Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Tuesday, March 08, 2011

Weekly Australian Health IT Links – 08 March, 2011.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment:

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While the big news of the week has been NEHTA awarding a contract for some help with NASH to IBM there has been a bit of a sleeper emerge.

This is covered in the first article below.

The important part of the article is the following:

“But Ms Kerr this week said “It doesn’t really matter what they use. Even if those health professionals are able to access them via certificates, if the computer us compromised by malware and people use the password on the infected computer then the criminal has the complete access to the system and the record.”

“What we don’t know is the platforms that people will be able to use to access the records – that’s what is important.”

Ms Kerr said that while there was a lot of focus on the privacy threat associated with PCEHRs, there was a security issue also in terms of criminal elements gaining access to the records. “Of course the key is how to monetise the information,” she acknowledged.

“I’m not sure how they would do it – but it is still a concern.”

Certainly the risk of identity theft could be heightened if computer criminals were able to access personal identifying data associated with the PCEHR.”

It will be interesting to see just how NASH addresses this sort of problem. The cost and effort of securing all the PCs that might be enabled to access the PCEHR will be an interesting challenge. We know the banks do a reasonable job - but it costs a lot but they have a powerful incentive (losing money) to do a good job. I wonder will DoHA be prepared to invest as heavily to protect patient information?

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http://www.itwire.com/it-policy-news/government-tech-policy/45531-e-health-security-spooks-auscert-

E-health security spooks AusCERT

Leading security group AusCERT has raised concerns about the safety of the Personally Controlled Electronic Health Record (PCEHR) which Australians will be able to sign up for starting next year, and which is the cornerstone of the Government’s proposed e-health initiatives.

Speaking at Kickstart 11 this week, Kathryn Kerr, AusCERT’s manager for analysis and assessments, said that to date there was not much information available about the operation of the PCEHR but she believed patients would be able to nominate who would have access to that record, providing access to the record for themselves, health professionals, family members or carers.

“What we don’t know is, are they accessible by patients anywhere and anytime?” which according to Ms Kerr could pose a real security problem.

AusCERT, which is based at the University of Queensland, was until 2010 Australia’s national Computer Emergency Response Team, after which the role was taken over by the Government owned CERT Australia. While no longer the official national CERT, AusCERT’s concerns about a fundamental element of the national e-health strategy should prompt serious consideration.
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http://www.theaustralian.com.au/australian-it/government/mckinsey-to-study-e-health-readiness/story-fn4htb9o-1226014754894

E-health: McKinsey asks what's up doc?

  • Karen Dearne
  • From: Australian IT
  • March 02, 2011 2:04PM

CONSULTANCY McKinsey & Co has pocketed $1.55 million for four months' work researching the e-health readiness of Australia's medical specialists and allied health providers.

The federal Health department has paid $600,000 to survey specialists and $950,000 to cover the allied health sector.

According to the latest Australian Institute of Health and Welfare workforce statistics, in 2008 there were more than 90,000 allied health professionals, encompassing dieticians, optometrists, physiotherapists, psychologists, chiropractors and osteopaths.

And the medical specialist workforce was around 24,700, including internal medicine specialists, surgeons, anaesthetists, obstetricians and pathologists.

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http://www.theaustralian.com.au/australian-it/australia-pipped-by-us-in-the-race-to-rollout-the-bionic-eye/story-e6frgakx-1226015930315

Australia pipped by US in the race to rollout the bionic eye

AUSTRALIA's aim to be world leaders in commercialising the "bionic eye" has been dealt a blow with a US company gaining approval to sell its device this year.

Los Angeles-based Second Sight Medical Products said Australia was now one of a series of countries "on its radar" for marketing and transplanting its bionic eye, which this week received commercial go-ahead in Europe.

Second Sight’s bionic eye, the Argus II, will be available commercially after it attained the required CE Certification in Europe.

The Argus II will go on sale "in the coming months", initially in Europe, Second Sight business development vice-president Brian Mech told The Australian.

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http://www.theaustralian.com.au/news/world/surgeon-anthony-atala-creates-new-kidney-on-stage/story-e6frg6so-1226016026031

Surgeon, Anthony Atala, creates new kidney on stage

  • From: AFP
  • March 04, 2011 4:12PM

A SURGEON specialising in regenerative medicine yesterday "printed" a real kidney using a machine that eliminates the need for donors when it comes to organ transplants.

"It's like baking a cake," Anthony Atala of the Wake Forest Institute of Regenerative Medicine said as he cooked up a fresh kidney on stage at a conference in the California city of Long Beach.

Scanners are used to take a 3D image of a kidney that needs replacing, then a tissue sample about half the size of postage stamp is used to seed the computerised process, Atala explained.

The organ "printer" then works layer-by-layer to build a replacement kidney replicating the patient's tissue.

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http://www.cio.com.au/article/378237/medicare_revises_healthcare_identifier_developer_agreement/

Medicare revises healthcare identifier developer agreement

A new identifier licence is to be released shortly to plug legal gaps raised before their introduction last year

Medicare Australia has reached an agreement with e-health vendors surrounding a legal blackhole in developer agreements signed for use of individual healthcare identifiers, with hopes a revised license to be released in the coming week will encourage wider use of the identifiers in clinical software.

The negotiations, which were sparked last year, accompany ongoing testing of the identifier system among consumers by lead e-health agency, the National E-Health Transition Authority (NEHTA), more than eight months after legislation for use of the identifiers passed Parliament, and the numbers assigned to 23 million Australians and healthcare providers.

Sources told Computerworld Australia that the legal blackhole was identified as impossible to comply with by both Medicare, the current managing agent for the identifier system, and NEHTA.

Under the current contract, the developer would be held liable for any mistakes made by Medicare or the healthcare provider - however unlikely - involving the use of a patient’s healthcare identifier after implementation of the clinical software.

The issue was first raised by the Medical Software Industry Association (MSIA) in April last year, but it is believed an agreement was only reached on Monday this week.

A spokesperson for Medicare confirmed the agreement had been revised and would be available on the agency’s website once fully complete.

Note: I can find nothing on www.medicare.gov.au as of today.

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http://www.theaustralian.com.au/news/health-science/doctors-slam-model-for-lead-clinician-groups/story-e6frg8y6-1226011623295

Doctors slam model for Lead Clinician Groups

  • Adam Creswell, Health editor
  • From: The Australian
  • February 26, 2011 12:00AM

DOCTORS have argued for medical practitioners to form the majority of members of the federal government's planned Lead Clinician Groups, designed to return a say in the running of hospitals to care providers.

In a submission in response to a recent government discussion paper on the likely shape of the new groups, the Australian Medical Association says while membership of each should include at least one nurse or midwife and one allied health practitioner, most seats should go to doctors, "given they take responsibility for the whole of patient care".

The submission also makes the case for the clinician groups to advise hospital chief executives "on all matters regarding patient care and health outcomes", including clinical workforce issues, teaching and training requirements, research and audit, workforce responsibilities and scopes of practice and "efficient and equitable use of hospital resources".

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http://www.theaustralian.com.au/australian-it/government/pharmacy-software-vendors-gets-federal-boost/story-fn4htb9o-1226014534164

Pharmacy software vendors gets federal boost

  • Karen Dearne
  • From: Australian IT
  • March 02, 2011 8:47AM

PHARMACY software-makers were paid $2 million to upgrade their software for the federal government’s new PBS medicine subsidy for Aboriginal and Torres Strait Islanders living with chronic illnesses.

Under the program, eligible patients pay the concessional rate of $5.40 per item, rather than the full PBS co-payment of up to $33 per item.

The Closing the Gap health measure was introduced last July to improve access to medications.

Eleven software firms received payments ranging from $140,000 (Mountaintop Systems) to $326,000 (Pharmhos Software) to modify their pharmacy systems, according to documents just released by the Health department.

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http://delimiter.com.au/2011/03/01/rivals-nash-teeth-as-ibm-wins-e-health-deal/

Rivals NASH teeth as IBM wins e-health deal

IBM today revealed it had won a $23.6 million contract with the National E-Health Transition Authority (NEHTA) to deliver the Federal Government’s National Authentication Service for Health (NASH) project.

As part of a $466.7 million investment in the e-health records announced in September last year by the Federal Government, the nation’s peak e-health body NEHTA has chosen IBM to build and manage its new NASH system, which aims at establishing a nationwide secure and authenticated service for both healthcare organisations and personnel that have to exchange e-health information.

NEHTA chief executive Peter Fleming said NASH would improve healthcare for both professionals and patients. “Our agreement with IBM enables NEHTA to build a system that will give healthcare professionals timely and secure access to appropriate patient information,” he said in a statement. “In turn, the NASH program will take us one step closer to broader healthcare access for all Australians.”

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http://news.theage.com.au/breaking-news-national/121-qld-health-workers-in-fraud-probe-20110302-1bdu6.html

121 Qld Health workers in fraud probe

March 2, 2011 - 10:29AM

AAP

About 120 Queensland Health workers are under investigation for fraud over $662,000 in emergency payments claimed during the state's payroll crisis.

A new Queensland Health payroll system introduced in March last year left hundreds of staff underpaid, overpaid or not paid at all.

The department introduced an emergency cash payment scheme to counter the payroll problems.

Queensland Health has confirmed the Crime and Misconduct Commission has investigated 121 cases for fraud. The total figure of payments claimed is $662,000.

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http://www.cio.com.au/article/378221/queensland_health_payroll_problems_far_from_over/

Queensland Health payroll problems far from over

New payroll system has made thousands of mistakes since March last year.

  • AAP (AAP)
  • 01 March, 2011 10:39

Queensland's health minister says the state's health pay woes will improve but he doesn't know when they'll be fixed.

A new payroll system introduced for Queensland Health (QH) last March has made thousands of mistakes.

An independent report in November estimated it would take 18 months and cost $209 million to fix.

Geoff Wilson, who became health minister one week ago in a cabinet reshuffle, told reporters on Monday there would be "significant improvements" over the next several months.

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http://www.smh.com.au/nsw/state-election-2011/patients-come-first-but-the-system-needs-help-now-20110228-1bbsq.html

Patients come first but the system needs help now

BRAD FRANKUM

March 1, 2011

Installing electronic patient medical records in hospitals and reducing unnecessary procedures are two of the big fixes for NSW.

I WORK in a public hospital which still requires me to write notes in a paper file when I see a patient on a ward round. This is in 2011, in metropolitan Sydney. I am unable to email a patient's discharge summary to their general practitioner.

The local doctor is also unable to download any of the patient's health records into the hospital's information system. The result is a constant risk to the patient through poor documentation, duplication of investigations and miscommunication.

Recently I cared for an elderly man who was already seeing six different specialists, in addition to his GP, for his various health problems but still ended up being admitted to the hospital under the care of a seventh specialist: myself. I had never met him before, so had to start over from scratch. He, like many chronically ill and elderly patients, spends an inordinate amount of time travelling to doctor’s appointments.

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http://www.theaustralian.com.au/australian-it/the-goal-is-better-health-outcomes/story-fn7uxvjw-1226005578132

The goal is better health outcomes

THE man stepping into the top Health IT job, Paul Madden, wants you to know his title is chief information and knowledge officer.

"I'm taking on a knowledge and intelligence management role, as well as the IT side," he says.

"As we step into the e-health world, we do have some new opportunities to simplify and standardise performance reporting, and to bring in new levels of intelligence about what's happening across the community.

"Our end goal is better health outcomes for people.

"We're just reaching a point where the technology and visions for connection are being embraced, and I think it's time to make sure we have an integrated way of making that happen."

Madden comes from a strong background in the Tax Office and Treasury. Over the past four years he led Treasury's ambitious standard business reporting program, aimed at slashing red tape for companies when dealing with government.

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http://www.theaustralian.com.au/australian-it/sector-in-dire-need-of-funding/story-fn7uxxqa-1226013415909

Sector in dire need of funding

THE local e-health industry is in for a shake up, with acquisitions, new entrants and consolidation ahead this year, Adam Powick says.

"Many parts of the sector are just hanging on, and they need an injection of funds," he says. "That may come from government for those who are successful in the next round of projects.

"But I think there will also be fresh money as newcomers take equity in local firms, particularly those with good technologies.

"Private health insurers and telcos will also be playing a more active role in the market."

Powick says serious progress has to be made on the ground this year if the Gillard government's 2012 deadline for the introduction of personal e-health records is to be met.

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http://www.theaustralian.com.au/australian-it/project-risks-medical-record-privacy-expert-warns/story-e6frgakx-1226013780344

Project risks medical record privacy, expert warns

HEALTH bureaucrats risk exposing patient medical information by starting e-health projects before key decisions on security, consent, technical controls and regulatory oversight are made.

And Australian Privacy Foundation chair Roger Clarke has attacked the National E-Health Transition Authority and federal Health officials for cutting consumers out of the design process for the $467 million personally controlled e-health record system.

"Because consumer representatives have had so little input, there's a very strong chance sensitive data will be compromised, and the system won't suit people's needs," he said.

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http://www.computerworld.com.au/article/378072/isoft_swings_84m_loss/

iSOFT swings to $84m loss

Shares in health IT company iSOFT (ASX:ISF) slumped 10 per cent on Friday after the company revealed it had swung to an $84.1m loss

Health IT company iSOFT (ASX:ISF) swung to an $84.1 million net loss in 1H11, due to restructuring costs and impairment charges.

ISF shares fell 10.29 per cent to $0.061 in Friday's trading following the announcement.

The company, which had made a $4.8 million profit in 1H10, spent the most recent half attempting to restore the financial health of the business.

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http://www.itnews.com.au/News/250094,e-health-protocols-trump-network-speed-in-nbn-inquiry.aspx

E-health protocols trump network speed in NBN inquiry

Data transfer protocols would "save lives the fastest", committee hears.

The Australian Medical Association today highlighted a lack of data transfer protocols as one of the chief barriers to effective, electronic healthcare provision.

Addressing a Parliamentary Inquiry on the role and potential of a National Broadband Network, AMA vice president Steven Hambleton said non-network barriers were holding back electronic information transfer.

Despite having an ADSL2 connection that was shared between 15 desktop computers, Hambleton said most communications left his Brisbane office via fax or paper.

Inefficient communication methods could lead to drug prescription errors and a lack of follow-up, he warned.

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Telstra makes broadband warning: NBN laws 'create new monopoly'

  • Annabel Hepworth and Lauren Wilson
  • From: The Australian
  • February 28, 2011 12:00AM

TELSTRA says the Gillard government's proposed laws for the National Broadband Network threaten to wipe out the public benefits of the $36 billion project by allowing the NBN Co to monopolise new areas and strangle future competition.

Even as Telstra negotiates remaining hurdles to the $11bn deal to join the nation's biggest infrastructure project, it is demanding changes to the next set of NBN legislation, which sets the rules for the NBN Co building the national network.

Last night, the office of Communications Minister Stephen Conroy said the government was "keeping an open mind to any amendments" and was in discussions with Telstra about the legislation.

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Enjoy!

David.

Anonymous Comments On Prof Patrick Blogs

With respect to the discussion on the work on Firstnet by Prof Patrick I am seeing much to much of the playing the man and not the ball.

From now on - only people who are prepared to use their names publishing on this topic or contributing properly to the debate - the call at my discretion will be published. The blog is NOT going to become personal abuse central!

There has become just too much evidence lacking assertion from many commenters in my view.

David.

It Has Taken Me A Day or So To Spot These Documents on the PCEHR. Too Much Else On!

The following was posted on the DoHA site few days ago.

NIP Industry Briefing

On 15 February 2011, The Department of Health and Ageing released an RFT to source a National Infrastructure Partner/s to develop and implement the national infrastructure for the Personally Controlled Electronic Health Record (PCEHR) system. This includes the detailed development, implementation, and testing of the physical systems, ICT solutions, products and interfaces necessary for the reliable and efficient operation of the PCEHR system. Also included in the role of the National Infrastructure Partner is the integration of the PCEHR system with existing eHealth infrastructure around Australia.

On 1 March 2011, an Industry Briefing was held by the Department in Sydney. Informative presentations were given and attendees’ questions were answered by representatives of the Department of Health and Ageing and the National eHealth Transition Authority (NEHTA) regarding the requirements of the RFT, and the wider PCEHR Program. These are available below for download.

The source page is here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/nip-industry-briefing

At first look it seems they are just digging a bigger hole for themselves.

Example - how can you start evaluation before anything is actually seriously operational. The is to start in July 2011?

What is interesting is the assumption on page 6 of the Concept of Operations slides that clinicians will manage local records and also be uploading material to the PCEHR. The workflow and other implications of such a design a disastrous I suspect - to the extent pretty no one will have the time or inclination to do so - unless working in a salaried environment where time is not money as it is in most General Practice now!

Comments on documents welcome. (Note this is not the V11 actual documentation we should all be reading!)

David

Monday, March 07, 2011

This Is Really Just Profound Nonsense. We Are Living In Something Close to an E-Health Police State!

I had a call from an old mate from the industry this morning.

In the call he told me he was having a good time reading the Version 11 of the NEHTA PCEHR Concept of Operations (ConOps) as well as parts of the NEHTA Contract with DoHA so, I presume, he could figure out just who was planning to do what with whom in this the round of PCEHR tenders.

I suggested that now we were at Version 11 it must now be perfect but he was just a mite sceptical of that!

What was really amazing, he found, was that the PCEHR timetables in the DataPak were essentially unchanged but that the way the tender was structured any delay risk had been transferred from NEHTA and DoHA to those tendering.

Astonishingly, apparently part of the proposed deal is that tenderers have to plan based on the assumption the HI Service and NASH will be delivered when needed and that the response cannot mitigate risks associated with these events not actually happening.

What this means, by my interpretation, is that either you sign up to un-realistic timelines or don’t bid. This is a classic commercial ‘rock and hard place’ situation.

You would be not surprised to know that when I suggested I might be sent a copy and I was told that was not possible as the Non-Disclosure Agreement (NDA) was pretty draconian.

As an example of how dire the NDA is, is that both his lap top and my computer logs would be subject to search and review of logs should I be found to have a copy (I really wonder if that can actually be enforced? - feel free to send me a copy and we can see!)

Even more alarming was that when I suggested he might give me a copy of the NDA I was told that was also protected in a rather recursive way and was as restricted as the ConOps documentation.

All I can say is WTF. This is a document (the ConOps) describing something that is allegedly being developed for the good of our health and yet the whole process is being surrounded by military grade security. Just why would that be? There is no valid reason I can see!

My view is that this is utterly out of control! My feeling is that frankly NEHTA has become a threat to good and open government in our country with this sort of paranoid and anti-democratic behaviour.

As other sites often say ‘What do you think’?

David.

AusHealthIT Poll Number 60 – Results – 07 March, 2011.

The question was:

Please Rate The Quality of the Work from NEHTA / DoHA you are Seeing on the PCEHR Proposal.

The answers were as follows:

10/10

- 4 (11%)

7.5/10

- 4 (11%)

5/10

- 4 (11%)

2.5/10

- 12 (33%)

0/10

- 12 (33%)

Well that is seems pretty clear with only 22% giving more than a bare pass! They need to do a great deal better clearly!

Votes : 36

Again, many thanks to those that voted!

David.

Prof Patrick Has Really Hit the Bullseye It Would Seem. Lots of Supportive Comments From All Over!

The work reported yesterday has triggered a major reaction from all over.

From the Sydney Morning Herald we have:

Patients put at risk by software

Julie Robotham

March 7, 2011

THE computer system that runs emergency departments in NSW hospitals is compromising patients' care, according to the first systematic review of the troubled project that found it was crippled by design flaws.

The FirstNet system allows treatment details and test results to be assigned inadvertently to the wrong patient, according to the review. It is based on a technical study of the software and interviews with directors of seven Sydney emergency departments.

The system is so compromised it should be scrapped, a specialist doctors' group said yesterday.

Difficulties retrieving patient records could delay treatment, and the system - on which $115 million has been spent - automatically cancelled pathology and radiology requests if the person was transferred from the emergency department without checking whether these were still needed, according to the study by Jon Patrick, the director of the University of Sydney's health information technology research laboratory.

Sally McCarthy, the president of the Australasian College for Emergency Medicine, said Professor Patrick's findings confirmed that the system, loathed by doctors and nurses, was unsuitable for its purpose.

''When do we stop throwing good money after bad?" said Dr McCarthy, who heads the emergency department at Prince of Wales Hospital. "Anything that takes staff off the floor to spend their working time on an inefficient IT system is a detriment to patients."

The project, part of a 10-year electronic medical records plan intended to make patient histories, X-rays and test results accessible from any hospital in the state, had proceeded too fast - apparently because of contractual obligations - for clinicians' feedback to influence it, Dr McCarthy said.

Lots more here:

http://www.smh.com.au/technology/technology-news/patients-put-at-risk-by-software-20110306-1bjn9.html

We also have some very interesting US reaction:

From here:

http://histalk2.com/

For March 7 we have:

From Aussie: “Re: Jon Patrick’s article. Mr. HIStalk, I have never seen a dissection (without anesthesia) of Cerner going to this depth. Unbelievable, although in the USA, one would be professionally dead in the HIT industry if even contemplating talking about these long known issues. Hope you will have the courage to publish something about it.” Professor Jon Patrick of the Health Information Technologies Research Laboratory of University of Sydney expands his writeup (currently in draft) about problems with the implementation of Cerner FirstNet in emergency departments in New South Wales.

You’ll love it if you sell against Cerner because everybody from doctors to software validation experts tears into FirstNet (and, by implication, Millennium in general) from every angle — usability, software and database design, and implementation methods. FirstNet competitors could create a fat anti-Cerner prospect piece just by excerpting from it.

On the other hand, I wouldn’t say it’s necessarily unbiased, it focuses on implementation of a single department application that didn’t go well for a variety of reasons (despite many successful FirstNet implementations elsewhere), it uses the unchallenged anecdotal comments of unhappy users who make it clear they liked their previous EDIS better, and it nitpicks (I wasn’t moved to find a pitchfork when I learned that the primary keys in the Millennium database aren’t named consistently).

But it is interesting when it tries to associate user-reported problems with observed technical deficiencies, such as why information known to have been entered sometimes disappears (problems with non-unique primary keys and referential integrity are mentioned – certainly the latter is a problem with many systems).

In other words, it’s not just about Cerner or some ED project in Australia. The real message is that design and support patient care software is the Wild West at this point since we’re arguably still in the first generation of systems claiming to be clinical (even though they often are really business systems masquerading as such).

Lots more of this article is on the site.

Also Scot Silverstein blog has been busy:

See

http://hcrenewal.blogspot.com/2011/03/what-to-do-about-state-of-ed-ehr-in-nsw.html

http://hcrenewal.blogspot.com/2011/03/on-emr-forensic-evaluation-from-down.html

I am sure more will follow. A big reading day.

The links to the original report is found here:

http://aushealthit.blogspot.com/2011/03/professor-jon-patrick-pops-his-head.html

Enjoy all the reading.

David

Sunday, March 06, 2011

A Story of Consultation NEHTA Style - Pretty Sad!

The following appeared a few days ago.

http://www.consumerehealth.org/index.html

4 March 2011

Initial PCEHR consumer consultation of sorts

Recently the National E-Health Transition Authority (NEHTA) and the Department of Health and Aging (DoHA) called 3 workshops to ostensibly gauge consumer views and enable consumer centred policy input into the early concept development and design of the Personally Controlled Electronic Health Record (PCEHR) and other eHealth initiatives. Time is quickly running out before the 467 million dollar PCEHR will be implemented in patient care environments. Experience tells us that a resounding silence has greeted voluntary feedback over previous years. Nonetheless, for all Australians, we hope the situation will improve this time.

For example, the findings of the NEHTA funded Individual Health Identifier IHI pre-implementation risk assessment report (here) reflects most of the constructive criticisms consumer and privacy groups have voluntarily provided in dozens of submissions over the years (see below). However neither DoHA or NEHTA have bothered to reply to these (see here). Nor is there evidence to suggest any part of the feedback has been reflected in IHI enabling legislation. Instead bureaucrats have driven the process, preferring to commission reports, such as the risk assessment report, that have cost tax payers thousands of dollars rather than listen to the advocates or citizens.

More alarming, in an age of rapidly growing rates of identity fraud, all of the personal details of every Australian is stored by Medicare in a centralized data base. Medicare has been tasked with leveraging a birth to death identification number (the IHI) from the notoriously unreliable Medicare number to enable national e-health projects. The market-speak DoHA and NEHTA use to describe the data-base simply refers to it as "distributed". A distributed database IS a centralized data base!

The IHI has proved to be unreliable in test environments and tends to jeopardize the quality of patient care outcomes. Even health authorities recognize that an IHI is too hazardous to use without some other type of patient identifier. Risk assessment findings assume the "Use of the IHI in conjunction with the local UR number for internal clinical and administrative patient activity (page 9)" in their analysis. This assumption contradicts the arguments published by the government when passing the legislation last year (here). In a press release designed to support the passage of the legislation, DoHA said " IHI’s are essential in creating a single process to accurately and consistently identify patients and healthcare providers". The IHI project clearly does not come up to scratch.

The tender for the National Authentication Service for Health (NASH) , which the government claims will protect the privacy and security of personal information stored in the richest, most up-to-date, centralized data base in Australia has only been awarded this week (click here). It hasn't been designed. Does this mean that access control to the IHI data base cannot be audited yet? Are Australians still unable to see who or why others may access their private information despite public government assurances to the contrary?

IHI and NASH projects and the risk assessment analysis document provide an interesting context within which to understand the PCEHR project. Minister Roxon promised that the PCEHR Concept of Operations document would be publicly available nearly two months ago. A Concept of Operations document "describes the characteristics of a proposed system from the viewpoint of an individual who will use that system" (Wikipedia). However the document still hasn't been publicly released by government authorities. Instead, a well-known blogger has published it (click here to read it). Thanks for providing some much needed transparency David!

Government authorities initiated a series of 3 workshops to ostensibly gauge consumer views about the early concept development and design of the PCEHR in January and February of this year (see above).They also funded a parallel process that excluded some of the advocates invited to the more public meetings. When the time finally comes to take consumer feedback into account, which process will inform the design of the PCEHR? Will the outcomes from both processes be reconciled? If so, how? Click here for further information.

We are growing frustrated with the NEHTA/DoHA led consultations process and skeptical about any useful outcomes incorporating consumer feedback. We ask for evidence the feedback has influenced a single aspect of the e-health experiment. Instead selective interpretations of international experiences have begun to emerge from government spokespersons (more here). Yet none of these refer to the benchmark analysis of the UK's Summary Care Record (SCR), which is similar to the Australian PCEHR. Analysis findings suggest the SCR data base contains inaccuracies, neither patient or doctor use them and the chance that a treating clinician will find needed information stored in the SCR is remote (click here to read the analysis).

.....

When attending NEHTA initiated meetings about the IHI in previous years, advocates were told NOT to analyze the way a PCEHR will work with IHI and NASH yet. Now that the IHI data base is an dysfunctional actuality, residing in a centralized data base and suffering from threats listed in the risk assessment report, as advocates warned years ago, we have been scurried along to contribute analysis of the PCEHR. What is all this compartmentalization about? It’s so abstract and useless. Yes there are some principled and talented people working for NEHTA and DoHA but they run neither organization. Are we actually being led up a "blind alley" masquerading as a way to influence PCEHR design outcomes?

This writer wants to trust DoHA and NEHTA but can't ... every alarm in my head is screaming that the consultations and meetings are simply propaganda to distract voluntary members of advocacy groups from key issues, such as governance, the urgent need for meaningful consumer advice and the poor project management skills government health bodies have demonstrated thus far.

----- End Article.

This is a classic ‘fool me once, shame on you : fool me twice, shame on me.’ The consumer and privacy advocates feel strongly they were misled by DoHA / NEHTA on the HI Service and are really keen not to be conned again.

If the PCEHR consultation process is not done a lot better than the HI Service effort then the likelihood the system will be a success is vanishingly small and it will be a terrible waste of money.

Time has come to dramatically lift the game - as well as fundamentally reshaping the direction the PCEHR is presently heading - which I believe is utterly wrong.

Sadly the author of this report wanted to stay anonymous - fearing retribution from some of the dark forces I wrote about last week.

David.

Professor Jon Patrick Pops His Head Above The Parapet On ED Systems. NSW Health Highlighted.

Jon has just alerted to e-Health Community to a Magnum Opus on Emergency Department (ED) computing based on a range on NSW Experiences and a lot of research.

I will let him introduce the work:

“For those of you interested in the problems in EDs and don't want to read my 190 page report at

http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146

which covers:

This is a study into the roll-out of Cerner FirstNet into EDs in NSW.

- The original study was issued in Dec 2009 (Part 3.1).

- This has been added to with a new study in 2010 consisting of discussions with 7 ED Directors (Part 3.2),

- Discussions with software experts who do performance evaluations on Cerner sites (Part 3.3),

- Reviews of Entity-Relationship Diagrams (Part 3.4),

- Schema descriptions and data tables from customer installations (Part 3.5 & 3.6).

- All this information is coalesced to establish a much more detailed picture of a Cerner installation (Part 3.7).

- A number of weaknesses are identified in the design and implementation and risk assessments are recommended for organisations using this software or intending to use it. Regulations that might minimise the risks to users of health software are recommended (Part 3.8).

- An alternative architecture and method for constructing clinical information systems is presented (Part 3.9). “

Already there has been some commentary and as Jon mentions there is a blog, by Scot Silverstein that has drawn out some of the more important points. This is found here:

http://hcrenewal.blogspot.com/2011/03/on-emr-forensic-evaluation-from-down.html

I am sure there will be many who are interested to have a look at both the blog and the work. Comments are welcome and I am sure he will respond to the useful and interesting ones.

The ED Director's comments are just damning of NSW Health and their approach to their clinicians (Part 3.2). Read and weep!

David.