This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
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."
Here are a few I have come across the last week or so. 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
Still lots of digesting of the now over 100 Submissions to the Senate myHR Inquiry and all sorts of issues in a few State systems.
"Risks not taken seriously enough": Scathing audit of WA Health’s digital patient record system reveals concerns
Lynne Minion | 26 Sep 2018
WA Health’s management of its electronic medical record system has received a scathing appraisal by the state’s Auditor General, with data security vulnerabilities, storage gluts and clinical staff manually working around the digital system among the problems identified.
The Information Systems Audit Report 2018 assessed key business applications at five West Australian government agencies, including the patient medical record system at the Department of Health, and found management was to blame for a litany issues.
“Common weaknesses across all our information systems audits indicate agencies are not taking risks to information systems seriously enough. Most of the issues raised can be easily addressed and it appears that risks are simply not properly understood. They are certainly not being effectively managed.”
SA Health review: EPAS must be overhauled or scrapped
Adam Langenberg, Political reporter, The Advertiser
September 26, 2018 6:56pm
Subscriber only
THE health system’s trouble-plagued electronic patient record system will be overhauled or scrapped altogether, after an SA Health review “confirmed” concerns about its operation.
Three health experts will determine if issues with the electronic patient administration system (EPAS) can be “addressed adequately” after a review found it couldn’t proceed in its current form.
SA Health chief executive Chris McGowan said the panel would also consider whether the problems were so significant that EPAS needs to be scrapped entirely.
Extra funds aren't turning around sick EPAS patient admin system.
South Australia’s troubled electronic patient administration system (EPAS) is set to be overhauled or discontinued altogether after an independent review confirmed longstanding concerns with the rollout.
In an update on the review into the system that kicked off in June, SA Health revealed that continuing the current implementation approach had been “ruled out” by the review panel.
Chief executive Chris McGowan said the review's diagnostic phase had confirmed concerns with the rollout of the system, which remains accessible by only 25 percent of the state's hospital beds.
EPAS: SA clinicians welcome decision to scrap current system, but wary of costs
Adam Langenberg, Political reporter, The Advertiser
September 27, 2018 11:09pm
SOUTH Australia must avoid another health budget black hole as a result of overhauling the state’s trouble-plagued electronic patient record system, a medical union says.
SA Salaried Medical Officers Association president Laura Willington supported an overhaul of the “clunky” electronic patient assessment system (EPAS), but questioned how it could be done without a significant funding injection.
“The issue (with EPAS) is there’s so much that needs to be overhauled and there’s already been so much money spent on it,” Dr Willington said. “At some point, you’ve got to stop spending good money after bad.”
Telstra Health is set to lose $50 million of its $220m government contract to build and operate a national cancer screening register because the project is running two years behind and has to be supported by public servants.
When the federal government controversially outsourced the new register in 2016, the telco’s health arm was expected to have it ready the following year. Telstra Health was to pull together nine cancer-screening registers, giving patients a single record.
However, the project has been beset by delays. The cervical cancer component, due to start in May last year, came online only at the end of June this year. That delayed work on the bowel cancer component, which is not likely to be ready until the end of next year.
Microsoft has launched a program aimed at leveraging artificial intelligence (AI) technologies to aid humanitarian causes.
AI for Humanitarian Action is the third program in the company’s US$115 million AI for Good initiative to launch over the past 18 months.
Frank X. Shaw, the company’s corporate vice president, communications, told a media briefing that new $40 million, five-year AI for Humanitarian Action program is aimed at harnessing the power of AI in four areas: Disaster response, the needs of children, refugees and displaced people, and promoting human rights.
“We’ll do this by working with specific NGOs and humanitarian organisations through financial grants, technology investments, and partnerships that combine our AI and data science know-how with these groups’ core expertise,” Shaw said.
Ten-year desktop deal not delivering on savings, jobs ... or anything, really.
The South Australian government’s desktop outsourcing deal has blown out by almost $50 million and faces the prospect of further exceeding its budget.
The consumption-based managed service arrangement with IT services company DXC – formerly CSC – was signed early last year by the former Weatherill Labor government.
The news that the RACGP had struck a deal to “support” a previously unknown, foreign software vendor, Hello Health, to build a completely new patient management system (PMS) for Australian GPs, sounded initially like fake news.
Certainly, Australian GPs are constantly wanting more out of their PMS software vendors, and it would be rare for you to find a GP that didn’t have some issue with their PMS. But the market is already served by about seven local vendors. It is highly competitive, evolving fast with new mobile and cloud players and dominated by two very longstanding and well-respected brands, Best Practice and MedicalDirector.
Between MedicalDirector and Best Practice, the amount of money spent on sponsoring and supporting the RACGP through events, publications and advertising over their collective 25 years in the market would be into the several hundreds of thousands of dollars. So, in a sense, the industry has supported the RACGP and its members in more ways than just supplying their key technology over the years.
The recent My Health Record (MyHR) debate has been essential for Australia – across government, technology and health sectors, as well as, with the broader community. It’s demonstrated how as new technology infrastructures are deployed and technologies evolve, we need to ensure that legislative frameworks keep pace.
And that people, not efficiencies, remain the centre of the system. Because those who engage, support or interact with the MyHR system need to understand it will support their personal health journey now and in the future.
E-health is changing the health sector
We know that new technologies are rapidly changing Australia’s health system and the way it operates in the future will be vastly different to the way it operates today. People will receive more health information through technology-enabled systems and devices. Many consultations will be done virtually, supported by measurement and diagnosis systems that are closer to the consumer’s point of need. Surgery, too, has already begun to be managed by computers. In the future many procedures will be monitored by humans – the same way we trust the autopilot in a plane – if we have extraordinarily well-trained pilots.
But it’s not just about technology – it’s also about people. It’s about how, when and where we access the health system. There are periods during our lives where we will rarely see a doctor and other times when we’ll need to access to doctors, specialists and hospitals – and our health records.
My Health Record – one solution to prepare us for the future
The My Health Record database was developed to help prepare for a rapidly changing health system. First deployed in 2012, it was built to be an index service for important health information. People could opt in to MyHR and control access to their personal health information. Those with MyHR records could ask their clinicians to upload health information to the record – so that others could access the information. There were default settings for what was considered sensitive information – such as a prescription for a medication to control an STD. But in most cases, information would be shared by default.
People could also allow carers and family members access to their medical records through the platform. They could also control which clinicians could see the information. An audit trail provided users with a record of the people or organisations accessing their health data. If an individual accessed the information inappropriately, this would be quickly and easily traced.
Without advertising and government promotion, and limited incentives, the MyHR adoption reached over six million people. Since the MyHR business case, there have been five Health Ministers from both sides of politics who, while needing to re-assess expenditure, agreed that the MyHR is a great initiative and if deployed and managed correctly, will save many lives and reduce the costs of health care delivery.
Privacy and security concerns
The recent decision to move all Australians to MyHR, with the opt out option, raised valid concerns about privacy and security. As pointed out in a Fairfax editorial:
“People who had previously ignored My Health suddenly had to think about the risk that embarrassing, personal information could be hacked and sold or used by governments to persecute or punish. There are precedents including the commercial misuse of social media such as Facebook and a leak of data for 26 million people last year from the British National Health Service.”
In response, Greg Hunt, Minster for Health, announced on 31 July that the MyHR leglisation will be strengthened to match existing Digital Health Agency policy.
This means that a court order is required to release any MyHR information without consent. The amendment will ensure no record can be released to police or government agencies, for any purpose, without a court order.
When it comes to the security of the system, I was directly involved in the designs for defence grade security that was deployed. The security layers were better than the banking sector when it was switched on in 2012. So, with the ongoing investments in the infrastructure, I am certain that the Australian Digital Health Agency, the Digital Transformation Authority and the Department of Health have maintained an equivalent capability.
“Without advertising and government promotion, and limited incentives, the MyHR adoption reached over six million people.”
No it was all those Aspen Medical staff signing up people in hospital corridors and all those in the opt-out trials they hardly knew about that got to 6 million!
“There are also stringent consumer controls that give Australians control over their medical records.
These controls allow individuals to:
apply a record access code to their entire record so that only those healthcare providers with that code can access their record
remove documents from their record if they do not want them as part of the record, or apply a limited document access code to restrict access to specific documents, or
cancel their record at any time to ensure no one can access the information in the record.”
If they know how, know they have a record and have a computer etc."If 97% of Australians adopt the MyHR, this will be a great step forward for the health sector.”
And the evidence for that claim is?
“While the focus has been on encouraging GPs, specialists and hospitals to adopt MyHR, other providers will use the platform as use and acceptance of the system increases. This includes allied health professionals, dentists, aged care facilities, local district nursing services or blood collection services. There are benefits to having a holistic record of a person’s interaction with health or wellness providers.”
I am not sure I want my pathology specimen collector reading myHR – Are you?
“The MyHR was designed on these principles. It is not a central national database of all health record data. The MyHR concept of operations stressed the design of an index to the data sources or ‘repositories’ using templates to structure the clinical information on a common terminology and Health Language Seven (HL7) – the international standard for health care interoperability standards.”
So why does the ADHA talk about “all your health information in one place”?
“The current MyHR and the centralised data store of shared health summaries, referrals and diagnostics is a stop gap until FHIR-based clinical systems are brought online. In five to ten years, the MyHR will likely evolve into an indexing database that accelerates the ability of local systems to interoperate effectively.”
So what we have now is a stop gap system that will evolve over the next decade into what is needed??? What are we to do in the meantime – just put up with a rubbish unusable system?
There is more but it is clear the former NEHTA CEO is not listening to those who wonder what on earth is going on with this program.
Thank you Andrew for explaining all this to us, we really needed the clarity.
