Quote Of The Year

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

or

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

Tuesday, August 02, 2011

Will This Be the Fate of the PCEHR? The Way It Is Going I Would Not Be Surprised.

The following report appeared a few days ago.

MPs blast government IT failures

28 July 2011 Lyn Whitfield

The Commons’ public administration committee has concluded that the government’s lack of IT skills and over-reliance on an “oligopoly” of large contractors is a “recipe for rip-offs.”

In a report that echoes the findings of successive spending watchdog investigations into government IT, the committee says that the “overall record of developing and implementing new IT systems is appalling” despite an “obscene” amount of public spending.

Although it did not take evidence from the Department of Health, the committee’s verdict that “IT procurement has too often resulted in late, over budget IT systems that are not fit for purpose” sounds very like the latest National Audit Office verdict on the National Programme for IT in the NHS.

In its third report on the project, which focused on detailed care record systems, the NAO concluded that successive contract negotiations had delivered less functionality to fewer trusts for hardly any less money; so the programme had not delivered value for money and was unlikely to do so.

Committee chair Bernard Jenkin said: “The government has said that it is overly reliant on an ‘oligopoly’ of suppliers; some of our witnesses went further and described the situation as a ‘cartel’.

“Whatever we call the situation, it has led to an inexcusable situation that sees government waste an obscene amount of public money.”

The PASC acknowledges that while successive governments have failed at large IT projects, they have also tried to find out what keeps going wrong. Its report says the NAO found 30 major cross-government policies, reviews and strategies of IT from 2000 to 2010.

It also finds that most of these reviews identified common problems; such as projects being: too big; open to only a limited range of suppliers; duplicating work that had already been done elsewhere; not interoperating with other systems; being poorly managed; and failing to engage users.

The PASC also accepts that the present government has tried to address these problems; for example by: “creating a presumption against projects having a lifetime value of more than £100m”; creating an asset register and cross-public sector app store; promoting open source software and open standards; and trying to hold ministers and senior responsible owners to account.

The Cabinet Office, under its minister Francis Maude, has been leading on these efforts, and is known to be taking an active interest in the NPfIT local service provider contract that still has to be decided for the North, Midlands and East of England, where CSC has missed a number of deadlines to deliver Lorenzo to trusts.

However, the PASC says that it is still not clear that the government has “grasped the fundamental causes of failure or simply listed its systems.”

More here:

http://www.ehi.co.uk/news/EHI/7058/mps-blast-government-it-failures

The real key paragraph is this one.

“It also finds that most of these reviews identified common problems; such as projects being: too big; open to only a limited range of suppliers; duplicating work that had already been done elsewhere; not interoperating with other systems; being poorly managed; and failing to engage users.”

Now, thinking of the PCEHR program.

- Too Big - Tick

- Open to Limited Suppliers - Tick

- Duplicating Work Already Done Elsewhere - Partly

- Not Interoperable - Think Wave 1 and 2 Projects

- Poorly Managed - Think IHI service and NEHTA’s implementation capabilities

- Failing to Engage Users - Public and Docs really don’t know what is going on.

There is little doubt we are setting ourselves up to fail. Especially with no real decent scale piloting and doing things in a politically set rush!

How sad is this when we could have done so much better for the money?

David.

DoHA / NEHTA Provides Some Analysis on the Submissions Regarding the Draft PCEHR Concept of Operations.

The following appeared in the Google Cache a day or so ago.

Here is the link:

[PDF] PCEHR Concept of Operations Public Consultation Submissions ...

www.yourhealth.gov.au/.../...

File Format: PDF/Adobe Acrobat - View as HTML

PCEHR Concept of Operations Public Consultation Submissions Process: Analysis of Key Themes. 3. 1 Introduction. In the 2010/11 Federal Budget, ...

The full text is currently viewable using the View as HTML link.

PCEHR Concept of Operations Public Consultation Submissions Process: Analysis of Key Themes

Here is the table of contents.

Table of Contents

1 Introduction ............................................................................................ 3

2 Analysis of submissions ........................................................................... 5

2.1 Overview .............................................................................................. 5

2.2 Acknowledgement of submissions ...................................................... 6

3 Process review ........................................................................................ 7

3.1 Overview of the ConOps submissions review process ........................ 7

4 Common themes .................................................................................... 9

4.1 Summary view of themes ................................................................. 10

4.2 Access control, security and privacy ................................................. 11

4.3 General design suggestions .............................................................. 12

4.4 Information model ............................................................................ 13

4.5 Long term governance and sustainability ......................................... 14

4.6 Administrative overhead of PCEHR and remuneration provisions .... 15

4.7 Policy and legislation ......................................................................... 16

4.8 Adoption of the ‘opt in’ model .......................................................... 17

4.9 Implementation planning and road map ........................................... 18

4.10 Rural, aged care, disability and mental health provisions ............... 19

4.11 Secondary use of data ..................................................................... 20

4.12 Legal and liability.............................................................................. 21

4.13 Education of stakeholders ............................................................... 22

4.14 Interest to be more involved with delivery of the e-health System . 23

4.15 Accessibility / Considerations for people with limited or no

access to a computer ............................................................................. 24

4.16 Integration with existing healthcare systems ................................ 25

4.17 Platform mobility .......................................................................... 26

5 Next Steps .......................................................................................... 27

-----

In terms of frequency of matters raised we had:

Access control, security and privacy - 17.6%

General design suggestions -11.2%

Information model - 9.8%

Long term governance and sustainability -8.1%

Administrative overhead / PCEHR and remuneration provisions -7.2%

Policy and legislation - 6.2%

Adoption of the ‘opt in’ model - 5.8%

Implementation planning and road map - 5.8%

Rural, aged care and mental health provisions - 5.3%

Secondary use of data 4.5%

Legal and liability concerns - 4.5%

Education of stakeholders - 4.3%

Interest to be more involved with delivery of the e-health system - 4.2%

Accessibility / Considerations for people with limited or no access to a computer - 3.3%

Integration with existing health care systems -1.7%

Platform mobility - 0.6%

-----

So far so good and there are useful things reported under each heading.

What may give a little more pause is this:

5 Next Steps

The draft ConOps document will be revised to incorporate changes based on the themes and key points identified in the public consultation process. The ConOps document is expected to be finalised in August 2011.

Numerous points raised during the ConOps consultation process have been identified as being change and adoption issues. These points will be taken in to consideration by the National Change and Adoption Partner and incorporated into the work being undertaken to plan, design and develop training, guidance and tools in collaboration with healthcare providers and software providers.

Many points also related to the detailed implementation of the PCEHR system, and will be considered as part of the work that is currently being done on the design of the PCEHR’s detailed requirements, and also the work that will be performed by the National Infrastructure Partner. It is anticipated that the lessons learnt from eHealth sites will also be taken into consideration in the detailed design of the PCEHR system.

DoHA and NEHTA will continue to actively engage in a process of ongoing consultation with key stakeholder groups, including consumers, healthcare providers, the ICT industry, and state and territory governments. As part of this process, the PCEHR System: Legislation Issues Paper has been released for public comment and feedback. The paper covers issues such as participation in the system by individuals, healthcare providers and system operators, access controls, privacy, security and governance. Submissions on the PCEHR System: Legislation Issues Paper will be accepted until 5 p.m. AEST Wednesday, 3 August 2011.

-----

One just wonders just how much of all this is really just ‘kicking the can down the road’ rather than actually changing the overall ConOps to address needed changes. The end of August will tell us I guess.

I note my submission is not mentioned despite the submission e-mail explicitly saying it could be used - it is however on the www.yourhealth.gov.au site. I wonder why it was not mentioned?

I also wonder why the .pdf has disappeared? It was clearly there at one point for the Google Spider to find it!

Enjoy reading the detail at the link above.

David.

Monday, August 01, 2011

Weekly Australian Health IT Links – 01 August, 2011.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

The first article concerns an apparent technology innovation which, if true, will certainly have a major impact on the NBN build out and does demonstrate the broader lesson that picking ‘technological winners’ is a fool’s game. This is a perfect example of why this is the case.

This is certainly a story to watch!

What follows is links to all sorts of interesting stuff that really seems to show we have a small groundswell of activity happening the e-Health space. A good thing.

All in all not a boring week at all!

Late Note: The results for the Infrastructure Partner for the PCEHR will be announced very soon. Only a few legal issues to be sorted I am told. Watch this space!

-----

http://www.theaustralian.com.au/national-affairs/wireless-challenge-to-future-proof-nbn/story-fn59niix-1226104623595

Wireless challenge to 'future-proof' NBN

A TECHNOLOGY guru who has been described as the Thomas Edison of Silicon Valley claims to have developed a new wireless technology that could one day rival the download speeds on the National Broadband Network.

The new technology, called DIDO, allows internet users to access download speeds up to 1000 times faster than possible on conventional wireless networks, without any fall in speed as more users get on to the network.

Opposition communications spokesman Malcolm Turnbull said the wireless breakthrough underlined the importance of being "technology agnostic" when it came to choosing broadband solutions to meet the nation's needs.

The federal government has pledged to spend $36 billion to roll out a fibre-to-the-premises network to 93 per cent of the nation over the next 10 years. The remaining 7 per cent will be served with a mix of wireless and satellite broadband technologies.

-----

http://www.smh.com.au/technology/technology-news/thousands-of-privacy-breaches-going-unreported-20110727-1hzes.html

Thousands of privacy breaches going unreported

Asher Moses

July 27, 2011 - 12:49PM

Privacy breaches affecting Australians are flourishing but laws provide inadequate protections.

There has been a 27 per cent jump in the number of incidents of stolen or lost personal information reported to the Privacy Commissioner in the past year but inadequate laws mean thousands of incidents go unreported.

At a seminar held this morning by the International Association of Privacy Professionals, the Privacy Commissioner, Timothy Pilgrim, revealed his office had received 56 data breach notifications in the year to June 30 - up from 44 in the previous year.

However, Pilgrim warned that this only included responsible companies that voluntarily owned up to losing personal information as the government had failed to introduce mandatory data breach notification laws.

The worst offenders often got away with little accountability and forensic investigators say almost all incidents they investigate on behalf of companies are not made public.

-----

http://www.brisbanetimes.com.au/opinion/society-and-culture/the-truth-that-sets-us-free-20110729-1i44u.html

The truth that sets us free

Frank Moorhouse

July 30, 2011

Opinion

Illustration: Michael Mucci

Revealing more about our lives helps break down stigma. Privacy law threatens to reinforce it.

I think we would agree - in some hazy way - that privacy as a value, and behaviour surrounding the idea of privacy, are considered fundamental in a good society and to our sense of self. But the more I've thought and conversed about this haziness the more I have had reason to be fearful about the enterprise of legal codification of privacy and have, ultimately, come to oppose it.

Some of my thinking is also, I suspect, wishful thinking springing from my own unorthodox values about candour, but even wishful thinking is part of the ethos-making process. The word ''privacy'' is a conceptual and semantic labyrinth and while, in some relatively rare situations, it can be used precisely, its use generally requires much discourse to establish that precision.

The report by the Australian Law Reform Commission on privacy laws was delivered to Parliament in 2008 and it has taken a long time to gain wider public attention but even there it is stalled by complexity. The defeating complexity is illustrated by the physical report itself. The result of two years' research, consultation and analysis, it runs to 2700 pages in three volumes and put forward 295 recommendations for change. In 2009 the Federal Government accepted 141 of the recommendations - 34 with qualification - and two others were noted. Acceptance does not mean that action will be taken. That is, less than half of the recommendations were accepted, which itself illustrates how far we are from clarity or a consensus on the questions of privacy.

-----

http://www.australiandoctor.com.au/articles/96/0c071d96.asp

GPs top health website referrers

28-Jul-2011

David Brill

GPs are ahead of other Australian health professionals when it comes to embracing websites as a source of information for their patients, research finds.

A new survey reports that 86% of GPs routinely recommend a health website to their patients -- a higher proportion than psychiatrists, pharmacists, dietitians, social workers or chiropractors.

And just 42% of physiotherapists and 33% of optometrists typically recommend websites to their patients -- making these the most reluctant groups to recommend websites, the study found.

HealthInsite was the top site recommended by GPs, followed by the beyondblue and Diabetes Australia websites. Psychiatrists, meanwhile, favoured the Black Dog Institute, beyondblue and MoodGYM websites.

-----

http://www.computerworld.com.au/article/395251/australian_it_health_spending_tipped_reach_2_1_billion_ovum/

Australian IT health spending tipped to reach $2.1 billion: Ovum

Technology infrastructure development will drive growth by 2016, says analyst firm Ovum

Local IT health expenditure is expected to reach $2.1 billion by 2016, according to a report by analyst firm Ovum, which is driven by increased spending on electronic health records (EHRs), picture archiving and telehealth services.

In the firm’s latest IT healthcare market forecast, the drive to cut costs in the sector, as well as improve patient services were highlighted as key reasons for increased spending.

Ovum analyst, Cornelia Wels-Maug, said telehealth services, such as the monitoring of conditions via telecommunications technology and EHR, were predicted to provide the strongest growth.

-----

http://www.smh.com.au/entertainment/tv-and-radio/q--pay-thats-the-answer-20110730-1i5k5.html

Q & pAy, that's the answer

Andrew Taylor and Jim O'Rourke

July 31, 2011

TONY JONES, host of the ABC program Q&A, is being paid to run mock versions of his influential discussion show at business conferences.

Prominent figures in the healthcare and information technology industries, as well as senior federal government bureaucrats, will be at the ''HIC 2011 Q&A with Tony Jones'' - promoted as one of the premier events at the conference on e-health opening in Brisbane tomorrow. Jones hosted a similar Q&A at the HIC 2010 conference in Melbourne last August.

The ABC, which gave Jones permission to conduct the sessions, says the moonlighting does not amount to media training or breach any of its editorial policies covering independence and conflict of interest.

-----

http://www.6minutes.com.au/news/pcehr-targets-unrealistic-say-software-companies

PCEHR targets unrealistic, say software companies

It is unrealistic to expect the government’s planned Personally Controlled Electronic Health Record system (PCEHR) to be up and running by next year, according to medical software makers.

The Medical Software Industry Association says it is a “very tight” timeframe to expect the system to be introduced by July 2012 and immediate action is needed to ensure more “appropriate” timeframes are developed.

In a submission to the consultation on the PCEHR system, (link) the MSIA criticises the government’s draft proposal which it says does not cover some key matters including how it intends to educate Australians about the benefits of the system.

-----

http://www.computerworld.com.au/article/395081/info_sa_hospital_inpatients_online/

Info on SA hospital inpatients online

Shows information on bed occupancy, length of stay and number of surgical or critical care patients

  • AAP (AAP)
  • 27 July, 2011 11:08

Real-time information about the number of patients being treated in South Australia's metropolitan hospitals is now available online.

South Australian health minister John Hill said the inpatient dashboard featured on the SA Health website provides information on the number of patients at each hospital.

The link which is updated every thirty minutes, includes information on bed occupancy, average length of stay, as well as the number of patients in each area of the hospital including surgical or critical care.

-----

http://ehealthspace.org/news/telehealth-gets-racgp-partner-boost

Telehealth gets RACGP partner boost

The Royal Australian College of General Practitioners (RACGP) has met with leading telehealth providers to discuss telehealth opportunities for its members.

The College met with a range of organisations including IBM, Medibank, Microsoft, Telstra and Optus. NEHTA clinical lead and federal government broadband champion, Mukesh Haikerwal, chaired the meeting.

-----

http://www.racgp.org.au/standards/telehealth

RACGP Telehealth standards project

The Royal Australian College of General Practitioners (RACGP) recognises that telehealth provides considerable opportunities to improve health outcomes and access for patients to 'attend' a consultation without some of the personal inconvenience and personal or travel costs ordinarily involved in a typical face-to-face consultation.

To guide GPs through telehealth consultations and provide a safety and quality framework for patients and GPs, the RACGP is working on a number of telehealth initiatives, including the development of standards for general practices offering video consultations and an online training and education module on video consultations that will be available next year.

The College is pleased to announce that the Department of Health and Ageing has engaged the RACGP in a project to develop standards for general practices offering video consultations.

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http://www.theaustralian.com.au/australian-it/opinion/time-to-use-nbn-to-deliver-better-cheaper-e-health/story-e6frgb0o-1226101599483

Time to use NBN to deliver better, cheaper e-health

AS the infrastructure for the National Broadband Network rolls out across the nation, work is ramping up on the applications that will leverage the power of high-speed broadband to drive economic growth and improve our quality of life.

Of these applications, one of the most critical is e-health, which promises to reduce the cost of healthcare while improving access to health services for all Australians, regardless of location.

The risks, and need for diligence around implementing e-health systems, are high in light of recent failures both locally and overseas.

According to the Australian Bureau of Statistics, annual health expenditure grew by 45 per cent between 1997 and 2007 to reach $4507 per person. With the rising incidence of chronic conditions such as heart disease, cancer, asthma, obesity and diabetes, combined with our ageing population, heath costs are set to soar.

-----

http://www.medicalobserver.com.au/news/data-danger

Data danger

25th Jul 2011

The blueprint on how the national e-health records scheme will be stored and managed is a minefield of medico-legal concerns, writes Leigh Parry. Leigh Parry

IN JUST one year, your patients will have unprecedented access to their medical records – not only will they be able to view their records online, but they will be able to control who sees them, and even add their own notes.

In theory, the personally controlled electronic health record (PCEHR) scheme will drive safer, more efficient and better quality healthcare – as Health Minister Nicola Roxon says, “Patients will no longer have to remember every immunisation, every medical test and every prescription as they move from doctor to doctor.”

Doctor groups are generally supportive of the scheme, which aims to address the fragmentation of medical records that exist across a vast array of different systems.

-----

http://www.6minutes.com.au/news/gp-software-gets-nehta-accredited

GP software gets NEHTA accredited

Plans for the $467 million personally controlled e-health record system are getting under way as a GP practice software becomes NEHTA accredited.

iSOFT which runs the practiX GP software says it is the first NEHTA conformant desktop software (link) as part of the implementation personally controlled e-health record (PCEHR) system.

It says the software will enable communication between GPs and hospital-based doctors, by allowing the exchange of clinical information through discharge summaries, specialist letters, referrals, health summaries and medications management.

-----

http://ehealthspace.org/news/racgp-inks-precedence-ehealth-deal

RACGP inks Precedence ehealth deal

The Royal Australian College of General Practitioners’ (RACGP) business arm, RACGP Oxygen, has inked a deal with clinical software provider Precedence that will see it offer the cdmNet online service to GPs treating chronically ill patients.

According to RACGP Oxygen chief executive Mark Donato, the new software will make it easier for GPs to interact with other members of the patient’s care team along with the patient.
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http://www.australiandoctor.com.au/articles/af/0c071daf.asp

Medicare Local in ASIC probe

28-Jul-2011

Paul Smith

ONE of the Federal Government's Medicare Locals appears on the brink of collapse after the Australian Securities and Investment Commission was called in to investigate a planned merger between two divisions to create the new organisation.

Murrumbidgee General Practice Network was to merge with the Riverina Division of General Practice to create one of the 19 new Medicare Locals due to be launched on 1 July. The current chair of Riverina is Dr Tony Hobbs, former AGPN leader and who is considered the architect of the government’s $460 million Medicare Local reforms.

But the board of Murrumbidgee claimed in a statement this morning there were "apparent failures in due process and inadequate disclosure of information by certain parties on matters of material significance to the merger".

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http://www.smh.com.au/technology/security/software-takes-brain-power-out-of-hacking-20110727-1i076.html

Software takes brain power out of hacking

Asher Moses

July 28, 2011

Self-taught hacker driven by ego

The Federal Government is warning businesses to better protect themselves after a man was charged with allegedly hacking into the National Broadband Network.

EVEN if David ''Evil'' Cecil is guilty, he is not necessarily a hacking mastermind. Computer security professionals say breaking into websites and computer networks is now as simple as downloading free software, selecting a target and hitting ''run".

Even without a specific target in mind, a method called ''Google hacking'' allows hackers to find target servers running vulnerable software using just the search engine.

''If an attacker wants to get in, it's just a matter of time really,'' Ty Miller, the chief technology officer at Pure Hacking, said.

-----

http://www.theaustralian.com.au/national-affairs/electronic-health-files-secure-despite-nbn-hacking-minister-insists/story-fn59niix-1226103013428

Electronic health files secure despite NBN hacking, minister insists

  • Sean Parnell and Ben Packham
  • From: The Australian
  • July 28, 2011 12:00AM

THE Gillard government has moved to assure Australians, and the booming e-health industry, that even if the National Broadband Network is hacked, sensitive medical records will be safe.

The NBN has long been promoted by its backers and the government as a potential driver of e-health initiatives, such as telemedicine and the Personally Controlled Electronic Health Record System (PCEHRS), due to be delivered next year.

But the hacking case now before the courts has reignited privacy and security concerns and raised doubts over the National E-Health Transition Authority's commitment to resolve such problems.

-----

http://www.ehi.co.uk/news/ehi/7059/morecambe-bay-says-lorenzo-works

Morecambe Bay says Lorenzo works

28 July 2011 Shanna Crispin

University Hospitals of Morecambe Bay NHS Foundation Trust appears to have turned the corner with its troubled implementation of Lorenzo as part of the National Programme for IT in the NHS.

In an update on the single patient record project, delivered to the trust’s board last week, head of informatics Steve Fairclough, headed the ‘key messages’ slide of his presentation: “It works!”

He also said that staff feedback was “encouraging” although there is still work to be done, and further improvements in performance and usability are planned.

-----

http://www.theaustralian.com.au/business/world/european-study-sees-no-mobile-phone-cancer-link/story-e6frg90o-1226103330514

European study sees no mobile phone-cancer link

  • Gautam Naik
  • From: The Wall Street Journal
  • July 28, 2011 11:34AM

A EUROPEAN study involving nearly 1000 participants has found no link between mobile phone use and brain tumours in children and adolescents, a group that may be particularly sensitive to phone emissions.

The study, published in the Journal of the National Cancer Institute, was prompted by concerns that the brains of younger users may be more vulnerable to adverse health effects -- such as cancer -- from mobile phones.

In the past two decades, mobile phone use has soared among children in developed countries, with one study suggesting that most youths start to use mobile phones by age 9 or 10. Children have a developing nervous system, and cellphone emissions penetrate deeper into their brains. Studies have indicated that the outer brain tissue of children ages 5 to 8 may absorb twice the amount of cellphone energy absorbed by adult brains.

-----

Enjoy!

David.

AusHealthIT Poll Number 81 – Results – 1 August, 2011.

The question was:

Is Senator Boyce Correct In Calling for a Pause and Review of the PCEHR Program?

Definitely

- 29 (58%)

Probably

- 6 (12%)

Probably Not

- 9 (18%)

Definitely Not

- 6 (12)

With 70% leaning to the need for a pause and review of the PCEHR Program a pretty clear outcome!

Votes : 40

Again, many thanks to those that voted!

David.

Sunday, July 31, 2011

The Frog Is Slowly Boiling And Sadly It Is Not Noticing Its Inevitable Fate. It Will All End in Tears!

It is now only 11 months to go until we will all be able to register for our own Personally Controlled Electronic Health Record (PCEHR).

Additionally I am told that pretty soon we will have an announcement of which consortium has won the tender to build the technical infrastructure to have this all happen, and which will underpin the central components of the PCEHR. This will be the last major tender as the others covering such things as marketing, change management, benefits realisation and so on have recently been announced.

Of course there is a fair number of pieces still missing. These include the technical standards to be used, a revised concept of operations following all the submissions which closed a few weeks ago and any explicit definition of just what is going to be delivered July 1, 2012.

For what it is worth I agree with the MSIA as quoted here:

PCEHR targets unrealistic, say software companies

It is unrealistic to expect the government’s planned Personally Controlled Electronic Health Record system (PCEHR) to be up and running by next year, according to medical software makers.

The Medical Software Industry Association says it is a “very tight” timeframe to expect the system to be introduced by July 2012 and immediate action is needed to ensure more “appropriate” timeframes are developed.

In a submission to the consultation on the PCEHR system, (link) the MSIA criticises the government’s draft proposal which it says does not cover some key matters including how it intends to educate Australians about the benefits of the system.

More here:

http://www.6minutes.com.au/news/pcehr-targets-unrealistic-say-software-companies

I believe what we will see is what I would describe as a ‘political switch on’ of the PCEHR at the due date - much as we saw a little over a year ago with the IHI service. All fanfare and then pretty much nothing,

This issue is more than a sleeper I believe as well.

Data danger

25th Jul 2011

The blueprint on how the national e-health records scheme will be stored and managed is a minefield of medico-legal concerns, writes Leigh Parry. Leigh Parry

IN JUST one year, your patients will have unprecedented access to their medical records – not only will they be able to view their records online, but they will be able to control who sees them, and even add their own notes.

In theory, the personally controlled electronic health record (PCEHR) scheme will drive safer, more efficient and better quality healthcare – as Health Minister Nicola Roxon says, “Patients will no longer have to remember every immunisation, every medical test and every prescription as they move from doctor to doctor.”

Doctor groups are generally supportive of the scheme, which aims to address the fragmentation of medical records that exist across a vast array of different systems.

But shared health summaries, in which multiple health providers and the patients themselves will be able to contribute information, opens the prospect of an unprecedented deluge of data – and a medico-legal nightmare for GPs.

In their responses to the recently completed consultation on the blueprint, or the Concept of Operations (Con Ops), both the AMA and RACGP raised concerns about the medico-legal ramifications of the scheme.

A key concern is how patient information will be shared and interpreted.

More here:

http://www.medicalobserver.com.au/news/data-danger

It is also highly relevant that we have just (27th July, 2011) had a new statement on the PCEHR from the Royal Australian College of GPs.

The full statement is here:

http://www.racgp.org.au/AM/Template.cfm?Section=ehealthPCEHR&Template=/CM/ContentDisplay.cfm&ContentID=43401

The relevant part of the Statement is this part.

“2.6 Potential risks

There are a number of potential risks associated with the PCEHR that will require further clarification and resolution. These include:

  • The increased workload, responsibility and role of the GP as the nominated healthcare provider
  • Risk to clinical safety and fragmentation of care if the patient changes their nominated healthcare provider
  • The perception by the patient of the consumer portal as a communications channel for medical assistance and associated risk that they may not seek medical assistance as the functionality of the consumer portal increases
  • Treating a patient when faced with limited access to information within a PCEHR, such as in circumstances where the patient has chosen to suppress certain clinical documents and/or information
  • Clinical risks arising from both the quality and the volume of data which may lead to information not being complete, accurate or current
  • The medico-legal ramifications associated with the burden of maintenance placed on the general practitioner.

3.0 Conclusion

The RACGP supports the principles of a PCEHR as recommended by the NHHRC,1 however the RACGP acknowledges that there are potential risks which will require clarification prior to uptake by general practice.

The RACGP acknowledges that a PCEHR can improve access to health information, improve coordination of preventive health and health maintenance activities, and support emergency and after hours care. Core to the success of a PCEHR are access, information availability and quality, data exchange, privacy, security and trust. Patients need to trust that their privacy will be preserved and clinicians need to be able to trust the data quality which includes accuracy, completeness and timeliness. It is imperative that this mutual trust is preserved by a safe system.

A PCEHR system needs to build on the foundation of the GP e-health summary. General practitioners are the coordinators of patient care and the gatekeeper to the healthcare system. The RACGP supports the PCEHR as an e-health innovation that will reduce fragmented care and provide timely and accurate information at the point of care.

The RACGP supports the sharing of a medical record that:

  • Supports a person-controlled electronic health record
  • Contains reliable and relevant medical information
  • Aligns with clinical workflows and integrates with clinical software
  • Aligns with National Privacy Principles and the overarching National E-Health Transition Authority (NEHTA) Privacy Framework and Security Access Framework
  • Is governed by a single national entity
  • Is fully funded by governments and supported by appropriate incentives, education and training.”

This all makes for the most qualified support and politest possible this is really going to cost you and needs a great deal more work you’ will ever see. Frankly, from an information management perspective, I simply do not think what the College is asking for is actually doable! As far as cost, it isn’t in the budget and won’t be cheap.

I think it is probably time to put a stake in the ground on all this. Essentially I think we are all being treated like the unfortunate frog and we will be frog’s legs before we notice what an enormous con the spin being put out by NEHTA and DoHA is. The con really has two parts. The first is the claim that anything useful will be delivered in eleven months and the second is that the PCEHR is the optimal model to progress e-Health in Australia. They will fail on two out of two.

As I wrote in an e-mail to a mate:

“We need to be clear this whole (PCEHR) thing emerged as a 'thought bubble' from a single NHHRC member (who is an enthusiastic e-health amateur) in 2009 and has been grasped by NEHTA and DoHA as a way of 'doing something' without any real review or cost benefit analysis of the proposal. All that was done was to warm over their older NEHTA IEHR business case and then suggest the same benefits would flow - which was, and is, just wrong, as they well know.

I am 100% sure that in 2 years those that make this clear, and that the plan is conceptually deeply flawed, will have quadrupled their credibility by being the clearest in pointing out how badly flawed all this is. Equally those that are spruiking it are going to look pretty dumb.

This all reminds me of the times when many thought you could not do without slavery, that evolution was just a theory and when it was obvious that women should not vote - until eyes opened and we can now understand what nonsense was being foisted on us.”

It is time for DoHA to explain just how the technical, standards, adoption, consent and medico-legal issues will be addressed in credible detail.

It is also time for DoHA to explicitly explain just how much will be delivered on July 1, 2012 and, even more important, if and when the authorisation for ongoing funding of the project and NEHTA is going to be announced. This ignores the huge extra that will be needed to get the GPs on board (100s of millions I estimate).

This whole disastrous project is being given far too much support by all sorts of vested interests as increasingly e-Health experts and clinicians are seeing just how silly the whole thing really is!

We have already seen some stirrings of political concern about all this and , unless some real review is undertaken to test out the practicality and viability of the PCEHR plan, this will only get stronger.

David.