What Do You Notice Is Wrong With This? No Wonder The HI Service Has Very Real Problems With Adoption and Use.

In a presentation in late June (released a few days ago) David Bunker (NEHTA’s Head of Architecture) showed this slide - Slide 6.

Update – national foundations

NEHTA has made significant progress in designing, operationalising and enhancing the essential foundations required to enable eHealth:

·         Built and implemented the Healthcare Identifiers Service. As at December 2011 there are 24,350,000 IHIs, 526,000 HPI-Is and 624 HPI-Os issued.

·         More than 2 million IHIs downloaded into clinical systems, including 1.3 million in the Lead eHealth sites and in the TAS and ACT Patient Administration Systems

·         Built and implemented the National Clinical Terminology and Information Service; including Australian Medicines Terminology and SNOMED CT, the National Product Catalogue, and the Security and Access Framework. The NPC is being used by NSW, WA, SA, VIC, QLD and the ACT. VIC has begun limited AMT rollout.

·         Designed the National Authentication Service for Health – currently being built.

The full presentation is found here:

http://www.nehta.gov.au/component/docman/doc_download/1516-annual-cac-conference-29-june

Referring to the Australian Bureau Of Statistics to population of Australia is - as of today - 22,677,692 souls.

See here for the latest figure:

http://www.abs.gov.au/

This means there are 1,672,303 more Individual Health Identifiers than there are people. Even allowing for those who have died between December 2011 and now (say 50,000) and the suggestion that visitors from overseas who get a prescription or service stay on the system for ever it seems to me there is a very big information integrity problem here.

To me the problem is that there has never been the needed money spent to initiate and maintain the IHI system in a way that is really fit for purpose and this claim ‘bells that cat’ well and truly. Basically we have a Health Identifier Service which was started on the cheap and now seems to be drifting.

I wonder what the clinical safety implications of all this are. Can’t be positive.

No wonder NEHTA keeps talking about the number of identifiers issued and not about the number that are actually using their IHI with the service. I wonder what having ‘downloaded’ the identifiers into local systems actually means?

It’s interesting to note that after more than five years we are still only seeing a ‘limited rollout’ of the AMT. Again hardly a strong endorsement of what has been done.

I note, in addition, that NASH is still being built rather than implemented. I wonder when that will actually start and how much it will wind up finally costing?

NEHTA’s record would have to be described as ‘patchy’ at best. Separately the Australian is reporting the forward agreements on NEHTA’s funding have not been signed off and  we do know of considerable job losses - especially among contractors.

See here:

http://www.theaustralian.com.au/australian-it/government/e-health-delivering-on-its-rollout-commitments/story-fn4htb9o-1226427500101

“Meanwhile, the National Partnership Agreement on E-Health, under which COAG funds NEHTA, expired at the end of last month.

Mr Madden (DoHA CIO) said a new intergovernmental agreement was "still being developed".

NEHTA's role was to develop the specifications and standards needed to support e-health systems under a COAG program set more than three years ago, he said.

"They don't develop clinical software and put that in the hands of practitioners to use, but the jurisdictions are using products based on their work," he said.”

Dear oh dear - looks a bit messy.

David.

Just Where Does This Move Leave Those Who Signed Up for the NEHRS / PCEHR? In A Labyrinthine Managerial Maze With No One Accountable I Suspect.

This appeared yesterday:

Health Department to outsource PCEHR operations and management

• by: Karen Dearne
• From: Australian IT
• July 25, 2012 3:31PM

THE Health Department wants to outsource its operational and management responsibilities for the personally controlled e-health record system to a single provider.

It has released a tender calling for "provision of project support services" for the PCEHR program, which went live earlier this month despite warnings that the system was unstable and plagued with known bugs.

"Over the next two years, the government will provide $161.6 million to Health to operate the PCEHR and support its gradual enhancement and adoption," the tender says.

"As the systems operator, the department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction.

"Our objective is to identify one provider with the required range of expertise, skills and quality assurance processes that will support the department in its management of the PCEHR program and its new operational role."

The supplier will also have to liaise with a "network of stakeholders" including the National E-Health Transition Authority, Human Services, Accenture and the Office of the Australian Information Commissioner.

"The successful tenderer will be required to assist the department to achieve the objectives of the program: to improve the quality, safety, efficiency and coordination of healthcare by reducing the fragmentation of information across the healthcare sector," the tender says.

Based in Canberra within the department, it envisages a team of two people for high-level program management services, one person to perform contract management services, a business systems analyst and two people for operations management duties.

More details are here:

http://www.theaustralian.com.au/australian-it/government/health-department-to-outsource-pcehr-operations-and-management/story-fn4htb9o-1226434907586

There is also coverage here:

Aus Govt looks to outsource e-health record management

Summary: The Australian Government is looking to outsource the management of its Personally-Controlled E-health Record system.

By Josh Taylor | July 26, 2012 -- 00:15 GMT (10:15 AEST)

The Department of Health and Ageing has gone to tender for an organisation to support the operation of the Personally-Controlled E-Health Record (PCEHR) system.
The Federal Government's e-health record system was launched on 1 July after two years of planning and hundreds of billions of dollars worth of investment. Although it hasn't been a smooth start for the program, over 3500 people have so far registered for their own e-health record.
The request for tender document, published yesterday, calls for a company to manage the running of the system for just under two years, to at least the end of June in 2014 and starting as soon as the contract is awarded. Up until this point, the government has been managing the operation of the system.

More details here:

http://www.zdnet.com/aus-govt-looks-to-outsource-e-health-record-management-7000001602/

This is really a very interesting Tender - for what the Department seems to be asking for is 8 reasonably high level people to work internally in the Department for the next 2 years.

The introduction and what follows is very interesting:

1. INTRODUCTION

From July 2010, the Personally Controlled Electronic Health Record (PCEHR) program has been funded to design, build and implement a national PCEHR system. The system was launched in early July 2012 and will gradually transition into an operational and management phase requiring the external support of a range of project management skill and expertise. The Department of Health and Ageing (“the Department”) is therefore seeking to engage one organisation to provide all the project support services required to assist the Department to manage the transition to and demands of the new phase of the PCEHR program. The Department will not accept tenderers who only tender for part of the required services, as specified in Condition of Participation (f). The Commonwealth may also offer contracts to preferred tenders for specific activities that are being sought under this tender.

-----

4. BACKGROUND

Commencing on the 30th of June 2010 the Australian Government allocated $466.7 million over two years to design, develop and implement a Personally Controlled Electronic Health Record (PCEHR) system to improve access to health information and avoid the proliferation of divergent and fragmented systems. From early July 2012, the PCEHR system became operational with consumers able to create their records either online, by phone or via selected Medicare shopfronts. As the capability of the system expands, Australians who choose to participate will have their health information securely available to them and their approved healthcare providers when and where it is needed. A range of health information will be able to be accessed including a patient’s general health history, pathology and radiology summaries and prescription information.

5. CONTEXT

Over the next two years the Government will provide $161.6 million to the Department of Health and Ageing to operate the PCEHR system and support its gradual enhancement and adoption through the continuation of the PCEHR program. As the systems operator, the Department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction, and liaising with a network of stakeholders which includes the National eHealth Transition Authority, the Department of Human Services, the National Infrastructure Operator and the Office of the Australian Information Commissioner.

6. OBJECTIVES

The objective of the project is to identify one provider with the required range of expertise, skills, and quality assurance processes that will support the Department in its management of the PCEHR program and its new operational role, and will provide value for money.

The successful tenderer will be required to assist the Department to achieve the objectives of the program: to improve the quality, safety, efficiency and coordination of health care by reducing the fragmentation of information across the health care sector through a personally controlled electronic health record. The operation and continued development of the national PCEHR system will enable a seamless transition between health care settings, a reduction in time spent reiterating clinical history or waiting for test results to be located, and a reduction in adverse medical events.

7. REQUIREMENT

The successful tenderer will be required to provide personnel with the requisite skill and experience to co-locate in Canberra with the Department, and work collaboratively with the Department, its staff and its contracted business partners. In addition, the successful tenderer will be required to provide a flexible number of personnel to meet a variable workload demand as the requirements to operate the PCEHR system are progressively rolled out.

Here seems to be the core of the staff requirement:

-----

The Commonwealth may offer contracts to preferred tenders for specific activities that are being sought under this tender. The successful tenderer will be required to provide a minimum of the following numbers of personnel with the following skill and expertise to undertake the following services:

(a) Two people to perform High Level Program Management services, that include but are not limited to:

•  Assistance with determining strategy and its application to the implementation of the PCEHR Program;
• Integration and coordination of decisions and initiatives within the PCEHR Program;
• Direction and coherent management of numerous parallel projects and multiple service providers and stakeholders through strong governance models;
• Monitoring of the overall PCEHR Program and project performance and benefits realisation;
• Ensuring rigour in the PCEHR Program and its associated projects;
• Focusing the PCEHR Program and individual projects on delivery of business benefits in time, cost and quality measures, with well-defined metrics that demonstrate success;
• Ensuring a balance between short term tactical and longer term strategic objectives;
• Providing well defined statements of work, evaluation plans, requests for quote/requests for tender documentation and contracts, as well as business and technical requirements for third party suppliers; and
• Ensuring individual projects are aligned within the overall PCEHR

Program thus enabling:

(i) critical dependencies to be established and managed;

(ii) critical path to be understood;

(iii) critical risks and issues to be identified and managed;

(iv) high level administrative and clerical support; and

(v) meaningful reporting against program objectives

Program Management personnel will be required to have skills and experience including, but not limited to: Demonstrated ability in administering Prince2 project management methodology.

(b) One person to perform Contract Management services.

- lots omitted

(c) One person to perform Business Systems Analysis services, that include but are not limited to:

• Supporting the Department to set the required outcomes and overall business design of the PCEHR operational period;
• Establish, maintain and support the

(i) Reporting structures and standards;

(ii) Issue/risk management and escalation procedures;

(iii) Status reporting; and

(iv) Resources and cost forecasting of the PCEHR Program.

• Manage, store and quality assure PCEHR Program and project documentation;
•  Assess the effectiveness of the policy through the evaluation of Program benefits.

(d) Two people to perform Operations Management services, that include but are not limited to:

• Supporting the Department to manage uptake, complaints, systemic issues, performance reporting, system integrity, data custodianship, and strategic direction;
• Ensuring the PCEHR program complies with legislative constraints, to achieve the policy intent.

(e) One person to perform Capability Development services, that include but are not limited to:

• Establishing long term governance structures;
• Monitoring and revising as required:

(i) Sourcing strategies for the Department’s operational partners;

(ii) Policies and procedures for contract staff;

• Provide job descriptions and assistance with the sourcing of additional resources as requested by the Department.

(f) One person to perform Change Management and Continuous Improvement services

----- End abbreviated extract.

So one organisation, eight pretty senior people to take the PCEHR forward. The scope of what these people are meant to do is just staggering and what is more - as far as I can tell there is no associated control of the various activity arms that are in place.

This paragraph is pretty telling:

“As the systems operator, the Department will be responsible for managing uptake, complaints, systemic issues, performance reporting, system integrity and strategic direction, and liaising with a network of stakeholders which includes the National eHealth Transition Authority, the Department of Human Services, the National Infrastructure Operator and the Office of the Australian Information Commissioner.”

So you have all these roles and objectives but have to work through all these other entities and stakeholders.

Frankly this is utter madness. Either you outsource control, budget and staff and ask a contractor to get on with things - with appropriate accountability - or not. This is a seriously half pregnant proposal if ever I saw one.

What is needed is a separate agency to do the lot - properly governed and led - and separate from DoHA, NEHTA and the DHS. Anything else will just implode on itself in confusion and mayhem.

What nonsense.
There is no doubt, however, serious help is needed. The Access To Medicare Services tab still crashes after 2 weeks.
On the matter of yesterday's rather messy COAG meeting it seems NEHTA funding has been shunted off to a committee. It will be interesting to see if the Liberal states are similarly hesitant with the NEHTA funding as they are with the NDIS. Time will tell I guess.

David.

Well COAG Has Just Not Done Anything With Funding E-Health. I Wonder What That Means?

Here is the communique.

Council of Australian Governments Meeting–Communiqué
Canberra, 25 July 2012

The Council of Australian Governments (COAG) held its 33^rd meeting in Canberra today.  The Prime Minister, Premiers, Chief Ministers and the President of the Australian Local Government Association (ALGA) attended.  The Leaders acknowledged this was the final COAG meeting for Councillor Genia McCaffery, President of ALGA, and thanked her for her contribution.

National Disability Insurance Scheme

COAG noted progress in establishing the first stage of a National Disability Insurance Scheme (NDIS) from July 2013, and that the Commonwealth has reached in-principle agreement with South Australia, Tasmania and the Australian Capital Territory for a launch to commence from July 2013.  These jurisdictions agreed to engage closely in the implementation of the first stage, noting this will inform the move to a national insurance-based approach to disability care and support.

These jurisdictions agreed to work together on the development of Commonwealth legislation to establish both the scheme and a national launch agency to administer the scheme during the launch phase.  The agency will be responsible for managing Commonwealth and State funds in a single national pool, and undertaking planning, assessment and approval of individual support packages.

The Commonwealth, South Australia, Tasmania and the Australian Capital Territory welcomed the opportunity to establish launch sites so that, from July next year, governments will start the first stage of an NDIS and improve the quality of support for people with a disability and their carers.  These jurisdictions agreed that participants in the launch sites will receive ongoing support until a decision is taken to move to a full NDIS.  All governments also agreed that the funding and governance arrangements agreed for launch do not create a precedent for the full scheme.

COAG welcomed a report from the Select Council on Disability Reform on progress with establishing an NDIS.  First Ministers discussed funding and governance options for an NDIS and agreed to consider these issues further at their next meeting in 2012.

As part of its report, the Select Council has proposed an approach to defining eligibility and reasonable and necessary support under an NDIS, building on the work of the Productivity Commission. COAG agreed that, as a first step to settling the design of an NDIS, consultation with people with a disability, their families and carers, the workforce and disability sector and peak bodies would commence from late August on this approach.  These consultations would occur through Commonwealth and State Advisory Groups that have been established to support government consideration of an NDIS.  The consultations will inform the final approach to eligibility and reasonable and necessary support to be agreed by COAG, as well as further work on how these definitions would work in practice, and how they would be reflected in legislation, regulations or guidelines.

Future Competition and Regulatory Reform

COAG noted the progress report from its inter-jurisdictional Taskforce which was set up to advise COAG following the successful Business Advisory Forum meeting in April.  The Taskforce has been consulting with peak business bodies and other organisations interested in specific reforms, including conservation groups which have an interest in environmental regulation reforms.

COAG reiterated its commitment to reducing duplication and double-handling of environmental assessment and approval processes while maintaining high environmental standards that are risk- and outcomes-based. In line with the timing agreed at the COAG meeting in April, consultations are underway and negotiations for bilateral agreements are about to commence.

The Taskforce has worked with the Select Council on Climate Change to examine options to expand and expedite planned reviews into the complementarity of climate change measures with a carbon price.  Significant progress has been made in establishing the scope for reform and in identifying measures for review. This process will be largely completed by late 2012.

On energy market reform, considerable work is already in train through the Standing Council on Energy and Resources.  COAG expressed concern over the recent substantial electricity price increases arising from factors including increases in transmission and distribution charges and requested energy ministers to focus current reviews of market regulation in the interconnected market on achieving efficient future investment which does not result in undue price pressures on consumers and business. COAG noted the Taskforce’s advice that the current program of work is consistent with its original vision for an interconnected national electricity market. Nonetheless, noting the interest of governments, business and consumers in competitive markets, COAG asked the Taskforce to undertake further work and advise COAG in late 2012 on any additional action required to deliver a regulatory framework that promotes a competitive retail electricity market, including appropriate support for vulnerable customers, and efficient investment. 

Work to develop best-practice approaches to lift regulatory performance and policy initiatives to meet the red tape challenge is also being advanced. 

COAG noted that a report would be provided to the next meeting of the Business Advisory Forum and recommendations to COAG in late 2012.

Progress on Seamless National Economy Reforms

COAG has released two report cards on the implementation of its deregulation priorities and competition reforms under the National Partnership Agreement to Deliver a Seamless National Economy.

COAG welcomed completion of the business names reform and noted that 17 of the 27 deregulation priority reforms are now operational and three of the eight competition reforms are complete.

In relation to directors’ liability reform, to ensure the operation of directors’ liability is applied in a nationally consistent and principle-based manner in future legislation, COAG agreed to a set of Principles and Guidelines, noting that this reform is still under consideration by the Queensland Government.

COAG welcomed the release last week for consultation of the Regulation Impact Statement (RIS) for electrical occupations, under the National Occupational Licensing Scheme reform, and noted the three remaining RISs are about to be released for consultation.

COAG welcomed the progress on infrastructure reform, the National Construction Code, chemicals and plastics reform, e-conveyancing reform, legal professions reform and trades licensing.

Construction Industry Costs and Productivity

COAG agreed to establish an independent review panel to conduct a broad ranging investigation into cost, competitiveness and productivity challenges in the commercial, civil and large scale residential construction industry.  COAG will appoint three eminent persons with relevant expertise to conduct the review over the next 12 months and report back to COAG.  A secretariat within the Department of the Prime Minister and Cabinet, comprising Commonwealth and State representatives, will support and report directly to the review panel.  The panel will undertake analysis and consider reforms that could be pursued nationally or by individual Commonwealth, State, Territory and Local governments. Terms of reference are attached.

Expiring National Partnerships

COAG noted that a number of programs under National Partnerships have supported increased service levels. COAG recognised the importance of a coordinated approach to the consideration of ongoing funding for National Partnerships.  It endorsed the criteria developed by Heads of Treasuries to determine the treatment of expiring National Partnerships. COAG also agreed to establish a working group to report back to COAG in September, to provide early identification of those agreements expiring on or before 30 June 2013 that have led to increased service levels, and options for their treatment if they were continued, noting that any Commonwealth funding decisions are contingent on Commonwealth Budget processes.

Improving Funding Arrangements

COAG discussed ongoing concerns about the proliferation of National Agreements, National Partnership Agreements and Project Agreements. COAG is committed to ensuring that only matters of truly national significance will be progressed as new multilateral National Partnership Agreements, with consideration of existing or alternative funding mechanisms before any new funding agreements are entered into. To support this, the working group which will consider expiring agreements will also consider and recommend measures to streamline the development and administration of selected funding agreements, for reporting to COAG at its December 2012 meeting.

National Response to Organised Crime and Firearms

COAG acknowledged that organised crime and firearms-related issues are of considerable concern to all governments and the community, and noted the initiatives agreed through the Standing Council of Police and Emergency Management (SCPEM). COAG agreed that the Commonwealth will continue to work with the States on a coordinated approach to organised crime, and firearms-related crime, in line with the work agreed by SCPEM.

Not-for-Profit Reform

COAG reconfirmed the objective of minimising regulatory compliance costs to the
not-for-profit sector and requested further advice from Senior Officials on any legislative and regulatory changes required to achieve this objective. This includes legislative impacts of the proposed Australian Charities and Not-for-profits Commission Bill.  Senior Officials will finalise this work within a month and before the Bill is settled for introduction to the Commonwealth Parliament in August 2012.

COAG agreed to consider before the end of 2012, the results of a regulatory impact assessment on governance and reporting standards in the not-for-profit sector, in light of the proposed Bill.

Royal Succession

Leaders confirmed Australia’s support for changes to the rules for Royal Succession agreed by leaders of the Realms on 28 October 2011 which would: allow for succession regardless of gender; and, remove the bar on succession for an heir and successor of the monarch who marries a Catholic.

New Zealand Engagement in COAG Fora

COAG welcomed New Zealand’s move from long-term observer to a member of the National Counter-Terrorism Committee and the National Emergency Management Committee to ensure the closest possible coordination and cooperation on counter-terrorism and emergency management issues.

Canberra                                               
25 July 2012

----- End Extract.

The section that matters is the part on Expiring National Partnerships - of which NEHTA / E-Health is one.

What do you read into this?

“It endorsed the criteria developed by Heads of Treasuries to determine the treatment of expiring National Partnerships. COAG also agreed to establish a working group to report back to COAG in September, to provide early identification of those agreements expiring on or before 30 June 2013 that have led to increased service levels, and options for their treatment if they were continued, noting that any Commonwealth funding decisions are contingent on Commonwealth Budget processes.”

This may cause some real heartburn in NEHTA I would imagine.

Here is the page where you can see the old funding agreements - under e-Health.

http://www.federalfinancialrelations.gov.au/content/national_partnership_agreements/health.aspx

I wonder what happens next?

David.

This Is A Really Worrying Piece Of News From The ACT. Data Manipulation Of Health Information On A Grand Scale!

The following appeared a few days ago It is an amazing saga of health information deception and abuse:

http://www.canberratimes.com.au/act-news/data-doctoring-sparks-hospital-records-privacy-concerns-20120719-22bst.html#ixzz217HtWRP4

Data doctoring sparks hospital records privacy concerns

Date July 19, 2012

Noel Towel

The privacy of hundreds of thousands of patient records at the Canberra Hospital was vulnerable to compromise because of the poor quality of data management in the Emergency Department, according to the Auditor General.

Auditor-General Maxine Cooper told an Assembly Committee this morning that the poor quality of the department's systems had implications that went beyond the "data doctoring" scandal.

Dr Cooper was giving evidence to the Assembly's Public Accounts Committee about her report into the manipulation of patient records in the Canberra Hospital.

Dr Cooper told the multi-party committee that her audit had been confined to the data manipulation and that she had not inquired into whether there had been any breaches of privacy laws caused by the lack of control over information systems in the hospital.

.....

Senior Hospital Executive Kate Jackson has admitted to tampering with thousands of patient records between 2009 and 2012 in an effort to make the department's performance on waiting times look better.

The committee heard today that Ms Jackson, who has been stood down from her $200,000-a-year job, used four different generic log-ins to access the data system and make changes.

.....

Full article is here:

http://www.canberratimes.com.au/act-news/data-doctoring-sparks-hospital-records-privacy-concerns-20120719-22bst.html#ixzz217HtWRP4

The media release around this is really quite alarming:

It can be found here:

http://www.audit.act.gov.au/auditreports/reports2012/Media%20Release%20Report%20No%206%20of%202012.pdf

This extract from the Exec Summary says a fair bit to say, to say the least.

“Hospital records at the Canberra Hospital have been deliberately manipulated to improve overall performance information and reporting of the Canberra Hospital’s Emergency

Department. The very poor controls over the relevant information system means that it is not possible to use information in the system to identify with certainty the person or persons who have made the changes to the hospital records. Under affirmation, an executive at the Canberra Hospital has admitted to making improper changes to hospital records. While this is the case, Audit considers that it is probable that improper changes to records have been made by other persons.

There is evidence to indicate that hospital records relating to Emergency Department performance were manipulated between 2009 and early 2012. It is likely that up to 11,700 records relating to Emergency Department presentations were manipulated during this period. The records that were manipulated mean that publicly reported information relating to the timeliness of access to the Emergency Department and overall length of stay in the Emergency Department have been inaccurately reported over this period.

Data manipulation

The executive has admitted to manipulating hospital records initially in 2010 and on a much larger scale throughout 2011 into early 2012. The executive’s admission of manipulating records does not account for all of the changes that were made to hospital records, where timeliness information was improved. The executive did not admit to making changes to records in 2009. Furthermore, changes to hospital records made throughout 2010 and early 2012 are not all accounted for by the executive’s admission.

The executive’s rationale for manipulating records was that they felt under significant pressure to improve the publicly reported performance information of the Emergency Department. In this respect, Audit notes that there is a significant and ongoing focus on the timeliness performance of the two Canberra hospitals more broadly, and their emergency departments more specifically. Audit also notes that the recent National Partnership Agreement between the states and territories and the Commonwealth has placed an additional focus on hospital waiting times, targeting $3.4 billion in investment over the eight years to 2016‐17 on hospital improvement. Of this Commonwealth funding, a comparatively small proportion ($200 million nationally and $3.2 million for the ACT) is directly dependent on improvements to Emergency Department timeliness performance. There is a considerable lack of attention on qualitative indicators, which may provide a more appropriate and rounded assessment of Emergency Department performance.

Managerial pressure was placed on the executive to improve the performance of the Emergency Department. This managerial pressure reflects the significant and ongoing focus on the timeliness performance of the Canberra Hospital and the requirements of the National Partnership Agreement. An organisational change management agenda was also underway at the Canberra Hospital since the restructure of the Health Directorate in early 2011. The organisational change process underway at the Canberra Hospital sought to achieve improved performance and accountability for performance.

Organisational change can be challenging and confronting for staff. In relation to the organisational change that was underway at the Canberra Hospital throughout 2011, one stakeholder commented to Audit:

The hospital is very resistant to outsiders coming in, very resistant. In a way, it’s a very protected community and it has developed from a small regional hospital, you know, the Woden Valley Hospital, to the major tertiary referral centre for the region. And one of the challenges...is whether the change has happened as it’s needed to for staff to move into that much more professional high‐pressure dynamic organisation.

Although managerial pressure was placed on the executive to improve the performance of the Emergency Department, this was not manifested in direct or indirect instruction or guidance to deliberately manipulate hospital records. Furthermore, there was no direct or indirect instruction by any other person, including the Minister for Health.

Very poor systems and practices

The very poor systems and practices in place in the Canberra Hospital and the Health Directorate for preparing and publicly reporting performance information created the opportunity for persons to manipulate the hospital records. The Emergency Department’s management information system, which is used to prepare the performance information, has very poor system access and user controls. There is a lack of governance and administrative accountability for this system, which means that there is no identifiable system owner with responsibility for ensuring the integrity of the system and the appropriateness of its access and user controls.

The very poor system access and user controls over the Canberra Hospital’s Emergency Department management information system has wider implications beyond the inaccurate reporting of timeliness performance. There are risks to the privacy and confidentiality of patient information. The very poor systems and practices also mean that there is a risk that the Health Directorate does not meet the requirements of Principle 4.1 of the Health Records (Privacy and Access) Act 1997 relating to the safekeeping of personal health information.

Audit notes that the same management information system, albeit a newer version, is used at the Calvary Public Hospital. There are more effective system access and user controls over the newer system at the Calvary Public Hospital. Nevertheless, some features of the newer system and its implementation at the Calvary Public Hospital may also give rise to risks relating to the privacy and confidentiality of patient information and the potential manipulation of hospital records to improve timeliness performance reporting. There is also a risk, albeit to a lesser extent, that Calvary Public Hospital does not meet the requirements of Principle 4.1 of the Health Records (Privacy and Access) Act 1997 relating to the safekeeping of personal health information.

There was also a lack of monitoring, review and assurance of the integrity and accuracy of the Health Directorate’s publicly reported Emergency Department performance information. Various data validation processes are in place within the Health Directorate, but these processes have not been designed to provide assurance over the integrity and accuracy of publicly reported Emergency Department performance information. Audit notes that the current monitoring, review and assurance processes over the publicly reported Emergency Department performance information are not consistent with the apparent importance of the performance information, as demonstrated by the significant Health Directorate management and stakeholder interest.

Commonwealth funding

A comparatively small amount of Commonwealth funding under the recent National Partnership Agreement ($3.2 million over the four years to December 2015) is contingent upon the ACT meeting relevant timeliness targets. $0.8 million is contingent upon the ACT’s timeliness performance in 2012. This funding may be at risk, as it appears that the ACT is not meeting its timeliness performance targets. However, it should be noted that this reward funding may be rolled over and provided in future years up to 2015.’

---- End Extract.

Audit’s ten recommendations all seem pretty sensible to me - but they really do need to get to an individual user sign-on sooner rather than later - despite user objections.

There are a good few lessons here that need to be carefully considered. Given the financial pressures I wonder of other States or Territories are the victims of similar activities?

David.

Council Of Australian Governments - Meeting Alert

I am assured there is a meeting of COAG which will have an impact on e-Health funding and NEHTA later today.

There will be a communique later in the day on what was decided between the Prime Minister, State Premiers and so on.

I will bring it to you when I get hold of it.

Watch this space...

David.

This Really Awful Headline Appeared From The Australian Today. Talk About Political Expediency Trumping Common Sense.

The following great read appeared earlier today.

E-health records system went live despite known bugs

• by: Fran Foo
• From: The Australian
• July 24, 2012 12:00AM

THE Gillard government knowingly launched the national e-health records system despite warnings from its own e-health agency that it had more than 60 high-severity and critical bugs.

The personally controlled e-health system was pushed live and accessible to the public without a back-up system that would have ensured patient data was available at all times.

The consumer portal, where people enter personal information, medical history and medication details, contained hundreds more bugs of different severity levels as the system went live, The Australian can reveal.

About two weeks before the launch of the personally controlled electronic health record system on July 1, the National E-Health Transition Authority told key government stakeholders the system had more than 200 high-severity and critical bugs.

NEHTA warned that going live with the unstable system was highly risky, according to PCEHR test results seen by the Department of Health, NEHTA, the contractor Accenture and other stakeholders.

The results show that about a week before go-live the high-severity bug count had been reduced to just more than 60 items, mainly because of a "reprioritisation" of defects to future releases, but NEHTA issued the same warning to delay the launch.

It is understood the Health Department and other stakeholders had been aware of the roadblocks for months.

Sources close to Health said the government was told specifically "NEHTA has not had a window of more than two days without an outage or functionality impact, and as such NEHTA has concerns regarding stability of the production environment.

"Due to these concerns, NEHTA has requested a full root cause analysis for these issues from Accenture which has not yet been provided. As such, assurance cannot be given that these types of issues will not be experienced in production."

The production environment refers to a live, online system. Accenture is the main contractor for the taxpayer-funded PCEHR program.

A spokesman for Health Minister Tanya Plibersek said that, based on advice by the Health Department, the Minister rejected claims the system had problems before launch.

"No critical defects remained at the time of the release," he said.

Yesterday, Ms Plibersek said: "As we've said before, the system will roll out in stages over time. This is the sensible way to deliver the reform.

"The release was appropriately an operational matter for the experts in IT and cyber security overseeing for the project.

"The system went through rigorous testing, defect resolution and assurance processes prior to release, including tick-off by IT and cyber-security experts at the Defence, Finance and Attorney-General's departments."

As reported by The Australian, Accenture failed to detect a hacking incident for several months while the system was being developed. The company was awarded about $108 million for the e-health program.

As reported on July 3, a Health spokeswoman insisted Accenture had finished building the system, which met "all of the requirements of the National Infrastructure Partner contract".

"Those requirements have been completely built and the majority of those requirements are delivered as at July 1," she said.

But although the system had been built, it had yet to be fully tested and hence was not completely functional.

NEHTA warned there would be major ramifications such as the e-health system crashing if the launch were not postponed. There was not sufficient time to fix all the bugs, sources said.

Read more of the safe here:

http://www.theaustralian.com.au/australian-it/government/e-health-records-system-went-live-despite-known-bugs/story-fn4htb9o-1226433298913

Now everyone knows any computer system that is at all useful will have a few bugs:

As Murphy correctly states:

Every non trivial program has at least one bug
Corollary 1 - A sufficient condition for program triviality is that it have no bugs.
Corollary 2 - At least one bug will be observed after the author leaves the organization.

Refer here for all of Murphy’s comments on the nature of computational life and reality.

http://www.murphys-laws.com/murphy/murphy-computer.html/murphy-laws.html

That said the NEHRS is pretty functionally trivial to be so bug infested!

I have now had the time to closely observe the consumer portal in its present form and it is really hard to give it anywhere near a passing grade.

It is difficult to access, agonisingly slow, laid out in ways to hide needed buttons and clearly buggy.

It also suffers from the problem of having been ‘designed for consumer use’ and so is really, really annoying for anyone who wants rapid responses, information rich screens and minimal context flips (i.e. the clinician).

I have shown the system to some system / web designers who were stunned at the cost of the system - suggesting $50 million at the absolute outside as what it should have cost.

At some point quite soon we are going to have to face the facts we have been given a lemon.

Equally the ridiculous rush to respond to political deadlines is just a joke and shows management which simply does not have the courage of its convictions. That really is not good enough either. Why did NEHTA simply not say "it isn't ready and this is not happening until we are confident it is"?

David.

Weekly Australian Health IT Links – 23rd July, 2012.

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

A quiet week with the level of discussion on the NEHRS / PCEHR dropping below the radar. One has to wonder just what happens next with no future plans available and nothing to see if you log on!

Other than this we have discussion of the CareTrack study and a couple of small e-Health initiatives that have been started - a very good thing indeed! Pity there is not a bit more support for such things coming from Government as well as the support for the NEHRS. I am sure some improved leadership and governance would help balance things out.

Last of course we have one man’s view of the way the world will finally - in zillions of years - end - not that I expect to be around.

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http://www.abc.net.au/news/2012-07-17/canberra-e-health-records-still-not-online/4135330?section=act

E-health system yet to come online

By Clarissa Thorpe

Updated July 17, 2012 08:32:04

Two weeks after the introduction of the national e-health system, patients in Canberra still cannot obtain a working electronic health record.

The Federal Government announced July 1 as the start date for new online medical records system, which aims to improve the availability of information for doctors and patients.

The secure electronic records are expected to include medications, allergies, immunisations, doctor and hospital notes, and prescriptions.

In the ACT, residents can sign-up to get their own Personally Controlled Electronic Health Record (PCEHR), but doctors are currently not able to add medical information.

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http://www.theaustralian.com.au/australian-it/government/e-health-delivering-on-its-rollout-commitments/story-fn4htb9o-1226427500101

NEHTA has 'delivered' e-health foundations for PCEHR: Madden - Updated Version

• by: Karen Dearne
• From: The Australian
• July 18, 2012 5:24PM

FUNDING of $135 million for the National E-Health Transition Authority will support a new work program over the next two years following its delivery of Australia's e-health foundations.

But the health department cannot yet provide any details of NEHTA's forward work plan allocated $67.4m in the recent budget -- a sum to be matched by the states and territories under Council of Australian Government funding arrangements.

Health chief information officer Paul Madden says NEHTA has "delivered" specifications for all foundation capabilities, including infrastructure and services.

Mr Madden said The Australian was wrong to suggest $1 billion had been spent on the national e-health program since former health minister Nicola Roxon unveiled her personally controlled e-health record vision in mid-2010.

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http://www.theaustralian.com.au/australian-it/government/states-not-ready-for-e-health-system/story-fn4htb9o-1226429582355

States not ready for e-Health system

• by: Karen Dearne
• From: The Australian
• July 19, 2012 6:56AM

GENERAL practitioners will have to wait up to three years to receive secure discharge summaries digitally signed by hospital doctors following more delays to the Gillard government's e-health system.

State and territory health departments say they are not ready to use healthcare providers' 16-digit unique identity numbers created for the national system to verify the identity of doctors or other medical staff creating a patient's discharge summary.

Healthcare providers individual identifiers - dubbed HPI-Is - were created and assigned to all registered doctors two years ago as part of the Healthcare Identifiers service launch, which also saw unique 16-digit identifiers allocated to every Australian enrolled on the Medicare database.

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http://www.pharmacynews.com.au/features/setting-the-records-straight-pharmacies-confront-t

Setting the records straight - Pharmacies confront the e-health revolution

19 July, 2012 Fran Molloy

Australia’s new e-health system launched on 1 July. What will it mean for pharmacy? And for health consumers? Fran Molloy talks to pharmacists who have been involved in the pre-launch trials about the impact on their processes and how their consumers responded.

Although Australians were able to register for a Personally Controlled Electronic Health Record (PCEHR) from July 1, it will be some time before the system starts to deliver benefits to pharmacy patients.

However, once people start getting on board and information starts to flow around the system, the eHealth record trials show there will be some real practical advantages for pharmacists.

 “We had one gentleman, a regular patient, come in to the pharmacy and he swore black and blue that a doctor he had seen at the hospital a few days ago had changed his medication,” said Linda Dew, manager of Soul Pattinson’s Pharmacy at Geelong, which participated in the trial.

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http://www.theaustralian.com.au/news/health-science/new-e-health-system-ignores-available-data/story-e6frg8y6-1226430308128

New e-health system ignores available data

• by: Karen Dearne
• From: The Australian
• July 21, 2012 12:00AM

DESIGNERS of Australia's electronic health system are more intent on capturing data than using existing information to improve patient care.

Mikael Hagstrom, vice-president of SAS, a global leader in data analysis software, says Australia isn't alone. Health care worldwide lags the banking, telco, retail and other sectors in the application of intelligence tools. He claims advances in digital imaging, diagnostic tools, real-time electronic medical records and the ability to mine patient information from data streamed live from remote monitoring systems will "transform healthcare delivery".

It can happen now, he adds, simply by using information that's already available.

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http://www.australiandoctor.com.au/news/latest-news/more-gps-sign-up-for-online-booking

More GPs sign up for online booking

18 July, 2012 Paul Smith

Increasing numbers of general practices are signing up for online booking services that allow patients to identify doctors with vacant timeslots, despite fears the systems could fragment care.

Sydney-based booking system 1stAvailable launched in April and charges practices $50 a month to use its service.

Health Engine, another online booking system in WA, started in February, while Clinic Connect offers online booking to patients at 150 practices Australia-wide.

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http://www.smh.com.au/national/health/mental-health-help-goes-online-20120721-22gsr.html

Mental health help goes online

Date July 22, 2012

Rachel Browne

For years the advice has been to avoid consulting Dr Google for any medical concerns but new Australian research is showing online programs have marked benefits for people experiencing mild to moderate mental health problems.

The leading mental health group the Black Dog Institute and the federal government will launch a new online self-help service called myCompass tomorrow, offering help for people with mild depression, stress or anxiety.

Part of the federal government's e-mental health strategy, the program is supported by research showing the effectiveness of online help for mild mental health disorders.

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http://ehealthspace.org/news/consumer-advocate-backs-level-pcehr-patient-control

Consumer advocate backs level of PCEHR patient control

Posted Fri, 20/07/2012 - 12:57 by Will Turner

The head of Australia’s peak healthcare consumer body has criticised Australian Medical Association president, Dr Steve Hambleton, over comments he made this week about the level of patient control over the eHealth record.

Dr Hambleton said in a statement the personally controlled electronic health record (PCEHR) was flawed because patients “might not give access to their treating GP, or they could omit or remove important medical information without consultation with their doctor.”

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http://www.canberratimes.com.au/act-news/data-doctoring-sparks-hospital-records-privacy-concerns-20120719-22bst.html#ixzz217HtWRP4

Data doctoring sparks hospital records privacy concerns

Date July 19, 2012

Noel Towel

The privacy of hundreds of thousands of patient records at the Canberra Hospital was vulnerable to compromise because of the poor quality of data management in the Emergency Department, according to the Auditor General.

Auditor-General Maxine Cooper told an Assembly Committee this morning that the poor quality of the department's systems had implications that went beyond the "data doctoring" scandal.

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http://www.smh.com.au/opinion/political-news/roxon-doubts-over-security-plans-to-store-web-history-20120720-22fel.html

Roxon doubts over security plans to store web history

Date July 21, 2012

Dylan Welch, Ben Grubb

''THE case has yet to be made'' for a controversial plan to force internet providers to store the web history of all Australians for up to two years, says the Attorney General, Nicola Roxon, who has acknowledged the financial and privacy costs of such a scheme.

She expressed her reservations in an interview with The Herald in what may be a sign the government does not have the appetite for forcing through Parliament the most controversial proposal among more than 40 national security proposals.

The proposals, if passed, would be the most significant expansion of national security powers since the Howard-era reforms of the early 2000s.

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http://www.smh.com.au/technology/technology-news/data-trail-easy-to-follow-for-big-brother-20120720-22ffm.html

Data trail easy to follow for Big Brother

Date: July 21, 2012

Policy changes could mean the end of online privacy, write Dylan Welch and Ben Grubb.

'If you have something that you don't want anyone to know, maybe you shouldn't be doing it in the first place.''

Thus spake the world's First Digital Citizen, Google supremo Eric Schmidt, during an American television interview in 2009.

Unsurprisingly, it provoked outrage when it was uttered, not least because Schmidt himself once blacklisted an online media company for publishing details of his private life gleaned from Google searches.

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http://ehealthspace.org/news/ama-outlines-major-problems-pcehr

AMA outlines major problems with PCEHR

Posted Tue, 17/07/2012 - 10:43 by Will Turner

Australian Medical Association (AMA) President, Dr Steve Hambleton, has reiterated his organisation’s dissatisfaction with the personally controlled electronic health record (PCEHR) in its current form.

Dr Hambleton said in a statement it will be some time before large numbers of patients or their doctors register with the system because of “serious adverse claims around privacy, security and compatibility.”

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http://www.theaustralian.com.au/australian-it/it-jobs/stavailable-taps-klaus-bartosch-as-executive-chairman/story-fn9ytfio-1226428699392

1stAvailable taps Klaus Bartosch as executive chairman

• From: The Australian
• July 18, 2012 7:36AM

AUSTRALIAN online healthcare search and appointment service 1stAvailable.com.au has secured experienced executive Klaus Bartosch as executive chairman.

Bartosch is well known for his successful tenure with then ASX-listed Hostworks, an online media managed services company, prior to its sale to Broadcast Australia.

While there Bartosch worked closely with customers including Wotif.com, Seek.com, Carsales.com.au, Realestate.com.au, GraysOnline and ninemsn.

Just back from a charity cycling event in Canada where he raised funds for the fight against cancer, Bartosch describes 1stAvailable as a terrific business. "It is an opportunity to make a huge difference to the healthcare experience of many Australians," he says.

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http://www.marketwatch.com/story/mmrglobal-and-visiinc-plc-announce-major-ehealth-record-solution-for-australia-2012-07-17

press release

July 17, 2012, 8:36 a.m. EDT

MMRGlobal and VisiInc PLC Announce Major eHealth Record Solution for Australia

LOS ANGELES, CA and PERTH, WESTERN AUSTRALIA, Jul 17, 2012 (MARKETWIRE via COMTEX) -- MMRGlobal, Inc. MMRF -0.56% (MMR) and VisiInc PLC have announced a combined product offering representing an immediate solution within Australia for the Personally Controlled eHealth Record (PCEHR) standard as defined by the government's National E-Health Transition Authority (NEHTA). The product incorporates MMR's Australian eHealth patent portfolio combined with VisiInc's Vistime solution and addresses the opportunities created from the launch of Australia's Personal Health Record on July 1 as well as interoperability of numerous eHealth and telehealth platforms being used in countries around the world.

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http://ehealthspace.org/news/study-reports-care-shortfalls-urges-better-use-it

Study reports on care shortfalls, urges better use of IT

Posted Tue, 17/07/2012 - 15:19 by Will Turner

A major study has found significant quality shortfalls in the delivery of health care in Australia, and urged better use of information technology to address the issue.

The $2 million CareTrack study published in the Medical Journal of Australia (MJA) assessed what proportion of health care encounters result in appropriate care being received by patients. The National Health and Medical Research Council-commissioned study involved patients with 22 common conditions and found that “whilst there are areas of excellent practice, there are also large gaps in the provision of appropriate care.”

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http://www.theaustralian.com.au/news/health-science/doctors-argue-over-recipes/story-e6frg8y6-1226430308320

Doctors argue over 'recipes'

• by: Adam Cresswell, Health editor
• From: The Australian
• July 21, 2012 12:00AM

THE authors of Australia's taxpayer-funded CareTrack study, which cost $2.5 million and took more than two years to conduct, are under no illusions about the challenge they have set themselves - to review and, if necessary, rewrite guidelines that will outline what treatments are considered best practice for the 22 most common medical conditions seen by doctors.

As Jeffrey Braithwaite puts it, the need is pressing. While many guidelines exist, they are often problematic for various reasons.

They may be out of date, conflict with other guidelines, be poorly backed up by the relevant medical literature, or may just be presented in a way that makes them hard for busy doctors to use.

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http://www.smh.com.au/technology/sci-tech/supercomputer-mimics-common-cold-in-search-for-way-to-treat-it-20120716-226k0.html

Supercomputer mimics common cold in search for way to treat it

Date July 17, 2012

Julia Medew

AUSTRALIAN scientists have used a new supercomputer to simulate the movement of the virus that causes the common cold for the first time.

The breakthrough opens up new targets for potentially life-saving drug treatments.

While the common cold does not cause much harm to healthy individuals, it often exacerbates lung conditions such as asthma and chronic obstructive pulmonary disease, causing hospitalisations and deaths.

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http://au.news.yahoo.com/thewest/regional/kimberley/a/-/news/14225305/sim-man-3g-helps-medical-students/

Sim Man 3G helps medical students

NICOLA KALMAR, Broome Advertiser Updated July 16, 2012, 5:14 am

A state-of-the-art, high-tech mannequin, which simulates a real- life patient, is helping a group of young doctors prepare for real emergency scenarios.

The Sim Man 3G is a life-size dummy that provides simulation based education to challenge and test students’ clinical and decision-making skills during realistic patient care scenarios.

Sim Man arrived at Broome Hospital from Perth last week, provided by WA Country Health Services, through government funding.

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http://www.theaustralian.com.au/business/companies/tech-entrepreneur-gary-cohen-promises-to-transform-hyro/story-fn91v9q3-1226430401636

Tech entrepreneur Gary Cohen promises to transform Hyro

• by: Rebecca Urban
• From: The Australian
• July 20, 2012 12:00AM

TECHNOLOGY entrepreneur Gary Cohen is back at the helm of a publicly listed company, having struck a deal with the board of Hyro to transform the business into a leading investor in digital technology assets.

A month after narrowly failing in his bid to stop the sale of Hyro's assets to the Nasdaq-listed Kit Digital, Mr Cohen's private investment company Marcel Equity Group has announced a cornerstone investment in the remaining shell.

It intends to invest $1.2 million in Hyro in return for a 19.8 per cent stake, with funds to be used to discharge debts and buy a substantial stake in the privately held Global Internet Technologies, owner of marketing play Social Loot, takeaway food site Menulog and shopping comparison site Get Price.

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http://www.smh.com.au/technology/sci-tech/scientific-research-will-be-free-online-20120716-226aw.html

Scientific research will be free online

Date: July 17, 2012

Ian Sample

LONDON: The British government has revealed controversial plans to make publicly funded scientific research immediately available for anyone to read for free by 2014, in the most radical shake-up of academic publishing since the invention of the internet.

Research papers that describe work paid for by the British taxpayer will be free online for universities, companies and individuals to use for any purpose, wherever they are in the world.

The universities and science minister, David Willetts said he expected a full transformation to the open approach over the next two years.

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http://www.smh.com.au/national/machines-pose-threat-to-humans-20120718-22aph.html

Machines 'pose threat to humans'

Date July 19, 2012

Asher Moses

Technology Editor

ONE of the founding engineers of Skype and Kazaa is in Australia to sound a warning to the human race: fasten your seatbelts, as machines are becoming so intelligent that they could pose an existential threat.

Jaan Tallinn argues human-driven technological progress has largely replaced evolution as the dominant force shaping our future.

Machines are becoming smarter than people, but Mr Tallinn warns that if we are not careful this could lead to a ''sudden global ecological catastrophe''.

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http://www.smh.com.au/technology/sci-tech/universe-could-end-with-big-rip-20120719-22bbl.html

Universe could end with 'Big Rip'

July 19, 2012 - 8:23AM

Stars will disappear, the sun will go out and then the Earth and our bodies will be ripped into pieces.

This Big Rip, Nobel Laureate Brian Schmidt says, might be the way our universe ends and it may happen "on literally a human time scale".

At a public talk by the Australian Astronomical Observatory in Sydney last night, Professor Schmidt - a joint winner of the 2011 Nobel Prize for Physics - described how our universe is rapidly expanding.

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Enjoy!

David.