I Bet There Is Some Government Scrambling To Fix This Total Mess. Just Amazing!

Earlier this week we had a case resolved in the High Court that suggested that the way School Chaplaincy was funded by the Commonwealth was invalid / illegal.

You can read all about the decision and what it means here:

The introduction says it all:

Commonwealth left scrambling by school chaplaincy decision

Posted on June 19, 2014 by a1068313

In this post Adelaide Law School’s Gabrielle Appleby explains the High Court’s decision in Williams v Commonwealth [2014] HCA 23 (19 June 2014) and the need for an immediate response from the Commonwealth. This article was originally published on The Conversation.

The High Court has again put the future of the federal government’s school chaplaincy program in jeopardy, confirming its 2012 decision that the Commonwealth’s spending programs must be supported by valid federal legislation.

In a case brought again by Toowoomba man Ron Williams, the High Court insisted federal spending programs respect the constitutional division of powers between the Commonwealth and the states.

The full article is here:

http://theconversation.com/commonwealth-left-scrambling-by-school-chaplaincy-decision-27935

or here:

http://blogs.adelaide.edu.au/public-law-rc/2014/06/19/commonwealth-left-scrambling-by-school-chaplaincy-decision/

This did not seem to be all that relevant to e-Health until I had an email from a very thorough reader who had read further.

He noticed that the fix put in place by the previous government a few years ago had a schedule attached that listed all sorts of Government spending that an urgent Act of Parliament was intended to validate which now seem to be invalid again.

Again from the Conversation here is the situation.

“The government’s initial response
In response to the 2012 Williams decision, the then-Gillard government introduced Section 32B into the Financial Management and Accountability Act 1997. This section gave the Commonwealth the power to vary or administer funding arrangements and grants that were specified in the regulations.

The parliament also inserted a schedule into the Financial Management and Accountability Regulations 1997 that listed over 400 funding programs, including the National School Chaplaincy and Student Welfare Program. Future programs could be inserted into the schedule by the government itself through amending regulations.

The primary constitutional difficulty with the remedial legislation was that many of the programs authorised in the regulations had little, or dubious, connections to federal legislative power, including a number of grants to schools, higher education and research institutions, local government and, of course, the chaplaincy program itself.”

My reader had downloaded and looked at the schedule and guess what? It looks like Medicare Locals, some telehealth and Commonwealth funding of e-Health implementation are not presently validly funded!

Don't be confused - this funding is the 'guts' of the total funding for e-health initiatives.

Search for medicare or eHealth in the .pdf to find the references.

Oh dear oh dear. Does this mean that we as citizens can have our money back?

What a fiasco!

David.

Official NEHTA Announcement - Appointment Of New Chair.

New Chair for NEHTA

Created on Thursday, 26 June 2014

After completing six years in office, David Gonski AC has concluded his role as the Chair of the National E-Health Transition Authority (NEHTA).

Mr Gonski has served two consecutive terms as Chair and in accordance with NEHTA’s constitution is not eligible for a third term.

The Board of Directors would like to sincerely thank Mr Gonski for the leadership he has shown in his role as Chair.

Mr Gonski became Chair in 2008 and was responsible for revitalising the board and galvanising cooperation between the governments of Australia to deliver urgently needed infrastructure and standards for health information.

NEHTA CEO Peter Fleming is pleased to announce that Dr Steve Hambleton MBBS FAMA, immediate past president of the Australian Medical Association (AMA) has been appointed the new Chair of NEHTA.

Dr Hambleton was elected Federal President of the Australian Medical Association (AMA) in May 2011, after serving a two-year term as Federal Vice President. He was most recently one of three panel members responsible for conducting the Government’s review into the personally controlled electronic health record system.

The clinical expertise and leadership Dr Hambleton brings to this role will be vital in ensuring that eHealth becomes widely adopted in clinical settings across Australia.

Here is the link:

http://www.nehta.gov.au/media-centre/news/662-new-chair-for-nehta

 I look forward to comments regarding this appointment and its likely impact.

David.

NSW Announces A Plan For NSW Health For The Next Decade. E-Health Gets A Good Deal Of Coverage!

This appeared a little while ago.

NSW State Health Plan: Towards 2021

The NSW State Health Plan: Towards 2021 provides a strategic framework which brings together NSW Health’s existing plans, programs and policies and sets priorities across the system for the delivery of ‘the right care, in the right place, at the right time’.

Related Link

File Link: NSW-State-Health-Plan-Towards-2021.pdf

File Size: 5097 kb

Type: Report

Date of Publication: 19 June 2014

Author: Health System Planning and Investment

ISBN: 978-1-74187-977-3

SHPN: (ODG) 140065

Here is the link to the relevant page:

http://www.health.nsw.gov.au/statehealthplan/Pages/NSW-State-Health-Plan-Towards-2021.aspx

On Page 25 we read:

Strategy 3 - Enabling E-Health

Technology is transforming how we live and work through improved connectivity, intelligent software, and smart, mobile devices. Health and medicine are no exception as the rapid introduction of Information and Communications Technology (ICT) continues to impact nearly every aspect of patient care, treatment and research.

What NSW Health Is Doing

NSW Health is using technology to support the healthcare system as it changes and evolves, embedding eHealth into everyday models of care that help link patients, service providers and communities in a connected, smarter healthcare system.

NSW Health has been harnessing eHealth to strengthen patient care and drive value for money in the delivery of healthcare services. The Blueprint for eHealth in NSW sets out the vision for technology led improvements in quality, delivery, efficiency and safety of healthcare for patients.

Putting the patient first, NSW Health is rolling out a number of major clinical eHealth systems:

• Electronic Medical Record (eMR) – 142 of our hospitals – or 80 percent of our bed base – now use an eMR enabling clinicians to order tests, schedule surgery and prepare discharge summaries electronically.
•  The Picture Archiving Communication System (PACS) and Radiology Information System (RIS), are used in the majority of our hospitals, and allow clinicians to receive electronic radiology reports and images in less than 24 hours for faster, more accurate diagnoses and treatment plans for patients
•  HealtheNet links the electronic medical records used by public hospital and community services with the National eHealth Record or Personally Controlled Electronic Health Record (PCEHR). Clinicians working in our public hospitals – with patient consent – can now view all the information held on that patient’s PCEHR and use it for improved planning that is crucial to integrated care
•  The eBlue Book documents health and development checks along with immunisation details for babies and children, replacing the hard copy booklet. Currently being trialled in the west of Sydney, the eBlue Book provides a convenient, easily accessible health record where inbuilt checks and reminders help parents better manage their child’s health

NSW Health has also invested in eHealth business – or ‘back of house’ solutions – to manage health services as effectively and efficiently as possible including:

·         Every hospital has access to the Patient Flow Portal, which is used to manage an estimated 3,250 patient transfers per month, providing timely access to care

·         A new online Learning Management System HETI Online has been developed to support front line and other staff remain up to date with access to the latest statewide training resources. HETI Online will also provide tools and data for staff and managers to better manage training requirements

·         Stafflink, a single statewide payroll and human resources system provides an integrated source of workforce information and facilitates better planning and staff management

·         CBORD, the Food Services, IT system is being upgraded and standardised to enable more accurate management by clinicians of each patient’s dietary requirements and sophisticated inventory management by Food Services staff

NSW has also invested in IT infrastructure upgrades and boosted broadband access so that eHealth solutions work better and faster.

What NSW Health Will Do.

Invest in clinical systems:

·         Community Health and Outpatient Care to integrate clinical and electronic record systems

·         Electronic Medical Record Phase 2 to upgrade functionality and reach of the system, and expand voice recognition capacity

·         Electronic Medication Management to improve the accuracy and scope of intelligent prescription systems

·         Intensive Care Clinical Information System to bring a suite of online and digital systems for improved integration.

Invest in business systems:

·         Trial a new system, HealthRoster, to allow managers to more effectively match the availability and skill levels of staff to the needs of patients. The new system, which is earmarked for statewide roll-out, will also be linked with our payroll and HR systems

·         Overhaul the current Incident Information Management System to better track, record and report clinical incidents

·         Instigate an Asset and Facilities Management Performance Improvement Program

Invest in infrastructure:

·         Infrastructure upgrades for equal access to high speed broadband

·         Streamline the NSW Health Data Centre for efficient and reliable IT infrastructure support

Strengthen eHealth governance – to create a contemporary, responsive and world-class eHealth system in NSW

·         Establish eHealth NSW as a dedicated organisation within NSW Health to guide eHealth planning, strategy, program implementation and operations

·         Establish an eHealth Executive Council to provide statewide strategic direction and support to eHealth NSW

·         Appoint a Chief Clinical Information Officer to engage with clinicians to align informatics and clinical practice across NSW Health

·         Develop a federated governance approach for eHealth NSW where Local Health Districts and Specialty Health Networks are active partners in planning and program roll-out as well as enabling local solutions and innovation in eHealth

Refresh the eHealth vision to set a clear direction for the future

·         Set a strategic direction to guide investment in new statewide eHealth initiatives

·         Clearly articulate new arrangements in governance, privacy, capacity-building and telehealth responsibilities

·         Establish key eHealth performance measures

·          Set out a rural eHealth strategy to improve eHealth delivery to rural and remote areas.

-----  End Extract.

This is a really useful summary of just what NSW is up to in E-Health and is worthwhile to be aware of for all who are interested in what is happening in Australia.

I am interested as to what people think of what NSW is planning.

David.

Unconfirmed Rumours - Dr Steve Hambleton to Replace David Gonski As NEHTA Chair.

Will follow up when confirmed.

Also hearing Jane Halton is to take on a new job as of July 1, 2014 - Also unconfirmed.

Comments welcome.

David.

Opt in or Opt Out - A Discussion From A Privacy Expert.

This article is reprinted from the iappANZ Journal with permission of the Author - Ms Emma Hossack.

You can see the whole May 2014 Issue of Privacy Unbound here:

http://pams.com.au/iapp/StaticContent/Images/iappANZ_Journal_May_2014.pdf

To Opt in or to Opt Out, THAT is one of the questions for the Personally Controlled Electronic Health Record [1]in Australia

Forgive me if it feels like Groundhog Day.

“EHealth is a complex infrastructure project that requires a fundamental change in consumer and business practice as well as a cultural shift in both professional and consumer behavior…..In such a project, implementation is key. I want to make sure we bring consumers with us in the eHealth journey by adopting an “opt in” model – allowing them to choose when to sign on. I believe that the benefits of giving the Australian public the choice as to whether they participate will be key to the successful implementation. I think moving to an “opt out” position would be a serious mistake.”

The Hon Nicola Roxon MP

Minister for Health and Ageing

Address to the Consumer Health Forum, Canberra. 14 September, 2011.

The above quote was the introduction to a piece published in this Journal in September 2011.  That article is useful background to the current and is reprinted in the current Journal. In essence, this is what happened in the interim:

·         The PCEHR Act 2012 (Cth) became law on 26 June 2012

·          The assurance that “…the Government is not going to build a massive data repository. We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks” (Ministers own bold type)[2] appears to have been forgotten.  A massive data repository has been built.   

·         The Opt In model was adopted and $50 Million AUD was spent on Medicare Locals to assist them with engaging consumers.[3]

·         The Medicare Local Review was released which impacts on the PCEHR implementation.[4]

·         The cost of the PCEHR Project blew out from $467 Million AUD to $1 Billion AUD.[5]

·         The lack of consumer and clinician engagement resulted in the current Health Minister stating in Parliament in 2013 that the cost was equivalent to over $100,000.00 for each person enrolled in the system.[6]

·         Minister Dutton called for a review of the PCEHR in November 2013.

·         The PCEHR Review[7] contained 38 recommendations, including one to convert the opt in system to an opt out system.

·         The Clinical Document Architecture, known as CDA which is used by the PCEHR has been found to be flawed with security risks[8]

·         The security flaw in the myGov website potentially opened health information held in the PCEHR to malicious attacks.[9]

·         The clinicians and consumers have not been given a business case for using the PCEHR and remain confused[10]

·         Clinicians having to renew PCEHR security tokens by fax has been criticised as it is not very efficient or modern[11]

·         It is suggested in the PCEHR Review that the name of the system be changed from the PCEHR to” My Health Record”. This would not normally rate a mention, but the fact that the concept has been given 5 names to date, suggest confusion not only about what it is, but what to call it. [12] “What’s in a name?  That which we call a rose

By any other name would smell as sweet.”[13] It is unlikely the name change will be the answer to a better system.

When a system works well, and people who benefit from using it would know about it and any risks, then opt out is clearly a good option to maximise the benefits for the community. When a system is not understood and is flawed, converting it into an opt out system is risky and inappropriate. We all know that “The most effective way of controlling information about oneself is not to share it in the first place.”[14]  We also all know that most people are naturally lazy, and the statistics for organ donation demonstrate that clearly.[15]However in health, where sharing of information and co-ordination of that information is critically important for the best outcomes, trust is the foundation. Earning the trust of patients is the difference between empowering individuals with knowledge, and saving or improving lives or not. Sharing clinical information in a privacy compliant way is worth getting right, and informing consumers and respecting their trust are the first steps.

Health information is amongst the most sensitive information, and the complexity and beauty of being able to share that information privately through technology is what changed my career.[16]The benefits when it is done well are compelling[17]it is also one of the hardest areas to get right. It involves politics (funding issues between states and commonwealth, enabling individuals and doing as much as necessary), technology (a world of architecture and acronyms), ethics, clinical support [18]and patience.[19] Underlying everything that we do in eHealth is the concept of “…abstain from doing harm”[20].  A system which is accessible by a consumer who is not aware of what kind of information the PCEHR holds, or what it means could result in harm.  The sharing of certain sensitive information has resulted in depression, embarrassment and suicide.

Having worked in this area for almost a decade I am committed to seeing ehealth reform work. This does not simply mean the economic benefits of $AUD7Billion savings annually which have been suggested[21].More importantly there will be better health outcomes and individuals will have more autonomy over their lives and health. The PCEHR Review supports returning to the decentralised architecture for ehealth which has been supported by the National Health and Hospital Reform Commission[22] which means it supports an ecosystem of different technologies with dedicated purposes which are interconnected.

Once the eHealth ecosystems s are working and Australians are fully educated about the pros and cons of the system, Opt Out would be justifiable. Getting more “numbers” in the system will not change the fact that the current PCEHR is not achieving its goals. Merely counting registrants is not a meaningful measure. We need meaningful use that provides clinicians, patients and all Australians with benefits. Adding empty numbers to a system to make it better is like changing its name – lipstick on a pig.  It’s too soon for Opt out.

Emma Hossack

President iappANZ

CEO Extensia

Vice president of the Medical Software Industry Association

-----

Many thanks to Emma for a useful article!

David.

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[1] The Personally controlled electronic health record is an initiative of what was known as the Department of Health & Ageing in 2010 and was a part of the then Government’s eHealth reform and was allocated a spend of $467 Million

[2] The Hon. Nicola Roxon, MP, Minister for Health and Ageing – November 30 2010, opening address to the e-health Conference, “Revolutionising Australia’s Health Care”, Melbourne.

[3] http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1001:50m-extra-for-pcehr-implementation&catid=16:australian-ehealth&Itemid=328

[4] http://www.health.gov.au/internet/main/publishing.nsf/Content/review-medicare-locals-final-report

[5] http://www.theaustralian.com.au/technology/peter-dutton-shifts-into-high-gear-for-e-health-overhaul/story-fn4htb9o-1226725516175; PCEHR Review p.82.

[6]http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22chamber%2Fhansardr%2Fb408ffb8-34a8-4da1-bb08-aaa9dfc02b0e%2F0109%22

[7] http://www.health.gov.au/internet/main/publishing.nsf/Content/PCEHR-Review

[8] http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1894:cda-use-in-the-pcehr-lessons-learned&catid=16:australian-ehealth&Itemid=327

[9] http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1886:sleepwalking-into-catastrophe-with-mygov-and-the-pcehr&catid=16:australian-ehealth&Itemid=327

[10] http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1849:barriers-to-pcehr-uptake-on-the-frontline&catid=16:australian-ehealth&Itemid=327

[11] http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1764:clinicians-have-to-renew-pcehr-security-token-by-fax&catid=16:australian-ehealth&Itemid=327

[12] Originally in 2009 the National Electronic Health Transition Authority called it the Shared Electronic Health Record “SEHR”, then the Individual Electronic Health record “IEHR”, then the PCEHR”, then the previous Government suggested the National Electronic Health record System “NEHRS” and now we see the fifth suggestion.

[13] Romeo & Juliet, Shakespeare Act 2, Scene 2.

[14] A Michael Froomkin, “The Death of Privacy” Vol 52: 1461 may 2001] 1462. 1463

[15] Cass Sunstein, Nudge

[16] The inherent conflict led me to post graduate work in privacy and ownership of shared electronic health records. I subsequently retired from legal practice and became CEO of Extensia a shared electronic health record company.

[17] 26% reduction of avoidable admissions to hospital in just one trial:

Part 2, Pg. 103, Tables 32 & 33: The National Evaluation of the Second Round of Coordinated Care Trials – Final Report, Commonwealth of

Australia 2007

[18] Doctors ready to pull plug on eHealth http://www.australianageingagenda.com.au/2013/08/16/doctors-ready-to-pull-plug-on-ehealth/

[19] A ten year journey according to The Deloitte eHealth Strategy 2008 http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

Endorsed by the National Health and Hospital Reform Commission 2009 http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/nhhrc-report

[20] Hippocratic oath

[21] PCEHR Review at p.9 Booz & Co

[22] See recommendation 123 http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/nhhrc-report and PCEHR Review recommendation #31.