Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Tuesday, July 02, 2013

The Six Month Saga To Get NEHTA’s Memorandum Of Understanding Signed Finally Ends. Shows The Commitment Level From Some States.

This e-mail arrived today - Originating from NEHTA.
Good morning all
Many of us were involved last year in supporting DOHA to develop a statement setting out a commitment to eHealth by each Australian state, territory and Commonwealth government. I’m pleased to advise that a Memorandum of Understanding in relation to Developing an Effective National eHealth Capability has now been signed by relevant Ministers and is in force.
Separate to funding for NEHTA, governments have traditionally entered into a “National Partnership Agreement for eHealth” which describes the common goals and activities the country will take in the coming period. Rather than a National Partnership Agreement, Ministers decided last year that they would enter into a Memorandum of Understanding (MOU) instead, which serves much the same purpose.
The MOU recognises that the Commonwealth and all states and territories have a mutual interest in developing a national eHealth capability that will improve health outcomes and health system efficiency, and which is underpinned by national specifications, standards, services and infrastructure.
You can read the MOU on DOHA’s website
You will note that many of the initiatives and goals reflect NEHTA’s role in leading this work for the country on behalf of Australian governments. It is common in these types of documents that goals are quite high level, which makes the NEHTA strategic priorities and plan even more important to provide the details about how the goals are being achieved.
This joint commitment by Ministers is a strong endorsement for eHealth by Governments of all political persuasions (despite taking 6 months to obtain signatures from relevant Ministers – a challenge not unique to eHealth in the current environment!). In this statement, Ministers communicate their shared view that eHealth will lead to significant
improvements in the quality and delivery of healthcare provided to consumers and the efficiency of the Australian health system, which is as strong an indication as any that our funders value the work we are doing.
Here is the relevant page:

eHealth Memorandum of Understanding

The eHealth Memorandum of Understanding (MOU) commenced on 25 June 2013 and will expire on 30 June 2014, unless terminated earlier or extended as agreed in writing by the Parties.
The MOU recognises that the Commonwealth and all states and territories have a mutual interest in developing a national eHealth capability that will improve health outcomes and health system efficiency, and which is underpinned by national specifications, standards, services and infrastructure.
It is interesting to note the following.
1. It seems that NSW and Victoria were the laggards in signing up. All the others seem to have signed up quite quickly (late last year).
2. The funding arrangements give NEHTA $135M for the financial year and DoHA adds an additional $165M for the PCEHR Program
3. There are reviews of the HI and PCEHR Legislation required by mid-2013 (so now late) and end 2014 respectively.
4. Before July 2014 there is a Business Case for EHealth developed for consideration by COAG.
Additionally there is a great summary of who is doing what with whom in E-Health.
Table 1:  Joint funded NeHTA progam
Specifications and Standards
A standard establishes uniform criteria, methods, processes and practices, while a specification is a set of requirements to be satisfied by a material, product or service.
Specifications and standards enable the meaningful and secure exchange of information, ensure a common approach to accessing the information generated by different health care providers, and allow both local and internationally developed systems to be used in Australia.
Commonwealth, States and Territories
Incremental adoption of standards by public and private healthcare providers in the following priority areas requiring a common approach:
-          critical infrastructure:
o   secure messaging;
o   information security; and
-          priority systems and communications:
o   medication management;
o   discharge summaries;
o   specialist letters;
o   electronic referrals;
o   event summaries;
o   shared health summaries;
o   radiology;
o   pathology; and
o   telehealth.
Compliance with standards and specifications when investing in new information systems.
Clinical Terminology
Clinical Terminology is a structured vocabulary used in clinical practice to accurately describe the care and treatment of patients.
Clinical Terminology improves confidence that information that is recorded, sent and retrieved supports continuity of care for patients across different times, settings and care providers.
Commonwealth, States and Territories
Work towards implementing a national approach to Clinical Terminology, including:
-          migration of AMT into SNOMED-CT AU;
-          SNOMED CT-AU / AMT (Australian Medicine Terminology) integrated into priority specifications and services; and
-          Taking steps towards incorporating SNOMED CT-AU / AMT into new clinical systems and upgrades.
Work towards integrating Clinical Terminologies into priority areas.
Specify the inclusion of standard terminology functions when procuring new systems or replacing existing systems.
Authentication for Service Providers
An appropriate authentication service is the means by which healthcare providers are authenticated to access the national eHealth system. It provides confidence around the security and authentication of access to eHealth systems, and around the secure delivery of messages (information) between systems.
Commonwealth, States and Territories
Plan for the implementation of an appropriate authentication service over the next three years.
Take steps towards adoption of an appropriate authentication service when investing in new information technology systems.
All organisations which are using PCEHR are to obtain an appropriate authentication certificate.

Healthcare Identifiers
The Healthcare Identifiers service is a national system for consistently identifying consumers and healthcare providers.
It provides a way of ensuring that an entity that provides, or an individual who receives, healthcare is correctly matched to health information that is created when the healthcare is provided.
The universal provision of identifiers to all consumers of health services in Australia.
Encouraging the incremental adoption of Healthcare Identifiers by service providers in areas of the health system where the Commonwealth Government has policy and funding responsibility, such as primary healthcare, private medical specialists, and the Pharmaceutical Benefits Scheme.
States and Territories
The incremental adoption of Healthcare Identifiers for patients (IHIs) into electronic record systems of public healthcare services, such as when:
-          new patients are added to electronic record systems (including new births);
-          investments in new or replacement systems are made, such as new patient administration systems; and
-          the reliability of matching legacy healthcare identifiers to the new national Healthcare Identifiers is improved.
Take steps towards Healthcare Identifiers being used in public hospitals so that:
-          inter-provider communications of health information can use Healthcare Identifiers; and
-          Healthcare Identifiers for healthcare provider organisations are more broadly adopted across health sectors (HPI-Os).
National Product Catalogue and e-Procurement
The NPC is a central repository of data for the accurate identification of healthcare products in both supply chain and clinical applications within health departments in each State and Territory. The e-Procurement solution specifies the best practice in the electronic generation of business to business transactions.
The NPC has benefits including increasing supply chain efficiency and supporting electronic trading, while the e-Procurement system will reduce order errors, improve compliance, and improve payment processes.
Commonwealth, States and Territories
The NPC will be utilised by States and Territories as appropriate in each jurisdiction.
Integrated processes implemented for acceptance of a medicine or medical device on to the Australian Register of Therapeutic Goods (ARTG) that are aligned with the National Product Catalogue.
Integrated processes implemented for listing of prostheses onto the national DoHA Prosthetic Rebate List that are aligned with the National Product Catalogue.
States and Territories
All State and Territory health departments will use the NEHTA eProcurement solution as is appropriate in their jurisdiction.
All states and territories consider the use of improved medical product and device recall systems.
Table 2:  Other initiatives
The PCEHR is a secure, consolidated electronic record of health information relating to a person.
The PCEHR system will help overcome the fragmentation of health information, improve the availability and quality of health information and improve the coordination and quality of healthcare provided to consumers by different healthcare providers.
Progressive implementation of the national infrastructure associated with the establishment of the PCEHR system.
Encouraging progressive uptake of the PCEHR by consumers and its use by clinicians.
Take steps towards enhancing functionality of PCEHR to support pathology and diagnostic imaging.
States and Territories
Supporting the incremental connection of the health information, within the services they manage and fund, to the information held in the PCEHR system, including progressive uploading of clinical documents, subject to the approval of the Rapid Integration Project by the NEHTA Board.
Public hospitals progressively adapt software and adopt e-discharge summaries.
Commonwealth, States and Territories
Focus best endeavours on supporting connection with providers in the PCEHR lead sites and support evaluation of their benefits.
Encourage vendor community to enhance their products to interface to the PCEHR.
The NHSD is a national directory service that includes service and provider information for all healthcare and related human services provided by government, the private sector and not-for-profit organisations.
The NHSD will make available accurate and current provider and service information to support health service providers in their delivery and transfer of care, and widen public access to quality information about health providers and their services.
Commonwealth, States and Territories
Subject to the finalisation of migration plans, incremental implementation of the NHSD, initially including:
-          GPs, pharmacies, hospitals and emergency departments, and evolving to include allied health, specialists and related human services.
Progressive replacement of existing directories with new datasets, including:
-          simple service information (such as location, contact details, opening hours), and evolving to support Endpoint Location Services, HI Service Integration and Telehealth.
Progressive enhancement of functionality.
Telehealth involves the use of information and communications technology in the direct delivery of healthcare.
It has the capacity to improve real-time access to healthcare information and clinical advice, and supports new models of service delivery.  Telehealth is able to facilitate the involvement of multidisciplinary teams, and allow potential for early intervention in the prevention of the onset or escalation of disease with appropriate clinical networks and support, and better self-management by consumers of their own health will be possible.
Commonwealth, States and Territories
Public specialists increasingly participating in delivering telehealth consultations to remote patients.
Agreeing and adopting the Telehealth Technical Standards.
Developing the National Telehealth Connection Service and Strategy for achieving national interconnectivity and interoperability of telehealth.
Review and enhance best practice implementation guidelines for privacy in telehealth.

All in all a very useful summary. I note NASH seems to have been pushed out a few more years. Also interesting to see the perspective NEHTA puts on this.
Comments welcome on all this.


Anonymous said...

So with another $300 M being dropped in NeHTA's bucket for the next 12 months over $1.3 billion will have been spent with nothing of any use being delivered to date.

50% from DoHA = $67.5 M
50% from the states = $67.5 M
DoHA funding of the PCEHR = $165 M
TOTAL = $300 Million !!!

Take careful note of Steve Hambleton's article in the AFR 26 Jun - Overcoming e-Health Roadblocks. Quote: The practical clinical value of the PCEHR has been compromised by its design.

What a waste; what a waste; what a bloody great waste and no-one can do anything about it except watch.

Anonymous said...

NEHTA needs to publish the original BCG Report (2004) that gave rise to its existence again, and its original and present articles and Objects of Incorporation (2005, 2008) to truly demonstrate what an utter waste, malinvestment and misappropriation of taxpayers monies this ongoing ehealth crime against the taxpayer undoubtedly is.

Those continuing to feed this gift that keeps on giving to the self-serving bureaucrats and QANGO sycophants need themselves to re-read these documents, cognisant of the fact of when they were written, how much taxpayers money has been consumed by this maladministration of taxpayers’ funds and especially, what absolute absence of anything observable or measureable of value has been achieved in return!

Let's not mistake activity for action here and the presence of an HI Service and/or PCEHR, or any other spelled-out NEHTA morsel of meaninglessness (above), does not constitute value until they have been objectively assessed as creating real value for Australia's healthcare system and for its key stakeholder constituents - Patients + Clinicians, with healthcare Administrators as supporting cast members.

The next election of government will present the opportunity for any party of any persuasion to address this issue and instil accountability for taxpayers funds where it is visibly absent, and time will only tell if whomever is elected seizes the opportunity and terminates this decade of ehealth largess and taxpayer abuse.

An unadulterated WASTE of taxpayers money this undoubtedly is, and a heavy veil of denial is the only thing perpetuating this crime against the Australian NET TAX PAYER.

Bernard Robertson-Dunn said...

I suggest that the most critical problem that DoHA is going to face is one of trust.

If the community doesn't trust the government to properly manage health information, then there is no chance the PCEHR will find broad acceptance.

IMHO, the government has a major problem with transparency. There is no single place where you can go and find out, definitively, what the PCEHR really is, what it does, how it does it, how it is supported, who is responsible for what, who does what when it comes to disputes, how they are resolved.

There are so many public documents that specify different aspects of the system, many being incomplete and inconsistent, that it is impossible to unravel the architecture, design, functionality, roles and responsibilities and potential value of the system.

It also means that claims made in the media such as in "Labor comes up short on personally controlled e-health plan" by Fran Foo in the Australian yesterday (2/July/13)

He (Dr Kruys) singled out two clauses in the contract that say all confidential patient information uploaded to the PCEHR can be used in any way by the government and "other organisations forever". The contract also states that all PCEHR information will belong to the government.

I managed to find the Participation Agreements but cannot tell from them if these claims are true or not.

I did find this clause:
7.3 You grant us a perpetual, irrevocable, royalty-free and licence-fee free, worldwide, non-exclusive licence (including a right to sub-license) to use, reproduce, copy, modify, adapt, publish and communicate (including to other healthcare provider organisations and to organisations that store health information) material you have uploaded to the PCEHR system for the purposes of the PCEHR system.

"You" refers to the healthcare party, "us" is the government

The clauses are qualified in the comments by "The licences in clauses 7.3 and 7.4 only apply for the specified purposes. They do not remove the need to comply with other laws that may also be applicable – e.g., in relation to confidentiality and privacy"

In other words, you have to look elsewhere. It also means the other laws may change.

There are so many questions that can be asked about just these clauses, never mind about all the rest of the documents. e.g. what does world-wide mean? What does communicate mean?

These may or may not be defined elsewhere but I doubt that there is anyone outside DoHA/NEHTA has any idea of the full extent of the system and I have my doubts about DoHA/NEHTA. I say this because of, IMHO, the poor state and inconsistency of the ConOP and High Level System Architecture.

As an example, the Architecture document (on the NEHTA site) says it is Final and is based on the April 2011 release of the ConOp. So why did they ask for comments on the ConOp, produce a Final ConOp and then ignore it?

Another example:

The ConOp refers to anonymity and pseudonymous, the architecture document never refers to the word pseudonym and the only place anonymous appears is

"A portal account may be anonymous in nature and may not necessarily require upfront proof of identity. Before access to a PCEHR may be granted the individual must prove their identity"

These issues may or may not have been resolved, but their resolution are not in the public domain, therefore there is a suspicion they haven't been dealt with. Suspicion leads to trust.

Information on an individual's health is the most private and personal of all. Do I trust the government (politicians and public servants) to manage this nation's health information properly? I'm afraid the evidence suggests very strongly that the answer is a clear No.

If I could offer some advice: a single, well presented repository of all current and relevant documents that define the PCEHR and associated systems might be a step in the right direction.

On the other hand it might just prove our suspicions.