OAIC Reveals What It Has Done In Digital Health For The Year.

We noted this a few days ago:

Annual report of the Australian Information Commissioner's activities in relation to digital health 2022–23

Published: 20 Oct 2023

Executive summary

Download the Annual report of the Australian Information Commissioner's activities in relation to digital health 2022–23

This annual report sets out the Australian Information Commissioner’s digital health compliance and regulatory activity during 2022–23, in accordance with section 106 of the My Health Records Act 2012 (My Health Records Act) and section 30 of the Healthcare Identifiers Act 2010 (HI Act).

Digital health is an increasingly significant part of the healthcare system, and while the use of digital health information continues to grow, it is it is critical that privacy measures are upheld.

The Australian Government has established two key services to underpin digital health in Australia: the Healthcare Identifiers Service (HI Service), and the My Health Record system. Both involve the management of personal information – and for the purposes of this report, we refer to them collectively as ‘digital health’.

Healthcare identifiers are assigned to individuals, healthcare providers, and healthcare provider organisations. They help healthcare providers communicate accurately with each other and identify and access patient records in the My Health Record system.

The My Health Record system is an online summary of an individual’s health information, including their medicines, immunisations, allergies and medical history. Registered healthcare providers, including doctors, nurses and allied health professionals involved in their care can view and add information to it, subject to legislative obligations and any individual access controls.

Following the earlier establishment of the HI Service, the My Health Record system commenced in 2012 as an opt-in system: people needed to register in order to establish and share their record. In 2017, the Australian Government announced the creation of a My Health Record for every Australian. Following an opt-out period that ended on 31 January 2019, a My Health Record was created for everyone who had not opted out of the system.

Privacy is critical to ensuring trust in digital health, and the legislation establishing the My Health Record system and HI Service include important privacy provisions which are regulated by the Office of the Australian Information Commissioner (OAIC). These provisions recognise the special sensitivity of health information, and protect and restrict its collection, use and disclosure. We work to ensure that healthcare providers understand and comply with their privacy obligations.

This report provides information about digital health activities undertaken by the OAIC, including our assessment program, handling of My Health Record data breach notifications, development of guidance material, provision of advice and liaison with key stakeholders.

In 2022–23, the OAIC received 10 privacy complaints relating to the My Health Record system with 11 complaints ongoing at the end of the reporting period, including 6 complaints received in previous reporting periods. We finalised 8 My Health Record system complaints, including 3 complaints from previous reporting periods.

We received 5 new privacy complaints relating to the HI Service in 2022–23, of which we finalised 1, as well as another 7 complaints from the previous year.

Over the reporting period, the OAIC has continued its focus on regulatory policy work in relation to the HI Service and continued to handle complaints and enquiries about healthcare identifiers. These complaints and enquiries primarily concerned the inclusion of Individual Healthcare Identifiers (IHIs) on COVID-19 digital vaccination certificates (vaccination certificates). On 3 December 2022, IHIs were removed from vaccination certificates and we updated our published privacy guidance to assist entities and individuals who had collected vaccination certificates containing an IHI.

We received 10 data breach notifications during the reporting period in relation to the My Health Record system and closed 10 notifications.

We also carried out other digital health-related work including:

• commencing one assessment regarding the My Health Record system and finalising 2 further assessments as part of the My Health Record access security policy assessment program
• providing advice to stakeholders, including the Australian Digital Health Agency (ADHA), Services Australia and the Department of Health and Aged Care about privacy-related matters relevant to the My Health Record system and HI Service
• developing and promoting guidance materials, including publishing a template for healthcare providers to help them comply with security and access policy requirements under the My Health Records Rule 2016 and updating our My Health Record emergency access function guidance
• engaging with the Department of Health and Aged Care regarding the proposed amendments to the Healthcare Identifiers Regulations 2020 and the HI Act , and
• monitoring developments in the My Health Record system and the HI Service.

---- End Summary

Here is the link:

https://www.oaic.gov.au/about-the-OAIC/our-corporate-information/digital-health-annual-reports/annual-report-into-the-australian-information-commissioners-activities-in-relation-to-digital-health-202223

I was going to comment on the detail but it seems the Information Commissioner’s site is down on Sun at 4:30pm.

Try later

David.

 

What Can We Make Of This Latest Plan For Re-Structuring And Sharing

This popped up last week….

Sharing by default: delivery of health interoperability plan in full swing

25 October 2023

By Kate McDonald

The Australian Digital Health Agency (ADHA) will release quarterly updates on the ambitious goals of the national healthcare interoperability plan following the recent creation of the independent Council for Connected Care (CCC), and in light of the federal government’s commitment to a “share by default” policy on health information sharing.

The CCC was announced at the MedInfo conference in July (pictured), to provide strategic advice to ensure implementation of the national health interoperability plan, which was also launched at the conference.

Chaired by Australian Institute of Health and Welfare CEO Rob Heferen, the CCC had its third meeting recently, concentrating on standards. Attendees included representatives from the Australian Commission on Safety and Quality in Health Care, Department of Health and Aged Care, the CSIRO, Standards Australia, HL7 Australia, GS1 Australia, Integrating the Healthcare Enterprise (IHE) and the AIHW.

An update was provided by ADHA’s standards advisory group, chaired by University of Melbourne associate dean of digital health and informatics Wendy Chapman.

The meeting also discussed the new Sparked program, a FHIR accelerator the has brought together the CSIRO’s Australian eHealth Research Centre, the Department of Health and Aged Care, the Australian Digital Health Agency, CSIRO, and HL7 Australia to develop an Australian core dataset for interoperability and FHIR.

ADHA CEO Amanda Cattermole said the council was designed to be as broad a stakeholder engagement group and an advisory and stewardship group as possible.

“The way that it’s framed is that each meeting will be a deep dive on one domain that is going to drive change under the plan,” Ms Cattermole said.

More here:

https://www.pulseit.news/australian-digital-health/share-by-default-delivery-of-health-interoperability-plan-in-full-swing/

We now have the first quarterly progress report on the national healthcare interoperability plan and it is  is available from ADHA.

The report is a nice 25 slides. The summary of progress is as follows (Page 4).

“Key progress towards a better-connected healthcare system for all Australians includes:

• Establishing strong governance – the Council for Connected Care and the Australian Digital Health Standards Advisory Group – and developing a communication and engagement plan for collaboration and transparency.

• Sharing resources in central locations – the Agency’s Online Interoperability Toolkit and Digital Health Developer Portal – for collaboration and to build the knowledge base.

• Developing roadmaps for healthcare identifiers and the Fast Health Interoperability Resources (FHIR) Accelerator program and commencing consultations with jurisdictions on the National Health Information Exchange Architecture and Roadmap.

• Developing guidelines for ICT procurement and a framework for conformance.

• Publishing guiding principles for digital health standards, developing a standards gap analysis tool and designing a community platform for a standards catalogue that will bring resources together in one place.

• Building the digital health capability of the workforce through assessment tools and training on FHIR and healthcare identifiers.

• Measuring maturity through the 2022 Interoperability Benchmark Survey, identifying appropriate maturity models and monitoring progress against the actions in the Interoperability Plan.”

Why do I get the feeling I need to come back in 5 years time to see if anything much has changed. Right now all we seem to have guidelines and wish-lists!

The more closely I read these seven points the stronger my sense of déjà vu! If I tried I reckon I could find you similar documents from the 1990’s. Will someone please tell me where the hard evidence of real progress resides and send me a copy! Is that too much to ask?

David.

 

I Have To Say I Did Not Know eConsults Were A Thing Until Now!

This popped up a few days ago.

EConsults? Show me the time and money

By Laura Woodrow

27 October 2023

Broad structural change is necessary if this model is ever to take off in Australia.

EConsults could increase access to specialist care and improve GP-physician relationships, if implemented well – but structural change is needed to allay concerns over remuneration and time allocation, say Australian specialists.

With a 13% rise in referrals from GPs to non-GP specialist over a decade (2006-07 to 2015-16) and 28% of patients waiting more than four weeks for non-GP specialist care, there is a growing need for easy access to timely specialist advice.

EConsults, in which GPs securely share case information with non-GP specialists for advice and support, rather than referring, have been successfully incorporated internationally as a means of asynchronous health provision.

But while the concept of an efficient platform for GP and non-GP specialist communication may appeal, concerns remain over implementation, according to a study recently published by the Australian Journal of Primary Health

The study investigated what 14 RACP fellows, across a range of specialties, genders and ages, thought of implementing eConsults, with a 72-hour turnaround time, in Australia.

According to the study, specialists generally felt this model would improve access to specialist advice and could be of “considerable benefit” for non-urgent consultations.

“RACP fellows agreed this could improve access to timely specialist advice, place downward pressure on outpatient face-to-face clinic waiting times and reduce unnecessary patient travel.”

The fellows interviewed felt that these asynchronous consultations might provide opportunity for ongoing GP education and reduce the need for future referrals or non-GP specialist advice.

But remuneration and time allocation were a recurring concern among study participants.

“It is clear from our work that Australian physicians require reassurance that they will not be pressured to add this work to existing consultation numbers and demand without support,” the researchers said.

“They also did not see the model as workable if it intruded into out-of-work time.” 

According to the researchers, for primarily public health physicians the concerns centred around time constraints.

“Without dedicated time, participants were concerned that uptake would be low among their colleagues, and that the 72-h turnaround time would not be feasible, which in turn, would reduce the effectiveness of the model,” they said.

But for private physicians, concerns were around matching existing consulting rates to face-to-face consultation rates.

Ultimately, the RACP fellows felt broad structural change would be necessary to make the model viable across Australia.

“All participants viewed the success of a future eConsult model as contingent on the formal structures that would be required to underpin it.

“They were of the opinion that eConsults would represent a fundamental change to the primary–secondary care interface, and as such, would require a proper administrative and governance structure.”

The change would require incorporating suitable and safe technology, ensuring indemnity was addressed with providers and administrative support.

“All participants viewed a formal administrative structure as essential to the success of the eConsult model of care,” said the researchers.

“An informal or haphazard approach would result in low provider satisfactions and low uptake among both GPs and non-GP specialists.”

Speaking to The Medical Republic, dermatology specialist and associate professor at the University of Queensland Jim Muir discussed an educational and resourcing platform, Tele-Derm, that facilitates advice exchange between dermatology specialists and other doctors and is currently up and running in Australia.

Professor Muir is one of four moderators of the Tele-Derm service that is provided through ACRRM, alongside Dr Dan Kennedy, Dr Rachael Foster and Dr John Bingley.

The Tele-Derm online service offers free advice and education, contributing to CPD point, to all rural doctors, whether they are ACRRM members or not, and now has around 4000 doctors registered on the platform.

Tele-Derm combines hundreds of case studies, videos, how-tos with telemedicine platform to bolster specialist advice with educational support, allowing 80% of the cases received to be managed locally by GPs, said Professor Muir.

More here:

https://www.medicalrepublic.com.au/econsults-show-me-the-time-and-money/101370

Now I understand, what we have here is really just a new name for electronically enabled joint consultation!

It seems to me there are lots of circumstances where such a care model makes perfect sense and equally some where it my not be appropriate.

I reckon it is up to each clinician how they wish to proceed with remote consultation and to go from there. There are certainly a lot of consults where virtual – especially when video-enabled -consults are totally fine – and to have two doctors involved is hardly a stretch!

What do others think?

David.

 

I Am Not Really Sure Just Why This Is Happening.

This was announced last week:

Epic to supply NSW patient record system

Technology

By Amanda Sheppeard

23 October, 2023

The worst-kept secret in digital health is finally confirmed with news global health software giant Epic has signed up to deliver the NSW government’s promise of a single digital patient record. 

The government’s eHealth NSW department announced late last week that the contracts had been finalised to form the partnership for the project that will be rolled out over the next six years. 

“The contract signing marks an important milestone with work now starting on the initial design and build of this next generation system,” the statement said. 

Epic will work closely with local health districts, specialty health networks and other NSW Health organisations, facilitated by eHealth NSW and NSW Health Pathology. 

“Hunter New England Local Health District (HNELHD) will be the first LHD to go live with the new platform in 2025,” said eHealth NSW. 

“The sequencing of other local health districts is currently being considered, with a readiness assessment underway.” 

The single digital patient record (SDPR) will deliver a state of the art, secure digital record-keeping platform that will transform the digital systems that NSW Health staff use every day to deliver care, according to the statement. 

“For the first time, our healthcare teams will have access to an integrated all-in-one electronic medical record system, patient administration system and pathology laboratory information system,” said eHealth NSW. 

“Having one statewide system will support consistency and continuity of care for all patients, while also streamlining the way clinicians work.” 

Clinicians will be able to access a patient’s clinical records quickly, securely, and safely, regardless of their location. The SDPR will also provide simplified clinical workflows in an intuitive, user-friendly system with streamlined technical support. 

“Patients will benefit from a better, more consistent experience no matter where they seek care,” said eHealth NSW. 

“Having confidence that their healthcare team will have all the relevant information at their fingertips.” 

The NSW government’s decision to partner with Epic Systems followed a procurement process that took more than two years and involved over 350 clinical and technical experts from across the system. 

Epic Systems is a world-leading software company specialising in the design and delivery of electronic medical records systems and associated technologies.  

Its software is currently being used in the ACT and in hospitals in Melbourne, as well as offshore in health services in the UK and the US. 

The SDPR program is working towards the following timeline: 

• Finalise contract negotiations: 2023. 
• Design and build: 2024–2025. 
• Lead site deployment in Hunter New England LHD: 2025-26 
• Statewide rollout in remaining LHDs/SHNs: 2026–2029/30 
• NSW Health Pathology adoption: 2026–2029/30 

A website has been set up to provide more information about the SDPR program. 

The NSW government yesterday announced the planned overhaul, describing the state’s current health records system as “complex, cumbersome and outdated”. 

“Currently we have nine systems used for electronic medical records, 10 patient administration systems and five pathology laboratory information manage systems in use across NSW Health,” the government said in a statement. 

“Currently, these systems are not connected statewide. Data is routinely collected but is often unable to be shared or integrated in real time. This can create duplicative data collection or create information gaps in decision making.  

“As a result, patients may have to recall and repeat complex medical information when they’re feeling unwell. Often this is when patients are receiving care at different locations or from separate treatment teams and impacts the experience of care they receive.” 

New chief executive of NSW Health Pathology, Vanessa Janissen, told Health Services Daily a statewide pathology laboratory information management system would a key component of the single digital patient record (SDPR) and would improve pathology service delivery. 

“A statewide record keeping system will support consistency and continuity of care for all patients, including providing enhanced analytics, tools and reporting to support patient safety, and streamlining ways of working for our public health professionals,” she said. 

More here:

https://www.medicalrepublic.com.au/epic-to-supply-nsw-patient-record-system/101054

In recent weeks I have been in and around the Health System and have been quite impressed to see the level of communication and information access available both in and out of Hospital.

Here we have the announcement that all this is going to be replaced with an Epic based system over the next few years. What is not made clear is just why, having got lots of stuff working, a new transition is required for what must be pretty incremental gains, and enormous cost.

Here is how NSW Health sees the problem:

“The Challenge

Clinical information is captured in many different systems across NSW Health. Currently, healthcare teams must access several platforms to get a comprehensive patient history. These include various electronic medical record systems, patient administration systems and laboratory information management systems. This makes it difficult to quickly access comprehensive information about a patient.

Some of these systems are also not connected statewide. This means different care teams must manually request patient information from other local health districts if a patient is visiting multiple health services. Data is routinely collected but is often unable to be shared or integrated in real time. This can create data duplication or information gaps that could affect providing the best patient care possible.

To solve these challenges, a single source of clinical information is needed.”

The Plan is outlined here:

“The SDPR program will transform the digital systems NSW Health staff use every day to deliver care. All NSW Health care teams, no matter where they work, will securely access the same information about a patient in real time from one source.

The SDPR will replace several existing systems that are widely used across NSW Health services. This includes 228 public hospitals, 600+ community health centres, 60 pathology laboratories and 150+ pathology collection centres. The highly secure system will house medical, pathology and administration records all in one place.

The SDPR will be delivered collaboratively and in partnership with local health districts (LHDs), specialty health networks (SHNs) and other NSW Health organisations, facilitated by eHealth NSW and NSW Health Pathology. Input will be sought from clinicians, consumers, patients and technical experts. Epic Systems, a world-leading software company specialising in the design and delivery of electronic medical records systems and associated technologies, has been contracted to supply the technology platform for the SDPR.

SDPR will first be available in the Hunter New England LHD, followed by a phased rollout throughout NSW. The rollout schedule for the SDPR will be planned in consultation with LHDs, SHNs, and other partners.

The overall implementation timeline is anticipated to be 6 years (2023-2029/30). This includes the design and build of the system, and statewide rollout.”

It seems to me this is a HUGE project that is going to have all areas of NSW in various states of disruption for the next 6 years (if it goes on time) while all this happens and at the end of ti we wind up with a single centralised system with all the risks that brings

I bet the Business Case of this project is not disclosed but one can be sure it will be costing a fortune and that one installed it will be moving towards obsolescence! I have no idea what the disruption that will be caused will cost!

I may be wrong but this seems just too big and too centralised a project to be sensible! Empire building on a grand scale!

What do others think?

David.

AusHealthIT Poll Number 720 – Results – 29 October, 2023.

Here are the results of the poll.

Has The Move To A Commonwealth Funded Health Insurance System (Medicare), As Developed By Bill Hayden, Been A Good Thing, In Hindsight, For Australia?

Yes                                                                           21 (84%)

No                                                                             3 (12%)

I Have no Idea                                                          1 (4%)

Total No. Of Votes: 25

A clear outcome with most feeling that Medicare has been a good thing overall.

Any insights on the poll are welcome, as a comment, as usual!

A poor number of votes. But also a very clear outcome! 

1 of 25 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those very few who voted! 

David.

The Federal Health Minister Unplugged! - Link Included!!

 At the end of ABC Insiders this morning (29/10/23) (On iView soon) our Federal Health Minister does a high-voltage "Elvis:" impersonation.

Has to be seen to be believed!

Here is the link:

https://www.adelaidenow.com.au/news/south-australia/health-minister-mark-butler-pulls-dad-dancing-moves-on-the-karaoke-stage/news-story/57205644136058d80690629075661808

David.

It Looks Like The Aged-Care Health IT Sector Is Due For Some Major Rationalisation.

This appeared last week:

Use of clinical software differs greatly among providers

by Natasha Egan October 19, 2023

A research project led by the aged care sector’s technology peak body has identified high rates of data duplication, the need for standardised terminology and almost 300 unique clinical software vendors in residential aged care.

The report Residential Aged Care Use of Clinical Care Systems produced by the Aged Care Industry Information Technology Council in collaboration with the Australian Digital Health Agency was released on Thursday. It identifies the need for aged care providers to develop comprehensive data-related policies and procedures as they move to implement the royal commission’s recommendation for the universal adoption of digital clinical care technology and the My Health Record.

“First of all, the exciting thing about the report is it’s the first time we’ve had a chance to actually look at what software is in place and how it’s used end to end,” ACIITC chair Dr George Margelis told Australian Ageing Agenda on the sidelines of the Aged Care Transformation stream at Victorian Healthcare Week in Melbourne on Thursday.

“The standout finding is the heterogeneity – the differences between providers in what they’re using and how they’re using it – the lack of standardisation, not just around data but around processes, and also the fragmentation.”

The fragmentation reflects the way the industry has grown so that medication management, prescribing, inventory, payroll and so on are all separate, he said. “Nothing’s integrated and that’s because they’ve had to add systems on the fly. There’s never been a strategic roadmap saying, ‘here’s where we are going to go forward’.”

Dr Margelis is hopeful the findings will provide an opportunity to identify all the functions needed and integrate the common data across those functions with common terminologies. “The different ways things are described in the industry is frightening. And that’s just that massive fragmentation.”

The issue of integration was raised among the aged care transformation discussions on Wednesday by Tanunda Lutheran Homes chief executive officer Lee Martin. He said his organisation used more than 30 systems that did not talk to each other.  

“I don’t think we’ll ever integrate to one. But we should be able to integrate to a couple of platforms that we can use to solve the problems,” Dr Margelis told AAA.

Key report findings

• a notable amount of duplication of core clinical information in multiple clinical systems, highlighting the importance of data integration
• the absence of consistent terminology across the sector presented challenges in data collection and analysis
• 287 unique clinical software vendors identified in residential aged care
• widespread Wi-Fi connectivity
• visiting clinicians have higher access to input, extract, and review data on-site than remotely
• clinical software integration with visiting clinicians’ software and community pharmacy software varies widely
• most organisations reported limited integration with My Health Record, and most did not record data in residents’ My Health system
• organisations have varying technology investment strategies, with some lacking a specific focus on clinical software
• barriers to clinical software adoption include the cost of products, training, upgrading, employee culture, time, resources, and digital literacy
• a significant percentage of clinical software systems have been in deployment for five to 10 years, indicating a need for updates and improvements.

Opportunities for providers, vendors

In addition to the challenges, the report outlines opportunities for both aged care providers and software vendors.

“The key message for providers is that there are opportunities for efficiency,” Dr Margelis told AAA. “Because of their fragmentation, there’s a lot of inefficiency, double entry of data, disparate data and same data being captured in different formats in different systems.

More here:

https://www.australianageingagenda.com.au/technology/use-of-clinical-software-differs-greatly-among-providers/

This looks like a useful report that shows just what is needed to remedy the present chaos in the sector.

Worth a browse!

David.

Does It Make Sense To Make Patients Wait For Their Results?

Since way back when patient access to results has been delayed so the clinician can review the results and discuss anything that may be worrying with the patient to avoid panic, scares or worse!

End seven-day ‘lock’ on patients seeing tests results in My Health Record: Mark Butler

Viewing results without a doctor's explanation is low risk, says the health department's consultation.

Antony Scholefield

19 October 2023

Health officials will weigh up whether pathology and imaging results in My Health Record should still be “locked” from patient access in the first week after they are uploaded.  

The seven-day delay was introduced back in 2014 so that patients were less likely to look at results on their own before a doctor had explained them, according to the federal Department of Health and Aged Care.

There are a few exceptions — such as tests for respiratory illnesses, including COVID-19, and results for HbA1c and INR tests.  

However, Minister for Health and Aged Care Mark Butler said earlier this year that the delay were “a barrier to good clinical practice, cause untold frustration for Australians”.

He called for them to be scrapped in all but exceptional circumstances.

The health department opened a consultation on potential changes last month, where it argued that immediate access to imaging and pathology reports would “empower consumers to better manage their own health and protect others in the community”.

More here:

https://www.ausdoc.com.au/news/end-seven-day-lock-on-patients-seeing-tests-in-my-health-record-butler/

The concern has always been a patient seeing a result reading “cancer” or some such and not being able to find out quickly and easily what it means for them!

Frankly I think this is a real concern and that some care and moderation is needed with a few results.

With the exception of “life-threatening” reports I see no issue with instant access as long as the exception management works well and that people are not terrified by something that they do not understand!

What do others think?

David.