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."

Thursday, October 06, 2011

It Seems There Might Just Be Another Way To Move Forward With E-Health. KISS!

Now here is an idea that will send shivers down the spine of those obsessed with unimplemented technical perfection within NEHTA.

ONC's Mostashari: 'We can't afford to wait another 5 years before we have exchange'

September 28, 2011 | Mary Mosquera
Dr. Farzad Mostashari, the national health IT coordinator, urged the Health IT Standards Committee to lean forward with standards that are “good enough” to get started on robust health information exchange instead of waiting until they gain maturity and wide adoption.
The lack of transport standards is one of the biggest barriers to providers’ sharing information on a national scale, he said. And it is holding back recognition of the progress made in stage 1 of meaningful use. Currently, exchange occurs mainly through proprietary exchange technology formats and Health Level 7 standards. 
Yet stage 2 meaningful use requirements will call for more complex health information exchange, he said at the Sept. 28 standards committee meeting, which advises the Office of the National Coordinator for Health IT (ONC). Providers need a portfolio of standards, tools and services to meet exchange goals.
“My request to you is to push. There is a sense in which not moving on anything is a greater risk than moving forward on something that may be imperfect,” Mostashari said. “We can’t afford to wait another five years before we have exchange in this country.” 
The committee wrestled with how to scale nationally the specifications for the nationwide health information network (NwHIN Exchange) and aspects of how data moves. NwHIN is the set of standards and services that enable typically large organizations and federal agencies to share information securely through the Internet. ONC wants to expand NwHIN Exchange participation.
The NwHIN team explored “if we were to adopt today standards for nationwide use, what seems directionally good enough for that particular purpose and what needs more work,” said Dr. John Halamka, committee co-chair and CIO of Beth Israel Deaconess Medical Center. The group provided its best observations and evaluation of what is available.
Standards, services and policies for NwHIN Exchange must be deployable within an architectural framework capable enough to support secure information exchange at a national scale. “The building blocks have to fit and operate within an architectural framework,” said Dixie Baker, NwHIN team lead and SAIC senior vice president and chief technology officer for health solutions.
More details are here:
When you have the US National Co-ordinator for Health IT saying we need to actually just get moving rather than obsessing with technical perfection all I can say is Yeah!
We have watched NEHTA now for over 5 years produce more documents than you could climb over - and where is all this work and cost actually making a difference? I am sure those who consult to or a paid by NEHTA are thrilled -but the clinicians and patients who they are meant to be serving - what have they had or really seen as yet.
There really is a crying need for a profound strategic review that focusses on working out just what can be moved into real implementation and have a real impact and how can this actually be achieved.
As they have recognised in the US, enough is enough! Let’s actually get going with practical and useful. And while we are doing that lets re-think the PCEHR and how it will work and be used to make it practical and useful!
David.

Wednesday, October 05, 2011

It Does Not Seem The Concern About What Is Going On Inside Queensland Health Is Going Away.

The following appeared a few days ago:

Queensland Health rejects claim of bias in e-health deal

QUEENSLAND Health has defended its procurement of a $182 million e-medical records (eMR) system for state hospitals amid claims of bias towards the market leader, Cerner.
Opposition health spokesman Mark McArdle has obtained 3120 pages of emails, strategies, plans and minutes generated about the eMR tender between June 2009 and April this year under state Right To Information laws.
Another 942 pages were not released due to being either "cabinet or commercial in confidence".
Mr McArdle claims the documents show senior departmental officers asked research firm Gartner to make changes to its independent report on a market scanning exercise in 2009.
He has asked the Queensland Auditor-General to "conduct a full audit of the health IT program to ensure future patient care is not placed at risk and taxpayers' funds are not wasted".
Mr McArdle is concerned that the process may have unfairly prevented potential competitors from bidding.
More here:
Additionally we had this well researched contribution a day later

Gartner defends Queensland Health report

James Hutchinson

Analyst firm dragged into 'political wrangling'.

Research firm Gartner has stepped in to defend a report at the centre of allegations Queensland Health was biased in choosing a provider for its $182 million state-wide electronic medical record.
Senior departmental staff were alleged to have requested changes from the authors of a 2009 Gartner report to favour e-health provider Cerner over other bidders for the project.
Confidential emails between Queensland Health chief information officer Ray Brown, senior e-health director Tam Shepherd and staff were obtained and published by shadow health minister Mark McArdle under state Right to Information laws last week.
The emails [pdf] revealed that Graham Bretag of the department's e-health contract and vendor management e-health division had asked Gartner to alter a column denoting Cerner as the only company having a "generation three" computer-based patient record (CPR) installation in Australia.
Bretag had also asked for "unambiguous clarification" that rival bidders Lorenzo and i.CM did not having the same level of installation locally.
Gartner's report highlighted a total of five bidders with installations in Australia at differing "generations" of capability.
The authors had agreed to make the changes, according to the emails.
However, Gartner's Asia Pacific head of research Ian Bertram told iTnews the changes were part of the usual fact-checking process undertaken by the research firm during authoring of the report.
The changes did not change the recommendations or conclusions of the report, he said.
"In this case it was just a fact clarification, having a look at the exact same data but just calling out more explicity which CPR gen 3 was installed in Australia," he said.
Gartner had approached all potential bidders for the project, as well as the department, to partake in the process.
"There was a raft of different recommendations that we came to," Bertram said.
"We never, in our engagement, said there was one clear winner. That's not what we were engaged to do, we were engaged to help put together selection criteria to help them go out and find a [winner]."
Bertram said the change was absolutely factual and did not place Cerner in a more favourable light.
As a "generation three" install, Cerner systems were shown to have integrated pharmaceutical functionality and cover both ambulatory and acute care settings.
Gartner's framework used a scale of five generations, with each level delineated by certain minimum requirements.
Queensland Health chief information officer Brown denied any wrongdoing on the behalf of departmental staff.
"Independent probity experts, governance experts and lawyers reviewed the process adopted by Queensland Health, raised no concerns with actions taken, and confirmed the process was appropriate," he said.
The probity report had found procurement processes were consistent and "undertaken with attention to transparency and fair dealing".
Brown said the probity adviser had found there was "no reason to believe Cerner has been treated with undue bias in any of the procurement processes, communications or stages".
iTnews was denied access to the report by Queensland Health.
The department also confirmed that Shephard resigned from his position last week, as initial allegations against the procurement processes were first made.
Shepherd would take on a chief executive role in the primary health sector.
More here:
Now after my original post on the matter (see here):
we have had a voice from north of the Tweed be in touch. A few extra points were made:
First I was told that the last post in the comments of the previous blog was very close to the full truth.
Anonymous said...
This is nothing of a surprise - Cerner have been trying to get into Q'health for at least 5 years. Their ploy was always to use their Radiology contract at PA Hospital as the way in and avoid a public tender. They have a real strong supporter in a well-known doctor at PA who wanted the Cerner solution prior to Trak Health. Truth is it will fail - there is no way Cerner can deliver a solution to Q'Health and replace so many inbedded departmental solutions that are state wide. Whilst this is clearly a 'back-door' deal it will flop. And as a foot note, if any government thinks that spending $180M plus without the need for a market tender is OK - they too will fall. Problem is, will Cerner get ink on the contract before the election ?
Additional points were also made:
1. Initially QH had hoped to purchase Cerner via the NSW Period Contract. This would remove the need for tendering and keep all above board. This plan was apparently referred to internally as Project Mango.
2. About 2 years ago it was realised this would not work and so a selective procurement was planned based on having a consultant provide a market report.
3. This ‘process’ led to Cerner being selected but there was a distinct lack of a requirements statement on which a contract for delivery could be properly framed - such a requirements document having (apparently) never been developed.
4. The situation is now that negotiations for a contract are going on with no real clarity as to what is being actually procured - which is pretty risky and was concerning the voice from the North greatly.
The reader will see the Anon comment and my informant match up quite nicely so it is possible that a. It is true, b. the source is the same person or some other possibility - such as evil intent etc.
Whatever I suspect there will be more to come on this and that the Qld Opposition won’t let it go. We await the next episode!
David.

Tuesday, October 04, 2011

A New And Very Interesting NEHTA Document Has Come To Light. The Number Of Copies That Have Arrived Here is Amazing!

The document is entitled as follows:

Specifications and Standards Plan

PCEHR System

Version 1.1 —30 September 2011
For Discussion
You may download your own personal copy from the link below.
What the document is proposing - in response to the fact that Standards are not ready for many aspects of the PCEHR - is a process involving the formation of Tiger Teams. These teams will produce Draft Standards for Trial Use (DSTU). These will essentially be the NEHTA specifications as previously developed.
The Tiger Teams will be made up as follows:
“It is proposed that the Tiger Teams are co-led by PCEHR participation and an IT-014-XX representative(s). If more than one of the IT-014-XX committees are involved, one would take the co-lead on behalf of the IT-014 community.
Tiger teams must also include suitable representation from the National Infrastructure Partner, Change and Adoption Partner, and the Benefits Evaluation Partner, as well as contribution from the Lead Implementation Sites.”
It is intended, apparently that this work will be finalised before November, 30 2011, so that all the Wave Sites and Accenture can get on with implementation.
In the meantime it is planned that the DSTU is tidied up, formatted and published, later, as an Australian Standard. This does rather seem to be a cart before the horse approach if we are to have a standards based PCEHR.
It will be very interesting to see the response of the IT-14 Committee Members to this approach. I get the sense they are not thrilled with what they are reading. Time will tell I am sure.
As far as I am concerned this is just politically driven nonsense which quite severely distorts Health Informatics Standards creation in OZ. But in these crazy times - so it goes!
David.

Monday, October 03, 2011

Weekly Australian Health IT Links – 3rd October, 2011.

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

General Comment

The main news of the week has been the release of the PCEHR draft legislation - as discussed yesterday.
In the background we still have the apparent problems in Qld Health rumbling along with progressive dribbles of information as to what has gone on.
Additionally we have a few odd random pieces of news on telehealth, Medicare Locals and so on. It is interesting that concern about the Medicare Locals program continues to rumble on. I suspect this is another situation where the continued concern is pointing to some basic flaws in the whole Medicare Local program which are not going to be easily solved.
Certainly just how Medicare Locals will contribute to e-Health does not seem to be yet fully defined. I guess this will all become clear over time.
-----

Medical association concerned over PCEHR draft legislation

According to the industry body, the proposal fails to address the issue of availability of critical information for practitioners
The Australian Medical Association (AMA) has raised concerns that the federal government’s released draft of legislation for the Personally Controlled Electronic Health Record (PCEHR) still fails to address the availability of critical information for practitioners.
AMA federal vice president, Steve Hambleton, told Computerworld Australia the government’s nominated healthcare providers, which includes medical practitioners, nurses, aboriginal health practitioners and others, remained a concern for the system’s success.
“We’d prefer to start with medical practitioners to get used to the system and get it up and running and then widen it after that if it seems suitable,” Hambleton said.
-----

The PCEHR treasure hunt

Techno Blog | 30 September 2011 | 0 Comments
BY KAREN DEARNE
LONG weekends, school holidays, Christmas—politicians never like to waste an opportunity to quietly announce something potentially controversial when it may be overlooked or when people are otherwise engaged.
This time, it’s Health Minister Nicola Roxon releasing long-anticipated draft legislation to underpin the establishment and operation of the government’s $500 million e-health record system.
She needs to get the new laws rushed into place, because she has set a deadline for the commencement of the program of July 1 next year.
To make it even harder for those inclined to take a look, the material is not on the Health Department’s main website, it’s at www.yourhealth.gov.au
-----

Hefty fines for e-health record misuse as Roxon releases draft legislation

  • by: Karen Dearne
  • From: Australian IT
  • September 30, 2011 10:28AM
HEALTH Minister Nicola Roxon has released long-awaited draft legislation to support the introduction of a nationwide electronic health records system, due to commence operations on July 1, 2012.
The proposed bill features penalties of up to $66,000 for inappropriate access to a record, with penalties being multiplied by the number of records which have been inappropriately accessed.
Ms Roxon said proactive monitoring of the system will take place to detect suspicious behaviour, and ensure records are only accessed when there is a need to do so.
"Using a combination of legislation, security and technology, backed by strict penalties for infringements, we will give patients peace of mind that their sensitive medical information is safe and secure,” she said in a statement.
"For the first time patients will have control over who accesses their information and, further, they will know who has accessed their medical records, and when."
-----

Health department issues PCEHR legislation draft

The document calls for public submissions and outlines the security and privacy framework underpinning the project
The federal government has released draft legislation for its $466.7 million Personally Controlled Electronic Health Records (PCEHR) project, following the release of the Concept of Operations document earlier this month.
Minister for Health and Ageing, Nicola Roxon, said the draft (PDF) had been released for public consultation and outlined the process for consumers, healthcare providers and data sources to register for the e-health system.
“For the first time patients will have control over who accesses their information — and further they will know who has accessed their medical records, and the exact time that record was accessed,” Roxon said in a statement.
-----

Draft e-health Bill tough on privacy

By Luke Hopewell, ZDNet.com.au on September 30th, 2011
Federal Health Minister Nicola Roxon has today aired the exposure draft of the legislation behind the government's personally controlled e-health records (PCEHR) project, while outlining tough penalties for those found in breach of the proposed privacy provisions.
The 74-page draft legislation (PDF) was published today, and specifies how Australians can sign up for, control and restrict their own e-health record. The draft also detailed the role of a national operator — who will run customer and provider access portals, core services and the National Repositories Service in a dual-datacentre environment — and revealed the harsh penalties for those found breaching patient confidentiality on the system.
"Using a combination of legislation, security and technology, backed by strict penalties for infringements, we will give patients peace of mind that their sensitive medical information is safe and secure," Roxon said in a statement today.
-----

Fines levied for e-health data breaches

Patient records available to law enforcement and courts.

The Federal Government will penalise health practitioners to the tune of $66,000 for any personally controlled electronic health record compromised, leaked or “inappropriately accessed” under draft e-health legislation released today.
Health Minister Nicola Roxon said in a statement that she expected the PCEHR system to be “more secure and private” than paper-based records.
The draft legislation [pdf] includes strong penalties of $13,200 per instance of a record being accessed without authorisation or confidential information leaked.
-----
Yearb Med Inform. 2011;6(1):131-8.

The Role of Social Media for Patients and Consumer Health. Contribution of the IMIA Consumer Health Informatics Working Group.

Source

Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia. Tel: +61(2) 9385 8891; Fax: +61(2) 9385 8692; E-mail: a.lau@unsw.edu.au.
-----

Gartner defends Queensland Health report

Analyst firm dragged into 'political wrangling'.

Research firm Gartner has stepped in to defend a report at the centre of allegations Queensland Health was biased in choosing a provider for its $182 million state-wide electronic medical record.
Senior departmental staff were alleged to have requested changes from the authors of a 2009 Gartner report to favour e-health provider Cerner over other bidders for the project.
Confidential emails between Queensland Health chief information officer Ray Brown, senior e-health director Tam Shepherd and staff were obtained and published by shadow health minister Mark McArdle under state Right to Information laws last week.
The emails [pdf] revealed that Graham Bretag of the department's e-health contract and vendor management e-health division had asked Gartner to alter a column denoting Cerner as the only company having a "generation three" computer-based patient record (CPR) installation in Australia.
-----

Queensland Health rejects claim of bias in e-health deal

QUEENSLAND Health has defended its procurement of a $182 million e-medical records (eMR) system for state hospitals amid claims of bias towards the market leader, Cerner.
Opposition health spokesman Mark McArdle has obtained 3120 pages of emails, strategies, plans and minutes generated about the eMR tender between June 2009 and April this year under state Right To Information laws.
Another 942 pages were not released due to being either "cabinet or commercial in confidence".
Mr McArdle claims the documents show senior departmental officers asked research firm Gartner to make changes to its independent report on a market scanning exercise in 2009.
-----

Telehealth simulation lab launches at UWS

The lab simulates a remote or stay-at-home patient environment with the aim of improving telehealth services
A new research lab that simulates telehealth services for remote and stay-at-home patients has opened at the University of Western Sydney (UWS).
The Telehealth Research and Innovation Lab (THRIL), located at UWS’ Campbelltown campus, has a fully furnished home lounge room equipped with sensors that transmit data about its occupants to researchers in a control room residing next door.
UWS School of Computing and Mathematics, Associate Professor Klaus Veil, said in “real life” the home could be thousands of kilometres from medical staff and still be linked to multiple healthcare providers and specialists.
-----

Many questions still plague Medicare Locals

26th Sep 2011 Dr Steve Hambleton
THE AMA has raised concerns about Medicare Locals (MLs) since they were first announced.
We still have no answers to our original questions around form and function and, importantly, guarantees on the key leadership roles of GPs in the management and decision-making of MLs.
I announced at the National Press Club in Canberra in July that I would visit each of the MLs and find out from the local GPs what they thought of the cornerstone of the government’s bold new direction in primary care.
So, in recent weeks I have visited three South Australian MLs – Country North, Country South, and Central Adelaide and Hills – and there is clearly a lack of knowledge and understanding of what is supposed to be going on at the grassroots level.
-----

Cancer patients die waiting for hospital letters

CANCER patients have been kept waiting so long to receive follow-up letters from their specialists that some have died before the advice arrived at their GPs.
A backlog of correspondence needing to be typed up at Westmead Hospital means about 700 people have waited up to three years for the letters to be sent.
In one case, a Sydney doctor received a letter from Westmead about a female patient with advanced skin cancer that had been dictated by a specialist on August 21, 2009, but was not typed up until September 16, 2011. By the time it reached Dr Adrian Sheen the woman had been dead for a year.
-----

Hard to swallow: pharmacists split over pill push

Julia Medew
September 27, 2011
PHARMACISTS who market dietary supplements to patients with prescription medicines may be breaking the law, the pharmacists' union says.
The chief executive officer of the Association of Professional Engineers, Scientists & Managers Australia, Chris Walton, said under Australia's Health Professions Registration Act, pharmacy owners could not direct employee pharmacists to engage in unprofessional conduct, which would include ''pressuring the public to buy vitamins they may not need''.

Computers produce brain scan 'movies'

  • September 23, 2011 12:23PM
IT sounds like science fiction: While volunteers watched movie clips, a scanner watched their brains.
And from their brain activity, a computer made rough reconstructions of what they viewed.
Scientists reported that result yesterday and speculated such an approach might be able to reveal dreams and hallucinations someday.
In the future, it might help stroke victims or others who have no other way to communicate, said Jack Gallant, a neuroscientist at the University of California, Berkeley, and co-author of the paper.
-----

Mozilla puts Firefox 7 on memory diet, patches 11 bugs

Continues to support aged Firefox 3.6 with security updates
  • Gregg Keizer (Computerworld (US))
  • 29 September, 2011 06:31
Mozilla yesterday patched 11 vulnerabilities in the desktop edition of Firefox as it upgraded the browser to version 7.
The company has batted a thousand so far in its rapid release schedule: Firefox 7 marks the third consecutive upgrade that Mozilla has met its every-six-week deadline for a new version of the browser.
Mozilla switched to the faster release tempo last March, when some wondered whether the open-source company -- which has historically struggled to ship on time -- would be able to make its milestones.
The biggest improvement to Firefox 7 is a reduction in memory use. Mozilla has previously claimed that the upgrade slashes memory consumption by as much as 50%
-----
Enjoy!
David.

AusHealthIT Poll Number 90 – Results – 3rd October, 2011.

The question was:
Should Large Complex Tertiary Hospitals Conduct Individualised Clinical System Implementations Or Be Forced Into a Statewide Model Build?
Full Implementation Autonomy
- 7 (21%)
Major Implementation Autonomy
-  9 (28%)
Neutral  
-  5 (15%)
Forced To Mostly Fit State-wide Model
-  4 (12%)
Full Compliance With State-wide Model
-  7 (21%)
 Votes : 32
A pretty clear  vote. 49% want major autonomy or better and 33% want a more inflexible approach.
Again, many thanks to those that voted!
David.

Sunday, October 02, 2011

Draft Legislation for the Planned PCEHR - Well Done or Not? It Has A Few Gaps and Kludges To Me!

Just before the two day ‘Festival of the Boot’ we have had Draft enabling legislation for the PCEHR along with the submissions made in response to the consultation document.
The announcement is found here:
The web site for the whole process is here:

Exposure Draft PCEHR Bill Released

The Exposure Draft PCEHR Bill 2011 will establish the legislative framework to support the establishment and implementation of a national personally controlled electronic health record (PCEHR) system.
The Exposure Draft PCEHR Bill 2011 (PCEHR Draft Bill) has been developed following feedback and submissions received by the Department of Health and Ageing for the public consultation of the PCEHR System: Legislation Issues Paper along with feedback from the Concept of Operations: Relating to the introduction of a PCEHR system released in final form on 12 September 2011.
The PCEHR Draft Bill supports ‘personal control’ by consumers, enabling individuals to access their own health information and to choose how access by healthcare provider organisations to their PCEHR is managed by the system.
The PCEHR Draft Bill includes provisions relating to participation in the PCEHR system, the circumstances in which PCEHR information can be accessed, obligations on users, penalties for inappropriate use, and functions and responsibilities of the PCEHR System Operator and other regulators.
To assist readers, the PCEHR System: Exposure Draft Legislation – a companion document to the PCEHR Draft Bill – sets out the proposed legislative provisions in plain English, explaining the reasons behind those provisions and describing how they are intended to operate.
.....
The closing date for comments and submissions is 10:00 am Australian Eastern Standard Time, Friday 28 October 2011.
 ----- End Page.
To me - as a legal novice - by far the most useful document is the one found here:
Here is the Executive Summary:

Executive summary

The personally controlled electronic health record (PCEHR) system is a key element of the Australian Government’s national health reform agenda. The PCEHR system and other health reform programs are designed to improve the delivery of health services and healthcare outcomes for all Australians.
The Department of Health and Ageing is responsible for managing the design and implementation of the system in association with consumers, the National E-Health Transition Authority, states and territories, clinicians, health sector stakeholders and key market partners.
The Exposure Draft Personally Controlled Electronic Health Records Bill 2011 and Exposure Draft Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 have been developed to support the implementation and operation of the personally controlled electronic health record (PCEHR) system. The consultation process undertaken for the Draft Concept of Operations—Relating to the introduction of a PCEHR system1 and the PCEHR System: Legislation Issues Paper2 informed the development of this legislation.
The Draft Bills set out:
• key definitions and concepts necessary for the legislative framework to operate, including;
− the PCEHR of a consumer, which is constituted by a record
assembled by the System Operator from a number of separate data sources accessed through the record; and
− the entities that are participants in the PCEHR system;
• the functions and obligations of the PCEHR System Operator and its advisory committees;
• the registration of consumers, healthcare provider organisations, repository operators, portal operators and contracted service providers. Registration enables them to participate in the PCEHR
system. It does so by:
− authorising them to collect, use and disclose PCEHR information in specified circumstances; and
− imposing certain obligations on them to maintain the integrity of
the PCEHR system;
• civil penalties for:
− unauthorised collection, by means of the PCEHR system, of information included in a consumer’s PCEHR;
− unauthorised use or disclosure of such information;
− compromising the integrity of the PCEHR system;
• authorisations of various collections, uses and disclosures of PCEHR information;
• that contraventions of the legislation relating to health information included in a consumer’s PCEHR can also be investigated under the Commonwealth Privacy Act 1988;
• general matters, including:
review of decisions made by the PCEHR System Operator;
annual reports to be provided by the System Operator and the Information Commissioner;
review of the legislation; and
regulations and legislative instruments including the PCEHR Rules.
----- End Extract.
Before discussing my thoughts - while reading I came upon this - on Page 11- where prior consultation is discussed.
March 2011: The Department of Health and Ageing selected nine organisations as part of the second wave of lead sites. The e-health lead sites have been set up to implement and evaluate e-health infrastructure and standards in real life settings. The sites are required to demonstrate tangible benefits and outcomes from e-health projects, to build stakeholder support and momentum behind the system work program, and to provide a meaningful foundation for the PCEHR system’s further enhancement and roll-out. Because the sites will test critical elements of the PCEHR system in real life settings, they will help to ensure that lessons from their experience can be incorporated into the continuing development processes of the PCEHR system. While the first three lead e-health sites are focused on e-health infrastructure and standards around general practice and will allow the important elements of the PCEHR system to be tested in a range of practical settings, the following nine e-health sites will also allow important elements of the PCEHR system to be tested in a range of settings, but with a focus on specific cohorts including people with chronic illness and mothers and newborns.
As far as the section in bold is concerned is all one can say is ‘good luck with that’. I wonder what ‘tangible benefits and outcomes’ actually means and how it will be evaluated?
Back to the Draft Legislation:
Here are a few comments (on the explanatory document):
Page 8: (As reported by Adobe)
“Binding of the Crown
The Draft Bill applies to the Commonwealth, states and territories and section7 of the Draft Bill provides that all jurisdictions will be subject to this law.
While each jurisdiction will be legally bound by the arrangements set out in the Draft Bill, the Crown in right of the Commonwealth, states and territories will not be subject to prosecution and will not be liable for pecuniary penalties.”
So it seems no Government can be sued or prosecuted for any of this?
Page 13:
"It is intended that the Secretary will fill the role of System Operator initially. Further discussions will be held with the states and territories around possible future options for the long-term governance of national e-health such as an inter-jurisdictional body."
So it is clear they have not yet sorted PCEHR system Governance and that for now Jane Halton will operate the PCEHR system!
It is my view this is utterly un-acceptable to be creating a system to contain a very wide range of private personal information and not have the governance properly laid out and defined before the whole thing starts.
Page 14:
“(the System Operator) In performing these functions and in exercising any powers associated with those functions, the Draft Bill requires that the System Operator must have regard to advice provided to it by the two advisory bodies established by the Draft Bill: the jurisdictional advisory committee and the independent advisory council.
The System Operator is not required to follow the advice of these advisory bodies, however the existence of these bodies provides the System Operator with access to specialist advice in a broad range of areas.
The System operator and the advisory bodies may, of course, draw on other expert advice as appropriate, such as the Office of the Australian Information Commissioner in relation to privacy matters.”
This makes is clear the advisory committees are just that - advisory!
Page 16:
“This council will have the privileges and immunities of the Crown, which means the council will be immune from prosecution regarding the performance of its duties.
Membership of the council will comprise:
• a Chairperson, to be appointed by the Minister on a part-time basis;
• a Deputy Chair, to be appointed by the Minister on a part-time basis; and
• a minimum of four other members (maximum of seven), to be appointed by the Minister on a part-time basis. In appointing members, the Minister must ensure the members have experience in one or more of the following fields and that all fields are represented on the council:
− provision of healthcare as a medical practitioner;
− provision of healthcare as a healthcare provider (other than a medical practitioner);
− receiving healthcare as a consumer;
− law and/or privacy;
− health informatics and/or information technology relating to healthcare; and
− healthcare administration.
These fields of experience will ensure that detailed advice can be provided by the independent advisory council to the System Operator regarding the operations of the PCEHR system.”
The quality of all this - given that the committee can just be ignored - will depend on who is chosen to fill these slots. We can be sure no one who is at all sceptical of the whole thing will get a call! Of course that is what is needed! At least there is one e-Health expert to be involved!
 Page 22:
Authorised users
By registering, a healthcare provider organisation will be able to authorise persons within the organisation to use the PCEHR system. The organisation may authorise healthcare providers, administrative and other support staff, trainees (including medical students) and contractors as users of the PCEHR system.
The PCEHR Rules with which the organisation must comply will include arrangements for how the organisation must manage the authorisation of such users.”
What this means is, as I read it, that a practice location is authorised and anyone who that practice then authorises is able to access the system and that there won’t be individual practitioner and staff credentials - just an internal to the organisation system (see below). With this out goes any real Audit Trail capacity I reckon. We are not registering individual providers organisational users except for those who will upload summaries!
Page 23:
The doctors will just love this...
“• The organisation must not refuse to treat a consumer or otherwise discriminate against the consumer if the consumer does not have a PCEHR or, if the consumer has a PCEHR, the consumer has set particular access control, such as not permitting the treating healthcare provider to access the PCEHR or some information contained in the PCEHR. This goes toward ensuring that participation in the PCEHR system does not affect a consumer’s entitlement to healthcare.”
This is just offensive to my way of thinking - either you can be open with your doctor -or you go and get another one!
Page 24:
Nominated healthcare providers
A nominated healthcare provider will be responsible for creating and managing a consumer’s shared health summary, and is nominated by the consumer. It is intended that a nominated healthcare provider is involved in the ongoing care of the consumer.
Not all healthcare providers will be eligible to be a nominated healthcare provider. This restriction will ensure the utility of shared health summaries for use by other healthcare providers.
In order to be eligible to be a nominated healthcare provider, a healthcare provider must have an HPI-I (within an organisation that has an HPI-O) and must be a medical practitioner, a registered nurse or an Aboriginal health worker (i.e. Aboriginal and/or Torres Strait Islander health practitioner). The healthcare provider must also agree to be the consumer’s nominated healthcare provider.
Additional types of healthcare providers may be added by the regulations. Only a consumer’s nominated healthcare providers will be permitted to upload” the consumer’s shared health summary.”
So you need to quote a HPI-I to upload a summary but anyone can browse who has access to an HPI-O. I wonder where NASH is up to and when it will be active to secure all this - it seems to have gone pretty quiet!
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“3.3.5 Division 5—The Register
This Division will provide for the establishment of the Register which will be the responsibility of the System Operator.
The purpose of the Register is to record the information submitted as part of the registration process for consumers, healthcare providers, repository operators, portal operators and contracted service providers. This information will consist of personal information such as names, dates of birth and healthcare identifiers.
This information needs to be retained for use by the System Operator to authenticate PCEHR use and access.”
It seems we are building yet another ID database of personal information for registration details.
It is not clear why another one is needed to me - but I am sure there is a reason.
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“Registered healthcare provider organisations must ensure that individuals accessing PCEHRs on their behalf (i.e. authorised users) provide, at the time of access, sufficient information to identify the individual accessing the PCEHR. This requirement is essential to ensuring a comprehensive audit trail is maintained of access to consumers’ PCEHRs.”
What does this actually mean and how will it work? Does it mean the provider organisation needs to retain an audit trail of which user who logged on to what system using the organisational certificate. Note this appears to transfer an obligation back from the PCEHR system to the healthcare provider organisation.
The details here need to be spelled out for certainty given there are apparently penalties here!
Overall it seems to me there are two major issues here:
First the Governance Framework for the PCHER System is being pushed off into the never never. This is really unacceptable.
Second it is clear an approach to providing a user specific audit trail from provider to the PCEHR system is still pretty much a work in progress (in the absence of NASH actually being defined and implemented) - and that the assurances given by NEHTA and the Minister may not be quite there yet!
We will all have to just wait a little longer to see how all this will actually work. That the legislation has penalties for issues arising from the lack of an operational individual authentication system for providers would certainly give many a pause before signing up!
David.