The ADHA were at a session last Friday.
The time was a little after 11.00 AM
Begin Extract of Hansard:
Senator WATT: Still in outcome 1: My Health Record. Thanks again for coming today. I'm sure you were expecting to front up. Are you able to tell me on how many occasions someone has had a My Health Record created for them without their consent?
Mr Kelsey : My Health Records have historically, until opt-out was enacted, been created only with the consent of an individual. During the period of the opt-out trial we discovered that quite a number of people seemed not to have known that they had had a record created. In some cases that was because they were living in areas where opt-out was trialled. A number of people appeared not to have realised that a record had been created in that context and they hadn't known or taken advantage of the opportunity to opt out there. In other cases we're aware that people have been surprised to have a My Health Record, because they subscribed to the previous iteration of the My Health Record system, called the PCEHR, and the name change in some cases had been confusing. We investigate incidents in which people have raised concerns about whether or not they were aware that a record had been created for them and, in cases where somebody subsequently doesn't want a record, they can now be permanently deleted.
Senator WATT: Is it possible to put a figure on the number of times that someone has had a record created for them without their consent?
Mr Kelsey : As far as we know—
Ms McMahon : Zero.
Senator WATT: Zero?
Ms McMahon : To confirm: there has never been a record created before opt-out without someone's explicit consent, but there have been instances where someone has forgotten or hasn't realised or appreciated that they have a record, and we've taken action in those instances.
Mr Kelsey : Other than in the opt-out trial areas, where the same model of consent was deployed as nationally rolled out recently.
Senator WATT: How much in total has been paid in practice incentive payments?
Ms Edwards : I have a 2017-18 total number of $96.4 million.
Senator WATT: Remind me: these practice incentives were payments made to GPs?
Ms Edwards : To practices.
Senator WATT: Is that another way of saying GPs or is that wider than GPs?
Ms Edwards : A practice might have varying numbers of GPs working in it.
Senator WATT: Yes, but a GP practice.
Ms Edwards : Yes, but paid to the practice. There might be five GPs working together in a practice.
Senator WATT: They played a role in promoting and informing people about the My Health Record.
Ms Edwards : The ePIP measure is there to encourage general practice to be up to date digitally. It has been around for quite a while, and various elements had to be met. Not all of those elements have to do with My Health Record. The current eligibility requirements are integrating healthcare identifiers into electronic practice records, having a standard-compliant secure messaging capability to electronically transmit and receive clinical messages, working towards recording the majority of diagnoses for active patients electronically, ensuring the majority of prescriptions are sent electronically, using compliant software for My Health Record and uploading an average of five shared health summaries per GP per quarter. That fifth element which needs to be met is about being compliant and able to work with My Health Record and having a minimum number of shared health summaries loaded in relation to patients who have a My Health Record.
Senator WATT: Do you know the number of practices that have received payments?
Ms Edwards : Yes. As at 31 January 2019: 4,982 general practices were registered for the ePIP incentive. The number actually paid may differ slightly from that.
Senator WATT: Do you have a figure for the average incentives paid per practice?
Ms Edwards : I probably do. They're capped at $12,500 per general practice per quarter with a maximum of $50,000 per year. I don't think I have a per-practice average.
Senator WATT: I suppose it's a matter of dividing $96.4 million by 4,982.
Ms Edwards : I suspect it's more complicated, because some practices are big and some are small.
Senator WATT: I see. They don't all look the same.
Ms Edwards : I'll take it on notice and get you a full explanation.
Senator WATT: Could you also take on notice the median paid per practice incentive period.
Ms Edwards : Yes, and we might wrap around that explanation, if it is beyond my current knowledge of how it fits together.
Senator WATT: What proportion of records are created in the week immediately preceding a practice incentive payment deadline, compared to the rest of the corresponding period? Has anyone got any figures on that?
Ms Edwards : Sorry?
Senator WATT: I'm after the proportion of records that are created in the week immediately preceding a PIP deadline, compared to the rest of the correspondence—
Ms Edwards : Do you mean the shared care summaries that are uploaded?
Senator WATT: Sounds like I do!
Mr Kelsey : Obviously, records where somebody hasn't opted out or has chosen not to delete their record exist as of now. I think the point about the ePIP is that GPs qualify when they upload what's called a shared summary, which is a document type within the My Health record.
Ms Edwards : I think Mr Kelsey is reminding me that there's a misapprehension that the ePIP is somehow linked to the creation of a My Health record. So, the idea that, if you get your patients to sign up, that factors into the ePIP is not correct. As I mentioned, the requirement is that you have a system that's compliant with My Health records and that you load up a minimum number of shared care summaries for patients who have a My Health record. So, I think you may want to reframe the question, Senator, on notice, to check what it is you want.
Senator WATT: Let me have a think about that. Is the agency aware of any instances of practices breaching rules around the creation of records or creating records without consent in order to meet incentive targets?
Ms Edwards : Again, the creation of the record is not part of the incentive.
Mr Kelsey : We're aware of no instances—and, today, as of the end of 31 January and the creation of records in February, records are created for those who have not opted out or chosen to delete them. So, there's no role of a GP in creating a record.
Senator WATT: So, no instances that you're aware of. I suspect that because I'm asking these questions there has been some suggestion of practices creating records without people's consent. But you have no knowledge of that occurring?
Mr Kelsey : Well, I can only speak for the period from the agency's creation, in 2016. But we're aware of no cases since that point. But what I did mention at the beginning was that there have been people who have expressed concerns that they weren't aware of a record. When we've looked at those, they tend to fall into the category of somebody who's either lived in an opt-out trial area, may have forgotten, of course, or has subscribed to the previous scheme and the name change has proved confusing to them. In those cases where somebody wants subsequently to have their record deleted, obviously we're able to afford that service to them.
Senator WATT: In the event that someone has had a record created without their permission, what recourse do they have?
Mr Kelsey : We're not aware of any such incident, but in the event that somebody wants to have their record removed, the new legislative amendments, which were passed obviously before Christmas, allow people to permanently delete their record at any point of their choosing. That would be in any instance where a person did no longer want to have a My Health record.
Senator WATT: What proportion of records created does the agency believe have been created unlawfully? Would the answer be zero, based on what you've said?
Mr Kelsey : Zero. Yes.
Senator WATT: The last time we were at estimates, I remember asking about the number of people who had opted out?
Mr Kelsey : The number of people who had opted, which we gave to you at the last estimates, was just over 2.5 million.
Senator WATT: What's the current number?
Mr Kelsey : That was the number of people who had opted out. Since then, in terms of people who may have chosen to, say, delete records, I can get you those numbers. I don't have them to hand. Records were created on 22 February—
Senator WATT: Sorry, it wasn't opt out—they had cancelled.
Mr Kelsey : Yes.
Senator WATT: Could you take on notice for me the number of people who have—
Mr Kelsey : Deleted since records were created, yes.
Senator WATT: Yes, please. Are you absolutely confident that the practice incentive payments for GP practice owners have not led to people having records created without their permission, or in breach of regulations?
Ms Edwards : I think the point you're making is that the creation of records does not factor into whether you get your ePIP. Mr Kelsey said he is not aware of any instance of people illegally creating a record. Obviously, on ePIP, there are things you have to meet; and we do our ordinary compliance to make sure practices have done what they have to do. We are certainly not aware of anything like that, no.
ACTING CHAIR: We will now move to outcome 2. Senator Siewert.
End Extract.
Here is the link:
I have to say a very tame episode of Senate Estimates!
David.
9 comments:
I find this very telling. Ms McMahon Is rather bold cutting down her CEO more than once. Is that blood of a fresh kill I smell in the air?
"Senator WATT: Is it possible to put a figure on the number of times that someone has had a record created for them without their consent?
Mr Kelsey : As far as we know—
Ms McMahon : Zero.
Senator WATT: Zero?
Ms McMahon : To confirm: there has never been a record created before opt-out without someone's explicit consent, but there have been instances where someone has forgotten or hasn't realised or appreciated that they have a record, and we've taken action in those instances."
As chair of the health committee of the Australian Privacy Foundation, I was contacted by someone who discovered that, in spite of explicitly requesting that they not be enrolled, their GP had enrolled them. When confronted, the GP admitted they had and that it was a mistake.
This was before the opt-out period and before a myhr could be deleted. The system operator (ADHA) had been contacted and told the person involved there was nothing they (ADHA) could do about it. They were registered and that was it.
Any chance their is evidence of that Bernard that could be made either public ally available or at least submitted to the committee? Appreciating the individuals right to privacy.
There seems to be some indication that Ms M is presenting facts in a way that is not a perfect fit against the board papers.
Unfortunately no. It was done on the phone and I didn't make a note of their name. There were two calls, one to ask my advice and the other as a follow-up to tell me the eventual outcome. It as in the first half of last year.
I believe the questions were related to assisted registration which happened in hospital waiting rooms, shopping malls and Gp practises
for example,
https://www.digitalhealth.gov.au/using-the-my-health-record-system/digital-health-training-resources/software-demonstrations/provide-assisted-registration
https://www.aspenmedical.com/content/730000-records-created-ehealth-time-and-target
Noone can ever prove that they definitely did not provide consent hence the confident 'zero' despite all the complaints to the media and the ADHA and the OAIC https://www.abc.net.au/news/science/2018-07-18/my-health-record-opt-out-confusion/10000008
Surely "assisted registration" by enthusiastic young sales people no doubt paid per sign-up would require a signature on the form demonstrating that consent was given for the provision of personal details?
Saying that, it would be possible to fill in some key details, such as address etc, by a bit of creative googling. Also the Medicare card would provide details of other family members who could then be targeted..
I recall Aspen was paid to do this stuff, may have been others
Core issue is that GPs are required to ask consent and I think even get it written down, but no longer required to retain any of that documentation. There would be similar 'protections' I imagine for the consent gathered by Medicare Locals and the like
Chatting about this over coffee yesterday, my friend called the helpline to confirm she and her daughter had not had a record created as per their request during the copout period.
It seems apparent the ADHA cannot provide evidence that no record exists only confirmation that it was received on a certain date as per the generated email received when she filled in the online form. So they can confirm receipt and intent to not create a record. The only evidence was some gentleman on the help desk stating he believers there is no record... so not evidence of actual only of intent. Even then the ADHA help desk could only read out a case number, they could not text it, email it or post it in MyGov. Shame they could not have evaded it to her mobile.
For an Agency supposedly championing digital and evidence based benefits it left us both bemused and unimpressed.
@12:43. I just got off the phone, got the same story from the ADHA service desk. Oddly they were not able to resend the original notification from August when’s i opted out. I do hope they have not deleted commonwealth records related to opt out.
I simple self service capability would assist greatly, surely given the details I had to use to speak with someone is sufficient for my to do a simple DB lookup against account creation. I wonder if Tim realises just how digital our lives are and what we expect as minimal service outcomes.
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