Sunday, March 24, 2013

There Are Some Real Concerns Around How Citizens Are Being Corralled Into The NEHRS.

I found this a very interesting report a few days after some of the following comments (One alerted us all to it.):
PCEHR in for a 'big push' says DOHA Secretary
Posted Wed, 20/03/2013 - 13:57 by Fran Molloy
Launceston residents can register for the PCEHR via trained administrative staff using the new assisted registration tool from this week, with the tool to then be rolled out nationally, Department of Health and Ageing (DOHA) Secretary Ms Jane Halton said today.
The assisted registration tool is one of the final parts of the PCEHR puzzle, now that all major GP software developers have system upgrades to ensure compliance.
"From May this year we are ready for a publicity push on the PCEHR," Ms Halton said.
A slow rollout of the health record had been flagged from the outset, she said, but momentum is building and over 85,000 enrolments have been completed so far.
Of these, around 90 per cent have been done online rather than through a Medicare office or via the Medicare-staffed hotline.
Ms Halton told health professionals in the audience at the 2013 Health-e-Nation SUMMIT Conference in Melbourne that they needed to "all get out there" and encourage sign-ups.
"Word of mouth is one of the ways people find out about new technology; it takes a while," she said, citing the early adopters of 'brick' mobile phones as the vanguard of today's smartphone-enabled population.
Lots more here:

As if to cue we then had the following discussion break out.

Terry Hannan said...

This topic has distinct relevance in my local hospital this week. Our corridors are populated by DOHA staff wearing DOHA e-health T-shirts who confront people passing by with the request that "would they like to have their own "secure" electronic record. This is followed by "all you need to do is give us your Medicare Card and your Licence and we will set the record up for you." The initial data is 'transcribed by hand onto an clipboard then entered later on a portable device off site-after a given individual has signed the clipboard form containing their personal information.

When I asked one of the data collection person what they are doing she informed me they were registering the people for their SECURE medical record and that she understands it is secure because "she has been told it is secure"!!! An individual who signs up is then given a small pamphlet to take and read about the e-record. Personally I have a lot of difficulty with this data collection process-not only from patient data security but the real risk of transcription errors in the data recording. On straw polls in this institution ~0% of doctors know what a PCEHR is and for the rest of the staff I am sure the figure is not much more. This whole process seems like a political stunt to enhance the PCEHR registration numbers for a project that has been very costly and doomed to failure-implementation wise and politically.

3/21/2013 08:59:00 AM

Anonymous said...

Think you've nailed it Terry - a pretty cynical bid to boost registration numbers! It's also happening in some GP clinics, where people persuade you to sign up in the waiting room.

Who are these DoHA people - casual staff employed for the "campaign"?

Exactly what information are they collecting and what details are they entering later into the system?

And how many patients thus railroaded will actually go home and look up their record to see what's there, or otherwise make use of the record as intended?

3/21/2013 10:23:00 AM

Anonymous said...

Terry Hannan has highlighted a very disturbing activity which he describes as - a political stunt to enhance the PCEHR registration numbers.

It reeks of a blatant invasion of privacy. To waylay people inside the protected environment of the walls of a public hospital is sickening. Many people are just holding themselves together wrestling with illnesses and deep personal traumas.

To use the credibility and reputation of a trusted public hospital environment in this way is inexcusable. They should join the American Express sales people at the airport terminals if they want to use such enrollment techniques.

Handing out a simple explanatory flyer to people as they pass without interrupting their thoughts is probably still unacceptable in the protected confines of the hospital environment.

Good governance suggests that the Hospital Board should immediately instruct the Hospital Executive to terminate that activity without delay.

3/21/2013 10:30:00 AM

Anonymous said...

I say a PCEHR sign up team in the mall at Bondi junction last week, little desk, big signs. Clearly a broad push all over the place to get numbers up. What is the cost per sign up I wonder? Smells desperate to me.

3/21/2013 11:06:00 AM

Anonymous said...

Yes, there is a big push on...

At CHIK in Melbourne, apparently

3/21/2013 12:37:00 PM

Anonymous said...

How much (more) is being spent on this PCEHR activity and what funding bucket is this being sustained by?

+$1B and counting.

3/21/2013 06:55:00 PM

Paul Fitzgerald said...

How can accosting complete strangers in a hospital corridor/waiting area and taking their Medicare Number and Driver's Licence not be a breach of Privacy? This is enough to get a stolen ID up and running. Surely the Feds don't have an immunity to the Privacy Laws that we mere Plebs need to follow? And as someone else suggests, at what cost?

3/21/2013 10:10:00 PM

Anonymous said...

But they pretty much are immune...

the bill says: "While each jurisdiction will be legally bound by the arrangements set out, the Crown will not be liable for pecuniary penalties or subject to prosecution for offences. While the Crown cannot be liable to be prosecuted for an offence, or liable for a pecuniary penalty, this does not mean that all action against the Crown is precluded.

"If the Crown in any of its capacities does not comply with its obligations under this bill, other remedies are potentially available. For example, it may be subject to a declaration or injunction, investigated by the Information Commissioner under the Privacy Act, investigated by the Ombudsman, subject to Parliamentary scrutiny or subject to claims for breach of statutory duty.

"Further, while the Crown may have immunity in certain regards, the employees and contractors of the Crown will not necessarily have any such immunity. Finally, nothing in the Bill prevents an individual who suffers loss or damage from seeking to recover that loss or damage from the person who caused it."


3/22/2013 09:16:00 AM

Anonymous said...

Unbelievable - what will they stoop to next?

So just how "secure" is the data of the poor, sick individual who has been bullied into giving it to some bureaucratic types with clipboards in a hospital corridor?

What happens to it between the time it is captured on the clipboard and entered on a PC or iPad or whatever? Can't wait for the first time a clipboard full of personally identifiable information is stolen, lost, left in a taxi etc. How is Ms Halton going to explain that away?

Don't seem to remember this registration method being in any of the previous "design" briefs......

3/22/2013 05:29:00 PM

Our commenters have provided a rich set of comments to all this - thanks team!

The one that really worries me is the power imbalance between the hospitalised patient and the ‘clip-board wielding’ bureaucrat. What should happen is that the hospital patient be given a brochure and once at home and feeling better they should then consider if the NEHRS is for them. Anything else is just unfairly coercive in my view.

There is also this obvious issue that we have paid bureaucrats - who clearly must be paid for their time, wandering about doing all this recruiting. Or worse we have caring staff who have better and more useful things to do being diverted from their primary task. All this is happening when no one has seen any business case or evidence that the system will make the least difference to real world clinical outcomes.

I will leave it to others to comment on the obvious privacy and security implications of all this. Someone really needs to ask the Privacy Commissioner to have a close look at how this is all being done.

All this is not to ignore the great work being done in Dungog where 2% of the population have signed up for the NEHRS. What you are not told is the population of Dungog is a massive 2102 souls - so 40-45 people have signed up.

Here is the NEHTA headline:

2% of Dungog and surrounding area have registered for an eHealth record

Here is the link:
And this is what the NEHTA Benefits and Evaluation Team spend their time doing.

Sorry but WTF!


Anonymous said...

WTF?? Exactly!

Anonymous said...

Now they are making this a worthwhile target perhaps we will see just how secure it is, they will of coarse use the time it has not been a very attractive target as a measure of how secure the system has been.

Anonymous said...

Ms Halton you have some explaining to do to Minister Plibersek. Minister you have some explaining to do to the Tasmanian Health Minister and to the Hobart Hospital Board of Directors. The Board of Directors owe their patients an apology.

Anonymous said...

...... and the Hobart Hospital Executive need to have a very close look at this DOHA/NEHTA invasion of privacy.

WTF - Without Thought or Feeling – disgraceful and inconsiderate.

Anonymous said...

I think you mean The Launceston Hospital Executive

Anonymous said...

From the start they should have followed the UK's lead and used an 'opt-out' strategy. They current method is inefficient and will result in a low take-up.

Bernard Robertson-Dunn said...

Anonymous said...

"From the start they should have followed the UK's lead and used an 'opt-out' strategy"

How remarkably naive and ill informed.

The government tried that with the Human Services Access Card. This provoked an all-out war against the initiative - which was killed.

The PCEHR is moribund through lack of want.

IMHO, the problem with both the Access Card and the PCEHR is trust. Or more precisely, the lack of trust, when it comes to the government, personal information and IT.

And no amount of technology or standards is going to fix that little conundrum.

Dr Ian Colclough said...

The bottom line is that if it works, if it helps one do ones job, if it saves time, if it's more convenient it will be widely embraced and people will opt-in to use it.

Look at it this way. When the banks made Internet banking available they gave their customers the option of opting-in.

The system worked, it was fast and convenient. It was also trusted and secure and it came with the bank's guarantee that if you take care and use the system as intended the bank will cover your losses if something untoward occurs. The uptake was high and teller transactions at the counter decreased enormously.

Bernard Robertson-Dunn said...

Dr Ian Colclough said...

"The bottom line is that if it works, if it helps one do ones job, if it saves time, if it's more convenient it will be widely embraced and people will opt-in to use it."

I agree with that sentiment. I'd add - if an initiative has value it will be looked at favourably, even if it costs something to get that value.

In the case of internet banking, the costs to a customer went up. The banks did some cost shifting - customers need a computing device, internet access and have to deal with a greater level of risk. However customers are prepared to pay for that to get the value of convenience. The banks reduced their costs by offloading people and premises to technology.

A win win for everyone.

It is not clear to Joe and Jane Doe what value they'll get by opting in. It certainly doesn't seem to exceed the cost and increased risk.