesn't become you.
ReplyDelete"Ms Halton : Mr Fleming is not the operator so he will not have that information. "
ReplyDeleteUmmm....no, Mr Fleming isn't but Ms Halton is - the operator that is. So why didn't she (or her helpers) have that information and why did the question have to be taken on notice?
Yeah I would have thought there would be 3 things you would take with you to Senate estimates:
ReplyDeleteHow many consumers have registered
How many providers have registered
How many shared health summaries (or any other clinical document)s have been lodged.
There can only be two reasons why you have to take it on notice: Either the NEHRS does not have the functionality to measure it! Or the answer is very embarrassing.
Oops.
So why didn't she (or her helpers) have that information ...... because she is known as Teflon Jane - a master at deflecting anything where the truth might be embarrassing.
ReplyDeleteThe questions about the number of registrations and the number of health summaries uploaded are really quite immaterial. Of course the numbers are small and will remain so while there is no medical information in the NEHRS.
ReplyDeleteOne of the more significant exchanges was that concerning NASH. In response to the question "What is the status of the National Authentication Service for Health?", Mr Fleming responds "As you are probably aware, we did terminate the contract with IBM. We have been working with DOHA and DHS. We have implemented a NASH solution with DHS, which is in operation and rolling out. That is progressing." Then to the question
"When will this be complete?", he replies "NASH is doing what we need now. For PCEHRS there is a second component which will support secure messaging. DHS is working with some final phases there, and they will make some announcements in the very near future. Certainly everything we need NASH to do it is capable of and it is doing."
Notice, firstly that Mr Fleming completely ducks the questions. IBM got a $23.6M contract to build NASH, worked for 18 months and failed to deliver a product, but DOHA and DHS can conjure up a perfectly acceptable solution at short notice and presumably with little effort? Bollocks! Either NEHTA and IBM have both been monumentally incompetent or someone is not telling anything like the truth. Are we to believe that this Clayton's NASH is able to scale to satisfy the whole of Australia and all of the demands of the various cases for which NASH was specified? And do it with the standard of security and reliablilty which the system demands? Please explain Mr Fleming, Ms Halton, Mr Madden.
Also, Mr Fleming seems to believe that the PCEHR requires secure messaging. He should know, but as far as I can tell from reading the PCEHR Concept of Operations and several other docments the PCEHR does not rely on secure messaging (at least not as described in the SMD standards). As Karen Dearne usefully pointed out in one of her articles for The Australian "The PCEHR is not a communication system."