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."

Wednesday, April 20, 2016

I Suspect That The Department Is Getting Worried About The Public Level Of Trust In The myHR.

This popped up a few days ago:

Setting the record straight!

Published 12 April 2016
There are a number of positive and negative assertions circulating the media, so each month we will be ‘setting the record straight’ and highlighting which My Health Record rumours are facts and which are not, so you can be confident when dealing with your customers. This month we set the record straight on privacy.
Here are some of the misrepresentations, along with the actual facts:
Assertion: Individuals cannot control who sees their My Health Record
Not true. Individuals can ask their healthcare provider not to upload certain information to their My Health Record and can also choose to be notified when their My Health Record is accessed. They can also set controls to restrict access to certain information in their My Health Record or to prevent certain healthcare provider organisations from seeing anything in their My Health Record. For example, individuals may want to restrict access or ask a provider not to upload their sensitive health information, such as sexual or mental health issues accessible by all healthcare providers.
Assertion: Government agencies will be able to access people’s personal data
There are very limited circumstances where anyone, including the Government, may access someone’s My Health Record. Those circumstances are narrower than under existing laws like the Privacy Act 1988, so My Health Record actually provides more protection of sensitive health information than exists for health records outside of the system. Limited circumstances include:
  • For the purpose of providing healthcare to an individual, including in an emergency;
  • For law enforcement purposes – in line with current powers under the Privacy Act, enforcement bodies may access information for particular investigations;
  • For the purpose of a healthcare provider’s indemnity cover – for example as part of a provider’s defence (or that of their medical indemnity insurer, acting on their behalf) in proceedings of negligence. This reflects longstanding rights of providers to use health information in records they hold in their own systems as part of proceedings.
Assertion: Personal information won’t be safe - the My Health Record system is a gold mine for hackers and blackmailers
The privacy of people’s personal information is taken extremely seriously. A range of legislative and technical mechanisms work together to ensure the privacy and security of people’s information in the My Health Record system.
My Health Record uses bank-strength security including strong encryption and firewalls, secure logins and audit trails. It meets Australian Government Security Standards and is regularly tested for security compliance and vulnerability. These standards are regularly updated to address emerging cyber-threats. The staff who operate and maintain the My Health Record system are vetted and undergo police checks, consistent with government standards.
Further, the unauthorised collection, use or disclosure of information in the My Health Record system, is subject to both civil and criminal penalties where an action is deliberate or reckless. These penalties do not apply where a mistake has been made – for example, if a healthcare provider inadvertently or accidently accesses an individual’s My Health Record. The penalty for not complying with the My Health Records Rules is $18,000 for individuals and $90,000 for bodies corporate.
Further information about the My Health Record system’s privacy and security policies can be found on the My Health Record website
Here is the link:
All good? Well no actually.
On the first Assertion we need to remember that myHR cannot know which staff member is using the Practice Credentials to access the myHR. With that being the case the patient essentially has no control to who locally will have access and who might make changes and so on.
Equally the patient has to be very well informed to know just what might be deduced from what is uploaded in a health summary. For example, having a history of use of all sorts of types of legal drugs can provide rich information the patient may not understand they are making available.

For Assertion 2 the Government makes it clear all sorts of people in Government may be able to access the myHR records.  It will be interesting to see when we get richer details of just what Government ins doing with the data - as there is just no way the clinical benefits of the current myHR are remotely worth the billions being spent.
Equally Assertion 3 is just begging us to all wait for the first data breach. Sadly it is inevitable and it is just a matter of time - especially if the use of the system expands.
For anyone who wants to understand the full details and risks associated with the myHR can I recommend the following detailed information. It has been carefully researched and provides detailed references for all the points made.
David.

Tuesday, April 19, 2016

Weekly Australian Health IT Links – 19th April, 2016.

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

E-Health looks to have seriously got into the mainstream press this week. I hope the populous will at some point grasp what a waste of space, money and time the myHeath Record program is!
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Dead people given e-health records in latest bungle for $1 billion government program

April 16, 20167:00am
Sue Dunlevy News Corp Australia Network
EXCLUSIVE
THE federal Health Department is setting up My Health records for people who have been dead for over two decades in the latest bungle to beset the troubled $1 billion project.
It comes as a major international technology company CSC last month warned medical practices not to use the My Health Record because of a glitch that meant data for one patient “may be saved against an incorrect patient record”.
And as the Australian Medical Association calls for a major overhaul of the records to integrate them into existing medical software because just 300 GPs are using the records each week.
Four years after it was launched only 75,000 records are populated with a patient health summary that makes them useful to doctors.
-----

New online tool to teach young athletes about impacts of illegal drugs on sport

A new online tool with the aim of educating young athletes on the impacts of using illegal drugs in sport has been launched by the Federal Government.

Key points:

  • Sports authorities worried about levels of drug use in local community sporting groups
  • Program includes courses for athletes, coaches, officers, presenters and role models
  • Emphasis on showing illegal drugs just as off-limits as performance-enhancing drugs
The Illicit Drugs in Sport e-learning education program uses videos, interactive materials and printouts to educate people on the harmful impact of using illegal drugs in sport and was developed in partnership with the Australian Sports Commission.
Federal Health Minister Sussan Ley said the program was better than any previous resource and would be free for anyone to access.
-----

Another resources company switches to IT

Mineral exploration company MinQuest is changing tack with the acquisition of medical software developer ePat and a decision to sell off its current mineral projects.
MinQuest has reached a binding agreement to acquire ePat, which has developed a smartphone app that uses face recognition and other indicators of pain to provide a more objective pain assessment of patients who cannot communicate with their carers, such as people with dementia.
The ePat app is based on Curtin University research, and the company plans an early 2017 release for a second version tuned for young children.
-----

openEHR technical basics for HL7 and FHIR users

Posted on by wolandscat
Recent discussions on the FHIR chat forum with various HL7 people around the topic of how openEHR and other architectural frameworks (e.g. VA FHIM, CDISC) could work with FHIR led to a realisation that some people in HL7 at least don’t understand some of the technical basics of openEHR. This might simply because they have not been involved enough to learn them, but now that we appear to be in the era of FHIR, in which no e-health solution can be without FHIR (according to the now pervasive FHIR hype), I would argue that HL7 now needs to understand some of the basics of the other major architectural frameworks and model-based platforms in e-health – all of which precede FHIR.
One of the catalysts for this discussion was a recent post I made called Making FHIR work for Everybody, in which I proposed that FHIR could be opened up so that FHIR resources could be created that represent the reference models of other model-based architectures. This led to the above-mentioned discussions on chat.fhir.org (openehr channel), in which various misunderstandings about openEHR surfaced. I will now try to address some of these.
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DHS' plan to stop people complaining about MyGov

Inaugural chief digital officer outlines vision.

By Paris Cowan
Apr 12 2016 6:45AM
The Department of Human Service’s MyGov portal is one of the biggest, most visible - and undoubtedly most complained about - digital government initiatives in Australia right now.
It has roughly 9 million registered users - more than the Commonwealth Bank’s Netbank platform and chasing hot on the heels of Qantas’ Frequent Flyer club - and 200,000 visitors every day.
But many of them tear their hair out over the platform and its stringent demands, taking their frustration to outlets like Twitter.
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No more myGov? Federal government quietly plotting transformation of online services

April 13 2016 - 6:31PM
Prime Minister Malcolm Turnbull's pet agency, the Digital Transformation Office, is quietly planning a fundamental rethink of how Australians access government services online.
The office, recently tasked with fixing the troubled myGov website, has unveiled a new prototype to replace thousands of government websites and deliver a long-overdue digital reboot.
Aware of the risks and expectations, acting head Radi Kovacevic said the office had cautiously launched a alpha version of the website to gauge feedback and concerns after an extended period of user research.
Mr Kovacevic, the Department of Prime Minister and Cabinet's former chief information officer, said he was personally overseeing a gradual rollout of the project to mitigate risk.
-----

TPG to deliver 10Gbps network for medical imaging

Rohan Pearce (Computerworld) 14 April, 2016 17:08
Telco strikes deal with I-MED Network
TPG will deliver high-speed connectivity to I-MED Network under a deal announced today by the two companies.
TPG did not reveal the value of the contract under which the telco will use its fibre infrastructure to hook up I-MED’s medical imaging clinics but described it as a “a significant multimillion dollar commercial agreement”.
The deal covers a network of 180 clinics. TPG said it would deliver speeds of up to 10 gigabits per second to I-MED’s offices.
-----

TPG to flex fibre muscle

  • The Australian
  • April 14, 2016 3:58PM

Supratim Adhikari

TPG Telecom is putting its fibre assets to full use with the telco signing a multi-million dollar agreement to build a high speed network dedicated to medical imaging.
The deal will see TPG deliver a network, capable of speeds of up to 10 Gbps, that will connect the 180 sites of Australia’s largest medical imaging clinic I-MED Network.
According to TPG, most I-MED locations will achieve increases of between 20-50 times in network bandwidth.
I-MED Network chief executive officer, Steven Rubic, said that the increased bandwidth will allow the clinics to make full use of their advanced imaging hardware.
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6 wearable technologies doctors need to know about

John Kron | 8 April, 2016 | 
The explosion in wearable technology in recent years may be a commercial fad but many believe it will benefit doctors in treating patients. Australian Doctor takes a look.
Basic is probably the word that best describes the technology used in most pedometers back in the 1990s.
The device attached to your belt. A sensor counted up the steps and, well, that was about it.
Now, compare this with the Samsung belt launched in January.
-----

Setting the record straight!

Published 12 April 2016
There are a number of positive and negative assertions circulating the media, so each month we will be ‘setting the record straight’ and highlighting which My Health Record rumours are facts and which are not, so you can be confident when dealing with your customers. This month we set the record straight on privacy.
Here are some of the misrepresentations, along with the actual facts:
Assertion: Individuals cannot control who sees their My Health Record
Not true. Individuals can ask their healthcare provider not to upload certain information to their My Health Record and can also choose to be notified when their My Health Record is accessed. They can also set controls to restrict access to certain information in their My Health Record or to prevent certain healthcare provider organisations from seeing anything in their My Health Record. For example, individuals may want to restrict access or ask a provider not to upload their sensitive health information, such as sexual or mental health issues accessible by all healthcare providers.
-----

High-quality general practice research to continue through MedicalDirector network

With concerns being raised around access to reliable sources of data on general practice, MedicalDirector is committed to continuing its General Practice Research Network (GPRN) to lift understanding around primary care and to help practitioners.
“The future of Australia’s primary health care system relies on quality sources of continuous data and insight into general practice and patient consultations,” MedicalDirector CEO Phil Offer says.
“From our longitudinal database including more than 44 million GP-patient encounters from over four million patients, we can provide extensive information leading to a better understanding of patients, interventions and results. This enables us to uncover robust insights into Australia’s health issues and outcomes.”
-----

Does technology spell death for the retirement living industry?

By Natasha Egan on April 11, 2016
While technology offers Australia’s retirement village operators a number of opportunities, it could also mean their death, an aged care industry conference will hear this week.
Telstra Health’s national operations manager aged and community care Luke Greive is presenting on the future of technology uptake in retirement villages at LASA Queensland’s state conference on Thursday.
 “I will be covering issues around whether technology will be the death of retirement villages,” Mr Greive told Technology Review.
-----

Why health apps are bad, and why I'm hooked

Date April 11, 2016 - 8:33PM

Jenna Price

Columnist for The Canberra Times and Daily Life

Every single day, including weekends, I check. And if it hasn't hit the magic 10,000, I ask: "Anyone feel like a walk?"
I hate exercising with a passion.
Yes, yes, I know it's good for me. And I know it will extend my life (which is already 18 months longer than I thought it might be). It will improve my sex life. It will make travelling more fun. What's not to love?
But I find it hard. Every one of the little intervals of running at 11.6km/h is like torture. The inclines, the squats. All of the repetitions of the anti-batwing exercises (where you hold weights out to the side of your body, arms parallel to the floor) are agony.
As for endorphins, it's tremendous some people experience them. Not me. I fear they are an invention of my lovely GP, Dr Pandora, whose gift for pretending fitness is fabulous is wasted on me.
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WA Health locked into paying dubious data centre invoices

Lawyers say no recourse on $44m contract amendments.

By Paris Cowan
Apr 13 2016 6:47AM
WA government lawyers have told the state it has no choice but continue paying data centre operator Fujitsu for $44 million worth of additions to its contract that were signed by uncertified health officials without proper approval.
In February, WA’s auditor general Colin Murphy revealed the systematic abuse of procurement processes behind an $81.4 million blowout in the Health department's centralised computing contract with Fujitsu, which was originally signed for $45 million.
Many of the purchases, which have been traced back to just a handful of IT staff working well beyond their financial delegations, were for services and equipment that were never needed and remain unused by WA Health.
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Bionic eyes set to switch from fantasy to blinking reality

Date April 11, 2016

Marc Moncrief

Consumer Affairs Editor, The Age

Samsung are attempting to patent a contact lens with a built in camera.
Aficionados of the 1970s-era television series The Six Million Dollar Man, rejoice: contact lenses are coming that could make all your bionic-eye dreams come true.
A patent application published last week shows Korean electronics giant Samsung is working on a contact lens with a tiny built-in camera.
The lens, which would be controlled by blinking, includes an antenna that will allow the lenses to speak to your phone.
The patent follows the disclosure last year that a global team of academics, funded by the US defence industry, had developed contact lenses that could give the wearer telescopic vision.
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Revealed: Australia's new cyber security strategy

How the government plans to make the country a "cyber smart nation".

By Allie Coyne
Apr 11 2016 6:50AM
The federal government will lean heavily on the private sector to help it deliver its long-awaited national cyber security policy and initiatives like voluntary infosec health checks for businesses and joint threat sharing centres in capital cities.
iTnews can exclusively reveal the policy, which is expected to be released in the coming weeks, will contain five key pillars intended to help Australia grow by embracing disruptive technologies from a secure footing in all areas of the economy.
The 46-page strategy, sighted by iTnews, is the first update to Australia's national cyber security policy since 2009.
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A great quality tool for health bloggers, podcasters and patients

A while back I came across a new tool for those who, like me, use Dr Google but are concerned about the quality of some of the available online health information.
The tool contains two checklists and has been designed for medical education resource producers, editors, end-users, and researchers. I’ll let the authors explain:
“Through a rigorous research process, a list of 151 quality indicators for blogs and podcasts was formed and subsequently refined to elicit the most important quality indicators. These indicators are presented as Quality Checklists to assist with quality appraisal of medical blogs and podcasts.”
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HL7 and the Ringholm Effect

2016-April-14 | 18:09 By:
HL7 messages are the lifeblood of electronic health communication in many settings in many countries. In the healthcare sector in Australia, for example, they are ubiquitous in hospital settings for notification of patient Admissions, Discharges and Transfers and they are ubiquitous in both hospital and primary care settings for reporting pathology results to the ordering clinician’s or her organisation’s clinical system. Millions of HL7 messages flow between systems  every day in Australia. The vast majority are based on HL7 version 2.3, 2.3.1 or 2.4. These standards are the lingua franca for healthcare messaging.
However, their quality is often less than desirable. There is diversity in the way they are structured and represented from one system to another. The system interfaces that construct, route or process these messages are difficult and expensive to build and maintain. They are intended for point to point communication within a relatively confined and stable eco-system, rather than as components of a national infrastructure to support patient-centred care. Many of their well-known idiosyncrasies embody and epitomise the profound difficulty faced in trying to share information amongst heterogenious systems in healthcare – often dubbed “lack of interoperability”. Some of this “lack of interoperability” is due to shortcomings of, or ambiguity in the HL7 v2 standards. Some is due to ambiguity in implementation guides, or more often, conflict between various implementation guides and between implementation guides and their referenced standards. Some is due to developers’ and implementers’ ignorance or misapplication of the “standards”. Some is due to the lack of standardisation of infrastructure upon which the messages depend – e.g. lack of standardised patient and provider identification infrastructure, or the lack of adequate value set infrastructure to describe clinical concepts.
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All the bottom-line action

April 11, 2016
Orion Health (OHE:NZX/ASX) has signed an agreement with Metro North, the largest health service in the Australian state of Queensland, to deliver its ground-breaking Referrals Management platform. Metro North Hospital and Health Service serves over 900,000 people, and employs more than 16,000 staff in five hospitals and eight community health centres, along with oral and mental health facilities. The Referrals Management platform will enable healthcare professionals to submit, track and manage patient referrals as the individual moves from home to hospital to community care. Orion Health CEO Ian McCrae says the contract with Metro North will be delivered as a subscription license with Orion Health Application Managed Services. “Metro North’s goal of improving health outcomes by providing healthcare professionals across the care continuum with access to comprehensive patient information is closely aligned with our company vision for enabling personalised healthcare,” Mr McCrae says. Orion Health Executive Vice President for Asia Pacific Darren Jones says that Metro North serves one of the fastest population growth regions in Australia and required a data platform that could accommodate the addition of new solutions over time. “Metro North has the ability to extend the functionality of the platform beyond Referrals Management over time through the addition of other modules that support better care coordination between its hospitals, community health centres and other healthcare providers,” he says.
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Why the Orion Health Group Ltd share price jumped 30% in April

By Sean O'Neill - April 12, 2016 |
E-Health solutions provider Orion Health Group Ltd (ASX: OHE) has been on a tear in the past month, following a number of major contract announcements in quick succession.
On 30 March, Orion announced a contract with a major US health insurer. While financial specifics were not provided, if we use the number of patient records Orion manages as a proxy, then the announcement for 3 million patients represented an increase of around 3% on the company’s previous total of 90 million records.
On 6 April, Orion announced it had won a contract with Metro North, the largest health service in Queensland, to provide its Referrals Management software platform. Metro North serves 900,000 people, and Orion believes the company could be convinced to subscribe to additional services from Orion in the future.
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UK expansion continues as Orion Health wins deals in England and Scotland

Currently Orion Health’s software manages over 90 million patient healthcare records worldwide.
Ian McCrae - CEO, Orion Health
Orion Health has signed two contracts that will significantly extend the New Zealand’s company its presence in the United Kingdom, following deals in both England and Scotland.
Terms of the deal will see Orion Health provide a technology solution for two leading hospitals in London, while also implementing an integrated health and social care solution for NHS Fife in east Scotland.
Orion Health CEO Ian McCrae says the success in both countries demonstrates the “substantial impact” that the company is having in the EMEA (Europe, Middle East, Africa) region.
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Orion Health snares new contracts to boost UK presence

New Zealand-based healthcare tech solutions provider Orion Health has secured two new contracts that it says will significantly extend its presence in the UK market.
Orion Health CEO Ian McCrae said the company will provide a comprehensive technology solution for two leading hospitals in London, and implement an integrated health and social care solution for NHS Fife in east Scotland.

McCrae said both contracts will boost the number of patient healthcare records managed by Orion Health software, as the London hospitals care for one million people and NHS Fife and Fife Council serve a population of over 360,000.
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Who’s who of Aussie ICT

April 11, 2016
CANCERAID formed in 2014 by three like-minded doctors with a passion for oncology. Over 14 months the team work has been to develop an application for cancer patients, caregivers and clinicians. CancerAid is a ‘first-of-its-kind innovation that addresses the deficiency in cancer care by providing patients and caregivers an easy to use smartphone application that specifically targets disease illness’s uncertainty. The team developed the product in conjunction with over 100 cancer specialists and 20 Cancer Charities. The app’s fundamental aim is to provide a comprehensive telecommunication service that helps patients particularly those in rural areas, with access to care and mental health services. http://www.canceraid.com.au/
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IBM puts Watson to work on cancer with new patient-advisor tool

It will tap natural language processing and offer personalised advice
Katherine Noyes (IDG News Service) 13 April, 2016 04:36
IBM is developing a new weapon in the battle against cancer that will put Watson to work in a new way. Partnering with the American Cancer Society, IBM is building a virtual advisor that uses machine learning to give patients personalized information and advice.
The advisor will begin by looking at the type of cancer the patient is suffering from, the stage of the disease and the treatments administered so far. Using that and other data, it will try to offer care advice and answer patients' questions.
Watson's voice recognition and natural language processing will enable users to ask questions and receive audible responses.
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Experts crack Petya ransomware, enable hard drive decryption for free

The technique is not exactly straightforward, but it works
Security experts have devised a method that allows users to recover data from computers infected with the Petya ransomware program without paying money to cybercriminals.
Petya appeared on researchers' radar last month when criminals distributed it to companies through spam emails that masqueraded as job applications. It stood out from other file-encrypting ransomware programs because it overwrites a hard disk drive's master boot record (MBR), leaving infected computers unable to boot into the operating system.
The program replaces the drive's legitimate MBR code, which normally starts the operating system, with code that encrypts the master file table (MFT) and shows a ransom note. The MFT is a special file on NTFS volumes that contains information about all other files: their name, size and mapping to hard disk sectors.
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Breakthrough Starshot: Man’s new mission to the stars

  • Tom Whipple
  • April 13, 2016 9:00AM

Hawking, Billionaire Announce Spaceflight to Alpha Centauri

Tiny spaceships will be blasted by laser beams from Earth to explore our nearest star system 25 trillion miles away under plans for the most ambitious space mission in history.
Yuri Milner, a Russian internet billionaire, joined Stephen Hawking to announce proposals for the spacecraft that they believe could travel 1,000 times faster and 2,000 times farther than any man-made object has gone before.
Mr Milner, who will also be collaborating with Mark Zuckerberg, the Facebook founder, said that they would achieve this feat by having a “Silicon Valley approach to space flight ... based on technology already available or likely to be available in the near future”.
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Enjoy!
David.

Monday, April 18, 2016

The Australian Privacy Foundation Releases Its Commentary On The Draft National Digital Health Strategy.

I was given this to publish this week:
Submission to the Department of Health on the draft National Digital Health Strategy.
Australian Privacy Foundation
Date 14 April 2016
Contact
Dr Bernard Robertson-Dunn
Chair Health Committee
1.     Executive Summary
This response to the draft National Digital Health Strategy for Australia, July 2016 – June 2019 is predicated on our belief that all information systems containing personal data represent a potential risk to privacy. However, that risk may be worth taking if the value of the system to the individuals involved outweighs the risk.
Our primary concern is that the value and benefits of the My Health Record system to consumers have not yet been adequately demonstrated.
Furthermore, making the system opt-out means that a large proportion of the population will have a health record with little or no value and as such represents a significant and un-necessary risk.
With regard to the draft strategy document, we contend that, as a strategy, it is flawed for reasons we discuss below, but just as importantly, its scope is skewed to the My Health Record project, not a strategy for identifying useful outcomes and associated issues as well as integrating access and privacy controls across the national electronic health record space. The latter is what a digital strategy must address, with the My Health Record as a subset of the larger picture.
On the strategy document itself we have several comments to make:
There are no References to Earlier Initiatives
The strategy seems to have been developed without reference to earlier initiatives. We specifically refer to the previous National Strategy issued in 20081, the Royle Review2 and the large body of feedback on the eHealth Legislation in June 20153. A number of key participants in the health, informatics and privacy domains expressed some serious concerns about the system and the proposed opt-out trials which appear to have been completely ignored by the Department since then. The feedback certainly has not been referenced or incorporated into the draft strategy.
In addition, we also draw attention to the considerations by several Senate committees regarding the eHealth bill of 2015. The Parliamentary Joint Committee on Human Rights and the Senate Standing Committee for the Scrutiny of Bills each raised significant concerns about the bill, especially regarding the proposed change to opt-out. Not including references to these committees, the issues raised and the way the strategy has incorporated the views of these committees is a significant and unwise omission.
The Purpose and Audience are Unclear
The purpose of the strategy is unclear. At whom is it aimed? The Federal government and its agencies? State governments as managers of health care facilities? State run health care facilities? Private health care facilities? Software vendors? Hardware vendors?
We suggest that the purpose of the strategy be made very clear, along with how the stakeholders at whom the purpose is aimed will be involved in both finalising the strategy and delivering it.
Our advice is to ensure that the purpose is directly linked to ways in which health care is made more effective first and more efficient second.
The Document Lacks Flow, Coherence and Analysis
The various sections of the document do not form a coherent, logical flow of evidential information, analysis, conclusions and initiatives. The content of each of the sections bear little, if any relationship with the others.
In addition there is no relationship between Digital Health – a technology enabler - and the problems and challenges of information management. Furthermore, the aims and objectives of information management lie in the delivery of better health care.
Turning this around, the need to deliver better health care through improved information management should be the drivers of Digital Health. Technology may offer opportunities for better use of data but it needs to be shown explicitly that this will lead to improved health care without unwarranted risks to privacy and that unintended consequences are minimized and that an approach to dealing with them is in place.
What is mainly missing is the linkage through information management through to improved health care processes and outcomes. There are some references to Digital Health and improved administrative processes, but the high value outcomes are more likely to be achieved from better health care decisions – a phrase that occurs only once in the draft strategy and only then in the context of engaging the patient.
The result is that, without a linkage to improved health care, the contents of Section 6 - Digital Health vision and Section 7 - Key strategic areas of focus lack justification and any explanation of why the particular objectives and initiatives have been selected and how they will achieve the vision.
This means that making an assessment of the value of the Vision, Objectives and Initiatives to Australians very difficult. It is our preference that a strategy as important as that driving eHealth in Australia should be based upon evidence, logic and analysis.
We recommend a cost/benefits analysis of the system should be undertaken to answer questions about the financial returns on the investments of the federal government, state governments, software vendors and medical practitioners.
With an estimated total cost over the first ten year period of the operation of the system of between $1.5-$2.0 billion, we are skeptical that improvements in health care that match that expenditure and which could be attributed to the system are achievable.
We would be interested in seeing the government’s calculations and predictions as to when the financial benefits of the My Health Record system are expected to overtake the cost of the system.
Also missing in the draft strategy is any detailed analysis of capability or funding constraints or expectations. The draft strategy says that “government and the private sector is funding the development and delivery of local digital health systems”, however, the strategy should be structured and predicated on the capability of the various parties and stakeholders to participate, not just state who will pay for it. Participation requires resources, both skills and financial. If the stakeholders do not have available the necessary resources, then the strategy needs to be tailored appropriately. A strategy that is not integrated into a known and agreed funding model is most likely to end up as shelf-ware or only partially implemented.
A National Electronic Health Record Privacy and Security Framework is Needed
A high priority for a strategy aimed at establishing trustworthy electronic health record systems (the My Health Record system is only one) for Australia should be elevating the issue of privacy, information security, confidentiality and access control. This means formulating a widely-accepted national framework to assist in dealing with these issues, solving the major problems in this area, clarifying how different schemes and protections fit together -- with an initial focus on secure, reliable clinical system intercommunication.
We suggest that the strategy be expanded to include such a framework.
As part of this framework, a priority should be to recognise the urgency to finally pass the long-overdue improvements to legal protection in this area, particularly what is often called the Tort of Privacy law, and the Data Breach Notification law. Without these laws, which are ready to go, the framework will lack necessary legal foundations to give confidence to patients and others that if something goes wrong, they will find out about it and could hold those responsible to account. At present neither is true.
Conclusion
In our opinion, the draft we have been asked to review is a start, however it requires major work before it could be seen as a useful document. The APF is more than willing to participate in its development.
We see the strategy as badly distorted by too much emphasis on the My Health Record, rather than the primary unresolved 'safe and easy communication' issues for the larger national eco-system of clinically relied-upon EHR systems, but we cover the MHR in some detail.
We are not convinced that the value of a national opt-out health database, paid for by the Federal Government, (which implies a strong degree of control) has been justified.
Neither are we convinced that the primary use of the database is to improve health care or efficiency.
The fact that the concerns about the usability, purpose and risks of the system raised by many institutions last year in the context of the eHealth bill have not been addressed has left the lasting impression that clinical support is not the driving force behind the government’s intentions of the My Health Record project.
----- End Exec Summary.
You can read the full document here:
I had a small part in putting this together and am pretty happy with the work that has been done at pretty short notice by the Health Sub-Committee.
As ever comments are welcome.
David.

Sunday, April 17, 2016

This Really Shows Just How Badly The Government Is Doing In E-Health And The myHR. Just Too Stupid!

This article appeared a day or so ago.

Dead people given e-health records in latest bungle for $1 billion government program

April 16, 20167:00am
Sue Dunlevy News Corp Australia Network
EXCLUSIVE
THE federal Health Department is setting up My Health records for people who have been dead for over two decades in the latest bungle to beset the troubled $1 billion project.
It comes as a major international technology company CSC last month warned medical practices not to use the My Health Record because of a glitch that meant data for one patient “may be saved against an incorrect patient record”.
And as the Australian Medical Association calls for a major overhaul of the records to integrate them into existing medical software because just 300 GPs are using the records each week.
Four years after it was launched only 75,000 records are populated with a patient health summary that makes them useful to doctors.
As the project to drag health care into the digital age flounders it has emerged the government is setting up My Health records for people who are no longer alive.
Alison McLaren says her family was shocked and upset to receive a letter from the Department of Health in February informing them a My Health record would be established for her nanna Muriel Stratton who had passed away 20 years ago.
“It was a real shock to mum because it was so close to the 20th anniversary of Nanna’s passing and was strange to get this letter out of the blue,” said Ms McLaren.
“I support e-health but what concerns me is if they are using information that old and getting that wrong, what else are they getting wrong?” she said.
Roger Grearly says his wife Lillian passed away 23 years ago but he received a letter recently informing him a My Health record would be set up for her.
“It bought back a few memories and was a bit emotional,” he says.
He says another Facebook friend also received a letter informing her a My Health record would be set up for her 19-year-old son who had passed away.
“Whether it’s blundering or carelessness it’s pretty pathetic,” he said.
The Department of Human Services says it sent letters to people who were deceased because it did not have a date of death recorded against their customer records.
“The department is aware that of the one million letters sent about the My Health Record trial, a small number have been sent to deceased individuals,” a spokeswoman said.
 “The department sincerely apologises for any distress this has caused.”
The department says it is notified of a death from family members and other authorised persons such as health professionals, funeral directors and, in more recent years by data-matching with Birth, Deaths and Marriages registrations.
“If the department is not notified, a date of death will not be recorded on a customer’s record,” it said.
Minister for Health Sussan Ley offered a direct apology to any family affected by the ‘unfortunate’ administrative error.
“What I find disheartening is Labor are quick to use this as an excuse to attack the Government’s IT and payment systems when something goes wrong, but are also actively blocking our attempts to upgrade them so they are more accurate and convenient for patients.”
A spokeswoman for the Department of Health dismissed CSC’s warnings about the possibility of one patient’s health details being mistakenly filed on another person’s My Health Record.
“Advice being provided by CSC is about organisations using a very specific combination of software products and versions “practIX with HIE suite 2.1 or less”, not the My Health Record,” the spokeswoman said.
The My Health Record lists a person’s medications and allergies, doctors can upload a health summary about the person’s health problems, eventually the system will include X-ray results, pathology results, hospital discharge summaries and other data that for the first time can be shared between medical practitioners.
One million Australians will automatically have their personal health information uploaded onto the internet in such records from July as the government trials switching the My Health Record to an opt out system.
There is a lot more to read on this nonsense here:
The issue here is that it is virtually certain the names for the letters and to create patient registrations were almost certainly derived from the Medicare Customer Database that also supports the Health Identification Service which provides Individual Health Identifiers.
That names can remain on this database for 20 years and not be noticed is really a worry - and is certainly indicative of there being all sorts of other errors in this really crucial database.
Given patient identification is crucial to assembling a patient record from diverse sources the Government just pretending that all is well is a joke. Worse still is the fact that the Minister thinks that their attempts to fix things are being blocked - rather it is actually true they are happy to see an error rate in the Medicare Database (because it would cost big time to fix it).
The letters to the dead are a canary in the coal mine regarding data quality in the Medicare Databases.
The letters to the dead are also a symptom of the Government’s haste in pushing a patient record  on a million unsuspecting patients (who may be alive or dead or demented or not etc.). The trials and their risks have not been properly thought through - it is as simple as that - and now we see the first evidence of that fact emerging.
A careful rethink is really required before an even bigger mess is created.
David.

AusHealthIT Poll Number 316 – Results – 17th April, 2016.

Here are the results of the poll.

How Do You Rate The Recently Circulated Draft National Digital Health Strategy?

Excellent 9% (18)

Good 6% (13)

Neutral 2% (4)

Poor 43% (89)

Just Awful 40% (83)

I Have No Idea 1% (2)

Total votes: 209

83% think the Draft needs a great deal more work on a large vote. Enough said I reckon. Back to the drawing board guys and gals!

Great turnout of votes!

Again, many, many thanks to all those that voted!

David.