Here are the results of the poll.
Does The ADHA Have Realistic Expectations For The Rate Of Phasing Out Fax Machines (2-3 Years) Given The Barriers To Universal Use Of Secure Electronic Messaging Throughout The Health System?
Yes 6% (10)No 92% (151)
I Have No Idea 2% (4)
Total Votes: 165
What an clear-cut poll again. Most seem to think that the axe the fax program is more spin than substance and that it will happen once a good alternative is in place.
Any insights on the poll welcome as a comment, as usual.
A more than reasonable turnout of votes!
It must have been a fairly easy question as just 4/165 readers were not sure what the appropriate answer was.
Again, many, many thanks to all those that voted!
David.
15 comments:
The easiest way to replace the fax would be to introduce the same requirements for email as for fax: instead of requiring fully trusted crypto, simply require that the email be sent via a trusted carrier - that is, you have a legal obligation not to use any old SMTP server. And that you only email to addresses in one of the (profusion of) public healthcare directories.
The requirement to use bullet-proof cryptographically secured exchange for push-communications in health is the problem; the cost of setting that up and maintaining it is prohibitive, and that's why the fax is being used so much. It's not about paper; emailing PDFs would be a perfectly equivalent. I'm not aware of any other industry that has solved the business issues created by that crypto requirement.
Of course, the reason for the full crypto requirement is obvious, and apparently justified. And we continue to have faxing mis-adventure that shows why the need exists. But we still use faxing because... the people who made those rules don't really believe it enough to actually spend the money to solve the problem. They just made it someone else's problem... and given budget constraints in health.... we just continue to use faxing.
We maybe able to reduce the use of GP <--> specialist faxing somewhat, or even a lot, but I have no idea how the general problem can be solved unless either (a) the requirement for full crypto on email is revoked, or (b) the government just sets the whole thing up (right) and imposes it
I'm not holding my breath for either of those things
@8:26 AM, Mr Grieve says - and given budget constraints in health..... I would debate that there is seemingly large sums of cash available to bail out tax funded implementations. I am sure given the $200 million a year the ADHA is given a rather nice solution could be found, even cashing in all those Oracle licenses that underpin the My Health Record would be a good start.
For me the current approach seems to deliver less than the current and there seems no real interest (from ADHA) in looking at what we want to do with that information being transmitted and received, where is the thinking around behaviour of information.
Reduction is fax use will and is a natural evolution, the current secure messaging dream risks losing not because of the fax but because focusing solely on the fax as the competing solution (evil enemy) the many other forms of digital communication are taking their own market share. I can do video consult and share files quite easily in real time and securely. Right now on my phone I have 6 just application 4 I use two of which depleted my need for a home phone because I as a consumer created the value from the developers output.
Perhaps the ball and chain is as you say around this crypto issue, I understand the standards being used are over a decade old, I am not sure if the latest SA technical standards have been profiled for tests and conformance specs. I am sure there are some very smart security options out there.
This need for clinical communication needs to progress it is a valid and measurable requirement. Perhaps we are looking at this through a single lens or the wrong lens?
Well stated Grahame, as someone who seems to have an independent voice at ADHA can you get them to drop these “axe the fax” and “bonfire of the telex” please. It was amusing the first time 10 years ago it no longer is and simply erodes the seriousness of the problem trying to be solved.
And for the other readers and David you might find this amusing - the FOI request regarding how the delete function actually works. And they expect trust and respect.
https://www.righttoknow.org.au/request/5264/response/14466/attach/3/IR%20190303%20Final%20Signed%20Decision%20Letter.pdf
https://www.righttoknow.org.au/request/technical_design_documents_for_d#incoming-14466
I prefer "bonfire of the telex" except that I think you spelled "bonfire" wrong ;-)
In healthconnect days they seeming managed to issue site certificates for every practice and were issuing individual certificates at a great rate and it was working... We even wrote a digital signature standard for V2 that is still working today.
You can make it easier by using same certificate for claiming, just like every provider under medicare gets a provider number, most practices have certificates for billing.
The rot set in when the microsoft platform for SOAP/SMD demanded specific permissions on the certificates which made the HISA ones unsuitable. Rather than leveraging the PKI infrastructure they already had, and choosing more efficient technology solutions for messaging then we full fad with technology and they paid IBM $24M to develop a PKI solution, which apparently wasn't a solution that worked, but satisfied the contract requirements.... mmm must have been a little embarrassing.
In reality extending the provider number solution to all healthcare personal and leveraging the then working HESA pki solution and the existing HL7 V2 standards would have been a workable solution as we even had AHML providing message compliance testing for about $1500.
But no they knew "better" and the subsequent non solutions have continues to fail, be unworkable and consume a lot of taxpayer $$. Now we have lost a lot of the expertise that existed and everyone is scared to put any $$ in proper technology/testing because they know there will be some new hair brained demand from the ADHA. Vendors have just learn to demand payment for any work, rather than do the work because that is what their business is all about. Their business is now extracting $$ from anyone they can while spending as little as possible on IT, which is the perverse effect of hiring evil clowns to run the show. Surely going backwards for 20 years is enough evidence that throwing government $$ at a problem that you don't understand is a recipe for disaster, and maybe its better to stop and try some simple standards based governance for patient safety reasons? We don't need them to create standards, they are hopeless at that, we just need them to say "If you use it for patient information it must be tested for compliance" Sort of like every other drug/device in the medical and other fields.
To Grahame and Andrew - well said, I agree totally.
IMHO, ADHA/Dept Health are totally out of their depth and/or have hidden agenda.
Well they are off and at it again - https://conversation.digitalhealth.gov.au/have-your-say
Thought I should post this as their twit account only has a few thousand followers and it has only been re-twitted 4 times. They survey is as you would expect.
Ha! I got your bonfire joke, Grahame!
Gee, there's a lot of rather vague questions that can be misinterpreted and be used to support a particular viewpoint.
e.g. First section "How important are the following priority areas to you or your organisation?"
"Improve the visibility of medications reconciliation and transactions "
Visibility? To who?
What does "medications reconciliation and transactions" mean?
The whole thing is framed to support the national strategy, not identify what people really think and/or want.
These question:
"Where people cannot afford digital technology that will improve their healthcare, arrangements should be available for them to access the technology."
"The design of digital health technologies should recognise the needs of vulnerable and hard to reach individual healthcare recipients."
should be asked in the context of other questions/alternatives such as
"should healthcare be designed to treat people with and without access to digital technology equally"
April 07, 2019 9:19 AM - RE: Righttoknow - My Health Record.
I am not sure if others have read this but this seems a very concerning chain of events. Clearly the ADHA has lost control/ownership of the My Health record system if all they have is a vendors 277 page system user manual, which seems to contain a lot of padding around methodologies and the like.
For the ADHA not to have it's own architecture documents/models, test plans etc. is criminal. How will they be able to move to a new state if they do not hold the designs for the current state?
There are two grave issues here:
1. The treatment of members of the public in seeking information from the ADHA that is clearly in the interest of the public and public debate.
2. Negligence in the stewardship of public assets, clearly the ADHA has failed in its duty in managing key government assets and have in fact forced the people of Australia into vendor lock-in.
I think the ADHA top brass have gone to far this time and are trying to cover-up a complete and total collapse in even the most basic governance requirements.
If the Minister does not sack those responsible at ADHA, I will do my bit to ensure he is sacked at the upcoming election.
@3:31 PM. Agree 100% this is not a good look especially as we now know they carried a system flaw that blocked health records being updated. What other life threatening surprises does Tim NBD Kelsey have up his sleeve. The man and is merry band are just dangerous
Bernard Robertson-DunnApril 07, 2019 1:16 PM
Gee, there's a lot of rather vague questions that can be misinterpreted and be used to support a particular viewpoint.
You are not wrong Bernard, some of the principles are gibberish and the ADHA seems to want to step on other Departments toes. I get the feeling Timmy has delusions of walking on water and healing the poor and sick through the light of his presence.
I notice that the ADHA could not even publish this survey to a basic website with a bug or two. Do the ever test anything?
@8:49PM it would appear basic testing has not been performed and a work around for a known problem has not been implemented. Let’s not use David as a bug tracking system. Ironic then the ADHA is suppose to be a leading digital agency, not sure I would trust them with a stick and a clay tablet.
I use secure messaging extensively, but for referrals I still also fax, because a secure letter goes into an inbox of a provider, but appointments for referrals are made by reception staff, and I have no idea if the provider is on leave, or even checks their inbox, but I know the reception staff will see a fax.
Dr Brian Conway
Interesting Brian,
when we tell you that addressing a letter to a practice, rather than a provider, means that there is no guarantee that anyone will look at it it, does not concern you. The workflow of various systems is part of the compliance requirements that are lacking and that is part of the reason that the "Ban the Fax" chant is ill informed. First we need to make sure that expectations of the usual clinical care are being met. "First do no harm" is a better motto for the ADHA.
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