This appeared last week:
Raising healthcare identifiers adoption in Australia
The Australian Digital Health Agency has outlined specific steps to increase the uptake of healthcare identifiers across health facilities.
By Adam Ang
July 11, 2024 07:12 PM
The Australian Digital Health Agency has released a five-year roadmap for raising the uptake of national healthcare identifiers in Australia.Developed with the Department of Health and Aged Care and Services Australia, the National Healthcare Identifiers Roadmap 2023-2028 outlines specific actions to take for the broad adoption of healthcare identifiers, which are unique numbers used to identify individuals, healthcare provider individuals, and healthcare provider organisations. These identifiers are issued through the national system, HI Service, operated by Services Australia.
WHY IT MATTERS
The federal government envisions a future where national healthcare identifiers are readily available and universally used by all individuals and healthcare providers in all health information exchanges and digital health projects involving health information sharing. It also aims to reduce or eliminate the mismatch in individuals' identification; streamline the management of identifiers and associated documents, such as digital certificates; and enable individuals to use identifiers to control their information and manage their privacy.
"Increased adoption of the national healthcare identifiers will mean Australians will avoid having to retell their story as they move across the health system," Simon Cleverley, assistant secretary of Digital Health at DoHAC, explained.
"Access to information in real time will also support healthcare providers to make well-informed clinical decisions and care plans."
In the coming years until 2028, the government will pursue the activities outlined in the roadmap, focusing on legislative changes, service improvements, technical updates, and operational enhancements.
It seeks to reform the HI Act, which implements the national system for assigning unique healthcare identifiers; publish a federal government policy position on HI Service adoption; develop a simple guide to the HI Act; create a template of policies and guidelines on healthcare identifiers use; and issue a policy on healthcare identifiers use in consumer applications.
Work to improve the HI Service includes enhancing data matching (including for Aboriginal and Torres Strait Islander peoples) and data quality, reviewing existing messages and responses, improving search considerations, creating individual healthcare identifiers for newborns, and enabling consumers to enter or verify registration data and easily update their information.
On the technical side, the government seeks to create guidance for organisations on appropriate structures, the conduct of a conformance review and update of the HI Service, the update of its technical standards, the extensibility of the HI Service architecture, and the development of guidelines on clinical systems architecture and functional requirements.
To improve operations, a stakeholder engagement and communication plan and educational materials for the HI Service will be developed. There will be a review of support arrangements and monitoring and feedback processes and the continuous improvement of the HI Service. Finally, there will be a review and update of the HI Service's governance structure and processes.
THE LARGER CONTEXT
The creation of the National Healthcare Identifiers Roadmap is part of actions outlined in the National Healthcare Interoperability Plan 2023–2028. The plan also seeks the wide uptake of healthcare identifiers "to enable a connected and interoperable health system where every person, healthcare provider, and organisation can be accurately and quickly identified."
Also part of the ADHA's Interoperability Plan is collaborating with industry. In 2022, the agency partnered with Health Level Seven Australia to raise the adoption of FHIR standards across the Australian health system.
ON THE RECORD
"Healthcare identifiers are the linchpin for safe, secure, and seamless information sharing across the nation’s healthcare system in near real time. They are central to the evolution of digital health and will empower Australian healthcare consumers to have continuous care across all healthcare facilities in every corner of Australia,” Peter O’Halloran, chief digital officer at ADHA, said in a media statement.
Here is the link:
https://www.healthcareitnews.com/news/anz/raising-healthcare-identifiers-adoption-australia
What is not mentioned here is that use of Healthcare Identifiers have been facilitated by the HEALTHCARE IDENTIFIERS ACT 2010 so that the system is now 14 years old. Surely if it was so usefully implemented it would have been fully adopted by now? How can we still be developing an implementation plan from 2023-2028!
Here is the link to the Act:
http://www8.austlii.edu.au/cgi-bin/viewdb/au/legis/cth/consol_act/hia2010199/
The ADHA really needs to research just what they are doing wrong that is meaning that the system is not universally used after this length of time!
The outcome
of that research would be fascinating given the obvious benefits of a national
system! Right now it looks like a spectacular farce!!!
Why do you think most seem to just ignore the service?
David.
15 comments:
I understand that some jurisdictions initially allowed for a relaxation of the implementation scope of the Healthcare Identifiers (HI) for an unspecified duration. However, the Australian Digital Health Agency (ADHA), under all its CEOs and other leaders, has done little to maintain its products and services. The HI system is a clear example of low-hanging fruit that they have allowed to wither and die. They are presenting a "start again" mentality as an improvement strategy to cover up their shortcomings.
The ADHA will need some cash incentives to get the states to adopt the HI system and ensure that large electronic medical records (EMR) and clinical systems from international vendors support the HI service. Given the current state of the private health sector, these incentives will need to be substantial in order to achieve the following:
1. Reforming the HI Act: Implementing the national system for unique healthcare identifiers and developing guidelines and policies for their use.
2. Improving the HI Service: Enhancing data quality, creating identifiers for newborns, and enabling consumers to update their information.
3. Technical Improvements: Updating technical standards and developing guidelines on clinical systems architecture.
4. Operational Improvements: Developing a stakeholder engagement plan, creating educational materials, and continuously improving the HI Service's governance structure.
"We cannot solve our problems with the same thinking we used when we created them."
Albert Einstein
ADHA has a one track mind - just adopt technology and everything will be fine.
Which countries have successfully developed and deployed universal Health Identifiers?
The cost of implementing the HI (and IHI) is in the past, - a sunk cost.
"However, the Australian Digital Health Agency (ADHA), under all its CEOs and other leaders, has done little to maintain its products and services."
Maintenance is an un-budgeted ongoing impost that ADHQA has chosen to ignore. (that's assuming the recognised its need)
That's why the audit did not pick it up as a failure - it was not recognised as something essential.
In fact, the audit, unconsciously, said it was OK - it hadn't been included in any costing and nothing was spent. 0=0, everything is fine.
If anyone expects or even hopes the government to fix things real soon now, this was published in 1988
A bunch of amateurs : the tragedy of government & administration in Australia
by J. W. C Cumes
You can borrow/access it on-line
https://archive.org/details/bunchofamateurst0000cume/mode/2up
This is an excerpt (Cumes was a diplomat):
"The public service has no built-in guarantees against incompetence and waste. The incentives to save money or to do good work are weak. A colleague of mine who saved the Department of Foreign Affairs, and therefore the government and taxpayer, a cool $1 million was not regarded, in terms of his duty, as bound to save that money. No one would have noticed if he hadn’t — and the unkindest cut was that few noticed it when he did. He
involved himself in additional ‘work’ and ‘trouble’ to save the money. I reported favourably on his performance but he had no other acknowledgement. Some of his colleagues seemed to think he had been over-zealous, if not outright foolish, to set such standards. It didn’t help his future. Itjust didn’t matter to anyone that, in the matter of saving money, he had performed so capably.
If he had done something else — for example, caught the eye of a visiting minister because he gave some personal assistance — then of course his rise in the public service might have been dramatic.
Good management doesn’t matter. The bad managers at all levels are legion."
In the implementation phase Standards Australia (IT-14-6-5, now dead due to DOH withdrawing funding) pointed out that provider identifiers needed to be location specific and were not and this prevented there use in messages, as the results needed to go to the correct site!
We were told it's too late and its finalized and can't be changed, so the lack of use was quite predictable, unless you are a public servant, in which case understanding the actual use appears to be a bridge to far, It's done, sign off on it and get promoted to stuff up something else?
@10:34 AM Great question. Does ADHA or anyone else know the answer?
The UK implemented them nationally years ago as the NHS Number I believe....
David.
Ohhh gosh - the UK! So would that be the same as, or something similar to, Australia using the Medicare Number as nearly every Australian has one?
Pulse ITs 12 July Blog says: "It's crunch time for My Health Record".
Meanwhile, ADHA chief digital officer Peter O’Halloran has said "the new national repository platform that would underlie the modernised infrastructure would be built using FHIR."
"There’s no doubt the My Health Record will not go away, despite repeated calls by certain people for it to be cancelled."
In other words the future of My Health Record is totally dependent on the future of FHIR.
Why do I get the feeling hope and hubris now reign supreme?
So if that is the future of the MHR what the ADAH and DOHA are saying is that the "modernisation of the MHR" is in fact a complete redesign and rewrite from scratch and the deployment of the NEW system to REPLACE / DISPLACE the existing system.
Forgive me please for my stupid naivety BUT BUT BUT dare I ask:How much this is going to cost? and Will it cost another $2 billion++?
And, How and when will we know what problem they will solve in the process and why should we believe them this time around?
A highly complex set of interacting systems and subsystems with multiple user requirements needs more than just a silver bullet, which is how FHIR is perceived.
@1:16PM For some inexplicable reason the Medicare number was not deemed suitable as a Health Identifier yet the UKs NHS number is suitable!
Does anyone know why that is so?
Because the Medicare number is a funding authorisation, and a known target of fraud. Review of medicare numbers showed that it is not a reliable identifier for the purposes that the IHI was defined. It's not at technical issue, it's around the administrative procedures in the past.
A medicare number was not 1:1.
A patient has to be an Australian citizen or illegible for a medicare card to have one. So not all patients (incl those not paid by medicare) have a card/number.
A child could appear on more than 1 card of parents/guardians, not with the same number when they are seperated.
Even Doctors can have multiple provider numbers to work in different locations/states/Territory and/or different roles (multiple qualifications).
The card number slightly changes when replaced (eg. previous card expires & new card has 1 digit that increments).
If the people listed on a card changes then the position number may also change on the new card.
AnonymousJuly 15, 2024 5:59 AM - identifies layers that make interoperability so challenging - politics and politics tied to funding models. COAG funded and championed this until it came time to implement. Sounds like so many other attempts to improve a situation.
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