Joining The Dots Really Makes The PCEHR A Doubtful Proposition. Right Now Many Can’t Use or Afford the Interet!

A couple of recent articles prompted me to start joining a few dots and realising that the vision for an internet enabled patient driven PCEHR may be a lot further away than the spruikers think.

First we had this:

More than 670,000 households fail to submit census correctly

August 10, 2011 - 3:49PM

More than 670,000 online census surveys failed to submit on Tuesday night due to users missing a crucial step.

Around the nation last night, Australians sat down to fill out their census forms but among those who opted for the internet option there has been a problem.

Paul Lowe, head of the Population Census Program, said many people completed all the questions but neglected to hit the all important send button.

"We have got over 670,000 households that have logged on but haven't hit that submit button. I encourage people to log back on and hit that submit button," he told reporters in Canberra.

In all other areas, the census officials are billing this five-yearly gathering of national data from 9.8 million households a rousing success.

Mr Lowe said more than 2 million households logged on to the online census form with more than 100 census submissions arriving every second at peak time.

Despite apprehensions that the online census system would be overwhelmed, Mr Lowe said it did not go anywhere near capacity.

He said there was still plenty of time for people to complete a paper or online form.

More here:

http://www.smh.com.au/technology/technology-news/more-than-670000-households-fail-to-submit-census-correctly-20110810-1ilq8.html

Then the same day this popped up.

Net too expensive for seniors: study

By AAP on August 10th, 2011

More than 40 per cent of older Australians say that the internet is too expensive, leaving them at risk of being shut off from health and other online services.

A new survey suggests that seniors, and particularly pensioners, risk being left behind as businesses and governments shift more services online.

Queensland University of Technology researcher Dr Sandra Haukka interviewed 149 seniors aged 50 or older across the nation.

Haukka found that 53 per cent of participants had a moderate or above interest in the internet, while 46 per cent put their interest as low or nil.

Two thirds of respondents rated their internet skills as very low, and more than 40 per cent said that cost is a barrier to using the internet.

One third said that the internet would improve their daily life.

Haukka's work included in-depth interviews with seniors who did not use, or rarely used, the internet, including those in urban, regional, rural and remote areas.

"With the government and private sector spending billions on the National Broadband Network [NBN], we have to make sure that the internet can be used by all those who need it the most," Haukka said.

She said that society's increasing reliance on the internet for commerce and services is leaving older Australians with low web skills unable to conduct business transactions, access services, find out about community events or use the internet to communicate with friends and family.

More here:

http://www.zdnet.com.au/net-too-expensive-for-seniors-study-339320135.htm

So what we have had here is a bit of a community internet IQ test - and a good few failed. We also have some evidence (and I acknowledge the small size if the study) that a key target demographic thinks that internet access is either not interesting or too expensive.

More evidence I would suggest for the build of national e-Health to address the providers first and then build out to consumers as costs fall (if you believe that might happen with the NBN) and more of the population are properly ‘internet literate’.

David.

For The Record -The Official PCEHR Infrastructure Partner And Some Commentary.

The following press release came up yesterday - and is provided so provide clarity as to what is being provided in 10 and a half months from now.

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr151.htm

Accenture to Build Australia’s Personal e-Health System

Accenture, a world leader in IT, has been selected to lead the building of the IT infrastructure for Australia’s national personally controlled electronic health record (PCEHR) system in another major milestone for national health reform.

15 August 2011

Accenture, a world leader in IT, has been selected to lead the building of the IT infrastructure for Australia’s national personally controlled electronic health record (PCEHR) system in another major milestone for national health reform.

“A consortium led by Accenture has been selected as the National Infrastructure Partner for the development of the PCEHR system,” Minister for Health and Ageing Nicola Roxon said.

“Accenture will be responsible for designing and building the physical PCEHR system, which will be used by people to register for and view their e-health record.

“People will also use this system to allow their GP and other health professionals to view their record, helping to make sure their records are available whenever and wherever they are needed.

“Health professionals will use the system to view their patients’ e-health record, which over time will include information such as health summaries and discharge summaries. Health professionals will also be able to update this record with the most critical and up to date medical information to deliver safe and efficient healthcare.

“Accenture’s track record in the successful delivery of Singapore’s national electronic health record earlier this year was an important factor in their selection during the highly competitive independent tender process with applicants from around the world.”

Minister Roxon said Accenture will provide leadership to a consortium of companies, which also includes Orion Health and Oracle and will play a critical role in developing the PCEHR, including:

• developing internet portals so people can view their personally controlled e-health record, control access and enter their own medical information
• developing a portal to allow health care providers, when given access by the patient, to view and update a patient’s record
• providing for an audit trail that will show when and by whom a person’s record was accessed
• providing a reporting capability for critical information about the PCEHR system itself, including performance and usage.

“A key responsibility of the National Infrastructure Partner will be to ensure that the PCEHR system has high availability, including in a medical emergency, and that it works efficiently and securely for patients and providers alike,” Minister Roxon said.

“Personal, secure electronic health records are a critical part of the Gillard Government’s national health reform. They will drive improvements over time to the way people engage with our health and hospitals system – making it better coordinated and more efficient and effective.”

The National Infrastructure Partner, under the instruction and oversight of the Commonwealth Government, will ensure stringent protections are in place to safeguard the privacy of patient records. The infrastructure built will be the property of the Commonwealth.

Here is a link to the original Statement of Requirement so we can all see what was actually asked for.

http://moreassoc.com.au/downloads/Part%202%20-%20NIP%20-%20Statement%20of%20Requirement.pdf

This provides a lot more details on the costs which were not discussed above.

Accenture leads build on Roxon record system

• Karen Dearne
• From: The Australian
• August 16, 2011 12:00AM

THE Accenture-led team delivering Singapore's e-health record system will build the Gillard government's health records infrastructure, with contracts worth $77 million announced yesterday.

The consortium includes Oracle and Orion Health, while Accenture's local cloud computing partner, Telstra, will provide secure infrastructure as a service.

Health Minister Nicola Roxon said Accenture would receive $47.8m to develop the personally controlled e-health record system.

The department will also pay $17.8m to Oracle in licence fees for access to e-health records stored within all PCEHR repositories, and $11m in fees to Orion for operating a portal.

"Accenture's track record in the delivery of Singapore's national e-health record earlier this year was an important factor in their selection," she said.

"It was a highly competitive, independent tender process with applicants from around the world."

The Singaporean project cost $140m to deliver records for five million citizens.

Ms Roxon has said that by July 1 next year every Australian who wants one will have access to a personal e-health record.

With a very tight timeframe, it appears the project will be recast in the Singaporean mould, using already developed functionality rather than starting from scratch.

In June, Singapore's Ministry of Health announced the go-live of the first phase of its "one patient, one record" vision, 10 months after deployment began. However, Australia's unique consumer-controlled approach will involve modifications. Ms Roxon said Accenture, "under the instruction and oversight of the government", would ensure stringent protections were in place.

"Accenture will design and build the physical PCEHR system, which will be used by people to register for and view their e-health record," she said.

"The infrastructure will be the property of the commonwealth.

Many more details here:

http://www.theaustralian.com.au/australian-it/accenture-leads-build-on-roxon-record-system/story-e6frgakx-1226115493904

I have to say I am quite interested to know what the remaining $200 million or so of the initial $466.7 M is to be spent on - or has it already been spent? Hard to know.

It is interesting to note that the Minister’s statement now only refers to the development of two portals and that ‘over time’ there will be various pieces of information to be viewed and shared with the consumer’s health provider.

I do seem to sense a little scope contraction going on here. It is still not at all clear just why providers would interrupt their usual workflow to look up this portal - given its rather limited contents - to say nothing of the more obvious question of just who the PCEHR is actually for and why people would bother to use it.

As far as I am concerned this just seems to be getting sillier and sillier. What we now have is unseemly haste to implement a slightly tweaked set of systems which were designed to be used by healthcare providers for their use and provider to provider communication to be pressed into service and used by consumers. We all know how well software designed to solve one problem works when attempting to solve a different - and ill defined - problem.

Of course all the Standards used will not be the NEHTA ones, but whatever is easiest and quickest for Accenture and partners, so there may just have been a fair bit of wasted time with all this work. We will all see pretty soon!

David.

Weekly Australian Health IT Links – 15 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

There seems to me to be no doubt the biggest story of the week relates to the apparently continuing stand-off between DoHA/NEHTA and Standards Australia regarding how E-Health Standards are to be developed and who is to control the processes.

As late as the 12^th I am told the standoff continues and this is really not a good for the whole e-Health community and this flows through to the public at large in the end.

We will watch and wait on all this. It really needs to be sorted out sensibly and reasonably.

It is now three or more weeks since I first mentioned the issue and so far the progress is not obvious.

See here:

http://aushealthit.blogspot.com/2011/07/it-looks-like-desperation-and-heavy.html

While waiting for PCEHR Standards to be sorted out you can read one informed view here:

http://moreassoc.com.au/downloads/GRain_%2Bstandards%2Bfor%2BPCEHR.pdf

Of course the only Standards that will matter are those implemented by Accenture et al.

Lots of other fun stuff is found below.

-----

http://www.theaustralian.com.au/australian-it/government/e-health-gets-a-70m-boost-from-nicola-roxon/story-fn4htb9o-1226111257833

E-health gets a $70m boost from Nicola Roxon

• Karen Dearne
• From: The Australian
• August 09, 2011 12:00AM

NINE small health IT projects have received $70 million in funding, as Health Minister Nicola Roxon picks up the pace on the e-health record program.

The projects, announced in March, had to undergo a second round of bidding before receiving funds under the PCEHR (personally controlled electronic record program) "second-wave" initiative. Originally, up to $55m was allocated for the program.

Most of the money has gone to well-established state government projects: NSW Health, trading as Health Administration Corp, pocketed almost $15m; Northern Territory $12.8m; and Tasmania $3.5m.

In NSW, the Greater Western Sydney e-Health Consortium is focused on high-priority consumer groups. Its project includes secure messaging, electronic referrals and a medical imaging repository.

----

http://www.itnews.com.au/News/266246,states-demand-federal-funding-for-e-health-record.aspx

States demand federal funding for e-health record

By James Hutchinson on Aug 9, 2011 1:47 PM

State costs likely above $467 million capital spend.

Australia's State governments have called for federal funding to help implement the national e-health record by July 1 next year.

The Victorian Government in particular has accused the Department of Health and Ageing (DoHA) of failing to discuss Federal Government plans with state and territory governments ahead of implementation, according to a submission released this week.

In the Victorian Government's submission [pdf] to the Department of Health's draft concept of operations for the $467 million e-health records system, Victorian state health minister David Davis said the Federal Government's plans had ignored advice from the Council of Australian Governments (COAG).

-----

http://www.itnews.com.au/News/266469,nsw-health-seeks-accreditation-for-e-health-rollout.aspx

NSW Health seeks accreditation for e-health rollout

By James Hutchinson on Aug 12, 2011 6:43 AM

Formal framework could strengthen case for funding.

NSW Health has revealed plans to accredit the state’s rollout of electronic medical records in an attempt to better track its progress and strengthen its case for funding.

The department had informally used a US e-health record adoption model in business plans submitted to state Treasury during the past year.

Chief information officer Greg Wells said it hoped to gain accreditation with the model’s developer, the Healthcare Information and Management Systems Society (HIMSS).

The state department intended to participate in HIMSS Analytics’ quarterly reviews so its progress could be compared to hospitals across Asia Pacific.

-----

http://www.itnews.com.au/News/266582,feds-push-back-on-state-e-health-funding.aspx

Feds push back on state e-health funding

By James Hutchinson on Aug 12, 2011 7:04 AM

States want more money for e-health record integration costs.

The Federal Department of Health and Ageing has denied states and territories additional funding to implement its $467 million personally-controlled electronic health record (PCEHR) project.

The lack of federal funding would require individual state governments to front up their own money to establish infrastructure not directly tied to the rollout of the national e-health records.

"No additional PCEHR funding is expected to be allocated to states or territories," a department spokesman said.

-----

http://www.theaustralian.com.au/australian-it/funds-cut-halts-work-on-e-health-records/story-e6frgakx-1226111254946

Funds cut halts work on e-health records

• Karen Dearne
• From: The Australian
• August 09, 2011 12:00AM

STANDARDS Australia has stopped work on technology specifications needed for the $500 million e-health record program after the federal Health Department cut funding.

Development is on hold for about 60 technical standards relating to key aspects of the personally controlled e-health record system.

Members of the IT-014 committees, which do the standards work, were last month told that SA halted the program on July 1 after failing to secure a contract for 2011-12.

Minutes from the meeting show that the department had been informed of the situation.

-----

http://www.australiandoctor.com.au/articles/85/0C072285.asp

Medicare allowed to inspect patient records

12-Aug-2011

New powers that allow Medicare Australia bureaucrats to inspect, copy and retain patients’ medical records will soon be enforced, the Federal Government has confirmed.

In a statement today, the Federal Department of Human Services said it was writing to doctors to advise them of the changes, which is part of a wider drive to save $147 million from Medicare over four years.

Under the changes, Medicare can request that doctors produce clinically sensitive documents to verify the Medicare benefits they have claimed.

-----

http://www.theaustralian.com.au/australian-it/funds-will-boost-aged-care-technologies/story-e6frgakx-1226111832215

Funds will boost aged care technologies

• Karen Dearne
• From: The Australian
• August 09, 2011 4:36PM

THE proposed Australian Aged Care Commission will boost the use of technologies in the sector through new funding incentives, the Productivity Commission says.

Under the current system, aged care providers cannot find the capital and recurrent funding needed to introduce new technologies.

“The AACC will take into account the contribution of technology in delivering services in its recommendations on prices and subsidies for approved providers,” the commission said in its landmark report.

“This will reinforce the incentives for adoption.”

The AACC would be set up as an independent body that advises the federal government on aged care policy, and determines fee schedules for accommodation and services.

-----

http://www.theaustralian.com.au/news/health-science/hi-tech-stimuli-help-to-dull-the-pain/story-e6frg8y6-1226113730661

Hi-tech stimuli help to dull the pain

• Alexander Gambotto-Burke
• From: The Australian
• August 13, 2011 12:00AM

ASK neuroscientist Stuart Smith about the biggest problem with rehabilitation exercises for stroke patients and he'll be blunt: they're boring.

Despite their effectiveness at improving motor control and reducing sensory and intellectual impairment, many stroke patients in Smith's care find exercises repetitive and frustrating.

"This is especially the case with the young guys," says Smith, who is with Neuroscience Research Australia (NeurA) in Sydney.

"It's difficult to even get them to turn up to the rehabilitation sessions sometimes. You can move a bag of sand across a desk thousands of times a day and see a very clear improvement, but no one's going to do that."

What people would rather do is play video games. And, as it happens, that's just what they need.

-----

http://www.pharmacynews.com.au/news/project-stop-improvements-coming--guild

Project STOP improvements coming: Guild

• By Nick O'Donoghue on 11 August 2011

Changes to Project STOP are being researched that may enable it to interact with dispensing systems, but the Pharmacy Guild of Australia remains tight-lipped as to when improvement will be implemented.

Speaking to Pharmacy News in the wake of criticism of the system, Tim Logan, acting Guild national president, said Project STOP was a useful decision-support tool for pharmacists when it came to dispensing pseudoephedrine containing medicines.

He said the Guild was constantly looking at ways to improve the system, which has been mandated by the state governments of Queensland, Western Australia and South Australia to restrict access to pseudoephedrine – a key component in the manufacturing of illicit drugs.

“Project STOP delivers a useful decision-support tool for pharmacists facing requests for pseudoephedrine containing medicines,” he said.

-----

http://www.pharmacynews.com.au/news/guild-backs-ama-call-for-e-health-rethink

Guild backs AMA call for e-health rethink

• By Nick O'Donoghue on 8 August 2011

Plans to introduce an opt-in, personally controlled health record system in Australia next year are doomed to failure, according to the Australian Medical Association (AMA).

Dr Steve Hambleton, AMA national president, said the Federal Government should make the system opt-out to maximize uptake, otherwise her feared elderly patients and those who are not technically savvy may miss out.

------

http://www.computerworld.com.au/article/396498/web_reminders_reduce_cervical_cancer/

Web reminders to reduce cervical cancer

Pilot program will run for six months in parts of Sydney and the Hunter

• AAP (AAP)
• 09 August, 2011 08:21

Online reminders about cervical cancer check-ups could save the lives of hundreds of women, NSW health minister, Jillian Skinner, says.

The pilot program, which will be trialled in parts of NSW, will send online reminders to doctors if women miss regular tests and also generate letters reminding women to get screened.

"This is such a forthright idea that could potentially save the lives of hundreds of women across the state," Skinner said in a statement.

-----

http://www.phoenixmedical.com.au/ausdimobile_ios.php

Phoenix Medical Publishing launches AusDI Advanced Mobile for iPhone and iPad

Phoenix Medical Publishing has launched a mobile version of AusDI Advanced. AusDI Mobile is FREE for current subscribers.

AusDI Advanced is one of the recommended Pharmacy Board Resources for retail pharmacists.

The mobile App is yet another option for clinicians to access trusted, independent Australian Medicines information on the go. The App is simple to navigate and delivers monthly updates directly to your Apple devise. You can ‘Save Favourites’ and view them offline at your convenience.

------

http://www.smh.com.au/national/health/lost-in-translation-emergency-staff-dont-listen-properly-20110809-1ikzi.html

Lost in translation: emergency staff don't listen properly

Julie Robotham

August 10, 2011

HOSPITAL emergency departments function almost entirely on undocumented conversations that are frequently misunderstood, which puts patients at risk of wrong diagnosis or treatment, the first big study into the question has found.

And the situation is worsening as hospitals are overwhelmed with a growing number of emergency visits, including from an increasing proportion of elderly people with complex conditions and people whose language or cultural background poses extra communication challenges.

The research by the University of Technology, Sydney - based on more than 1000 hours of direct observation in NSW and ACT hospitals - identified the failure of doctors and nurses to listen properly to patients' descriptions of their illness as particularly problematic.

-----

http://www.computerworld.com.au/article/396383/privacy_guidelines_enough_prevent_data_breaches_law_lecturer/

Privacy guidelines not enough to prevent data breaches: Law lecturer

Australian privacy watchdog needed to prevent more Medvet data leaks, another Sony hack

• Lisa Banks (Computerworld)
• 08 August, 2011 12:45

To prevent online privacy breaches Australia needs a privacy watchdog rather than merely guidelines, a law lecturer has argued.

In an article at Thecoversation.edu.au University of Canberra law lecturer, Bruce Arnold, argues the high number of data leaks happening in Australia and overseas shows that the government must step up and move beyond privacy guidelines.

“Australia needs a privacy watchdog that is quick to act, a watchdog that, like its overseas counterparts in the UK and US, is equipped with the sort of financial penalties that get the attention of executives,” Arnold wrote.

-----

http://www.i2p.com.au/article/e-health-high-cost-very-little-return

E-Health - High cost for very little return

Peter Sayers

Politicians in the UK are starting to wake up to the fact that their Department of Health is unable to deliver its electronic care records system, after investing 2.7 billion pounds sterling in the project without being able to demonstrate a single benefit of the system.

The project has suffered from the same problems that have beset a similar Australian project being developed by the National e-Health Transition Authority (NEHTA).

It is now recognised that the pitfalls and wast might have been avoided in the UK had they consulted a range of health professionals before starting the project.

------

http://www.apo.org.au/research/predictive-risk-modelling-health-options-new-zealand-and-australia

Predictive risk modelling in health: options for New Zealand and Australia

• Laura E. Panattoni, and others
• Australian Health Review

PDF Predictive risk modelling in health: options for New Zealand and Australia

08 August 2011

Predictive risk models (PRMs) are case-finding tools that enable health care systems to identify patients at risk of expensive and potentially avoidable events such as emergency hospitalisation. Examples include the PARR (Patients-at-Risk-of-Rehospitalisation) tool and Combined Predictive Model used by the National Health Service in England.

------

http://www.smh.com.au/technology/sci-tech/second-skin-has-a-feel-for-those-vital-signs-in-need-of-attention-20110812-1ipey.html

Second skin has a feel for those vital signs in need of attention

Nicky Phillips TECHNOLOGY

August 12, 2011

THE days of connecting patients to medical monitoring machines with bulky electrodes and intrusive wires may soon be over thanks to an ultra-thin electronic device that can be applied to skin like a temporary tattoo.

The stick-on device can measure a person's heart beat, brain waves and muscle activity and, in future, could also be used for wound healing and muscle rehabilitation.

An engineer and co-inventor of the device, John Rogers, said the aim was to develop an electronic technology that could integrate with the skin and was almost unnoticeable to the user.

-----

Enjoy!

David.

AusHealthIT Poll Number 83 – Results – 15th August, 2011.

The question was:

Do The Views of Victoria and SA Health on the PCEHR Suggest A Need For a Design and Governance Rethink?

For Sure

- 18 (62%)

Probably

- 6 (20%)

Probably Not

- 4 (13%)

No Way

- 1 (3%)

With 82% on the affirmative we have a pretty clear outcome!

Votes : 29

Again, many thanks to those that voted!

David.

Rumours Confirmed On Winner of PCEHR National Infrastructure Tender. Condolences and Congratulations!

The following reports appeared today.

Accenture-Oracle bags major PCEHR deal

• Karen Dearne
• From: Australian IT
• August 15, 2011 9:34AM

AN Accenture-led consortium has won the pivotal contract to deliver a national IT infrastructure for the Gillard government’s $500 million personally controlled e-health records system.

The team includes Oracle and Orion Health, in a reprisal of the Accenture-led consortium that last year won a $146m contract to deliver Singapore’s e-health records program.

Health Minister Nicola Roxon has promised that by July 1 next year, every Australian who wants one will have access to a personal e-health record, leaving a very tight timeframe to complete the project build.

The contract -- originally due to commence last month -- involves the detailed design and construction of the whole system, integration with existing health IT infrastructure across the nation, and testing.

Accenture began hiring for the project last week, seeking staff with experience in Oracle’s service bus integration engine, identity management architecture, business intelligence enterprise suite and Siebel OnDemand customer relationship management.

Orion Health will supply its Concerto medical applications portal, which sits on top of existing information systems and gives doctors a single point of access for patient records, lab results, digital images and service orders.

Accenture has been boosting its health IT credentials for some time, with a particular focus on the public sector.

More here:

http://www.theaustralian.com.au/australian-it/government/accenture-oracle-bags-major-pcehr-deal/story-fn4htb9o-1226115032514

There is also coverage here:

Exclusive: Accenture wins national e-health IT contract

By Brett Winterford on Aug 15, 2011 6:58 AM

Oracle software to back Federal Government's e-health record system.

The Department of Health and Ageing has awarded a consortium led by Accenture one of the biggest IT deals to be offered in Federal Government this year: a contract for development of Australia’s personally controlled electronic health record (PCEHR) system.

The contract, awarded this week for an undisclosed amount, would be worth a sizeable chunk of the Federal Government’s $466.7 million investment into the records.

The tender, which had been delayed for several months in late 2010 and early 2011, called for a "national infrastructure partner" to design, build, integrate and test the PCEHR.

This involved the build of an operations centre and core ICT infrastructure for the PCEHR program, the development of portals for healthcare suppliers and consumers for access to e-health records.

It would also be required to build a call centre to handle inquiries about the system.

More here:

http://www.itnews.com.au/News/266723,exclusive-accenture-wins-national-e-health-it-contract.aspx

I have to say all one can do is with them luck. They are being driven to deliver an unworkable solution which will wind up being an enormous waste of money. If I were a vendor this is a contact I think I would have liked to lose!

David.

PCEHR ConOps Submissions Reviewed And Why The States Are Not Happy With the PCEHR.

A week or so ago I came upon a cached copy in Google of this recently created report.

You can read that blog here:

http://aushealthit.blogspot.com/2011/08/doha-nehta-provides-some-analysis-on.html

Over the last few days I have been sent the full .pdf file of that report. I can't find it on the web but it does not appear secret so here you go!

You may down load the file from here (about 850k).

http://moreassoc.com.au/downloads/ConOps%20Submissions%20Report%20v1%2004.pdf

It is interesting to note the planned process for the development and finalisation of the PCEHR ConOps.

3 Process review

3.1 Overview of the ConOps submissions review process

The development and finalisation of the PCEHR ConOps document has three phases:

3.1.1 Phase one: initial development of the ConOps

The content in the draft ConOps was shaped by the wide range of consultations which DoHA and NEHTA have held with stakeholders — consumer groups, health professionals, the Information and Communications Technology (ICT) industry and state and territory governments. These consultations are described in more detail in Appendix A of the Draft Concept of Operations: Relating to the introduction of a personally controlled electronic health record (PCEHR) system.

The draft ConOps document was released for public consultation on 12 April 2011. Public submissions were sought as part of this process. The original closing date for accepting submissions was 31 May 2011. The closing date was subsequently extended until midnight on 7 June 2011 in response to the high level of interest shown in the ConOps consultation process. Submissions on the draft ConOps were accepted via the following channels:

• Public comments submitted via the yourhealth.gov.au website
• Electronic documents provided by email
• Hardcopy documents provided by post

3.1.2 Phase two: review and analysis of submissions on the draft ConOps

A register was assembled by DoHA of all the submissions that were received on the draft ConOps. An initial analysis of all of the submissions was undertaken. Based on this initial analysis, each section of all of the submissions was then subject to a more detailed analysis by multiple reviewers.

A triage process was then undertaken to group, sort and prioritise the content of the submissions. Following this process a number of internal working groups were formed of subject matter experts to focus on specific areas to identify the key themes and points of interest raised in the submissions. An independent review of the key themes and points of interest raised in the submissions was concurrently undertaken in parallel with these working groups.

This information was then synthesised and consolidated with the information gained during the initial analysis of the submissions to produce this report.

3.1.3 Phase three: update and finalisation

The draft ConOps document will be revised to incorporate changes based on the submissions process, and further discussions with key stakeholder groups,

including individuals, healthcare providers, the ICT industry and state and territory governments.

The ConOps document is expected to be finalised in August 2011. This document will incorporate all changes that have been made to the ConOps based on the feedback received as part of the submissions process.

Where applicable, information and suggestions from the submissions on the ConOps will be incorporated into design work by the National Infrastructure Partner, and will also be included as part of the work being undertaken by the National Change and Adoption Partner for the PCEHR program.

----- End Extract

The main point here is that we should be seeing the final version of the ConOps by the end of August 2011. I suggest those interested read the full document that is linked above - a summary of which is provided in my earlier blog.

However, an even more interesting quote is found here in Section 1.0 of the document.

1 Introduction

In the 2010/11 Federal Budget, the Australian Government allocated $466.7 million for the development and implementation of a Personally Controlled Electronic Health Record (PCEHR) system. The Draft Concept of Operations: Relating to the introduction of a personally controlled electronic health record (PCEHR) system (ConOps) was initially based on a framework for a national electronic health record system agreed by the Australian Health Ministers Conference in April 2010. The ConOps document was further developed and refined through an extensive consultation process that included consumers, healthcare providers, the information and communication technologies (ICT) industry, and government organisations. The draft ConOps was made available to the public on 12 April 2011 for consultation and comment.

Note the bold part of the comment.

I thought I would go and have a look and see what was actually agreed:

Here is the COAG and AHMC reference:

http://www.coag.gov.au/coag_meeting_outcomes/2010-04-19/index.cfm

E-Health

COAG noted the importance of continuing to work towards a National Individual Electronic Health Record system and agreed to prioritise discussions over the coming months to move towards the implementation phase.

----- End Extract

The relevant meetings of AHMAC are found on this page:

http://www.ahmac.gov.au/site/media_releases.aspx

Here is the relevant April 2010 entry.

22 April 2010 - AHMC Communique

Australian Health Ministers from the Commonwealth and all States and Territories met in Perth today and discussed a range of health issues including the ground breaking national health reforms negotiated at COAG this week.

Sadly there is no mention in these documents of e-Health.

The only mention that is close seems to be this one from November, 2009 which only talks about the HI Service:

http://www.ahmac.gov.au/cms_documents/2009%20-%20Nov%2013%20AHMC%20Final%20Communique.doc

National e-health system one step closer

Health Ministers today affirmed their commitment to the introduction in 2010 of national healthcare identifier numbers and agreed to release for further consultation draft legislation for establishing the healthcare identifiers.

Ministers considered feedback from the first phase of public consultations held in July-August 2009. Following these consultations and feedback, further work has been done on the identifiers to clarify and strengthen patient privacy. Ministers have now agreed:

§ the legislative framework will limit the use of healthcare identifiers to health information management and communication purposes as part of delivering a healthcare service;

§ healthcare identifiers will be underpinned by effective national privacy arrangements, protecting health information wherever it is associated with healthcare identifiers, regardless of whether the information is held by a public or private organisation;

§ the Healthcare Identifiers Service (HI Service) will have an appropriate governance framework with transparent and accountable processes;

§ penalties will apply to the misuse of healthcare identifiers; and

§ to review the implementation of the healthcare identifiers after a period of two years.

Healthcare Identifiers are unique numbers that will be given to all healthcare providers, healthcare organisations and healthcare consumers. These unique numbers will provide a new level of confidence when communicating patient information between the myriad of private and government healthcare providers and systems. The identifiers are an important building block for the eventual introduction of a patient controlled Individual Electronic Health Record.

The legislation to establish the Healthcare Identifiers will be introduced to the Federal Parliament in the Autumn 2010 sittings.

-----

It is now clear why there is some angst on the part of State Governments. Essentially the PCEHR has just been ‘dropped-on’ them with no funding and as they say ‘they don’t like it’

See here:

http://www.itnews.com.au/News/266246,states-demand-federal-funding-for-e-health-record.aspx

States demand federal funding for e-health record

By James Hutchinson on Aug 9, 2011 1:47 PM

State costs likely above $467 million capital spend.

Australia's State governments have called for federal funding to help implement the national e-health record by July 1 next year.

The Victorian Government in particular has accused the Department of Health and Ageing (DoHA) of failing to discuss Federal Government plans with state and territory governments ahead of implementation, according to a submission released this week.

and here:

http://www.itnews.com.au/News/266582,feds-push-back-on-state-e-health-funding.aspx

Feds push back on state e-health funding

By James Hutchinson on Aug 12, 2011 7:04 AM

States want more money for e-health record integration costs.

The Federal Department of Health and Ageing has denied states and territories additional funding to implement its $467 million personally-controlled electronic health record (PCEHR) project.

The lack of federal funding would require individual state governments to front up their own money to establish infrastructure not directly tied to the rollout of the national e-health records.

"No additional PCEHR funding is expected to be allocated to states or territories," a department spokesman said.

-----

So we have a real stand off here. States won’t move without extra funds and the Commonwealth says there are no extra funds. It really is astonishing - and incompetent - that a program of this scale which inevitably involves the states in all sorts of ways was not agreed by COAG before it was commenced. Really bizarre!

It is, of course, worth noting that the ConOps really amounts to a wish list rather than what will be delivered by the National Infrastructure Partner. DoHA and NEHTA will take what they are offered. It is likely that, even then, the political deadlines they are working to will be made a nonsense of by reality!

We can all watch with interest as this plays out!

David.