E-Health Spin Central – A New Government Web Site – False, Exaggerated Expectations Here We Come!

For the pleasure of all we now have an Government e-Health propaganda site. This is as described in the HI Service Communications Plans some of us read a few week ago.

The site can be found here:

http://ehealthinfo.gov.au/

I note in passing we were promised the ‘non-draft’ Communications Plan and since we see the draft is now being actioned we can assume there is now an ‘approved ‘ plan available. Knowing NEHTA occasionally browse the blog – if they could e-mail this to me for posting that would be good! Otherwise I will have to repost the draft plans for download as the basis of my agreement to take down the ‘drafts’ would seem to have been broken.

Back to a few choice highlights from the site:

Consulting with consumers

The right person, the right place, the right time

The introduction of healthcare identifiers for consumers will improve the delivery of safe, quality healthcare. Legislation will set out HI Services governance, privacy safeguards and permitted uses of healthcare identifiers. Healthcare identifiers are the foundation for a future individual electronic health record. This will give individuals and their healthcare providers an up-to-date picture of your health status and with your permission, your doctor can share that information with your other healthcare providers.

Consultation is ongoing

The success of any reform initiative depends on acceptance of its implications by those who are most impacted. Consumer research suggests that 82% of Australians support the introduction of e-health. However, ongoing consultation is essential to ensure that consumer concerns are adequately understood and addressed.

On the proposed introduction of healthcare identifiers

In July-August 2009 Australian Health Ministers concluded a month-long period of public consultation on legislative proposals for healthcare identifiers and privacy. Submissions were invited on a public discussion paper and a series of consultative forums held in July 2009. The latter included stakeholder meetings and consumer focus groups.

A wide range of feedback was received from more than 90 public submissions during the consultation process and a report was compiled for consideration by the Council of Australian Governments (COAG). In December 2009, a second round of consultations on an exposure draft Healthcare Identifiers Bill was conducted to seek further public output prior to finalising the legislation.

See here:

http://ehealthinfo.gov.au/collaborations/

Comment : One small question – did anyone (like DoHA or NEHTA) ever let those who responded to the HI Service Legislation know what had been changed. Short answer nope. I wonder why? Could it have been they were told a lot of stuff they did not what to hear?

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Collaborating with Vendors

The National E-Health Transition Authority (NEHTA) is the lead organisation supporting the national vision for e-health in Australia, working openly, constructively and collaboratively with consumers, providers, funders, policy makers, the broader healthcare industry and health IT vendors.

The role of vendors

Vendors will play a key role in the implementation of the Healthcare Identifiers (HI) Service which will be broken into six phases.

Meeting vendor needs

NEHTA is committed to addressing vendor needs at each stage of the vendor journey:

· probity - no vendor will be given favoured consideration

· clarity - vendor briefings will be aligned with HI Service releases

· flexibility - product development can be staged to match each jurisdiction's e-health timetable

See here:

http://ehealthinfo.gov.au/collaborations/

Comment: It seems the HI Service has a six phase implementation plan. I wonder why no one has ever seen it outside NEHTA? I hear rumours we may soon – after asking for months.

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Who is involved in e-health?

In developing the foundations of e-health, Australian governments are collaborating with representative groups drawn from across the healthcare sector, as well as health leaders, consumer groups, software vendors, informaticians and standards experts. This group includes general practitioners and specialist medical and non-medical groups including allied health, pharmaceutical and nursing.

Clinical leadership

More than 20 clinical leaders from around the country are supporting the National E-Health Transition Authority (NEHTA), providing guidance, advice and first-hand experience to spearhead the innovations and improvements that will drive increases in health quality and safety.

These clinicians continue to practice medicine on a daily basis. Their years of practical experience give them a unique insight into what can work and what will make a difference in areas such as pathology, medicines, radiology, and hospital discharges and referrals.

Stakeholder feedback

Dozens of stakeholder groups have been consulted on the e-health journey. A formalised reference group process is conducted by NEHTA to ensure channels are available for informed feedback.

Success through collaboration

Collaboration is becoming increasingly important at all stages of the e-health roll-out. We are pooling resources to learn and innovate, design and develop the infrastructure to deliver e-health. We have one clear goal: to deliver a safer, better connected and more sustainable healthcare system.

See here:

http://ehealthinfo.gov.au/what-is-e-health/who-is-involved-in-e-health/

Comment:

Go here:

http://www.nehta.gov.au/about-us/stakeholders

Not a single stakeholder consultation report published in the last 6 months and who knows just how much impact part time (for NEHTA) advisory clinicians have. The evidence seems to suggest not much.

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Benefits of e-health

The national e-health initiative is the first time that Australian governments have embraced end-to-end integrated e-health. Whilst this is complex, it offers long-term benefits including:

• An advanced and secure healthcare environment
• Streamline the secure delivery of healthcare information
• Strip away repetitious and inefficient processes

Key benefits:

• Offers anywhere, anytime access: your health information will be electronically available to the right person at the right place and time
• Overcomes fragmentation and duplication: interconnecting the Australian health sector will remove much of the reliance on paper records and unnecessary duplication of tests
• More control over health outcomes: you or your carer will have electronic access to the information you need to better manage and control your personal health outcomes
• Best practice secure messaging: you will have confidence that your personal health information is being managed within a secure, confidential and tightly controlled environment
• Equity for all Australians: better access to health care services in remote, rural and disadvantaged communities

See here:

http://ehealthinfo.gov.au/what-is-e-health/benefits-of-e-health/

Comment: This is all based not on the HI Service but on some form of shared record. The work to confuse the public as to what you can have for what is on in earnest here!

This is also fun from the same page:

“NSW pilot lays foundation for electronic records

The Healthelink Electronic Health Record (EHR) pilot project was the first step in NSW Health's strategy to provide an online and integrated electronic record of an individual's health care across public and private health settings.”

This project has been limping along for years, is privacy invasive, and an example of ‘worst practice’.

An 30 page Summary Evaluation Report was published in Sept 2008 having had the project run for 2 years. Some 16+ months later it has not been expanded – which tells you what a roaring success it was!

And this is claimed as success and a model for the Shared EHR NEHTA wants. Joke Joyce!

I could go on, but why bother? This is just a deceptive propaganda web site in my view, which dishonestly raises public expectations – like so much else we see from this Health Minister.

David.

The Doctors Spike the NEHTA / DoHA Plans for E-Health.

The following appeared today in the Herald Sun.

Doctors stand firm over e-health costs

• Ben Packham
• From: Herald Sun
• February 16, 2010 12:00AM

A HI-tech health plan to deliver better treatment to patients could be derailed by a standoff between doctors and the Rudd Government.

The introduction of electronic patient records would be the biggest health reform in a generation, delivering an estimated $8 billion in savings over the next decade.

But the Government is refusing to guarantee compensation for doctors who will be expected to deliver the scheme on the ground.

The Australian Medical Association yesterday warned of a "bumpy ride" if doctors were expected to foot the bill.

"Where the doctor has to do stuff that is above and beyond what is necessary for their internal practice, there are various costs that need to be met," AMA president Andrew Pesce said.

The Royal Australian College of General Practitioners delivered a similar message last week, demanding "funding for general practices to support required software and business changes".

In a 2007 stoush with Government, doctors won an 18c-per-transaction sweetener to process Medicare rebates by Eftpos.

More here:

http://www.heraldsun.com.au/news/doctors-stand-firm-over-e-health-costs/story-e6frf7jo-1225830686827

This is a serious problem for e-Health in Australia. Unless you have the doctors and their staff on board e-Health will go exactly no-where.

The Government and NEHTA need a serious rethink and fast.

They are just so stubborn and stupid. It defies belief that they are imagining the doctors will pick up the costs for a program that mostly benefits patients and the Government. It just won’t happen.

David.

The Financial HoneyPot Beats Common Sense. How Silly!

This blog may well loose me many friends but I need to write it.

My thesis is that all the money NEHTA is throwing at ‘duff’ e-Health projects, like the HI Service, is preventing any quality debate as to just how sensible, rational and well planned what they are doing is.

It is really quite that simple, and we are all likely to suffer as a result.

Any e-Health program that, is centralised, denies individual’s consent, needs a major marketing campaign, does not provide clear-cut benefits for those who deliver healthcare, overstates the benefits for consumers and which attempts to spin that it is providing adequate and properly considered privacy and security for consumer protection when it has not actually tested and piloted the plan is doomed to failure is a spectacular and expensive fashion.

Many of those who know these ‘self-evident’ truths, that have been hard learned in the UK, Europe and the US seem to be strangely silent. A possible reason, they are having the meal ticket provided by NEHTA so what else can they do post the ugly GFC? Lie low and take the money I guess.

The level of anonymous but revealing and important posts confirms this view. I would argue the time to come out may have arrived.

The 'control freak' and secrecy mentality we see from NEHTA / DoHA hardly argues against my thesis!

I am probably wrong, and actually they are all carefully considered and thoughtful ‘true believers’, and all this is going to be wonderful, but unpaid and unbiased I really doubt it!

Tell me what you think, but I can’t understand why there is so little debate. I really want debate and discussion on this.

David.

Just So You Know What Was Actually Said By The Minister on the HI Service. A Real Worry!

Note: The commentary that follows the Hansard I see as very important indeed – please browse! Be alarmed, very alarmed indeed!

----- Begin Hansard.

Wednesday, 10 February 2010

Healthcare Identifiers Bill 2010

Second Reading

9:04 am

The Hansard Reads as follows.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing)

I move:

That this bill be now read a second time.

This bill seeks to establish a single national healthcare identifier system for patients, healthcare providers and healthcare provider organisations.

This new identifier system will facilitate reliable healthcare related communications, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system.

The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.

As noted recently by the third Intergenerational report and the final report of the National Health and Hospitals Reform Commission, we need to prepare the health system to meet the needs of the coming decades.

An ageing population, technological change, a rise in the prevalence of chronic disease and increasing consumer expectations mean we cannot continue with a ‘business as usual’ approach.

The government is currently undertaking the most important overhaul of our health system since the introduction of Medicare 25 years ago. An important part of this work will be ensuring that as a nation, we are well positioned to take full advantage of the opportunities presented by information and communication technology. The reform commission was clear in identifying the importance of e-health in driving and enabling reform to healthcare delivery. Among the 123 recommendations of the final report is a recommendation to introduce healthcare identifiers by July 2010 and individual electronic health records by 2012.

This bill establishes the healthcare identifiers, without which there cannot be an integrated, consistent, e-health system in Australia.

One of the major barriers currently limiting the progress of national e-health initiatives is the lack of a single process to accurately and consistently identify patients and healthcare providers.

For example, when a patient visits their GP for a check-up, the identifying number on their health record is different to the number at the pharmacy where they have their prescription filled or the pathology laboratory where they have their blood tests done.

Healthcare providers face a similar problem with professional or registration bodies, Medicare Australia, and their employers all identifying them through a variety of different methods.

This fragmented approach to identification does not provide the accuracy or consistency needed to confidently share health information in an electronic environment. Nor does it adequately support the safe delivery of health care with providers regularly required to match patients and patient information to their records, increasing the risk of mismatching records and tests needing to be re-ordered.

Studies in hospital environments have indicated that between nine per cent and 17 per cent of tests are unnecessary duplicates. Up to 18 per cent of medical errors are attributed to inadequate availability of patient information, which indicate the scope of the potential efficiency and productivity benefits possible when we have accurate patient information. Healthcare identifiers help progress our goal to utilise health resources in a smarter, more targeted and sustainable way.

In 2006 the Council of Australian Governments (COAG) agreed to a national approach to identification for patients and providers as part of accelerating work on the national e-health records system. This decision was re-affirmed in November 2008 when COAG agreed to universally allocate healthcare identifiers to all healthcare recipients in Australia.

A national approach to establishing healthcare identifiers has been adopted to avoid duplicating development costs and efforts and in recognition that identifiers are part of the core infrastructure needed to support secure electronic communication across the various elements of Australia’s healthcare system.

In consultation with the healthcare sector and the Australian community over the past three years NEHTA, in conjunction with Medicare Australia, has designed and developed an identifiers system for patients, healthcare providers and healthcare provider organisations.

The Healthcare Identifiers Service has been designed to include appropriate safeguards to ensure that:

• minimal demographic information will be required to assign and obtain healthcare identifiers;
• no clinical information will be held by the service operator;
• only authorised healthcare providers will be able to access the Healthcare Identifiers Service and obtain healthcare identifiers for their existing patients; and
• the Medicare card and Department of Veterans’ Affairs treatment card are used as a token to obtain an individual’s healthcare identifier.

The service has been designed to ensure that mechanisms currently available through Medicare Australia to protect the identities of vulnerable individuals (such as those in the witness protection program) will continue to be catered for.

An individual healthcare identifier will not alter the way in which anonymous healthcare services are currently provided. Where it is lawful and practical, individuals can seek treatment and services on an anonymous basis. In these instances, an individual healthcare identifier would not be used by the healthcare service.

The design of the service has been subject to three independent privacy impact assessments to ensure significant privacy impacts were identified and where necessary, addressed. This ensures the design of the service appropriately protects the privacy of those participating in it.

The design of the Healthcare Identifiers Service, combined with a national authentication system, an appropriate governance framework and the regulatory support this bill seeks to establish, healthcare identifiers will deliver the access and identity requirements critical to ensuring confidence in the way a patient’s health information is handled in an electronic environment.

While attention is often given to the potential benefits of the eventual adoption of electronic health records, there are immediate benefits associated with the implementation of a national healthcare identifiers system. These benefits will improve the safety and quality of healthcare in Australia and include:

• Minimising the likelihood of information being sent to the wrong healthcare provider or being assigned to the wrong patient;
• Reducing the likelihood of adverse events and inefficiencies associated with mismatching of patient information;
• Establishing a Provider Directory Service to enable, for example, GPs to locate specialists in a timely manner and to provide a greater confidence in electronic communications; and
• Improving productivity for healthcare providers and increasing patient convenience by helping to automate some of the more routine interactions between providers such as referrals, prescriptions and image processing.

For example, when eight-year-old Amy injures her arm rollerskating, her mum takes her to the emergency room at the local hospital. Using their family Medicare card as a token, the hospital collects Amy’s healthcare identifier from the Healthcare Identifier Service and adopts it as an identifier in its own system.

Using Amy’s healthcare identifier the treating doctor at the hospital orders an X-ray, the results of which are sent electronically from the radiology department to the doctor. This allows the doctor to quickly diagnose Amy’s fracture, treat her and prescribe any medication to assist with the management of her pain.

When Amy is discharged from the hospital, the doctor sends an electronic discharge summary to her regular GP with information about her condition, treatment and the medication prescribed. From this information, Amy’s GP knows when follow-up treatment is needed, reducing the likelihood of needing to go back to hospital for further care.

At each step in this scenario, Amy’s healthcare identifier is used to uniquely identify her in a variety of different healthcare settings and support the electronic communication of information relevant to her healthcare provision.

The scenario I have described can only become a reality if there is widespread use of a healthcare identifiers system by both patients and healthcare providers. To achieve this, the system must be easy to use, provide benefits to clinical care and be one that people can trust.

The bill seeks to establish appropriate limitations and protections for healthcare identifiers, including a robust complaints handling framework which will be managed by independent regulators. This will give patients and healthcare providers the necessary confidence in the safety of the system to encourage widespread participation.

The protections will be achieved by:

• Limiting the use of healthcare identifiers to:
• health information management and communications activities undertaken as part of delivering health-care; and
• other related purposes including health service management, research and emergency situations.
• Working to develop uniform health information regulation and privacy arrangements, for both the public and private healthcare sectors;
• Supporting appropriate authorisation and authentication processes for access to the healthcare identifiers system;
• Establishing strong inquiry and complaint handling arrangements with oversight conducted by the Federal Privacy Commissioner and penalties for misuse; and
• Providing for a review of the role of Medicare Australia as the service operator after a two-year period.

While all individuals receiving health care in Australia will be issued with an identifier, the bill does not impose a requirement that healthcare providers use healthcare identifiers when providing healthcare services, nor will identifiers be required by patients for claiming healthcare benefits.

On 7 December 2009, COAG signed a national partnership agreement setting out its commitment to implementing the governance, legislative and administrative arrangements necessary to implement e-health, starting with this healthcare identifiers system.

This agreement recognises the need for strong collaborative governance arrangements between jurisdictions, allocating responsibility for oversight of the Healthcare Identifiers Service, including the consideration of any proposed legislative changes and decisions regarding ongoing funding of the service to a ministerial council made up of representatives from each jurisdiction.

Two rounds of public consultation on the legislative proposals to support the Healthcare Identifiers Service have been undertaken. While there is strong support for the implementation of healthcare identifiers as a foundation for the development of e-health, patient and healthcare provider confidence in the regulatory support outlined in the bill is only one part of the story when it comes to ensuring widespread participation.

Getting a broad range of healthcare providers to actively participate in the system is going to be critical to achieving widespread use of healthcare identifiers in the healthcare system.

It is our aim to get as close to full participation in the healthcare identifier system as possible.

Engaging with and educating healthcare providers is the best way of ensuring widespread uptake of the identifiers. While most of the benefits associated with improving safety and quality and increasing patient convenience and productivity are obvious, the government will be strongly encouraging healthcare providers to participate in this system.

This is an exciting time for health reform and specifically for e-health development. Every Australian has a stake in our health system and e-health provides us with great opportunities to improve the way in which healthcare is delivered.

The implementation of a healthcare identifiers system for patients and healthcare providers is an important step towards building an effective national e-health system.

I commend the bill to the House.

Debate (on motion by Mrs Gash) adjourned.

----- End Hansard

The Hansard Record is found here:

http://www.openaustralia.org/debates/?id=2010-02-10.7.1

The holes in this speech one can drive a truck through are:

1. “This new identifier system will facilitate reliable healthcare related communications, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system.

The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.”

The point is remade here:

“The reform commission was clear in identifying the importance of e-health in driving and enabling reform to healthcare delivery. Among the 123 recommendations of the final report is a recommendation to introduce healthcare identifiers by July 2010 and individual electronic health records by 2012.

This bill establishes the healthcare identifiers, without which there cannot be an integrated, consistent, e-health system in Australia.”

So we are doing this HI Service to create a national e-Health record system. And what is this to look like, do and cost. Blowed if any of us know. We haven’t been asked. What is more it is not funded and there has been no serious consultation on how it might work that have seriously involved the Health Informatics community.

This is a very serious development in my mind. With the lack of governance and leadership NEHTA has provided in the HI Service program I would estimate that without a dramatic change in the delivery approach any national e-Health record system is doomed to catastrophic failure.

This is a classic example of NEHTA ‘not knowing what it does not know’ and to have NEHTA funded to deliver this sort of program makes me feel weak at the knees. I really don’t think they actually know what they want or what they are doing.

There is so much preparatory and structural work that needs to be done before a project of this type should be even considered it is staggering. It will be a reflection of ignorant hubris if the first step of a detailed feasibility and practicality study is not conducted and made public before this moves any further. The last decade of messing about in this domain has left us without the skills and the numbers to contemplate such exercises without some very serious capacity building first.

2. “Engaging with and educating healthcare providers is the best way of ensuring widespread uptake of the identifiers. While most of the benefits associated with improving safety and quality and increasing patient convenience and productivity are obvious, the government will be strongly encouraging healthcare providers to participate in this system.”

Tell me about the major change in the health system that has come about through Government ‘encouragement’ when the change involves extra time and cost – but does not come with some financial incentive.

3. “One of the major barriers currently limiting the progress of national e-health initiatives is the lack of a single process to accurately and consistently identify patients and healthcare providers.”

This is not true and NEHTA knows it. There are ways forward that do not involve what is being proposed here.

4. “On 7 December 2009, COAG signed a national partnership agreement setting out its commitment to implementing the governance, legislative and administrative arrangements necessary to implement e-health, starting with this healthcare identifiers system.

This agreement recognises the need for strong collaborative governance arrangements between jurisdictions, allocating responsibility for oversight of the Healthcare Identifiers Service, including the consideration of any proposed legislative changes and decisions regarding ongoing funding of the service to a ministerial council made up of representatives from each jurisdiction.”

See my commentary here:

http://aushealthit.blogspot.com/2009/12/details-of-new-national-partnership-on.html

and here:

http://aushealthit.blogspot.com/2009/12/coag-again-does-not-endorse-nehta-iehr.html

This is in no way what is needed. Note the absence of mentions of leadership and funding beyond the present NEHTA funding! Note also it all end in June 2012 unless re-done!

The full document is here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/docs/npa_e-health_signature.pdf

Overall, this really is just not the way to go about things.

5. I won’t go on about the confusion about what flows from having identifiers and what flows from having EHRs. They have just jumbled and confused that totally.

There are now rumblings that a new COAG submission on some form of S/P/I/EHR might be approved – or at least considered – in the rush to try and cover up the lack of progress in the health sector as the election looms.

There really needs to be a great deal more openness about all this before something goes to COAG or I can assure you it will be doomed and DOA – after a waste of even more money. As I say earlier it would be helpful to know exactly what they are actually planning!

It seems to me there is an ‘e-health deathwish’ loose in the land with Medicare and NEHTA as its sponsors.

David.

Senate Estimates Gets Tetchy on E-Health and NEHTA. Some Truths Come Out!

There were some fun and games at the Community Affairs Senate Estimates hearing on February 10, 2010.

The full transcript is here.

http://www.aph.gov.au/hansard/senate/commttee/S12751.pdf

The cast was made up of Senators and the following luminaries from the Department of Health and Ageing.

Ms Jane Halton – Departmental Secretary

Ms Rosemary Huxtable, Acting Deputy Secretary

Dr Penny Allbon – Director of the AHIW.

Ms Jan Bennett, First Assistant Secretary

Ms Liz Forman, Assistant Secretary, eHealth Branch

The full exchanges are below for your reading pleasure:

My comments, on what we have learned, are as follows.

Comment 1: Good news it seems – at least the AIHW and NEHTA are working to get basic information standards in place.

Comment 2: It is now totally clear that on July 1, 2010 there will be marginal to no change in the Australian Health System and that July 2 and many days and weeks to follow will be the same as June 30, 2010. The HI Service is to be phased in – timing unclear and not disclosed.

Comment 3: Medicare and NEHTA have set up a sandbox to play with the HI Service but essentially have no idea how it will go when subjected to the real world. This is really not the way you conduct a national program implementation I believe.

Comment 4: The commercial software providers have not really been brought into the tent and assisted as much as is possible to get their end of the service done.

Comment 5: DoHA has actually no idea who will want to use the identifiers – no-one has committed – all saying it is a good idea etc.

This says it all.

“Senator BOYCE—I guess the question is: how do we know when that enthusiasm is likely to turn into action? You do not have any sense of that, Ms Forman?

Ms Forman—I do not have a sense of that, no.”

Comment 6: There is clearly some fear the legislation might not have a totally smooth passage through the Senate.

Comment 7: Senator Boyce has clearly had some software vendors express concerns about how NEHTA is going about impinging on their commercial rights and trade secrets. I suspect, in fact, the level of trust between NEHTA and the software providers is pretty low right now. That again can hardly be a good thing for any national roll out.

Comment 8: The way private hospitals and private providers and practitioners are out of this loop is pretty spectacular.

Comment 9: We now know the secure messaging program will have a major test in April and an IHE Connectathon that is being funded by DoHA (not NEHTA).

All the following is worth a browse for if only so that expectations can be adjusted – way down.

Page 26

“Senator BOYCE—Unfortunately, it seems indicative of a lot of areas in Queensland Health. We have NEHTA and all sorts of work going on around developing e-health identifiers. Has the institute been involved in any of the development of standards for NEHTA or any of the NEHTA work?

Dr Allbon—Yes, we certainly have. We regard it as a really important leadership role on our part to ensure that the development of e-health will ensure that the data that we collect and the information remains compatible and that we keep time series. There are some risks from e-health which we are guarding against, as well as enormous benefits for the richness of statistical information.

Senator BOYCE—I am trying to think of how to phrase this. Does this include not just straight health data but the standards around the processes of developing the software and using the software?

Dr Allbon—We do not get involved in the software side of it. What we do get involved in is really the data supply chain—how that data will be collected, what the standards and definitions are and, therefore, how they will flow through into collections.

Senator BOYCE—Would you expect that, in all cases, they would meet international standards?

Dr Allbon—The standards that we have in relation to data are national standards, so we are looking very much for continuity with the information that has been collected in the past. In terms of the software and remaining developments of the interoperability, my understanding is that international standards are being used, but that is not my field, so I cannot comment on it.

Senator BOYCE—Okay. I may have some more questions put on notice around that depending on what NEHTA tells me this afternoon.”

Page 124 on – For 29 Minutes:

“[9.14 pm]

CHAIR—We are now moving to outcome 10.

Senator BOYCE—I put some questions on notice and asked some questions at the last estimates about ehealth.

I was told in the answer to question E09-245:

NEHTA is … working with the primary care sector and primary care software vendors to develop an implementation

pathway.

Would you be able to give me a list of who in the primary-care sector are the primary-care vendors that NEHTA has been working with in terms of developing an implementation pathway?

Ms Bennett—I am sure we could provide that information, though we may have to go to NEHTA to get it and then provide you the detail in follow-up, if that is all right.

Senator BOYCE—So you would provide that on notice?

Ms Bennett—Yes, if that is okay.

Senator BOYCE—That is fine. My next question was, when we have that list: when did the work on implementation which each of these organisations in the primary care sector and the primary care software vendors begin?

Ms Forman—That work and that collaboration is still very much at the discussion stage I think.

Senator BOYCE—So has the work actually commenced or are they talking about working?

Ms Forman—They are talking about working. They also have a working group relating to secure messaging where quite a significant amount of work has been done with the vendors.

Senator BOYCE—Is secure messaging being undertaking or is talk about secure messaging happening?

Ms Forman—Talk and development of software so the vendors are able to work towards bringing their software in line with the NEHTA specifications and then testing that.

Senator BOYCE—So is that being trialled?

Ms Forman—That is underway.

Senator BOYCE—Are there actual trials happening? Is software that has been developed to meet the NEHTA specifications actually being trialled right now?

Ms Forman—It is being developed, and we are expecting there to be a testing workshop in April.

Senator BOYCE—Can you explain to me what happens at a testing workshop?

Ms Forman—I can. In fact, the department is assisting in sponsoring this through IHE. They develop a system that sets up all of the specifications and the vendors are able to come together and test their product and see where it is meeting the specifications and where it is not.

Senator BOYCE—So who comes along to this meeting? NEHTA is there and anyone who would like to be a software vendor?

Ms Forman—That is correct.

Senator BOYCE—This is happening in April where?

Ms Forman—The location?

Senator BOYCE—Yes.

Ms Forman—I would have to take that on notice.

Senator BOYCE—And this is just around secure messaging?

Ms Forman—That is right.

Senator BOYCE—It is not in Canberra?

Ms Forman—I do not think so. I am not sure of the location.

Senator BOYCE—If you could take that on notice, that would be good. Does this assume that all those software vendors want each other to see what they have done? Are they all going to be in the one room demonstrating how they think they have dealt with the issue?

Ms Forman—I would have to take the fine detail on notice. I can get a description for you.

Senator BOYCE—Wouldn’t part of this be that some of those vendors would be hoping to get a commercial advantage over other vendors by having thought of a way of doing it in a way that other people are not doing it?

Ms Forman—It is very much around meeting the standards. There are a number of ways that vendors can meet the standards.

Senator BOYCE—But the standard is not prescriptive, is it? It does not say you have to do this, this and this. It says, ‘This is what the outcome has to be,’ doesn’t it?

Ms Forman—A standard does give a range of ways of achieving the outcome.

Senator BOYCE—Would any of those vendors in your view be concerned about confidentiality issues at that workshop?

Ms Forman—I am not sure. I can certainly ask NEHTA for advice on that issue.

Ms Bennett—Just to be clear: the workshop is a NEHTA workshop. It is not something the department directly—

Ms Forman—No, we are actually funding IHE to run the Connectathon.

Senator BOYCE—If NEHTA are not going to appear themselves, there has to be a forum in which we can ask questions regarding what NEHTA is doing. The minister today introduced the Healthcare Identifiers Bill 2010 into the House of Representatives. This is to bring NEHTA from a transition to a reality. Is it intended that all the healthcare identifiers would be rolled out nationally?

Ms Halton—When you say ‘all the’, the healthcare identifier nominated in the legislation would be national, yes, Senator.

Senator BOYCE—But we have the individual, the medical provider and the organisation—that is what I mean by ‘all the identifiers’.

Ms Halton—Yes.

Senator BOYCE—There are three categories of identifier.

Ms Halton—Yes, but basically you will have one and it will be relevant nationally.

Senator BOYCE—Who will have one?

Ms Halton—You would have one. I would have one.

Senator BOYCE—As an individual consumer?

Ms Halton—Yes.

Senator BOYCE—But all the medical providers also have to have one—

Ms Halton—One.

Senator BOYCE—and all the hospitals would have to have one.

Ms Halton—The thing about this is that it sounds so simple, but, boy, when you try and crash your way through the existing arrangements, you realise it is not simple. I am sure the minister next to me would have some views on this from when he was Minister for Human Services. With the way we currently classify ‘location of practice’, for example, an individual practitioner may have multiple identities because they practice in multiple locations. What we will do here is uniquely identify the practitioner, regardless of where they are, and uniquely identify locations and, dare I suggest, you and me.

Senator BOYCE—There are three categories of identifier, but it could get even more complicated for medical practitioners who are patients as well, couldn’t it?

Ms Halton—Yes, but let’s be honest—

Senator BOYCE—But we will not worry about that one.

Ms Halton—They are allowed to have two identities, Senator, because they are not inconsistent.

Senator BOYCE—With these three types of identifier, each—oh dear, we get into the organisational side of things there—individual entity within each category will have a unique identifier.

Ms Halton—That is right.

Senator BOYCE—It is intended that this be rolled out nationally through all three categories by when?

Ms Huxtable—Subject to the passage of the legislation, the health identifier service comes into effect on 1 July this year. As you will see in the legislation, Medicare Australia is the HI service operator from 1 July.

Senator BOYCE—And you would expect an operational national identification service—

Ms Huxtable—There has been a very significant amount of development work leading up to this point, both in crafting legislation and in ensuring that the appropriate structures are in place. The actual testing of the identifier service cannot happen until the legislation is passed, but that will set us on train to implementing the HI service.

Senator BOYCE—The states, in the main, already have their various independent health identifier systems. How is that brought into alignment? When will that happen?

Ms Huxtable—Senator, the states and territories are very much part of the development of this legislation. In fact, the legislation has been worked through in a subcommittee of AHMAC, the Australian Health Ministers Advisory Council. The Commonwealth legislation establishes the HI service and the identifiers will apply to state organisations also. It is only in regard to privacy that there is some state legislation that will need to be passed in time. However, the Commonwealth legislation has pre-eminence in that regard until that occurs.

Senator BOYCE—So what you are saying is that the states will stop using their current identifier systems and start using a national one? Is that what you are saying?

Ms Halton—Yes.

Ms Huxtable—Yes, the states, as you would know, have a range of identifiers that are currently in use. The major issue that the HI service will address is where patients, as they present at different settings, are identified in different ways. That leads to all sorts of discontinuity and impediments to continuity of care, increases duplication and leads to time being wasted in trying to match the record with the patient. These unique identifiers will apply nationally and will be incorporated into state systems as they are into private practice, effectively.

Senator BOYCE—Ready to start being used by patients, hospitals and medical practitioners by 1 July.

Ms Huxtable—The way in which it works for the individual patient is that when a patient presents for a GP consultation, for example, and provides their Medicare card, that Medicare card enables the provider to draw down the unique identifying number for the patient, so patient records will be populated over time as people present at a practice and have a consultation.

Senator BOYCE—So the time of population starts on 1 July, is that right?

Ms Huxtable—Yes, subject to the passage of legislation, of course.

Senator BOYCE—Obviously, yes. Are live trials of these systems being conducted with real patients now?

Ms Huxtable—I would need to get the details. NEHTA and Medicare Australia have worked together very closely in establishing the service. I can be corrected if I am wrong, but my understanding is that the systems are in place but will not be fully tested until the legislation has been passed. I can correct the record if that is incorrect.

Ms Halton—Essentially, Medicare Australia have set up a model health community and they have been doing—

Senator BOYCE—What is a model health community?

Ms Halton—It is a demonstration of what the e-health—what the capability is—

Senator BOYCE—It is a virtual community, so to speak.

Ms Halton—Yes, but in test, if I can describe it that way. You know how a lot of things are done in test environments to demonstrate capability and capacity. In much the same way, the health identifier arrangements have been set up to ensure that they are robust, they work et cetera. They have not been doing it in respect of real people, if I can put it that way, but they have done it in such a way that we have confidence that it will work if the legislation passes and we can push the ‘go’ button.

Senator BOYCE—Would you go into a bit more detail as to what gives you that confidence? What have you seen?

Ms Halton—There are a number of things that give me that confidence. Basically, this is a project that we have been working on for a good number of years—as you know well because you keep asking us questions about it. Medicare Australia are the agency who have had responsibility for running the Medicare arrangements for a long time—they understand these issues particularly well and they have had phenomenally close working relationships with NEHTA as part of this. We have had state and territory jurisdictions and the IT providers crawling all across it—it has been a very open and transparent arrangement. Medicare have put the proposed arrangements into a test environment so they can demonstrate the capability actually works.

Short of going live—and as you understand full well, until you actually do push the green button you cannot give a guarantee—but to the extent you can test, retest and practise these things—

Senator BOYCE—But you could do a live test in a contained environment, for want of a better term.

Ms Halton—That is effectively what we have been doing, without real people in it. Does that make sense?

Senator BOYCE—Real people are always the scary bit of any equation though.

Ms Halton—Indeed, but we have, sort of, dummy people—can I put it that way, Ms Forman?

Ms Forman—Yes.

Senator BOYCE—You can, Ms Halton!

Ms Halton—This is going to look terrible in Hansard. Notional people! I am corrected—notional people.

Senator BOYCE—The reason I was asking about that is that I have been told by people in the industry that the full specifications for the universal health identifier and how this testing has taken place are still a secret to people in the industry. They do not know what the full specifications are for the UHI and other identifiers— these have not been shared with people in the industry.

Ms Halton—The legislation is pretty jolly clear.

Ms Huxtable—We have consulted significantly. As to the specific discussions that may have occurred between NEHTA, Medicare Australia and others, we would need to take that on notice—if you are talking about the technical specifications of the service.

Senator BOYCE—So who does know the technical specifications—Medicare and NEHTA?

Ms Huxtable—Medicare and NEHTA are the ones that have worked collaboratively to get the service up and running. The work that we have done is around the legislative framework which, basically, is the umbrella under which the service operates, and there has been very significant consultation in respect of this legislation.

Senator BOYCE—Yes, but my questions here are going towards the more technical specifications.

Ms Halton—Yes, I understand. Medicare, as the deliverer, can answer those very particular questions. If I sit here with effectively two hats on—as a director of NEHTA and also as a portfolio secretary—I can say to you that I do have confidence in this.

Senator BOYCE—And as a director of NEHTA, presumably.

Ms Halton—Absolutely.

Senator BOYCE—Let me just confirm with you, Ms Forman, that anyone who wants to come is invited to your workshop for software companies that are interested in this.

Ms Forman—That is correct. It is the IHE Connectathon.

Senator BOYCE—A connectathon! Okay!

Ms Halton—That will go into the lexicon, Senator!

Senator BOYCE—Again, I have had concerns expressed to me that, even with this sort of development, six months would be a quick and short time frame in which to assure yourself that the software and the interfacing of all these identifiers worked. But you are saying that it can be done in the period from when the legislation is passed until 1 July.

Ms Halton—Senator, we have been working for a lot longer than six months on this.

Senator BOYCE—Sorry, but it has been said to me that you would want six months from when you first did live testing to get it right.

Ms Halton—We know that providers—I am not allowed to say ‘in the space’, because I will be fined—

Senator BOYCE—Sorry—what are you not allowed to say?

Ms Halton—‘In the space’, but, if I acknowledge that I am not allowed to say it before I say it, I do not get fined.

Senator BOYCE—I would have thought that was a double fine, personally, Ms Halton!

Ms Halton—This is a really large industry and a large part of the health system. There are a whole series of issues about rolling this out. We do not expect that on 2 July, miraculously and all of a sudden, capability will appear across the health system. We know that some people are preparing themselves now and will be in a good position very early while some people will take longer.

Senator BOYCE—When you say ‘some people’, do you mean software vendors or organisations or GPs or what?

Ms Halton—All of the above. Some people who put software onto doctors’ desktops are already looking to make sure that they are NEHTA compliant so that they are in a position to use this capability whenever it becomes available. Some people will be slower to react. That is an issue for the market. My strong advice to software providers is that this is going to happen, subject to passage of the legislation, and they ought to be thinking about NEHTA compliance, because we all know that, inevitably, e-health is going to happen. If they want to be part of that world they need to be looking at issues around compliance.

Senator BOYCE—Are you confident that they all have sufficient information to do that and to be compliant by 1 July?

Ms Halton—I cannot give you any assurance as to what level of attention they have paid to this.

Senator BOYCE—All the information is publicly available—all the specifications et cetera—that any one of those parties would need?

Ms Halton—We believe that there is sufficient information in the public domain for anybody who wishes to use the capability in the short term, subject to passage of the legislation, to be able to do that. We know that a couple of the big providers are already moving in this area. People have made investment decisions. We absolutely understand and respect that; that is their choice. Some people are making those decisions; some people are not.

Senator BOYCE—I am not talking so much about the investment decisions but simply the availability of information so that I, as an individual in any of those areas who needed an identifier, could satisfy myself that I have all the knowledge I need to be confident that I could be compliant on 1 July.

Ms Halton—I believe that is the case. Indeed, this workshop that we have just talked about is precisely part of people being able to assure themselves of exactly that matter. Ms Forman, is that correct?

Ms Forman—Yes.

Senator BOYCE—Could we just go back to the answers you gave, Ms Halton, when I asked, ‘Is it a national rollout from 1 July. Will all the identifiers for all the parties, all the stakeholders—whatever we want to call them—be ready from 1 July?’ The answers were ‘yes’, but now you are saying, ‘Not everyone will be taking part on 2 July.’ Can you try to explain to me what you think it will look like on 2 July, then?

Ms Halton—Probably very much like it does now, because, as I said, there will not be a revolution overnight. The capability will be there. Some people will get their identifier; some people will go to a provider who has, for example, picked up the software, which is already looking to enable this. So what you will have is progressive rollout over time, and what we expect it is that you will see some things happen more quickly: you will see point-to-point communication happen more quickly; there are some geographical areas that are already more prepared for this; we have some provider groups who are already working on these issues quite proactively. So I think what you will see is progressive rollout in different ways in different areas across the country. One of the things I genuinely hope, quite frankly, is that patients will go to the doctor and say: ‘Why can’t we get this stuff electronically now? I understand there is the potential. Why can’t we?’

Senator BOYCE—I am told that we have developed a standard here for the organisational identifier number that we have. Is that correct?

Ms Halton—There is a standard. There is a standard for all these numbers. It depends what you mean.

Senator BOYCE—I know, but I mean the one related to organisational identifiers.

Ms Halton—I am not clear how you are differentiating that from the other identifiers.

Senator BOYCE—Okay, so is there one standard for all identifier numbers?

Ms Halton—There is a standard. There may be some subtlety to your question which I do not understand.

Senator Fierravanti-Wells interjecting—

Senator BOYCE—No, we are talking about a national standard.

Ms Halton—Yes.

Senator BOYCE—But I understand that there is an international standard—it is on 8824:1990(e) for anybody who wants to know—that has been around for over 20 years now. On the basis of information I have—and I am certainly not an expert on this topic—it is considered safe and robust, and yet it was not used for our identifiers. Can you tell me why?

Ms Halton—We will have to take that on notice

Senator BOYCE—I would just like a fairly careful explanation of what we thought was wrong with the international identifier and what problems, if any, that could create in terms of international competitiveness for anyone developing software and the like here.

Ms Halton—On one occasion the media commentators took great offence to my use of the term ‘geek speak’ in estimates, so I will take great delight in saying again in estimates that we will give you an answer in plain English.

Senator BOYCE—Thank you. I will move through this a bit faster, shall I, Chair?

CHAIR—I think you should, and then Senator Siewert has some questions.

Senator BOYCE—Have any clinician groups yet signed up to use the identifier system from 1 July?

Ms Forman—The sense of it is probably not really one of ‘signing up’; it—

Senator BOYCE—Have any committed? Do you know who is going to be there on 1 July saying: ‘Give me my identifier. I am starting in this system tomorrow’?

Ms Forman—We have certainly had a lot of very positive feedback from the provider sector, particularly, during the public consultations. We had consultations during July-August and then again from November to January, and there was a lot of enthusiasm amongst a whole range of provider groups. We had a lot of the organisations represented there—surgeons, allied health, GPs, nurses—and a lot of enthusiasm. That is probably the best indication we have that providers are keen to get this and keen to use it.

Senator BOYCE—I guess the question is: how do we know when that enthusiasm is likely to turn into action? You do not have any sense of that, Ms Forman?

Ms Forman—I do not have a sense of that, no.

Senator BOYCE—Perhaps you would be the best person to answer this next couple of questions, Ms Halton. NEHTA is corporation limited by—

Ms Halton—It is a company limited by guarantee.

Senator BOYCE—You may or may not be able to answer this: is there any intention that NEHTA—when we drop the ‘T’ out, presumably—will function as a commercial entity?

Ms Halton—It is owned by the Commonwealth, states and territories so, whilst it is constituted as a company, it is a company with a particular purpose. We have not had, amongst the states and territories, a discussion about the future governance arrangements. I have to say my personal opinion is it is unlikely it would function in a commercial way. I cannot say one way or the other, but certainly given its function is quite specified and its owners are Commonwealth and state ministers, I cannot see why that would be the case.

Senator BOYCE—This concern has been put to me by people from private companies or who are stakeholders who are concerned that they are being asked to share secret commercial information with an organisation that they are not entirely confident may not at some stage be in competition with them.

Ms Halton—Yes. Let us be clear, whilst I cannot give you a categorical guarantee in relation to anything because it is not my guarantee to give, I think we do need to understand that NEHTA has been set up by the jurisdictions for some very particular purposes, most notably to ensure the efficient, economical rollout of electronic health across the country. If I, in my case as a director, with my state and territory colleagues were interested in basically building some vast monolith we would have indicated that. That is not what we are interested in. We are actually interested in the e-health world where the commercial sector actively has a role in delivering and driving adoption et cetera. The notion that we as governments could supplant or indeed play in that space, I frankly think is laughable.

As I said, I cannot guarantee that, but NEHTA has a very particular charter which is about ensuring that the investment that we are going to put in as governments means we do not get multiple rail gauges but we actually get the capacity of this system to deliver good outcomes for patients. State and territory colleagues are running very large systems and they want to get maximum value for dollar. I have the national interest absolutely front and centre in terms of patients and the dollars we are spending. It is not our business, core or otherwise, to be competing with the commercial sector.

Senator BOYCE—Thank you. I will put my other questions with regard to this on notice.

[9.43 pm]”

As I have said before these hearings are a gift that just keeps on giving!

David.

Great Summary of the Barriers to Health IT.

The US uber Health CIO –Jon Halamka has been doing a bit of Harvard research and teaching.

He wrote up one of the more interesting outcomes a few days ago.

Blog: The top 10 barriers to EHR implementation

February 02, 2010 | John Halamka, MD, CIO, CareGroup Health System, Harvard Medical School

Last week I taught Module II of Leadership Strategies for Information Technology in Healthcare at the Harvard School of Public Health.

My students included administrators, clinicians, CIOs, CMOs, and policymakers.

On the first day, I gave them a homework assignment - read my overview of the BIDMC/BIDPO EHR implementation project and then develop a list of barriers to EHR implementation in their organizations.

Here's the crowd sourcing results of the top 10 barriers to successfully deploying an EHR:

10. Usability - products are hard to use and not well engineered for clinician workflow.

9. Politics/naysayers - every organization has a powerful clinician or administrator who is convinced that EHRs will cause harm, disruption, and budget disasters.

8. Fear of lost productivity - clinicians are concerned they will lose 25% of their productivity for 3 months after implementation. Administrators are worried that the clinicians are right.

7. Computer Illiteracy/training - many clinicians are not comfortable with technology. They are often reluctant to attend training sessions.

6. Interoperability - applications do not seamlessly exchange data for coordination of care, performance reporting, and public health.

5. Privacy - there is significant local variation in privacy policy and consent management strategies/

4. Infrastructure/IT reliability - many IT departments cannot provide reliable computing and storage support, leading to EHR downtime.

3. Vendor product selection/suitability - it's hard to know what product to choose, particularly for specialists who have unique workflow needs

2. Cost - the stimulus money does not flow until meaningful use is achieved. Who will pay in the meantime?

1. People – it’s hard to get sponsorship from senior leaders, find clinician champions, and hire the trained workers to get the EHR rollout done. (this was the #1 concern by far)

.....

John Halamka, MD, blogs regularly at Life As a Healthcare CIO.

For the key list of 10 random but associated ideas from the session go here:

http://www.healthcareitnews.com/blog/blog-top-10-barriers-ehr-implementation

Sadly this list misses out on what I think are the biggest issues in Australia, mainly because they have been addressed as far as this group are concerned.

They are, as everyone knows by now, political commitment, skilled leadership, appropriate funding and a sensible well designed incentive program to achieve clinician adoption.

The US has made a serious attempt at these – we are sadly yet to start.

David.