Quote Of The Year

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

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Monday, March 21, 2016

Weekly Australian Health IT Links – 21st March, 2016.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Quite an interesting week, with issues in South Australia and with the mHR getting some air-time.
For the second week in a row we have had a registry operated by DoH (Immunisation Register) seemingly not being satisfactory.
I wonder what will break out next week. The problems in WA maybe?
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No end in sight for loathed electronic record system

18 March 2016
SA HEALTH is ploughing ahead with a much-maligned platform for electronic records that has been blamed for inducing “rage attacks” in clinicians.
Doctors remain concerned that the $422 million Electronic Patient Administration System (EPAS) remains user-unfriendly, despite assurances that bugs have been ironed out.
“The EPAS system will continue to evolve and improve over time and SA Health remains committed to working closely with our clinicians’ support (for) the roll out of EPAS”, SA Health told Medical Observer in a statement.
The Flinders and Far North Doctors Association (FFNDA) wrote to the department in January arguing that the system should be overhauled or junked.
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NSW Health hires new CIO

Acting chief wins role.

By Paris Cowan
Mar 18 2016 4:17PM
Zoran Bolevich has secured his spot at the top of NSW Health’s IT wing after winning an open selection process to take over as CEO of eHealth NSW.
Bolevich has been acting in the role, notionally the CIO of the health department, since his predecessor Michael Walsh was tempted back to the sunshine state to take over as director general of Queensland Health in July last year.
The government began taking applications for the role in January.
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5:57pm March 19, 2016

Time-poor Aussies turn to online health

By AAP
Time-poor Australians juggling caring for their children and elderly parents are among the most likely to access health services from home, a new report has found.
The study, commissioned by the National Broadband Network (NBN), found that 90 per cent of those "sandwiched" between caring for the two generations delayed trips to the GP in a bid to save time and money and avoid days off work.
The Digital Health at Home report found convenience was king among half of respondents using services including GP video conferencing and in-home monitoring for the elderly.
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App lets carers share a cache of information

18 March 2016
CareMonkey is aimed at parents or carers who want to share health information, care instructions and what to do in an emergency.
It is similar to other apps available on the market, although this one allows access to be shared with trusted individuals.
Users create a profile containing emergency contacts, health and safety alerts, allergy details, medications, asthma plan, immunisations, family history, organ donor details, health and ambulance insurance details. 
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CSIRO and Dell supercomputer to mothers’ rescue

  • The Australian
  • March 15, 2016 12:00AM
CSIRO is harnessing a supercomputer made by Dell to help combat post-childbirth complications experienced by mothers.
In a partnership forged with Melbourne’s Monash University, CSIRO and Dell have built a high-performance computer cluster to test mesh supports to counter organ movements women can experience years afterwards.
The weakening of abdominal muscles after childbirth can cause body organs to slip, resulting in a prolapse. This can happen weeks, months or sometimes years later, and can be brought on by a bout of coughing, lifting, bending, exercise or seemingly nothing.
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(When) Will #FHIR replace HL7 v2 messaging?

Posted on March 15, 2016 by Grahame Grieve
Question:
I’m working in the healthcare domain and has been hearing the FHIR developments for a while. In my hospital setting, we typically have a Patient Registration System, a EMR system, a LIS and RIS system, and some machine interface (Vital Signs, BMI). We are communicating with each other using HL7 V2 standard and is working fine.
My question is, how does the development of FHIR helps in existing interfaces? Do we need to eventually replace these interfaces with FHIR? If yes, all vendors of the respective systems needs to be FHIR ready.
I like to believe that FHIR is for a future expansion packs, and not a move to replace all existing interfaces. Meaning HL7 V2 are expected to stay.  Another question: In HL7, we dealt with messaging in asynchronous mode. But the FHIR standards, we are moving from the messaging world?
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eHealth Pathology Report and eHealth Diagnostic Imaging Report - My Health Record Conformance Profile now available

Created on Friday, 18 March 2016
The National E-Health Transition Authority (NEHTA) has published updates to the following specifications.
The consent management section of these conformance profiles (Section 3.4) has been rewritten to better reflect implementation requirements as a result of feedback from early adopters. Section 3.5 has updates to record keeping requirements to allow greater flexibility in how records are kept.
The related template package libraries and the template package directory have been updated to refer to the new versions of the conformance profiles.
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Thousands at risk of unfairly losing welfare benefits because of "no jab no pay"

Date March 14, 2016 - 6:44PM

Julia Medew

Health Editor

Thousands of Australians are at risk of having their welfare payments unfairly slashed because of inaccuracies in Australia's immunisation register, which is being used to process the Turnbull government's new "no jab, no pay" rules, health care workers say.
There are also fears that children are receiving unnecessary vaccinations, or doses at times when they shouldn't be because of errors in the Australian Childhood Immunisation Register (ACIR), and problems with how GPs and nurses upload information onto the database.
While the government plans to save $500 million through its new policy of cutting welfare payments for families whose children are not fully vaccinated, immunisation policy expert Julie Leask said research suggested 18 to 50 per cent of children who are listed as not fully vaccinated on the register, may in fact be fully vaccinated. A previous audit of records in Western Australia also pointed to this problem.
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Human Services Dept renews $484m contract with IBM

15/03/2016
news The Department of Human Services (DHS) has renewed a contract with IBM for the delivery of new technology that is aimed to drive new products and services.
The deal, worth $484m over five years, “will enable the DHS to realign hardware, software and services to critical areas of need”, Alan Tudge, Minister for Human Services, said in a statement. “This will ultimately achieve savings for the taxpayer while delivering better outcomes for Centrelink, Medicare and Child Support recipients.”
The department’s investment is aimed to provide better IT services for the millions of Australians that a range of DHS online services for payments.
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Sneaky health apps share private information

15 March 2016
MANY diabetes apps collect and share patients’ private information without their knowledge, US researchers warn.
An analysis of 211 Android diabetes apps has found 81% don’t have privacy policies. Of the 19% with a privacy policy, most of them state that they share user data with third parties without seeking express permission from the user.
Data collected by diabetes apps includes insulin and blood glucose levels, usually captured by tracking cookies.
“Patients might mistakenly believe that health information entered into an app is private (particularly if the app has a privacy policy), but that is generally not the case,” the researchers write in a letter to JAMA.
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Scalextric experiment paves way for willpower-driven wheelchair

  • Tom Whipple
  • The Times
  • March 15, 2016 9:45AM
How do you revamp a toy designed for a 1950s world where simulating a racetrack involved two small plastic cars on rails, and where the only power you had was to make them go fast or slow? Well, you make it mind-controlled, of course.
Engineers at Warwick University have built a Scalextric set on which the speed of the cars is determined by an electrode on your skull that measures how relaxed you are.
While mind-controlled slot car racing may not be the first application that springs to mind for such technology, and while trying to make a toy Le Mans car go fast may not seem like an obvious relaxation therapy, that is not really the issue. The point is more to show that the technology works, is not prohibitively expensive — and could soon be applied to uses such as wheelchairs for paralysed people.
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3D ‘dementia-friendly home’ app to assist carers and empower people living with dementia

Wednesday 16 March 2016
The Dementia-Friendly Home app has been launched by Alzheimer’s Australia Vic today. Using interactive 3D game technology Unreal Engine, the tablet app provides carers with ideas to make their home more accessible for people living with dementia.
Maree McCabe CEO Alzheimer’s Australia Vic said most people are not aware that people with dementia may experience spatial and visual challenges as well as the more commonly understood memory issues.
“Changes in the brain can impact on day to day functions and potentially confuse people living with dementia. Identifying ways the home and environment can be modified to ameliorate any challenges will make a difference to the person living with dementia,” Ms McCabe said.
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Game tech applied to making homes 'dementia-friendly'

"There's an app for that" is a cliche, and the phrase "ageing population" often turns up in political discourse. But even if there's a person with dementia in your family, would you have thought of an app that can make their home more accessible for them?
Launched by Alzheimer's Australia Vic, the Dementia-Friendly Home app uses the Unreal Engine interactive 3D game technology Unreal Engine provides carers with ideas to make their home more accessible for people living with dementia.
Alzheimer's Australia Vic CEO Maree McCabe pointed out that people with dementia may experience spatial and visual challenges as well as memory issues.
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Health

A ‘digital health’ industry is taking shape

By Tim Kelsey, Strategy & Commercial Director, Telstra Health | 2016-03-15
Healthcare around the world is characterised by fragmented and complex systems, but the sector is changing as technology opens up new ways to tackle critical challenges like ageing populations, chronic disease and stretched budgets.
Last year, Otsuka Pharmaceutical, a Japanese life sciences company, and its US-based partner Proteus Digital Health applied for regulatory approval of an anti-depressant drug incorporating an ingestible sensor. The sensor will measure how patients keep to their prescriptions, and the treatment’s effects, the data being transmitted to care providers. If approved, it will mark the first mass-market commercialization of a ‘smart pill’, and will be an important manifestation of the promise of digital health. 
This is just one example of the numerous alliances being forged between health and life sciences organisations and technology companies. Healthcare providers are emerging as active practitioners of digital partnering. 
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Why we need to get over the Medicare Locals disappointment

Many people are still getting over the disappointment of Medicare Locals. I get that. Although some MLs were able to make a difference, too many were not. The new Primary Health Networks (PHNs) may be a different kettle of fish. One thing is for sure: they are here for the long haul.
There is an enormous opportunity for PHNs to add value where they support quality primary healthcare services to the community. For that reason the RACGP is keen to work with the new organisations. I believe there are at least three areas where grassroots support from local PHNs can make a big difference.

Working together

The first area is relationship building and teamwork. We all know there are too many silos and tribes in healthcare. On the other hand, long-term relationships positively influence knowledge exchange, understanding and trust.
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Minister for Health and Minister for Ambulance Services
The Honourable Cameron Dick

Friday, March 11, 2016

Australia’s digital revolution begins in Brisbane hospital

Brisbane’s Princess Alexandra Hospital has become Australia’s first public digital hospital, heralding a revolution in the way healthcare will be delivered in Queensland.
Minister for Health and Ambulance Services Cameron Dick today announced that implementation of the digital hospital project was successfully underway.
“This digital hospital project will transform healthcare delivery in Queensland and allow clinicians to focus on the patient, not paperwork,” he said.
“This means improved safety and quality of care for patients and faster treatment to get them home sooner.”
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Using digital technologies to tackle chronic pain for rural Australians

March 17, 2016
Digital online systems are being used more widely to assist remote, rural and regional Australian access medical help. Babs McHugh speaks with Red Witham, a chronic pain sufferer, on his experiences, Dr Helen Slater about the painHEALTH online resource in WA and Jenni Johnson on an online program in NSW.
Babs McHugh
Source: ABC Rural | Duration: 4min 17sec
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Government Ignores Flaws In E-Health Push.

15 Mar 2016
The Federal Government is pushing ahead with mass trials of its My Health Record e-health system despite concerns that fundamental shortcomings are yet to be addressed.
Health Minister Sussan Ley has announced that the personal health information of more than one million people will be automatically uploaded to the internet from July as part of a large-scale test of My Health Record prior to a nationwide roll-out of the scheme.
Under the plan, 700,000 people living in North Queensland Primary Health Network (PHN) and 360,000 covered by the Nepean Blue Mountains PHN in western Sydney, will have until the end of June to opt-out or have a digital health record containing details of their health status, medicines and allergies automatically created and uploaded to the system.
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Telstra backs out of $1b Philippines wireless joint venture

Telstra has abandoned its negotiations with San Miguel over forming a wireless joint venture in the Philippines.
By Corinne Reichert | March 13, 2016 -- 23:17 GMT (10:17 AEDT) | Topic: Telcos
Telstra has cited the lack of an acceptable "risk-reward balance" as the reason for abandoning negotiations with Filipino giant San Miguel Corporation over a $1 billion equity investment in a wireless joint venture in the Philippines.
Telstra said the two companies were "unable to reach commercial arrangements" over the joint venture, announced at the end of last year, to form a wireless provider.
San Miguel, which generates approximately 6.2 percent of the Philippines' GDP through its infrastructure, fuel, oil, power, and mining, food, and beverage business, would have been its partner in the joint venture.
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NBN needs radical rethink

17 March 2016 | There are calls for the network to revert to an all-fibre NBN for future-proofing.

Network problems

Last updated: 17th March 2016
The plan for the national broadband network (NBN) needs a radical overhaul and should revert back to an all-fibre network, according to Internet Australia (IA), the peak body representing internet users. 
IA delivered the blunt message that the national network should deploy fibre and just do it now at last week's hearing of the NBN Senate Select Committee, which is investigating the NBN.

Nbn™ leaks question viability of multi-tech NBN

It comes after a series of leaked documents show that expanding the use of high-speed fibre is now a cost-effective option for the national broadband network (NBN). It raises questions about the viability of the current network that is repurposing technically inferior copper and pay TV cables and linking to fibre at nodes, at significant cost. 
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Computer's Go victory is a warning about the AI in our lives

Date March 17, 2016 - 8:35AM

Nello Cristianini

COMMENT
The victory of a computer over one of the world's strongest players of the game Go has been hailed by many as a landmark event in artificial intelligence. But why? After all, computers have beaten us at games before, most notably in 1997 when the computer Deep Blue triumphed over chess grandmaster Gary Kasparov.
We can get a hint of why the Go victory is important, however, by looking at the difference between the companies behind these game-playing computers. Deep Blue was the product of IBM, which was back then largely a hardware company. But the software – AlphaGo – that beat Go player Lee Sedol was created by DeepMind, a branch of Google based in the UK specialising in machine learning.
AlphaGo's success wasn't because of so-called "Moore's law", which states that computer processor speed doubles roughly every two years. Computers haven't yet become powerful enough to calculate all the possible moves in Go – which is much harder to do than in chess. Instead, DeepMind's work was based on carefully deploying new machine-learning methods and integrating them within more standard game-playing algorithms. Using vast amounts of data, AlphaGo has learnt how to focus its resources where they are most needed, and how to do a better job with those resources.
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Enjoy!
David.

Sunday, March 20, 2016

The DoH Asks That Some Information On Legislative Changes With The mHR Be Distributed. Happy To Oblige And Comment.

This arrived by e-mail a day or so ago and I assume I was being asked to distribute to my readers.

Update on legislative changes affecting the My Health Record system

The purpose of this email is to provide an update regarding recent legislative changes that impact on participants in the My Health Record system.  Please consider disseminating this information to your organisation’s members (if any). 
The Health Legislation Amendment (eHealth) Act 2015 which came into effect in late 2015 made legislative changes which affect the legal obligations of participants in the My Health Record system.  These changes commenced on 1 March 2016.
The key changes are as follows:
 Participation Agreements
Healthcare provider organisations and other entities no longer need to enter into participation agreements in order to register in the My Health Record system.  This makes the process of registering simpler.  The obligations in the participation agreement have been included in My Health Records Rules.  Organisations that registered before 1 March 2016 will continue to have a valid participation agreement in force after 1 March 2016.  The process for termination of those agreements is still being determined and the Department will be in contact with participants.
Changes to the My Health Record System Operator
The System Operator is the entity that administers the day-to-day running of the My Health Record system.  The System Operator is currently the Secretary of the Department of Health.  It is expected that from 1 July 2016 the System Operator will be the newly formed Australian Digital Health Agency.
Changes to Penalties
Changes have been made to the penalty arrangements as part of aligning the frameworks of the My Health Record system and Healthcare Identifiers Service.  These changes better protect the sensitive information that can be contained in a My Health Record and allow for us to respond more proportionally to the seriousness of a breach.
Unauthorised collection, use or disclosure of information in the My Health Record system, of healthcare identifiers or of other information collected in relation to the My Health Record system or Healthcare Identifiers Service is now subject to both civil and criminal penalties where an action is deliberate or reckless.  These penalties do not apply where a mistake has been made – for example, if a healthcare provider inadvertently or accidently accesses an individual’s My Health Record.
The penalty for not complying with the My Health Records Rules is $18,000 for individuals and $90,000 for bodies corporate.
Notification of Data Breaches
Participants need to notify the System Operator of potential and actual data breaches.  These obligations are contained in the My Health Records Act 2012.  The amended My Health Records Act 2012 now makes clear what constitutes a data breach and the entity that needs to report it. 
A data breach is an unauthorised collection, use or disclosure of health information in an individual’s health record or an event or circumstance that may compromise the security or integrity of the My Health Record system.  Where there is a potential data breach healthcare provider organisations must take steps to contain and evaluate the breach.  The healthcare provider organisation must also report the potential breach to the System Operator as soon as practicable.  Data breaches can be notified by calling the My Health Record help line on 1800 723 471.
Healthcare Provider Directory
Healthcare provider organisation information is automatically published on the Healthcare Provider Directory without the need for consent.  This approach reflects the treatment of such information by the Privacy Act 1988 where it is considered general business information, not personal or identifying information.  This will help improve communication between healthcare providers, and reduce administration by removing the need for provider organisations to have to consent to publication. 
New Intellectual Property Arrangements
Intellectual property licences are no longer required because of a new copyright exception.  The exception allows information that is downloaded from the My Health Record System for health and other permitted purposes to be used for those purposes without constituting an infringement of copyright.
Update on Healthcare Providers Uploading Information
Healthcare providers who do not have the appropriate professional authority should not author information that is uploaded to the My Health Record system.  There was previously no legislative restriction on this occurring.  The legislative changes provide that healthcare providers whose professional registration or membership in a professional association is cancelled, suspended, lapsed or conditional are prohibited from authoring anything that is uploaded to a My Health Record.  The only exception is for those who simply haven’t paid their renewal fees.
Uploading Third Party Information
Healthcare provider organisations are now expressly authorised to upload information to a My Health Record if it includes relevant information about a third party, removing any ambiguity about providers’ authority – for example, in relation to the person’s ongoing treatment of hypertension, the information may reference the fact that the person’s mother has a heart condition.  Certain state laws (specified in the My Health Records Regulation 2012) may still require the provider to get express or written consent form the third party before uploading certain sensitive information – for example, in relation to the person’s medical history, the information may reference the fact that the person’s mother was diagnosed with HIV during pregnancy (in this case, the NSW Public Health Act 2010 requires a provider to get express consent of the person who had HIV before disclosing it).
More detailed information about these changes is attached.  This information will also be published at www.myhealthrecord.gov.au.  More detailed fact sheets on these changes are currently being developed and will be available on the website over the coming weeks. 
If you have any queries regarding these changes please write to ehealth.legislation@health.gov.au.
Paul Madden
Deputy Secretary and Special Adviser
Strategic Health Systems and Information Management
Department of Health
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The attachment covers the timing of the various changes.

MY HEALTH RECORD: Timing for legislative changes

 Overview

Legislative changes are being made to the My Health Record system (previously known as the personally controlled electronic health record or PCEHR system) and the Healthcare Identifiers Service (HI Service).  These are taking effect at different times between November 2015 and July 2016.  Some of the changes will affect the obligations of participants in the My Health Record system – that is, the System Operator* and healthcare provider organisations, contracted service providers, repository operators and portal operators that are registered.
Please note this is not a summary of all changes – it is only a summary of changes that will affect individuals or participants.  More detailed fact sheets on the changes will be will be published on www.myhealthrecord.gov.au in coming weeks.
Forms, guides and other published information about the system are being updated to reflect these changes.
*The System Operator is the entity that administers the day-to-day running of the My Health Record system.  The System Operator is currently the Secretary of the Department of Health.  From 1 July 2016 the System Operator will be the newly formed Australian Digital Health Agency.
Changes in effect now
The following changes are minor and should not have any notable impact on individuals or participants in the My Health Record system.  They started on 27 November 2015.
·         The name of the personally controlled electronic health record system is now the My Health Record system.  The legislation (including the rules and regulations) is similarly renamed.
All material, including webpages and brochures, will be updated to reflect the new name and logo.
·         The Minister can implement an opt-out My Health Record system in trial areas.  These have been specified in My Health Records Rules which commenced on 9 February 2016.
The system currently operates on an opt-in basis for consumers.  In opt-out trials – in Northern Queensland and Nepean Blue Mountains – consumers will automatically have a My Health Record created for them unless they notify the System Operator that they do not want one.
·         The meaning of health service now expressly includes aged care, palliative care and disability services.
Previously there was ambiguity as to whether these services were considered healthcare services and therefore, for example, whether they were eligible to get an HPI-O and participate in the My Health Record system.  This change removes the ambiguity.
·         The meaning of health information has been clarified.
This now expressly includes reference to injury and illness, reflecting changes made to the meaning of “health service”.
·         A new permitted health situation is established under the Privacy Act to provide for the collection of third party health information as part of providing a health service to a person.
This means that an individual’s record can include information about a third party such as a family member where it is relevant to the individual’s healthcare – for example, in relation to the ongoing treatment of a patient’s hypertension, the information may reference the fact that the patient’s mother has a heart condition.  This applies to healthcare records in general, not just the My Health Record.
·         The System Operator can communicate electronically with individuals and participants.
Until now the System Operator has had to communicate decisions to individuals by letter.  The System Operator can now collect individuals’ email addresses and mobile phone numbers (optional) to communicate by email or SMS.
·         Records in the My Health Record system will be held for 30 years after the individual (about whom the record relates) dies or, if that is not known, 130 years from their date of birth.
The System Operator previously had to store records for 130 years from the time it was uploaded if the date of death was unknown.
·         Regulations can authorise other entities to collect, use, disclose and adopt healthcare identifiers.
This means it is possible for regulations to prescribe entities such as the National Disability Insurance Agency to use healthcare identifiers.  Previously this could only be achieved through amendments to the Act.
·         The term “network hierarchy” of a healthcare provider organisation is no longer used and is now just referred to as a “network”.
A network of healthcare provider organisations is a group of healthcare provider organisations linked together.  A network consists of a seed organisation (the head of the network) and one or more other healthcare provider organisations.
·         If the System Operator decides to cancel/suspend an individual’s My Health Record or other entity’s registration, the decision has effect from the date of notification or a specified date.
This removes a previous ambiguity about when such a decision would take effect.
Changes in effect from 18 December 2015
The following change will affect healthcare providers providing assisted registration and commenced on 18 December 2015.
·         Organisations providing assisted registration will no longer need to store individuals’ signed application forms, and may dispose of forms they already hold.
Healthcare provider organisations will still need to obtain a person’s consent before helping them to register for a My Health Record.  Previously, organisations had to store forms for three years, or send them to the System Operator to store for three years.
Changes in effect from 1 March 2016
The following changes affect the legal obligations of participants in the My Health Record system.  They started on 1 March 2016.    
·         Healthcare provider organisations and other participants no longer need to enter into a participation agreement with the System Operator as obligations in the agreement are now included in My Health Records Rules (where still relevant).
Healthcare provider organisations and other entities previously had to enter into a participation agreement in order to register.  This change makes the process of registering simpler because the entity no longer needs to select the type of participation agreement appropriate to their legal entity and enter into it as part of their registration application.  For organisations that are already registered, their participation agreement is still valid so the System Operator will contact them regarding the termination of their participation agreement.
·         The legislation requires all participants to notify the System Operator of potential and actual data breaches.
Healthcare provider organisations were previously subject to this requirement via the participation agreement.  This change centralises the notification requirement for all participants in the My Health Records Act.  These changes also make clearer what constitutes a data breach and when an entity needs to report it.
A data breach is an unauthorised collection, use or disclosure of health information in an individual’s health record or an event or circumstance that may compromise the security or integrity of the My Health Record system.  Where there is a potential data breach healthcare provider organisations must take steps to contain and evaluate the breach.  The healthcare provider organisation must also report the potential breach to the System Operator as soon as practicable.  Data breaches can be notified by calling the My Health Record help line on 1800 723 471.
·         The My Health Record system operates without the need to rely on intellectual property licences to avoid infringing copyright.
Organisations no longer need to license the System Operator (and be licensed) so that information uploaded to the My Health Record system can be used, copied, etc., in order to avoid infringing the author’s copyright.  This change establishes an exception so that use of this information does not constitute an infringement of copyright, including once it is downloaded from the My Health Record system for health and other permitted purpose’s.
·         Authorised and nominated representatives of individuals need to act in accordance of the will and preferences of the individual they represent.
Previously a representative was required to act in the best interests of the individual they represent.  This change reflects international changes in the treatment of individuals who require supported decision-making.
·         Healthcare providers whose professional registration (or membership in a professional association if they are not registered with AHPRA) is cancelled, suspended, lapsed or conditional are prohibited from authoring anything that is uploaded to a My Health Record unless they are suspended because their registration (or membership) fees are overdue by less than six months.
It is intended that healthcare providers who do not have the appropriate professional authority should not author information that is uploaded to the My Health Record system given the clinical risks.  The only exception is for those providers who simply haven’t paid their renewal fees.  There was previously no restriction on this occurring.
·         The System Operator is now able to remove (or instruct the removal of) documents from a My Health Record if they are uploaded by a healthcare provider without the necessary professional registration (or membership).
The System Operator can remove (or instruct a healthcare provider organisation to remove) documents with a defamatory statement or that may affect the security/integrity of the system.  This change addresses circumstances where a provider’s professional registration is suspended and their documents could pose a clinical risk.
·         Healthcare provider organisations are now expressly authorised to upload information to a My Health Record if it includes relevant information about a third party.
This change addresses concerns that providers have had about including third party information in an individual’s My Health Record.  It enables a healthcare provider to upload information which includes, for example, reference to the fact that a patient’s mother has a heart condition in relation to the ongoing treatment of the patient’s hypertension.   Certain state laws (specified in regulations) may still require the provider to get express or written consent from the third party before uploading certain sensitive information – for example, in relation to the patient’s medical history, the information may reference the fact that the patient’s mother was diagnosed with HIV during pregnancy (in this case the NSW Public Health Act 2010 required a provider to get express consent of a person with HIV before disclosing it).
·         The System Operator can temporarily suspend access to a My Health Record by an individual, representative or participant for security, technical or operational reasons.
This power was previously limited to suspension for reasons associated with the participant’s IT system, risk to the individual or the representative’s eligibility.  It has been expanded to support situations such as where the participant’s physical security arrangements pose a risk or the validity of an individual’s identity verification is under investigation.
·         The System Operator can collect, use and disclose information about an individual who has opted in for the purpose of including their health information in their My Health Record.
This change removes any doubt about the System Operator’s ability to take these actions.
·         If an entity is authorised (by law) to provide information to a healthcare provider, the information can be provided to an employee or person acting on behalf of that healthcare provider (or an employee/contractor acting for the contracted service provider). 
This reflects the practical operation of healthcare provider organisations that may have a variety of different structures governing their business and impacting on how information is received by the organisation.  All authorisations, obligations and penalties set out in the Healthcare Identifiers Act now apply to all relevant entities, notwithstanding different structures.
Changes relating to healthcare identifiers
·         Additional sanctions are available in relation to the HI Service.
Unlike the My Health Record system, the HI Service previously had no form of sanctions for a breach other than imposing a criminal penalty or doing nothing.  As part of aligning the frameworks of both systems, sanctions available in the My Health Record system (namely, that a person or entity may give an enforceable undertaking, or be the subject of an injunction, to take or refrain from taking certain actions to comply with the requirements) are now available in the HI Service.  This broader range of sanctions enables a more robust enforcement framework that is consistent with the My Health Record system and that allows the sanction to be better proportioned to the seriousness of the offence. 
·         Healthcare provider organisation information which is collected as part of assigning a healthcare identifier to an organisation is now automatically published on the Healthcare Provider Directory without the need for their consent.
The healthcare identifier of a healthcare provider organisation (an HPI-O) will is no longer treated as identifying information.  This approach reflects the treatment of such information by the Privacy Act 1988 where it is considered general business information, not personal or identifying information.
The HI Service Operator is authorised to publish contact and other details of the healthcare provider organisations registered with the HI Service.  This will help improve communication between healthcare providers, and will reduce administration by removing the need for provider organisations to have to consent to publication.
·         Any entity who knows a healthcare provider’s healthcare identifier may provide it to that healthcare provider.
This is to allow healthcare providers easy access to their healthcare identifiers which may have been previously unknown to the healthcare provider.  This is currently limited to certain entities.
·         A healthcare provider can adopt (for their organisation’s records) the healthcare identifiers of a person’s authorised and nominated representatives.
It may be necessary for healthcare providers to use the representatives’ healthcare identifiers in order to correctly associate the representative with the patient.
·         The obligation of healthcare provider organisations to update particular information about them held by the HI Service Operator is expanded to ensure that all information held by the HI Service Operator is maintained. 
The move to include all healthcare provider organisations in the Healthcare Provider Directory means that all information held by the Service Operator needs to be maintained.  A civil penalty of up to 100 units applies if a person knowingly or recklessly fails to comply with this provision (up to $18,000 for individuals and $90,000 for bodies corporate).  Responsible Officers and Organisation Maintenance Officers have additional obligations to update their organisation’s professional and contact information direct to the HI service.  The HI Service Operator will share that information with the My Health Record system to ensure that information is up to date.
·         The HI Service Operator can disclose identifying information about an individual to a healthcare provider in order to provide a healthcare identifier to the provider.
When a healthcare provider requests an individual’s healthcare identifier from the HI Service Operator, they provide identifying information about the individual.  The Service Operator is not always able to exactly match this information to an individual so it is cannot provide the healthcare identifier.  This change improves the success rate of matching a healthcare identifier to an individual and providing to the healthcare provider.
·         The System Operator can disclose an individual’s healthcare identifier to the individual or a responsible person (as defined by the Privacy Act).
The System Operator could already disclose this healthcare identifier to the HI Service Operator and healthcare providers.  This additional power makes it easier for individuals and responsible persons to get an individual’s healthcare identifier – for example, as part of their dealings with the System Operator rather than being referred to the Service Operator.
Changes to penalty provisions
·         The unauthorised collection, use or disclosure of information in the My Health Record system, of healthcare identifiers or of other information collected in relation to either the My Health Record system or HI Service is subject to civil and criminal penalties.
These changes better protect the sensitive information that can be contained in a My Health Record and allow for the System Operator to respond more proportionally to the seriousness of a breach.
Previously, misuse of healthcare identifiers was subject to criminal penalties while misuse of My Health Record information was subject to civil penalties.  This change aligns the enforcement options under the HI Act and the My Health Records Act and supports a graduated range of mechanisms to address contraventions allowing sanctions to be appropriately applied in a range of circumstances, proportional to the seriousness of the breach.  Penalties do not apply if a mistake has been made. 
Misuse may incur a penalty of up to two years’ imprisonment or a fine of up to 600 penalty units ($108,000 for individuals or $540,000 for bodies corporate).  Penalties will apply slightly differently to partnerships, incorporated associations and trusts.
·         If a participant (not including healthcare providers) takes My Health Record system information outside Australia, they are subject to civil and criminal penalties.
There is a prohibition on My Health Record system information being taken outside Australia which is consistent with broader Government policy regarding security of information collected by the Commonwealth.  This action was previously subject to a civil penalty.  The broadening of the penalties to include criminal penalties reflects the sensitivities of information in the My Health Record system and allows responses to match more proportionally to the seriousness of a breach.  A participant may incur a penalty of up to two years’ imprisonment or a fine of up to 600 penalty units ($108,000 for individuals or $540,000 for bodies corporate).  Penalties apply slightly differently to partnerships, incorporated associations and trusts. 
·         The penalty for failing to comply with the My Health Records Rules (previously known as the PCEHR Rules) will increase to 100 penalty units (up to $18,000 for individuals and $90,000 for bodies corporate).
The current penalty is 80 units ($14,400 for individuals and $72,000 for bodies corporate).  This increase better protects the sensitive information in the My Health Record system.
Changes in effect from 3 March 2016
The following changes affect the content of the My Health Record system, individuals in trial sites and may affect healthcare providers.  They started on 3 March 2016.
·         Individuals in the Nepean Blue Mountains and Northern Queensland may have a My Health Record created for them as part of the opt-out trials.
A record will be created if a person’s Medicare address is located in a postcode specified in the My Health Records (Opt‑out Trials) Rule on 3 March 2016.  Individuals will be notified in writing and given the opportunity to opt-out.
Changes in effect from 1 July 2016
The following changes will affect the governance of the My Health Record system.  They will start on a date yet to be specified (known as the governance restructure day) but is expected to be 1 July 2016 to allow time for the Australian Digital Health Agency (previously referred to in the explanatory memorandum to the My Health Records Bill as the Australian Commission for eHealth) to be established.
·         The Independent Advisory Council and Jurisdictional Advisory Committee will be abolished.
New committees will be established in the Australian Digital Health Agency to meet these functions.
·         The Australian Digital Health Agency will become the My Health Record System Operator.
The System Operator is the entity that administers the day to day running of the My Health Record system. The Secretary to the Department of Health is currently the System Operator.  A new regulation will need to be made to change the System Operator to the Australian Digital Health Agency.
·         The Minister will be required to consult the Australian Health Ministers’ Advisory Council and the System Operator before making My Health Records Rules (previously known as PCEHR Rules).
The Minister is currently required to consult the Independent Advisory Council and Jurisdictional Advisory Committee.
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You can find information on the Healthcare Provider Directory here:
I have to say some of the provisions seem a little problematic.
With respect to the Breach Notification one has to wonder just why, when the system operator is notified regarding a breach, those who might be affected are not also told!
I also wonder what the controls are on the information after it is downloaded -it might be good to make sure proper controls are in place wherever the record can be downloaded and stored.
Last I am not sure family history and family information are fully addressed in the summary we are given. A record of heritable illnesses of relatives in a patient record can be more than a bit of a problem in terms of privacy and security.
Anyway it is useful to have the official position on what is planned.
David.

AusHealthIT Poll Number 312 – Results – 20th March, 2016.

Here are the results of the poll.

Is The Public Receiving Value For Money For The Investment Presently Being Made In The My Health Record Program (mHR)

Yes 1% (2)

No 98% (142)

I Have No Idea 1% (1)

Total votes: 145

A really decisive poll. Basically no-one believes the Government is getting value for money with the mHR.

It is not good for the program that there are so many who do not think the Government is spending their taxes wisely. Again Ms Ley should take careful notice!

Really great turnout of votes!

Again, many, many thanks to all those that voted!

David.