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Wednesday, July 19, 2017

I Think The E-Health Community Would Like Just A Few More Details About This.

This popped up late last week:

Fax machines on the way out for Australian healthcare

Created on Friday, 14 July 2017
Fax-free healthcare is one step closer today, as the Australian Digital Health Agency (the Agency) and clinical information systems vendors work together to progress secure electronic messaging between healthcare providers.
This technology will enable health data to flow securely from one healthcare provider to another – irrespective of the software they are using, the organisation they work for, or with whom they are communicating.
Dr Nathan Pinskier, Chair of the RACGP Expert Committee on eHealth and Practice Systems, said the technology will have a big impact on the sector, where confidential patient records are regularly transmitted by dated systems such as facsimile and post.
"The number one issue to be resolved in health care communications is the ability for healthcare providers to electronically communicate with each other directly, seamlessly and securely," Dr Pinskier said.
"The interoperability solution is within our grasp and I thank the Australian Digital Health Agency and its CEO, Tim Kelsey, for listening to the sector and making this a high priority item."
Agency CEO, Tim Kelsey, said the Agency has partnered with industry, jurisdictions and healthcare professionals and undertaken technical work over months to progress discussions from theory into clinical practice.
"I have been listening to key partners in the community on their aspirations for the Digital Health Agency and ways it can support key health priorities in Australia," Mr Kelsey said.
"Secure messaging between providers is one of the key themes that comes up in these discussions, and getting it right will create opportunities to leverage these communications for other purposes, including uploads to the My Health Record."
Work is underway with HealthLink and Telstra – with a range of healthcare providers across a variety of locations engaged in current trials. The objective is to develop solutions that allow secure messaging between healthcare providers with different clinical information systems messaging vendors, in a way that can be scaled nationally.
The judges of the success of this integration will be the healthcare providers themselves – who must give each project their tick of approval before the projects are deemed a success.
The Agency called for tenders in February for industry and clinical consortia to work together to fix these integration problems. After a competitive process the Agency has entered into a contract with HealthLink to lead a consortium to send secure messages between GPs and specialists, and with Telstra to lead a consortium to send discharge summaries to GPs and other healthcare providers. The Agency anticipates announcing the third successful consortia shortly.
Media contact: David Cooper, Senior Media Manager
Mobile: 0428 772 421 Email:

About the Digital Health Agency

The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia. The Agency was established on 1 July 2016 by the Australian Government as a statutory authority in the form of a corporate Commonwealth entity, and reports to all Australian governments through the COAG Health Council.
Here is the link to the release:
To me this is the press-release you send out when you have just begun work rather than having actually having delivered something. Worse we have only two out of three providers announced and we have been given just no details on who is going to do what, how the end GP is to be treated and how the whole initiative will be seamless when organized.
Right now – lacking all these details I would suggest the death of the fax machine may be being announced rather too early.
We need much more clarity and details about what is planned. Maybe a few more technical details could help – assuming they exist. Given how fluffy the release is one might wonder!


Anonymous said...

So much for openness and transparency, this has been under the covers for a good 6-7 months. I am sure there has been lots of good stuff going on but we were promised complete transparency. A man of his word?....

Anonymous said...

Perhaps it is others letting the Board and CEO down and are struggling with openness, honesty and transparency, certainly a behavioural pattern when you join various dots.

However that does not dissolve accountability and we were promised a more inclusive and transparent new world order. Just what else is going on behind closed doors in the name of the tax payer?

Oliver Frank said...

Health professionals who have been using one or other of the available secure messaging systems, or who have been wanting to start using secure messaging, have endured years of silence about whether anything was being done, and if so what was being done, to enable users of any secure messaging system to communicate easily and routinely with users of any other secure messaging system, which is one of the essential elements for secure messaging to become the preferred and default method of communication between health professionals about patients.

Isn't it better that the Australian Digital Health Agency keeps health professionals informed about what it is now doing towards this? Would you seriously prefer to hear nothing until something has been achieved? Wouldn't you rather know about the work being done now, which can give everybody a chance to comment and have some input?

It is probably not necessary or desirable for a general medial release to go into the organisational and technical details, many of which a general audience will find baffling and/or boring. I expect that the Australian Digital Health Agency will provide much more detail on its Website and on request for those who want to know.

Dr David G More MB PhD said...

"I expect that the Australian Digital Health Agency will provide much more detail on its Website"

Sadly they have not done so so far! That is the point of my blog - open up a lot please!!!!


Peter said...

I note that Australia Post introduced their digital mailbox about four years ago. This is a government owned system deliberately designed to pass sensitive messages securely and reliably between individuals. As I understand it, it could easily be adapted to allow system generated messages - say from a EHR application.
If the off-the-self product is not suitable (although I suspect it would be) then I am sure AusPost would be happy to create a parallel system dedicated to the Health Industry. It would almost certainly be cheaper than building another from scratch.

Anonymous said...

When it comes to innovation and cross government co-operaton/co-ordination, this government has been a repeat offender. Why should now be any different? They never learn.

Anonymous said...

The strategic significance of funding SMD and MYHR which are very different projects both spawning over 20 discrete sub projects and numerous other initiatives may not move the agenda forward proportionate to their efforts. In fact, their results may just cause more strategic confusion than clarification.

I am not convinced the ADHA is ready. Tim and others in their hast to make everything new again may find that a lacking depth of knowledge in the ADHA (and I am guessing the NIO) from an engineering perspective will prove a real challenge.

Anonymous said...

20 discreet project might be extremely conservative, the drive for opt out will be as complex as the original PcEHR undertaking. I do agree though that the ADHA and others are not now equiped to undertake such a massive and highly complex undertaking, but then who knows? There is scant information or visibility of anything. Still time will tell I guess.

Bernard Robertson-Dunn said...

IMHO, making MyHR opt-out without changing the design and the underlying legislation will make the system even less usable and/or useful.

e.g. with opt-in, the "normal" process was to see your GP, register, confirm your GP as your nominated service provider, discuss what should go into your Shared Health Summary, the GP uploads it and you have something that might be useful occasionally (i.e. emergencies, new GP).

With opt-out, you will be registered for a MyHR but, unless you follow the above procedure, you won't get a nominated service provider or a SHS. What most people will get is a mishmash of documents uploaded from various places (e.g. MBS and PBS payment data) with no coherence or clinical value. The more in the MyHR, especially without a SHS the more useless it will be. Health professionals who might need access won't bother because they will know how much time they will waste trying to make sense of the pile of pdfs, none of which will contain much of use.

Most people will believe the government claim that "MyHR is a summary of your health data". Eventually the penny will drop and the fraud will be exposed. GPs already know there's very little in it for them and will do the minimum to get their ePIPs.

And talking about ePIP. Just before the last three month deadline SHS uploads peaked at 3505/day. Last week's was 2167/day, down from 2473/day the week before. There is a definite ePIP cycle which strongly suggests that financial incentives mean more to GPs than any clinical value from MyHR for them or the patient.

Bernard Robertson-Dunn said...

I was browsing through the Concept of Operations today (as you do) and there are some fascinating statements about what the original design was supposed to do and what they planned to do. This probably explains why it is no longer available on the AHDA website - someone might ask when certain things are going to happen.

For example someone might draw attention to the following clause and ask "Why has a search function never been implemented? It was supposed to be in the original release and it's still not there five years later":

"4.5 Search

In time, as the PCEHR System accumulates more clinical documents, the ability to find specific clinical documents via chronological views such as the Index View will become more challenging. In order to help users find clinical documents within a PCEHR more readily, the PCEHR System provides two search functions: basic search and advanced search.

4.5.1 Basic search

The basic search function allows users to find clinical documents within an individual’s PCEHR based on matching keywords. Users will, for example, be able to find all clinical documents that contain the term ‘kidney’ within the body of the clinical document.

The basic search is limited and will only support simple matching methods. In time, as the number of clinical documents within each PCEHR increases and demand for this function increases, more sophisticated matching techniques will be investigated.

4.5.2 Advanced search

The advanced search function allows the user to search an individual’s PCEHR for clinical documents via a number of parameters, including:

• Keywords
• Date uploaded
• Type(s) of clinical document
• Provider organisation
• Healthcare provider speciality / sub-speciality

The advanced search function is limited in its search capabilities. In time, as the number of clinical documents within each PCEHR increases and demand for this function increases, more search parameters will become available."

If anyone is looking for a copy of the Concept of Operations try here:


It will interesting to see if the ADHA strategy includes a program to deliver even the basic original design, never mind all the planned enhancements, never mind making it opt-out.

Not that it matters really, the whole concept is fatally flawed.

Anonymous said...

Bernard, looking on the ADHA website and cross checking with LinkedIn, the two people you would get the answers from would be, Bettina McMahon ( Gov and Industry) and Rachel De Sain (Design and Innovation).

Anonymous said...

9:41 AM If you listened to Rachel's performance at the live stream of the Partner Development Launch a few weeks ago you would have to conclude Design and Innovation were not her strong suit. Substance was lacking, waffle in abundance.

Bernard Robertson-Dunn said...

What individuals may or may not say is not as important as what the Strategy says and commits to.

The strategy needs to have a review of the PCEHR/MyHR which identifies how much of the original design (ConOp) has been delivered, how many of the "plans" in that document have been delivered or will be delivered, what new initiatives they are working on and what they intend doing in the near and far future.

And then they need to explain in a cause/effect manner how a further developed system will actually integrate into health care workflows, deliver value and reduce costs.

So far every strategy/plan/review I've seen has had little more than motherhood. "Technology is good. More technology is better" We've said it before, here it comes again - a cargo culture mentality.

Anonymous said...

10:04 AM. Glad to hear I am not alone it that take away. It is a big intellectual ask that component of ADHA, and I hear it now includes the CDA developers