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Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


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Friday, November 02, 2018

It Looks Like A National Real-Time Prescription Monitoring System Is Actually Coming.

This appeared last week:

Health hands Fred IT AU$23m for Australia-wide prescription data-sharing exchange

​Fred IT will lead the new national system for real-time prescription monitoring.
By Asha McLean | October 23, 2018 -- 21:49 GMT (08:49 AEDT) | Topic: Innovation
The Department of Health has this week announced the signing of pharmaceutical-focused IT services firm Fred IT to stand up an Australia-wide data exchange system for real time prescription monitoring (RTPM).
The AU$23 million contract, valid until September 2021, will see Fred IT design, build, and deliver the software system for the National Data Exchange component of the national RTPM system, tying together Australian state and territory prescription monitoring systems.
"The national RTPM system will provide an instant alert to doctors and pharmacists, through their clinician software, if patients have previously been supplied with target drugs," the tender documentation detailed in June. "This information will assist in clinical decision-making."
Fred IT will be charged with delivering the capability to monitor the prescription dispensing events from all states and territories, with the aim to prevent cross-border "drug shopping" abuses.
The National Data Exchange component will allow regulators, doctors, and pharmacists, as well as other system users, to interface directly with the national RTPM system from their existing clinician software.
According to Fred IT, the new national system for real-time prescription monitoring is designed to reduce the impact of prescription medicine overdoses.
"The introduction of a national approach to real-time prescription monitoring will play a significant role in preventing prescription medication misuse and saving lives," the company wrote.
Fred IT developed Victoria's real-time prescription monitoring system, SafeScript.
More here:
There is also coverage here:

Work to start on national real-time prescription monitoring system

Hafizah Osman | 24 Oct 2018
The push for a national real-time prescription monitoring system has gained momentum, with an Australian firm appointed to develop it. 
The Department of Health has selected pharmacy IT solutions provider, Fred IT Group, to lead the new national system, which aims to reduce the impact of prescription medicine overdoses.
As part of the agreement, Fred IT is expected to design, build and deliver the software system for the National Data Exchange (NDE) component. 
This includes collaborating with medical and pharmacy software vendors and jurisdictions in the delivery of a consistent user experience for health professionals practicing in different environments and to reflect individual state and territory requirements in the national system.
The move follows Fred IT’s development of SafeScript, a Victorian real-time prescription monitoring system, as part of a $29.5 million State Government investment. That system began its roll-out earlier this month.
Safescript uses each pharmacy’s Prescription Exchange Service (PES) to automatically transmits prescription records for high-risk medicines to a centralised database in real-time. Prescribers and pharmacists are then able to receive pop-up notifications to review a patient’s history in SafeScript.
The SafeScript roll-out was started in the Western Victoria Primary Health Network catchment area, and is expected to extend across the state in early 2019. 
According to Fred IT, its experience with SafeScript is crucial in its extension of real-time prescription monitoring to health professionals in all states and territories.
Fred IT CEO and pharmacist Paul Naismith said a national system would make medication management safer and more effective for all Australians.
More here:
This is all good except for two small details.
1. Fred IT is one half owned by Telstra Health.
2. The ADHA is meant to be steering the delivery.
It will be a triumph of hope over experience if this all goes smoothly as I really hope it will.


Anonymous said...

$8 million a year for 3 years to … "design, build, and deliver the software system for the National Data Exchange component of the national RTPM system" .....

That sounds 'good'. Fred should be able to come up with something, in fact it’s pretty well done that already with the exchange of scripts between the eRx doctors and pharmacists and the MediSecure doctors and pharmacists;

.... “tying together Australian state and territory prescription monitoring systems.”

That’s easy to say but incredibly difficult to achieve and, more importantly, it’s not clear from this WHO WILL BE RESPONSIBLE FOR “tying together the various state and territory monitoring systems.

Perhaps more money will be needed for each state and territory to tie their respective knots.

Of course, Telstra Health (which owns 50% of FredIT) will be able to help. Deep down this RTPM ‘solution’ has some similarities to the National Cancer Registry.

“Fred IT developed Victoria's real-time prescription monitoring system, SafeScript.” To which one should add …. SafeScript is still in pilot test mode in the Western District and yet to be tried and proven.

Perhaps it should read “Fred IT is still developing SafeScript.

Oh, and don't overlook the another $29.5 million dropped into the bucket recently by the Victorian Government; if the other states and territories are required to contribute a similar pro-rate amount that would be another $88.5 million.

But they won’t need to, will they? We don't have that much money to throw around; or do we!

BTW - whatever happened to the Department's commitment to rolling out DORA as as the national RTPM system?

Anonymous said...

"Data Exchange" Isn't that the same as interoperability?

What we really need is a national strategy for interoperability and then a framework for its design and construction.

Shouldn't take more than about 15 years or so. Just as well these things aren't important or anything.

Anonymous said...

Data Exchange" Isn't that the same as interoperability?
Not exactly.

Bernard Robertson-Dunn said...

"Data Exchange" Isn't that the same as interoperability?
Not exactly.


How about a strategy and standards that covers both?

Anonymous said...

Data is only one aspect, Symantec’s, Policy, Legislation, are but a few others, there is cost and reward equality or at least agreements, then there is the human system. Where do you want to see interoperability? What does it mean to a CIO of a hospitable vs a CIO of a Juraidiction? How do you make you data later a trusted part of a clinical workflow. Have a read of the Australian standard, do a google of nehta interoperability and then look up some of those authors papers etc...

Anonymous said...

AnonymousNovember 02, 2018 5:05 PM. Good observations and probably accurate. Health IT in the hands of Government is certainly a unique industry. Where else are projects not measured by success or failure but simply by the scale of the failure?

Bernard Robertson-Dunn said...

As someone pointed out (or at least implied) data exchange and interoperability are more than just the transfer of data from one entity to another.

Can anyone point me to any analysis of data flows, external to systems like myhr that would identify data flows between entities and discuss their requirements and consequences?

I have been asked about issues around personal data in the context of dental practices.

For-example, a dentist examines a patient and records various data, including identifying data and detailed bio-metric data involving the patient's mouth, teeth etc.

The dentist, being a registered health professional, is quite entitled to acquire and store that data as well as put it into a patient's myhr, either as test data or an event summary (I think and hope I've got that right).

A dental technician who is an employee of the dentist may be legally authorised to access this data.

That same dental technician may then, as part of their job, transfer some of the patient's data to a facility in China that manufactures dental prostheses. The dental technician may at some future date want to input relevant data into the patient's myhr. Are they permitted to? (I think they are not allowed to because they are not a registered health provider)

Has this scenario been documented, analysed and procedures developed to guide dentists in best handling the personal health data associated with dental procedures? And not just with respect to myhr.

What is the situation regarding a dental technician who is a contractor, i.e. not an employee of the dentist's business?

Is all this sort of information hidden in the provider only parts of the government's web pages?

Many of these issues may be generalised, but dentists seem to be a special case in that they send patient data to overseas destinations, probably without the permission or knowledge of the patient. One hopes that the data has been de-identified, but it would be good to know that there are defined procedures and appropriate legislative protections for this sort of thing.

Any pointers, help etc would be appreciated.

Andrew McIntyre said...

The ADHA/NEHTA etc do not understand interoperability, which exists on many levels. Currently they seem to think its delivering "Data" from one location to another and expecting it to work at the other end, which is far from the case. This is why messaging interoperability before basic message interoperability is quite dangerous and unsafe. If a message arrives you need to be sure it complies with the relevant standards and the system that receives it also processes it according to the standards. If it does not display correctly or crashes the receiver then vital patient data may not be seen by the clinician and patient safety is at risk.

I am 100% sure this has already happened as I frequently have to look at the PIT version of the message to see whats in it as the HL7 version is wrong and while the display is correct the content is malformed. This is not a failing of HL7, but a lack of standards compliance by the sender, but given that receivers all have different display errors and you have to make somethings wrong its hard to get it right all the time. There are many errors out there and health IT is actually unsafe when judged by any engineering standard, but it sort of works most of the time!

I have raised this issue with every rendition of the the national eHealth "Leader" since NEHTA V1 and they all said they would do something, but no one has done anything about technical standards compliance.

There are levels of interoperability above basic display correctness like proper use of terminology and clinical models, but until we can get compliant reliable messages that display correctly that is just pie in the sky. This is in effect why MyHR is mostly pdf, but moving to pdf is not actually addressing the issue as even pdf can be corrupted if the message compliance is poor.

I just don't think the "Leadership" has enough technical knowledge to do the job, any they are so full of Hubris that they won't take any advice from technical people and these problems cannot be plastered over with good public relations, even if the Minister says "Just make it work" To make it work we need a focus on compliance and technical excellence at the bottom levels, a level which is just completely opaque to the decision makers which is exactly why generic management is a total failure and we have monumental stuff ups like Queensland Health Payroll and PCEHR/MyHR. The sooner it all falls over the better!

Anonymous said...

Well put Andrew, the danger is they don’t know what they need to know or at least appreciate. Reality is never fooled and the debt is mounting. Our saving grace is work goes on away from the ADHA and that will result in advancements.

Anonymous said...

@Bernard, I am not aware of anything in the space you mention. Under the HI Act specifically the Healthcare Provider Identifier – Individual (HPI-I) — for individual healthcare providers, such as GPs, allied health professionals, nurses, dentists and pharmacists. So they are bound to all that entails including the Privacy Act. Dental Records are identifying records. The Dental Association has made a number of submissions over the years including the MyHR. Powerfully independent that they are it is probably way down on the list of specialists to tackle, which would be odd considering the enormous insights into your overall health that can be sourced from dental patterns.