Major Standards Harmonisation Announcement and Other Things.

There have been three interesting developments in the e-Health standards world recently.

First, a week or so ago this press release was issued by the ‘heavies’ of Health Informatics Standardisation globally.

Joint Initiative of SDO Global Health Informatics Standardization

Press Release

CEN TC, ISO TC and HL7 Launch first Joint Working Group and Integrated Work Program Activities

August 28, 2007

Brisbane

CEN/TC 251, ISO/TC 215 and HL7 launched their inaugural Joint Initiative Council and Joint Working Group at a meeting in Brisbane, hosted by ISO/TC 215. This was the culmination of months of planning by the standards development organization (SDO) leaders responding to the strong call for coordination and collaboration of health informatics standards developments from government, health provider and vendor communities across the world.

The Joint Initiative Charter provides the basis, purpose, and structure of the Joint Initiative on SDO Global Health Informatics Standardization. It has been ratified by all three SDOs and was confirmed by their respective Chairs. The Charter is available from each of the SDO Secretariats.

The Joint Initiative Council and the first Joint Working Group meeting confirmed their work will build on existing agreements and recognize existing standards collaboration work already in place. The readiness to engage with other SDOs and organizations that are involved in standardization work across the globe and that have potential common work products was also confirmed.

This first Joint Working Group meeting addressed their scope, structure and related processes and introduced the first set of work items that form part of the integrated work program. That set includes an EHR communications architecture standard, a joint data types standard, care information model standards requirements and patient and medication safety standards.

To satisfy health business requirements and to identify additional integrated work items the full lists of ISO, CEN and HL7 work programs was shared at the meeting.

Along with strong support for ongoing sharing of all work programs the Joint Working Group initiated a process to identify gaps and overlaps and to rectify them.

It was noted with appreciation by all attending that there were many groups represented at the Joint Working Group meeting and the work such as the ICH pharmacy standards within ISO/TC 215 is a great example of collaboration and cooperation. Ed Hammond, newly elected Chair of the Joint Initiative Council stated “the contribution of the many experts from each of the SDOs, all working together, is a huge strength of the Joint Working Group and we fully support this collaborative

work that is so essential in delivering shared care through interoperability of our health information systems.”

The next meeting of the Joint Working Group is scheduled to coincide with the CEN

TC 251 meetings at Dublin on October 2nd, 2007.

Kees Molenaar

Chair, CEN/TC 251

Dr. Yun Sik Kwak

Chair, ISO/TC 215

Ed Hammond

Incoming Chair, HL7

ISO/TC 215 is the International Standards Organization Technical Committee for

Health Informatics http://www.tinyurl.com/2m8qxk

CEN/TC251 is the European Committee for Standardization Technical Committee for

Health Informatics http://www.tinyurl.com/2vr954

HL7 is the Health Level 7 Inc, an American National Standards Institute affiliated

Standards Development Organization http://www.hl7.org/

ICH is the International Council on Harmonization

http://www.ich.org/cache/compo/276-254-1.html

----- End Release

This looks to be an important step towards moving the international Health Informatics Standardisation process forward. It would seem to me that as the Joint Working Group starts to push forward on the areas it plans to address the scope for national standards making is going to inevitably become confined to localisation of global standards rather than de-novo standards development – recognising that each of these parties will be receiving national input as to areas that need to be addressed and suggestions as to appropriate Standards content from all those with an interest.

It is clear Australia must ensure it has a lot of solid representation in all the various working groups that will inevitably spin off from these processes.

Second, on a parallel and quite related matter I recently was alerted to a report – written by Richard Dixon-Hughes of DH4 Pty. Ltd. - on the CEN/TC 251 Working Group Meetings held in London - 11 to 12 June 2007.

As of the time of writing this report is available here.

While browsing this long and fascinating report I came upon the following section.

“7.3 NSAI (Eire) letter re standards implementation

NSAI (National Standards Association of Ireland) had written to CEN/TC 251 requesting that its standardization processes include explicit testing and evidence of implementation prior to a standard being adopted.

The WG I convener, Prof Stephen Kay, recounted the history and background to this subject and (as a member of the relevant NHS Assurance Board) noted that the NHS in the UK require implementation of a standard as part of their assurance process.

It was also noted that, within the broader standardization community, experts have not typically been successful in requiring practical implementation as part of the standardization process, although the ISO key objectives for 2005-10 includes an emphasis on implementation. Points raised in discussion included:

· Due to many factors including greater demands on time and resources, those who apply standards are often remote from the processes and experts who create them – and many users do not appreciate that they need to be involved in a standard until it has been produced

· Implementation guides and other forms of lower-consensus documentation may have a role in that they can be used as a bridge from standards makers to users – however, implementers must be prepared to use them, if they are to have value – often they prefer to hold off until a standard is fully normative.

· National or regional standardization bodies don't have a (strong) relationship with national or regional authorities which enforce the use of standards. This has to be established or reactivated.

· It may be useful to explore projects in which it is possible to handle implementation trials. In this way standards will be tested while establishing and not after when they are formally approved. Opportunities to leverage additional resources for trials need to be identified and exploited.

It was agreed that Prof Kay will draft a position paper for discussion for the next WG meetings which will address all these points.”

It is good to see the Irish stirring a little and can I say I would be much happier with all the present efforts in e-Health Standardisation if there were a set of practical but strict requirements for full demonstrable implementation of any standard that is to be balloted – let alone adopted. If interoperation is involved I would be keen to see fully developed implementation guides made available with the draft standard and at least 2-3 groups produce interoperable implementations before acceptance is contemplated.

Note: for anyone interested in the e-health standards area there is a lot of interesting reading in the full report. Thanks Richard.

Last – to bring it all together it is worth highlighting again this announcement from earlier in the week.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070831/FREE/308310001/1029/FREE

Pact would coordinate key IT panels' activities

By: Joseph Conn / HITS staff writer

Story posted: August 31, 2007 - 5:59 am EDT

The leaders of two federally supported organizations—one tasked with anointing health information technology communications standards and the other with testing and certifying clinical IT systems—have proposed a formal agreement on how to coordinate their activities.

The proposed five-point memorandum of understanding would guide the relationship between the Certification Commission for Healthcare Information Technology and the Healthcare Information Technology Standards Panel. The proposal was worked out between the physician chairmen of the two organizations, Mark Leavitt of CCHIT and John Halamka of the HITSP. It is subject to review and possible amendment by the controlling bodies of the two organizations as well as their approval before it becomes effective, those leaders said. The proposal will be presented to the controlling bodies this month, they said.

The Certification Commission for Healthcare Information Technology was formed in 2004 by the American Health Information Management Association, Healthcare Information and Management Systems Society and the National Alliance for Health Information Technology as a private-sector organization to promote the adoption, particularly by office-based physicians of electronic health-record systems and other IT. In 2005, HHS awarded CCHIT a three-year contract totaling $7.5 million to develop a process to certify health IT products.

....( see the URL above for full article)

While I still see this co-ordination as very good news this paragraph – later in the article must cause some concern.

“As a result of the timing differences, at least one conflict resulted last year over data standards for the transmission of test results between laboratories and providers' EHR systems. CCHIT accepted for its criteria an older version of the Health Level Seven standard for lab results, a standard that its CCHIT members felt was, while a stretch, still reasonably attainable by the labs and EHR vendors. The HITSP, meanwhile, opted for a newer version, which would be far more of stretch, but would achieve goals set out in the AHIC use case. The HITSP's insistence on the as-yet largely unused and futuristic standard elicited protests from some providers and the national reference lab community.”

Again the flavour of standards making – if these organisations can be called Standards Development Organisations – without the discipline of implementation.

I am told informally that there is concern about the development processes used by these entities to ensure quality and robustness.

In summary of the above:

It seems to me there is getting to be too much haste and not enough speed and people are forgetting the need to make Standards both robust, agreed and implementable.

NEHTA has certainly produced a lot of documentation which has not suffered the test of implementation or practicality. This really should change.

I agree with the sentiments expressed in the second reference and reminds me of the comment a colleague used to use to describe similar situations. He used to say - "no time to do it properly - plenty of time to do it again". We need to avoid that outcome if at all possible.

David.

The Australian College of Health Informatics Elects a New President!

At MedInfo2007 last week the Australian College of Health Informatics (ACHI) elected a new president. Following this election Dr Hannan has developed a short position paper describing the direction he wishes to take the, still young, College over the next couple of years.

The following is a slightly edited version of this position paper.

-----

President’s Report September 2007

Dr Terry Hannan MBBS: FRACP; FACHI; FACMI

As the position of President of ACHI is elected by peers I first acknowledge with humility and respect the confidence you have expressed, and I look forward to working creatively and cooperatively in this role for the next two years.

ACHI is a ‘young’ organisation so it is worth reflecting on achievements to date. Since its inception in 2002 our College has seen a gradual growth in the numbers of Fellows and Members to a total of 44. While not a large number this is a solid foundation on which to analyse sources of membership, and further opportunities for recruitment.

It is in the domain of health informatics research, that ACHI has come to prominence. Members are growing in international recognition through research publications which can be seen in a standardised PubMed internet enquiry covering 2006-2007.

At the recent MEDINFO 2007 conference in Brisbane it was pleasing to hear Don Detmer, President of AMIA and Paul Tang, President Elect of AMIA, endorse the quality of research by ACHI members, thus reinforcing our local and international standing in health informatics.

Publications in the Journal of the American Medical Informatics Association (JAMIA) are considered world standard, and it is a pleasure to see that the work of several ACHI Fellows are attaining recognition at this level.

Yet, in spite of this progress we face new challenges as the role of ACHI and its relationships with partners and stakeholders is redefined and evolves over this 3-5 year phase.

From my perspective, our strong focus on the following three issues should serve to broaden our reach and reputation.

1. Education.
1. Evelyn Hovenga justifiably deserves acknowledgement for her contribution to the development of health informatics education in Australia. Her presentation with Professor Bill Hersch, Chair of Medical Informatics and Clinical Epidemiology, Oregon State University, the at the AGM, on the outcomes of the University of Central Queensland education program revealed the enormous challenge and at times rethink an organisation like ACHI faces when the intended goals are not achieved.
2. Bill Hersch outlined his experiences in informatics education that ultimately led to the development of the 10 X 10 program in North America. The AMIA 10x10 Program's goal aims to train 10,000 health care professionals in applied health and medical informatics by the year 2010 (10,000 by 2010 = 10x10). With reference to this experience ACHI can evolve variations to the initial program developed by the University of Central Queensland to roll out a different education model, and set some moderate targets to achieve.
3. I am of the view that there are several key deficiencies in health informatics education. Key among these is that ACHI does not have enough clinicians (nurses, pharmacists, doctors, physiotherapists, and other allied health professionals) and health administrators in its numbers. I strongly believe that ACHI has the opportunity (and mandate) to influence Royal Colleges (and other relevant training institutions in health care) as well as schools of health administration, to expand the role of health informatics with the ultimate aim of making this discipline an essential component of the undergraduate or immediate post-graduate course curriculum. Over the next 2 years a core focus of my activities will be to investigate how ACHI can take a lead in overcoming this deficiency.

2. ACHI Development and Promotion.
1. At MEDINFO some of the ACHI Committee had an opportune discussion with Professor Don Detmer (President of AMIA) and Professor Paul Tang (President-Elect of AMIA) during which they clarified the relationship between AMIA and ACMI. This provides a helpful guide to redefining all aspects the ACHI-HISA relationship particularly for promotion and marketing.
2. The new promotional brochure for ACHI, launched at MEDINFO 2007, is a sound first step to elevate the profile of this College.
3. As an organization we need to define and promote the collective expertise of ACHI to hospital administrators, chief information officers and policy makers in health care institutions and to all levels of government. Only then can we begin to influence a change in focus from solely administrative health informatics to the wider domain of clinical informatics both in Primary Care and Hospitals.
4. To this end I would like to build and maintain on our member talent bank. I will be requesting all ACHI members to provide details of their expertise and domains. While adding to the ACHI Fellowship it will make us more efficient at identifying experts within our organization who can promote our own development as well as acting as key advisors to external sources.

3. Research.
1. The core principle of health informatics lies in the tenet, “to improve care you have to be able to measure it” (W. Tierney, Regenstrief, Indiana).
2. An ability to measure and evaluate health care initiatives depends upon research resources and facilities. ACHI is fortunate to have a number of these recognised facilities in health informatics in Australia such as the University of New South Wales, Sydney University, Central Queensland University and Adelaide University.
3. These institutions will provide leadership to the wider informatics community and industry by innovative research in health informatics technologies and of equal importance research models in the direct patient care process.
4. Research in the modern era requires significant funding and Academic-Enterprise cooperation is essential. This will not always be a comfortable relationship as was demonstrated during the MEDINFO workshop on this topic. The issues needing consideration by ACHI must include the:

i. Diversification of sources of research and infrastructure support

ii. Support for career development (student internships, recruitment of graduates, consulting opportunities for faculty members)

iii. Assessment of “Real-world” impact of academic research products with the issues relating to technology transfer, licensing agreements, etc.

iv. Impact of “contracting” often with circuitous legal issues such as intellectual property ownership and ultimate benefits for industrial partners.

v. Avoidance of the elitist perspective sometimes attributed to university based organizations.

On behalf of the ACHI I welcome our new Fellows for 2007, who add a diverse mix of scientific disciplines and national origins which should serve to increase the intellectual capital of ACHI. The flowing three received their certificates from Professor Bill Hersch during the AGM.

1. Joanne Callen

2. Vitali Sintchenko

3. Dougie Boyle

4. Chris Pearce

For the duration of my tenure I hope that my performance sees the enhancement of ACHI’s profile, the expansion of its membership. Also I hope to see ACHIS’ influence on academic curriculum to promote health informatics as a core discipline. Our organisation must continue to push the boundaries of research both in Australia and overseas.

Your input is encouraged at all times to facilitate frank and robust debate. I looking forward to a successful working relationship with you all over the next 2 years.

Dr Terry J. Hannan MBBS;FRACP;FACHI;FACMI

Consultant Physician

President Australian College of Health Informatics

Department of Medicine

Launceston General Hospital

Charles Street

Launceston 7250

Ph. 61 3 6348 7578

Email terry.hannan-at-dhhs.tas.gov.au

-----

I had a number of purposes in publish this short position statement.

The first was to introduce to those blog readers who do not know of ACHI who it is and what it is aiming to achieve.

The second was to suggest that if any of this sounds interesting that a visit to www.achi.org.au would be very worthwhile.

The third was to ensure that those who might be interested in becoming a Member / Fellow of ACHI understand that appropriate senior experience in Health Informatics in Health Services, Government, the Health IT Industry and Academe are all valued. To do its job well it needs to have a broad representative base. ACHI wishes to properly represent the experienced and professional skills that are available in Health Informatics in Australia.

It is important to also recognise for those beginning their careers in Health Informatics, or those who want to explore what Health Informatics is all about the Health Information Society of Australia (www.hisa.org.au) is also a useful and central place to start and learn.

Please consider what you might have to offer and visit the either of the web site(s) depending on your interest and need.

Dr Hannan (Terry) has told me he is happy for e-mail contact to be made if you wish to discuss ACHI further.

HISA contact details are also available at its web site.

David.

Vale The Access Card – Dead as a Dodo!

It has been a big few weeks on the Access Card front.

First we had the following from the Federal Privacy Commissioner.

Media release: Access Card Bill makes progress in promoting privacy, says Privacy Commissioner

22/08/2007

The Privacy Commissioner, Karen Curtis, has acknowledged the progress made with the second public exposure draft of the Human Services (Enhanced Service Delivery) Bill 2007, in advancing privacy protections for the Government's proposed Access Card.

"While there are still a number of steps that can be taken to enhance the Access Card's privacy safeguards, the Bill provides protections for confidentiality and information integrity which usefully adds to what was in the first Bill," Ms Curtis said.

In a submission to the Department of Human Services, Ms Curtis recommended additional privacy safeguards to supplement the Bill, including:

• to advance the object of the Bill that the card should not become an ID card, the photograph on the card surface should be made optional;
• making the Bill's Administration Rules detailed and clear in how they affect information handling;
• creating civil remedies to allow individuals to seek redress where Access Card information is mishandled; and
• having a regular statutory review mechanism for the card.

Ms Curtis welcomed the following aspects of the Bill:

• the oversight mechanisms it proposes, including review and appeals processes, mandatory consultation with the Privacy Commissioner, Parliamentary scrutiny of Administration Rules, and annual reporting requirements;
• its listing of the Bill's objects and the intention that the Act should be interpreted to limit impacts on privacy;
• its provisions on confidentiality, and the combination of offences and infringement notices; and
• the limits it sets on the disclosure of protected information, such as for law enforcement purposes.

----- End Release

In summary her view was “good try – but really not good enough”.

Then we had:

http://www.australianit.news.com.au/story/0,25197,22297566-15306,00.html

Smartcard on hold till next year

Patricia Karvelas | August 24, 2007

PLANS for a national smartcard have been postponed for at least a year with the Government admitting the deadline for its introduction was unrealistic.

The proposal for one-card access to welfare payments has been dogged by controversy since it was raised in 2003, with opponents claiming it is an underhand method of introducing a national identification system.

Despite government hopes of introducing a bill this year, Human Services Minister Chris Ellison yesterday said public support was essential if the $1.1billion scheme was to succeed, and there was no way he would put forward legislation before 2008.

….. (see full article at URL above)

This is essentially an admission that it was all getting much too hard and that public concern was such that the Access Card needed to be neutralised as a political problem in the light of the looming election.

Then we had:

http://www.theage.com.au/news/national/labor-pledges-to-kill-off-access-card/2007/08/28/1188067111116.html

Labor pledges to kill off Access Card

Annabel Stafford
August 29, 2007

THE $1.1 billion Access Card could soon be dead, with the Labor Party confirming it would kill off the proposal if it won this year's election.

Coming after the Federal Government last week confirmed it would put off introducing legislation for the Access Card until after the election, Labor has confirmed a Rudd government would scrap the idea.

"As far as we're concerned, (the Access Card) is dead," Labor human services spokeswoman Tanya Plibersek said.

….. (see full article at URL above)

Interesting that the small target approach Opposition chooses this issue to make a stand. Tells you the internal polling is suggesting that this is not a winner for the present Government.

Last we have today some accounting for the Access Card so far!

http://www.australianit.news.com.au/story/0,24897,22356770-15306,00.html

Smartcard costs hit $52 million

Karen Dearne | September 04, 2007

SPENDING on the federal Government's mooted welfare smartcard has reached $52 million, despite uncertainty over whether the $1.1 billion program will proceed.

New contracts worth nearly $10 million have been signed by the Department of Human Services since June, with most due for completion well before the end of this year.

This may signal a slowdown of work, pending the outcome of the federal election.

In June, Human Services Minister Chris Ellison effectively put the controversial Access Card on ice, as opponents claimed it would become a national identity card.

The project's lead adviser, Booz Allen Hamilton, collected $30.5 million in fees during the past financial year, including $5 million for the months of May and June, and a slimmer $5.2 million for the current four months to October 26.

….. (see the rest of the breakdown at the Australian IT Site above)

What to do? Really that is quite easy.

Whoever wins the election needs to undertake a Strategic Review of Electronic Identity Management in Australia – reviewing all the rapidly proliferating set of initiatives – from the Access Card to the NEHTA UHI and the Document Verification Service and plan for one decent reliable fit for purpose system.

It would not be an easy task – but it could likely save billions of dollars if done well over the next few years.

David.

Senator Helen Coonan – Applying to be Minister for e-Health?

A few days ago the following article appeared on the MIS Australian web site.

Coonan moots plan to stitch up e-health

Julian Bajkowski

The Australian Financial Review | 31 Aug 2007 | Information

The Howard government's tactic of staging federal interventions in state health matters is primed to escalate after Communications Minister Helen Coonan gave the strongest indication yet that Canberra was ready to create a national electronic health record.

Senator Coonan yesterday confirmed that discussions with Health Minister Tony Abbott on a standardised national electronic health record were well advanced and had included how costs and medical fee structures could be affected.

"This issue has been identified in the Health Department and my understanding is that they are well advanced in getting an announcement [ready]," Senator Coonan said.

Senator Coonan's comments came during the announcement of $29.5 million in federal funding for five new electronic health projects under the $117 million Clever Networks program.

These included electronic medical record sharing facilities for the Royal Flying Doctor Service, interoperability funding for remote Western Australian hospitals and funding for new applications in the NSW Hunter-New England region.

….. (go to www.misaustralia.com to read full article)

If this was not enough we also have this announcement:

http://www.minister.dcita.gov.au/media/media_releases/clever_networks_improving_the_quality_of_life_in_australian_communities

Clever Networks: improving the quality of life in Australian communities

…..

“Round Two projects (in the Clever Networks Program), include:

• $5.2 million for the Loddon Mallee Virtual Trauma Care Unit project to install videoconferencing units connecting Bendigo, Echuca, Swan Hill and Mildura regional hospitals with base hospitals in Melbourne. This will allow metropolitan trauma specialists to provide ‘virtual’ consultations with doctors in emergency rooms across the Loddon Mallee region of Victoria.

• $9.3 million for the Bush Medivac Western Australia project to implement interoperable data networks to enhance the communications and coordination capabilities of all major health and emergency services in the state. This will make a significant contribution to Western Australia’s ability to respond to emergency incidents and health crisis situations in regional and remote areas. This project builds on a Round 1 proposal and also dovetails with the following proposal.

• $2.7 million for the eHealth for Remote Australiaproject for an electronic medical record system providing essential patient information. This will allow the Royal Flying Doctor Service to provide better primary health care for up to 750,000 Australians living in remote and isolated areas of New South Wales, South Australia, Queensland and Western Australia.

• $3.1 million for the Enhancement of Telehealth in Western Australia project to enable improved health service delivery for up to 454,740 residents in regional, rural and remote communities across the state, including more than 44,900 Indigenous Western Australians. This will address problems such as low life-expectancy and retention of health professionals in remote communities of the state.

• $3 million for the Clinical Outreach – Hunter New England project to provide greater access to advanced clinical applications to an additional 23 health facilities in the New England region. This will promote better health outcomes for residents of the region by improving communication, minimising treatment delays and supporting clinical practice. It also brings the total number of New South Wales hospitals and health facilities that are benefiting from the program to 138.”

….. (go to the URL above for the full release)

And as well as that we have:

http://www.minister.dcita.gov.au/media/speeches/address_to_5th_annual_australian_telecommunications_summit

Strengthening Communities Through Technology

Address to 5th Annual Australian Telecommunications Summit

Sydney Thursday, 30 August 2007

Here we hear about the following (in part)

“For example, many communities in regional, Tasmania will benefit from improved medical care thanks to the VirtualCare@TAS project, which I announced in July at the Launceston General Hospital.

It is worth explaining what this project has done to improve health care services throughout northern Tasmania by linking patients in the region with high-quality expertise via wireless and video conference technology and associated specialist equipment.

The VirtualCare@TAS program is made up of four innovation streams:

• The Statewide Medical Advice, Referral and Transfer Network;
• The Chronic Disease Health Coaching Network;
• The Remember Me Aged Care Network; and
• The Telehealth Tasmania Outreach Network.

This new service will focus on rural emergency management, diabetes, oncology, aged care and mental health rehabilitation in regional, rural and remote Tasmania.

The Statewide Medical Advice, Referral and Transfer Network will provide a first response remote medical advice, patient triage and assessment capacity, with access to specialist advice for rural hospital staff in an emergency.

During a medical emergency the network will provide access to remote specialist clinical support for patients in small rural hospitals.

Remote specialist advice will likely be invaluable to volunteer ambulance and emergency officers responding to an emergency in a remote location such as Flinders Island.

The Chronic Disease Health Coaching Network will provide remote clinical supervision for diabetes, cancer, mental health and spinal care and it will help people living in rural and remote Tasmanian communities, and there are many.

This means that a cancer patient will be able to undergo chemotherapy treatment locally administered by their local health professionals delivered via satellite clinics and video conferencing units.

These video conference units will enable peer support and specialist advice in the treatment of patients.

This will reduce the risks of severely ill patients in remote areas travelling long distances to receive their treatment in major centres.

When it comes to treating the sense of isolation in these communities, it’s not just the patients who benefit.

The opportunity for health professionals to increase skills and to engage in professional development without travelling vast distances and leaving these communities is an essential part of recruitment and retention.

The VirtualCare@TAS Program will tackle these critical issues head-on and, in this way, will not only keep more Australians healthy, but keep more Australian communities vibrant and viable.”

Suddenly Minister Coonan is all over the country announcing e-health initiatives and pre-empting Minister Abbott (who is meant to be the Minister for e-Health) by letting it be known there is to be a standardised national electronic health record!

What is to be made of all this?

Can I suggest a few things.

First it is hard to escape the conclusion – on the basis of these announcements – which are not even joint announcements with Health – that state agencies and area health services have got sick of asking the Health Department (DoHA) for e-health network infrastructure and have simply gone elsewhere in frustration.

Second it is clear there is no co-ordinated e-Health agenda or plan existing within Government or there would be much better co-ordination than this!

Third having Minister Coonan announce a EHR initiative is really bizarre. No wonder the NEHTA CEO felt the need to offer ‘no comment’ when asked..given this is what NEHTA said it was doing as recently as a few days ago. Were I him I would be feeling a little gazumped!

Fourth it seems clear DoHA has lost control the e-Health strategy and now any agency that feels like it can just announce what they want when they want. One really wonders how sustainable this flourish of little initiatives will be in the long term. One never seems to see much in the way of evaluation if initiatives of this ilk become public.

All this is really bit part nonsense and puts off further the day when common sense and rationality will be applied to the e-Health domain in Australia. It is virtually inevitable, in my view, a good portion of these funds will wind up being wasted – we can just hope not!

The pre-election period we are presently in does really yield much strangeness.

David.

Useful and Interesting Health IT Links from the Last Week – 2/09/2007

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

http://www.computerworld.com.au/index.php?id=543270264&eid=-6787

Tassie ambos move to electronic reporting

Rugged computers to replace pen and paper

Rodney Gedda 27/08/2007 11:37:50

The Tasmanian Ambulance Service (TAS) will procure some 70 rugged notebook computers over four years to facilitate the migration off its paper-based patient care reporting process to a new electronic system.

The Business and Risk Strategy Branch of the Department of Health and Human Services (DHHS), on behalf of TAS, is seeking offers from a business capable of supplying Panasonic CF19 Toughbook computers to be used in the new Electronic Patient Care Record (ePCR) project.

"TAS is in the process of implementing a major improvement to its management of patient care reporting by changing from a complex paper-based patient care report system to an electronic tablet system," according to the department. "In parallel with this new initiative are a number of associated business improvement activities based on adoption of the ePCR and supported, where appropriate, by a range of modern DHHS ICT capabilities."

The new business improvement initiatives are being coordinated through DHHS information systems, the state's HealthConnect program, and TAS.

…..( see the URL above for full article)

This is a really sad article. Why? First that the purchase of a few laptops to capture ambulance transport and presentation details would be seen as an e-Health initiative and second that there is continued mention of the now totally dead HealthConnect initiative with which this purchase has absolutely no relationship. More political pork I reckon.

Second we have:

http://www.australianit.news.com.au/story/0,24897,22317999-15306,00.html

Tax office gets tough on file privacy

Ben Woodhead | August 28, 2007

FRAUD detection systems have uncovered a rash of privacy breaches at the Australian Taxation Office as employees flout tough data protection rules despite ongoing monitoring and training.

The sweeps of data access logs led to three sackings during the 2007 financial year and another nine staff resigned after the ATO detected unauthorised access to taxpayer records.

The breaches came despite extensive privacy education programs at the agency and closely matched the 24 instances of tax officers inappropriately accessing client information that were uncovered in the 2006 financial year.

"While no level of unauthorised access is acceptable, in an organisation of about 22,000 people it is inevitable that a very small number of people will be tempted to do the wrong thing," an ATO spokeswoman said.

…..( see the URL above for full article)

This is an important report as it adds the Tax Office to Centerlink, Hospitals and Motor Registry Offices around the country that have had private information leaked or snooped upon. It seems to me this sort of abuse is inevitable and that what is needed is to ensure the monitoring of and punishment of offenders needs to be sufficiently draconian to make people very hesitant to mis-behave.

With patient records it is vital that the public is assured that snoops will be reliably identified and punished.

Third we have:

http://www.theage.com.au/news/national/labor-pledges-to-kill-off-access-card/2007/08/28/1188067111116.html

Labor pledges to kill off Access Card

Annabel Stafford
August 29, 2007

THE $1.1 billion Access Card could soon be dead, with the Labor Party confirming it would kill off the proposal if it won this year's election.

Coming after the Federal Government last week confirmed it would put off introducing legislation for the Access Card until after the election, Labor has confirmed a Rudd government would scrap the idea.

"As far as we're concerned, (the Access Card) is dead," Labor human services spokeswoman Tanya Plibersek said.

Voters worried about the card now had a clear choice between a Coalition government that would introduce the smartcard — which would replace up to 17 social services cards and be required by anyone wanting to access government payments — and one that would not, Ms Plibersek said.

…..( see the URL above for full article)

This is an interesting announcement by Labor – as, while in most policy areas they are seeking to only identify difference in those areas there is strong reasons to do so, it has been selected as an area of differentiation.

This decision also suggests – given the stated position of opposition of the other political parties – that this project may indeed face permanent cancellation.

This outcome would seem to be likely to bring some additional focus brought to bear on the NEHTA UHI service – which I note is increasingly being mentioned in submissions regarding the Access Card. The tenor of these submissions has been to ask how these initiatives are linked, and why are citizens being given multiple identifying numbers without any apparent co-ordination.

Fourth we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070830/FREE/308290018/1029/FREE

RHIO experts talk problems, future of movement

By: Joseph Conn / HITS staff writer

Story posted: August 30, 2007 - 5:59 am EDT

The recent faltering of a regional health information organization in Portland, Ore., and the outright folding of a RHIO in Scranton, Pa., may be indicative of a scaling back of some of the more ambitious goals of the RHIO movement, according to industry observers.

Are RHIOs like those proposed in Oregon and Pennsylvania between competing entities and multiple information technology systems dead?

"I'm definitely in the category of I don't know," said David Lansky, senior director of the health program at the Markle Foundation, who admits not having spent a lot of time tracking individual regional activities, but works primarily "one level up" on how regional networks communicate with each other. Markle was a participant in one of three consortia to present a prototype to HHS of a national health information network. The Markle collaborators moved electronic messages between RHIOs in Boston, Indianapolis and Mendocino County, Calif.

"It's not yet clear if the incentives exist for healthcare organizations to share information," he said. "So, I think it's become time to have more discussions about getting the incentives right. How? That's a deep question. Ultimately, it will be how we pay for healthcare."

…..( see the URL above for full article)

This is an interesting article that explores the reasons behind the stumbles that are being experienced in some of the Regional Health Information Organisation (RHIO) initiatives in the US. Well worth a browse.

Fifth we have:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070831/FREE/308310001/1029/FREE

Pact would coordinate key IT panels' activities

By: Joseph Conn / HITS staff writer

Story posted: August 31, 2007 - 5:59 am EDT

The leaders of two federally supported organizations—one tasked with anointing health information technology communications standards and the other with testing and certifying clinical IT systems—have proposed a formal agreement on how to coordinate their activities.

The proposed five-point memorandum of understanding would guide the relationship between the Certification Commission for Healthcare Information Technology and the Healthcare Information Technology Standards Panel. The proposal was worked out between the physician chairmen of the two organizations, Mark Leavitt of CCHIT and John Halamka of the HITSP. It is subject to review and possible amendment by the controlling bodies of the two organizations as well as their approval before it becomes effective, those leaders said. The proposal will be presented to the controlling bodies this month, they said.

The Certification Commission for Healthcare Information Technology was formed in 2004 by the American Health Information Management Association, Healthcare Information and Management Systems Society and the National Alliance for Health Information Technology as a private-sector organization to promote the adoption, particularly by office-based physicians of electronic health-record systems and other IT. In 2005, HHS awarded CCHIT a three-year contract totaling $7.5 million to develop a process to certify health IT products.

....( see the URL above for full article)

The Certification Commission for Healthcare Information Technology (CCHIT) and the Healthcare Information Technology Standards Panel (HITSP) are core players in determining the forward Standards directions in the US. This announcement seems to me to be unequivocally good news.

Lastly we have:

http://www.e-health-insider.com/news/2988/call_for_electronic_consent_for_secondary_uses

Call for electronic consent for secondary uses

30 Aug 2007

Consent to use patient records for secondary uses should be recorded using electronic mechanisms integrated with core NHS systems, the Working Group on the Secondary Uses of Patient Information has recommended.

The group, established to consider the issues around uses of patient-identifiable data for purposes other than direct patient care, said: “Consideration should be given to record consent, and ensure that the consent choices of an individual are automatically adhered to when providing data from their record.”

They argue that the opt-out approach currently suggested is inappropriate for keeping track of a patient’s wishes regarding their personal data where their identity is known to the researcher.

…..( see the URL above for full article )

The report can be found here:

The Report of the CRDB Working Group on the Secondary Use of Patient Information

This is an important resource as to date in Australia I do not think enough consideration has been given to the issues surrounding secondary use of patient information. Clearly robust polices that both protect individual privacy and maximise community benefit are needed. Getting the right balance is the trick!

All in all not a bad lot to start the week!

More next week.

David.

Privacy and e-Health – The Privacy Commissioner Provides a Very Useful Survey.

A day or so ago the Commonwealth Privacy Commissioner (Ms Karen Curtis) published an invaluable document for all those interested in privacy and health information sharing.

The full document can be downloaded from the this page in either .pdf or MS-Word Format.

The survey questions 1500+ adults about their attitudes on a range of privacy issues and appears to have been conducted in a robust and reliable fashion statistically.

I think the most important findings from the perspective of e-Health implementation and planning are:

1. By and large most Australians trust Health Service Providers to treat their private information in a trustworthy fashion. The more educated are slightly more sceptical than the less educated.

2. Most are happy to share private health information if they see the relevance in doing so.

3. There was a very strong dislike of being required to disclose any form information that is not relevant to the transaction at hand.

4. There was a strong rejection of the use of any information (especially by business and government) for purposes other than that for which it was collected. (This bears directly on what NEHTA is planning to do with Medicare Australia's personal records)

5. “The majority (76%) of Australians believe that inclusion in the National Health Information Network should be voluntary. At 21%, the minority believes all medical records should be entered. A greater proportion (76%) believe inclusion should be voluntary (cf. 64% in 2004 and 66% in 2001). As in 2004, females (80%) were more likely than males (72%) to say this. Unlike 2004 however, there were no significant differences in attitudes between age groups.”

This seems pretty clear cut that the public rejects compulsion in the sharing of their private health information and that the view on this is strengthening over time.

6. “Respondents were then asked whether, if such a database national health information network existed, permission should be sought before releasing their de-identified information. Females (53%) were more likely than males (43%) to say that permission should be sought. “

Again – even when not identified – close to half the population do not want to share without consent.

7. Interestingly, “While opinions varied, 52% thought that health professionals should share health information, but only if relevant to the condition being treated (35%) or if the condition was serious or life threatening (17%). A third (32%) believed health professionals should share health information only with the patient’s consent. The proportion believing anything to do with a patient’s health care could be discussed between health professionals stands at 25%.”

This says to me that people are wanting more control of information sharing, even the sharing of information between relevant professionals.

8.There is a low threshold for individuals to provide false identity information when conducting internet transactions. This has the implication that if access is provided for citizens to access major identity data-bases there will be at least a significant proportion who will provide false information.

It seems to me this survey makes it clear there is an emerging sensitivity in the populace to having their personal information leave their control without their specific consent and approval. All those implementing – or planning to implement – e-Health systems should take careful note of both the absolute values of the views as well as the trends.

NEHTA especially needs to take careful note of the results of this survey. The clear preference of the community is for all interactions with e-Health systems to be on the basis in individual specific consent. Just because it is inconvenient or more expensive to grant the public what they want is no excuse. Ignoring clearly stated public opinion has a habit of rebounding on those who move in these sort of directions. NEHTA you have been warned!

David.

BTW. Page 8 of the NEHTA Approach to Privacy document says:

“As further work on privacy and consent is conducted or finalised, additional information will be made available on the NEHTA website. The next privacy document to be published will be NEHTA’s Privacy Blueprint for the HPI and IHI (planned publication date August 2006). A Privacy Blueprint for the Shared EHR will be released in late 2006. “

It is fair to say these timelines were not met – we saw the UPI privacy draft in December 2006 (followed months later by a risible summary of the comments received – without the actual submissions) and the Privacy Blueprint for the Shared EHR is yet to see the light of day.

D.

e-Health in Australia – A Governance Farce that Will Hurt us All.

e-Health in Australia is a ‘rudderless ship’ in a very large storm and is way too close to the rocks!

Just a few short years ago everyone knew who was at least meant to be doing what in the e-Health Space.

We had the Australian Health Ministers Advisory Council (AHMAC) and the Council of Australian Government (COAG) who sorted out major policy directions and provided funds.

The Australian Health Information Council (AHIC) provided e-Health Strategy and Direction.

The Commonwealth Department of Health and Ageing (DoHA) set policy detail, sponsored national initiatives (such as HealthConnect) and tried to foster State co-operation and co-ordination.

Essentially, following the 2004 Boston Consulting Group (BCG) Review the HealthConnect Program was cancelled. It became a ‘change management strategy’ and a few annoying money-wasting remnant projects rolled on to use up the funds that had been committed.

By 2005 AHIC had been canned and the National E-Health Transition Authority (NEHTA) had begun operations. Virtually simultaneously most of the e-Health skills in DoHA left the public service and the place of e-Health was downgraded in the Commonwealth bureaucracy.

Come to 2007 and where are we?

First we have the BCG undertaking a review of the now 2.5 year old NEHTA. This review is a governance nightmare as we have senior health bureaucrats commissioning a report on their performance in managing NEHTA. Ever hear of a senior health bureaucrat criticising their own performance? Clearly the outcome will not say you have all done a poor job managing NEHTA as everyone knows they have. Talk about a conflict of interest!

Second we have the now resuscitated AHIC. It seemed to make some hopeful noises for a little while. The silence is now deafening and with an election due in a month or two we can be sure nothing will ever come of their work.

Last we now have a brand new E-Health Ministerial Advisory Council – established as an effort to blame shift away from the Minister and DoHA who have been negligent in their inactivity. Again we have a secret, non-communicating entity working away in a bureaucratic non-transparent vacuum.

Let’s not even consider the managerial qualities of the State Health IT bureaucrats. Most of them are still tied up in overly slow procurements (WA, SA etc) or are doing rigid state-wide system implementations that have the users more than a little grumpy.

IBA (our largest indigenous e-Health Company in which I have a few not so profitable shares) makes the point in its annual results, just released, that it has been forced overseas to survive as virtually no serious sales are likely until 2008/9 in Australia.

If ever there was a situation where an election offered hope for a re-start and a new plan this is it. What a humongous mess.

David.

Medicare, NEHTA and Your Privacy.

A week or so ago a quiet bit of regulation making occurred in the Federal Parliament. The following regulation was tabled under the Ministerial Authority of Senator Chris Ellison.

Here is the title of the Direction.

Medicare Australia (Functions of Chief Executive Officer) Amendment Direction 2007 (No. 2)

Medicare Australia Act 1973

I, CHRISTOPHER MARTIN ELLISON, Minister for Human Services, make this Direction under paragraph 5 (1) (d) of the Medicare Australia Act 1973.

Dated 8 August 2007

CHRISTOPHER MARTIN ELLISON

Minister for Human Services

The full text is downloadable from here. (It is only a page or two in .pdf format and well worth a read)

In plain language what this does is, without any contestability or assessment of value for money, have Medicare Australia scope, develop, build and test the NEHTA UHI (as defined in the regulation).

It also authorises them to make a copy of the two key identity databases supported by Medicare Australia (as defined in the .pdf file - essentially the client and the provider databases) and use them to provide an identity service.

This is really an amazing thing to be authorised. What seems to have happened is the despite the prohibition in the Commonwealth Privacy Act (2000) of personal information being used for purposes other than for which it was collected by Government Agencies it has been decided that information that was collected to enable Medicare benefits to be paid is to be used to operate the NEHTA UHI.

The implications this has for the trust the population will have in Medicare Australia to keep their private information private must be profound.

There are all sorts of questions this authorisation raises – such as:

1. Are the Consumer Directory Maintenance System and the Provider Directory System operated by Medicare Australia ‘fit for purpose’ in the role of electronic health record identification and linkage? (I think not).

2. How are those whose information is on this copy of the register able to see what is held and how accurate it is?

3. How will this information be protected from un-authorised or unwanted disclosure or look up. It seems every healthcare provider in the country will be able to search the customer data-base to find an associated UHI – this is a really terrible idea and will have victims of domestic violence and the like just terrified?

4. How are the Medicare and UHI data-bases going to be kept in synch as one or the other is updated? If a ‘snapshot’ of the databases is taken – how will the data’s currency be maintained into the future?

5. Where is the Privacy Impact Assessment that validates this approach?

6. Who is going to be responsible if there is a security breach or someone’s details are released and an individual is damaged or harmed. Is it the private company NEHTA or the Government through Medicare Australia?

7. Who is actually going to run the proposed service – NEHTA, Medicare Australia or someone else? Does anyone else notice a certain irony in a private company contracting a Government Agency for the delivery of services – as seems to be the case?

8. Why is such a potentially privacy destructive regulation just slipped through the House of Reps and the Senate with no public announcement etc?

It seems clear to me this proposal represents the health identifier you have when you are not prepared to pay for an identifier that one can be sure is fit for purpose in terms of safety and integrity.

Frankly this is a disaster in my view and should be aborted before it even gets started. If we are to have a UHI service (and I think it is vital) it should be based on privacy and security protections that are appropriate for clinical record linkage.

David.

Note: Comprehensive coverage on the basics of this issue is found in an article by Karen Dearne in the Tuesday Australian IT section of 28^th August, 2007. This can be seen on line at the following URL.

http://www.australianit.news.com.au/story/0,24897,22318001-5013040,00.html

Ellison unlocks Medicare databases

Karen Dearne | August 28, 2007

MEDICARE patient and provider databases will be the key sources of a healthcare identifier regime being introduced to support a shift to e-health programs.

Records belonging to 99 per cent of Australians are contained in Medicare's Consumer Directory Maintenance System, considered to be the most up-to-date and accurate government repository of personal information.

Although the law prevents the use of Medicare data for other purposes, Human Services Minister Chris Ellison has unlocked access via a legislative amendment tabled in Parliament on August 16.

Senator Ellison has authorised Medicare's chief executive to enter into a contract with the National E-Health Transition Authority and provide resources in support of the Unique Healthcare Identifier program.

Progress on the individual, healthcare provider and health organisation directories was flagged by NEHTA chief executive Ian Reinecke at MedInfo 2007 in Brisbane last week.

Dr Reinecke said NEHTA had established an operational governance model for contracting a universal identifier services operator, expected to be Medicare Australia.

….. (see URL above for full article)

D.