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."

Thursday, June 20, 2019

There Is A Con Being Perpetrated On The Public Regarding Health Record Access. It Is Not Useful For Most!

This popped up last week:

Having Access To Medical Records Is Useless For Most Patients

June 7, 2019
I knew up front that it would be ugly. After two years of treatment, a chronically-ill patient like me generates a lot of records, and I had every reason to expect that they would be disorganized and dense.
Still, when I sat down to tackle the 600-odd PDF that Kaiser Permanente made available, I was pretty intimidated. Yeah, when I say this I can almost hear you thinking “well, duh!” but your warnings couldn’t prepare me emotionally for the document that I got.
In any event, this encounter with my personal data has convinced me that if CMS doesn’t change its strategy, pushing consumer engagement with their online medical record will prove to be a complete waste of time.
Actually, getting my records was actually amazingly easy.  I logged into my Kaiser portal and navigated little difficulty to a link I could use to request records for the past two years of treatment. Having been a patient with Kaiser for just over two years this was perfect,
Within 24 hours, Kaiser has sent me a link to the FTP site for which I could download my records, and creating a login for the FTP server was simple. I logged in, clicked to fetch the PDF and voila, there it was. As an aside, this was a stunning exception to Kaiser’s usual foot-dragging and bureaucratic bluster, and my guess is that their Epic system deserves at least some of the credit.
In any event, you’ll be far from surprised to learn that from that point on, things got a little crazy.
First, it was the predictable but unfortunate fact that the document was 643 pages long and completely chaotic. Visit records from various providers were displayed in random order, with encounter information from say, May 2017 followed by documentation from November 2019 then August 2018.
Updates from my primary care doctor were followed by nursing notes from urgent visits, then records from podiatry consults the year earlier. There were pages and pages of repetitive blood pressure readings.
More here:
Of course as the #myHR for each patient gradually fills up the threat of a 600 page document will become moot – even if it were actually possible to download the whole record- let alone in any organized form.
For most people it will be impossible to make much sense of what they receive as so much will be disorganized, technical and hardly informative!
This article provides more evidence I reckon as to just how few will find much benefit from the system for the enormous amount we a paying for it. What proportion of the population do you think will actually receive real value from the #myHR and is that enough to justify the system?
David.

Wednesday, June 19, 2019

It Seems The Committee For Economic Development Of Australia (CEDA) Can’t Get Enough Of The ADHA And Its CEO.

I thought I was seeing double for a week or two but then I realized the ADHA CEO had been out and about all over spruiking Digital Health.
Selected examples include:

Digital health: a human imperative

VIC
May 29
Join Australian Digital Health Agency Chief Executive Tim Kelsey, for the latest update on the implementation of Australia’s National Digital Health Strategy and the vision for digital health.

Speakers

Tim Kelsey, Chief Executive Officer, Australian Digital Health Agency

Event overview

What are the big opportunities to integrate digital health services and improve patient health outcomes?

We discuss the Agency’s latest work on My Health Record, secure messaging between disparate clinical information systems, and wider health system interoperability.

Event presentations

Australian Digital Health Agency, Tim Kelsey MP3

Moderated discussion MP3

Delegate handout PDF
The
But then I noticed the same program on June 12 – in Sydney. (Sponsor – McKinsey & Co.)
It seems this is to be followed on June 26 by the same presentation in Adelaide (Sponsor EY)
Now we have to note that CEDA is ‘the big end of town’ if ever there was an organization to fit that bill.
It is interesting that EY, Deloitte and McKinsey have all strong representation within the organization and I suspect that this is at least partly based on potential engagements that may emerge from the ADHA.
You can see the affiliations of the attendees from the delegate handout linked above.
I don’t know about you but this all has the feel of a type of ‘Canberra Bubble’ where those who are seeking engagements in a particular space sponsor a speaker to help them identify just what the lay of the land is and where opportunities may lie!
It has been always thus I believe but it does seem a little close to the bone.
What do readers think?
I have listened to the talk and the questions. All we got were the usual anecdotes with little discussion of possible downsides and risk, the digital divide and so on. Interestingly, in response to one question he did admit there are real security and penetration risks that need to be balanced against the utility of the system, and that these are rather under discussed to say the least, and possibly need more coverage. Overall the downside of all this got pretty short shrift, which I guess is to be expected. Apparently there are funds from the ADHA to give everyone secure messaging to everyone else in the clinical world by June next year. We can all watch that with interest as the fax machines vanish!
It will be very interesting to see what the re-elected Government does with the system over the next few months. The thing that strikes one most about these presentations is the absence of any real evidence for risk adjusted benefit for the population rather than just a few anecdotes and 'down with the fax' rhetoric. After almost a decade under the NEHTA / ADHA regime one might expect better to be provided to a quality audience!
David.

Tuesday, June 18, 2019

Commentators and Journalists Weigh In On Digital Health And Related Privacy, Safety And Security Matters. Lots Of Interesting Perspectives - Week 48.

Note: I have excluded (or marked out) any commentary taking significant  funding from the Agency or the Department of Health on all this to avoid what amounts to paid propaganda. (e.g. CHF, RACGP, AMA, National Rural Health Alliance etc. where they were simply putting the ADHA line – viz. that the myHR is a wonderfully useful clinical development that will save huge numbers of lives at no risk to anyone – which is plainly untrue) (This signifies probable ADHA Propaganda)
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Note: I have also broadened this section to try to cover all the privacy and security compromising and impacting announcements in the week – along with the myHR. It never seems to stop! Sadly social media platforms get a large run this week and most weeks. Sadly there is also the need to recognize pollie based risks to privacy!
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How artificial intelligence uses chaos theory to predict death

6th June 2019
How does artificial intelligence make its decisions? What is the nature of its rational thought?
It’s a question that bamboozles even developers. The unknowable nature of artificial intelligence (AI) has led to its decision-making processes being called ‘the black box’.
You feed it masses of data, somehow it learns and out come the predictions.
A new study in Lancet Digital Health has found that AI can predict in-hospital, 30-day and 90-day mortality for ICU admissions with greater accuracy than even the best formulas used by human doctors.
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Email concerns for Australian IT chiefs amid deluge of malicious spam

By Ben Grubb
June 14, 2019 — 2.07pm
If your email inbox has been harder to sift through than usual, this might be why: seven in 10 emails in Australia were spam last month.
That's according to security and networking equipment manufacturer Cisco, which provides services that monitor and filters corporations' emails to weed out security threats and spam.
While some spam is caught by filters, it can still get through, and some contain security threats.
Last month, the Australian Competition and Consumer Commission (ACCC) warned that Australian businesses lost an estimated $7.2 million to email scammers last year. However, the number is likely to be much higher, as most email scams aren't reported.
The same report from the ACCC also pointed to a 53 per cent jump in business email compromise in the same year and said that Australian consumers reported losing $107 million to agencies that monitor fraud, which include Scamwatch and the Australian Cybercrime Online Reporting Network.
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Intelligence agency could be used for 'offensive cyber' operations in Australia

By David Wroe
June 15, 2019 — 12.00am
Australia's electronic intelligence agency could smash the computer networks of criminals domestically using "offensive cyber" operations presently confined to overseas targets under proposals being discussed among national security officials.
The Australian Signals Directorate (ASD) could also sit within the networks of major Australian power, water, telecommunications and other critical infrastructure companies to help defend them against foreign cyber attacks.
The Sydney Morning Herald and The Age can reveal that a greater domestic role for the ASD remains a live consideration for the Morrison government despite the political firestorm that has erupted since police raided a journalist's home to investigate a top-secret leak of the ASD proposals.
Senior officials have repeatedly stated that the proposal never amounted to spying on Australians - a position strenuously underscored by multiple sources in recent days.
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My Health Record: learning opportunity for PAs

Pharmacy assistants play an important role in helping customers obtain the medicines they need, and part of that process is using My Health Record in the supply of medicines and advice to customers.
Often pharmacy assistants have well established relationships with customers, based on familiarity, time and the previous high-quality service they have provided.
With the introduction of My Health Record, pharmacy assistants now have an opportunity to develop those relationships through helping pharmacists and customers get the greatest benefit from the system.
In recognising that the My Health Record system makes it easier and safer for pharmacists, doctors and other health professionals to provide care to customers, Guild Learning and Development has partnered with the Australian Digital Health Agency to develop an online module titled Introducing My Health Record.
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Future of warfare in the cyber grey zone

  • 12:00AM June 14, 2019
Defence Force chief Angus Campbell has warned the West must come to terms with new forms of “political warfare” being waged by totalitarian states seeking to subdue, disrupt and overpower ­Australia and its allies.
In a speech last night on the sort of war Australia might have to fight in 2025, General Campbell said the nation’s “worst nightmare” of armed conflict would emerge from “the grey zone” — ­information campaigns, cyber operations, theft of intellectual property, coercion and propaganda.
“Grey-zone operations that subvert, erode and undermine, breaking international rules and norms but ones that, in the eyes of the targeted state, fall short of ­requiring a war response,” he said.
General Campbell warned totalitarian states were masters of political warfare, naming Russia but not China as perpetrators, ­despite Beijing’s well-documented political coercion and offensive hacking operations.
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Doctor, just how safe is your patient data, really?

Siobhan is a reporter with Australian Doctor Group.
14th June 2019
A team of auditors recently hacked a number of health services and accessed sensitive patient records to make a point about data security complacency.
Their findings, published in a Victorian Auditor-General’s report last month, showed just how easily patient data could be stolen or altered.
The main targets were Barwon Health in Geelong, and the Royal Children’s Hospital and the Royal Victorian Eye and Ear Hospital, both in Melbourne.
The most common problems were weak passwords, inadequate access control, limited network monitoring and poor staff knowledge.
But the report also highlighted the techniques they used to infiltrate a hospital system — and none of these techniques required a cybercrime mastermind as you might imagine.
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Study highlights e-prescribing errors

Pharmacies are being left out of pocket, say researchers
13th June 2019
The increasing use of electronic scripts has been linked with a number of dispensing errors and pharmacy frustration, a US study has found. 
Researchers from the pharmacy colleges at the universities of Cincinnati and Arizona analysed 589 voluntary reports to an e-prescribing error portal made over a four-year period. 
They found problems with patient directions (210) were the most common issue, and 10% of mistakes were not picked up before reaching the patient. 
Errors with the drug quantity (158 cases) and drug selection were the next most common mistakes, with 20% reaching the patient, the researchers reported in Applied Clinical Informatics
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My Health Record CPD Accredited Course for Nurses Now Available

The Australian Digital Health Agency has partnered with the Australian College of Nursing (ACN) to develop a self-paced online course tailored to the nursing role in any healthcare setting. This course is eligible for CPD points. It will ensure nurses are supported to confidently use My Health Record.
The course contains five modules:
  • Module 1 – An Introduction to My Health Record
  • Module 2 – Clinical Documents and Patient-Entered Information
  • Module 3 – Accessing, Viewing and Uploading to My Health Record
  • Module 4 – My Health Record Privacy, Security and Consent
  • Module 5 – Supporting Patients’ Use of My Health Record
Dr Helen Almond, Specialist General Practice Nurse and Lecturer in Digital Health said the new module is the latest in a series of initiatives conducted by the Agency and the ACN to ensure nurses are intrinsic in the use of My Health Record.
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CFEH Integrate with My Health Record

12 June, 2019
The Centre for Eye Health (CFEH) has commenced posting all patient reports and associated images to My Health Record files, in order to help improve the quality of patient care for people who have, or at risk of, developing eye disease and vision loss.
CFEH is the first in the eye care industry to integrate with the new system, and aims to focus on the early detection and management of eye disease and the development of innovative referral pathways to allow timely access to affordable eye care.
uploading patient information to My Health Record will help facilitate better inter-disciplinary communication and represents a great step forward
“Nine out of 10 Australians now have a My Health Record. Secure electronic communication pathways between optometrists and ophthalmologists as well as with other health professionals involved with our patients’ care such as GPs, public eye clinics and other specialists are currently somewhat fragmented,” said Michael Yapp, CFEH Head of Clinical Operations and Teaching.
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The ethics of artificial intelligence: laws from around the world

In this article, we examine the creation of frameworks for the ethical use of AI in Australia and globally.
Key takeouts
AI offers significant potential as well as risks.
In Australia, CSIRO's Data61 has proposed a framework for managing the ethics of AI which appears to be developing similarly to efforts in Europe.
There is growing consensus on these issues and serious consideration of AI ethics and best practice globally by the tech industry.
The use of artificial intelligence and machine learning (AI) driven solutions is becoming increasingly common in Australian businesses. By processing enormous amounts of information in a very short time, AI can minimise human intervention in decision making processes, and allow organisations to optimise their operations. The Minister for Industry, Science and Technology, Karen Andrews has commented that "AI has the potential to provide real social, economic, and environmental benefits – boosting Australia's economic growth and making direct improvements to people's everyday lives".
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Damned lies and statistics: how to 'unspin' medical news

Antony is a medical reporter with a special interest in technology and pharmacy.
12th June 2019
At the risk of having to plead the fifth, let’s talk about the failings of health journalists.
In a novel series of randomised controlled trials, published recently in BMC Medicine, researchers tried to quantify the effect on readers of misleading ‘spin’ in health news stories.
As they noted, spin can have real-world consequences. In 2008, coverage of a mouse study evaluating lithium for motor neurone disease led many patients to try it, they say. Subsequent research showed the treatment was ineffective in humans.
For the BMC Medicine study, US and French teams, including epidemiologists and journalism academics, read 30 news stories, including one from Australia’s own Herald Sun newspaper, and attempted to unwind the spin by adding appropriate scientific cautions to see how the change would be received by readers.
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09 - Graham Grieve

Pete chat's with the "Father of FHIR" Graham Grieve about the motivations and drivers behind the plumbing of healthcare data.  Check out the FHIR community at www.fhir.org
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Jeremy Lee v Superior Wood: biometric data, the Privacy Act, and the employee records exemption

In Jeremy Lee v Superior Wood Pty Ltd, the Full Bench of the Fair Work Commission (FWC) considered the lawfulness of an employer directing an employee to provide their biometric data.
In this case, Mr Lee objected to his employer’s direction to use a fingerprint scanner to sign in and out of his work site, under Superior Wood’s Site Attendance Policy (Policy). Mr Lee argued that he owned the biometric data contained within his fingerprint, and that as ‘sensitive information’ under the Privacy Act 1988 (Cth) (Privacy Act), his employer was not entitled to require he provide this information.
Following the implementation of the Policy, Mr Lee was provided with verbal and written warnings, directing him to adhere to the Policy and provide his fingerprint. After Mr Lee’s continued refusal, his employment was terminated for failing to follow a lawful and reasonable direction to comply with the Policy.
At first instance, Commissioner Hunt held that the direction to provide the fingerprint scan was both lawful and reasonable. The Full Bench of the Fair Work Commission quashed this decision, finding Superior Wood’s direction to be unlawful, as it breached the Australian Privacy Principles (APP) in the Privacy Act, specifically, APP 3.
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How hackers can permanently lock you out of your accounts

Some hackers use malicious code, but most just hide in plain sight. It can be devastatingly effective
When their computer or social media account is hijacked by an unknown entity, most people probably picture something like this: a faceless man hunched over a sleek laptop in an abandoned building, eyes darting to and fro, hands dancing across a mechanical keyboard. Green ciphers wash down his screen faster than the eye can track until … ping! your face pops up on the screen. He just cracked your Facebook account, and now this digital mastermind is going to message all your friends asking for money. Jackpot.
This only happens in movies, of course, and while a minority of “hackers” do write Trojan horses, viruses and other malicious code, most just hide in plain sight and exploit human psychology to gain entrance. Social engineering can take many forms, including “tailgating” – following someone through a turnstile or into an elevator to access restricted floors; showing up at a restricted site disguised as an IT contractor; or the infamous SIM-swapping hack in which the hacker simply calls T-Mobile’s customer service, pretends to be you, perhaps gives your home address or SSN, and asks to port your number to a new SIM card, bypassing any two-factor authentication you have. This isn’t particularly difficult; the data needed to pretend to be you can be easily gleaned from the hundreds of data breaches that occur every year. Most often, hackers enter through the front door.
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City of Perth rolls out new facial recognition CCTV cameras, but is it surveillance by stealth?

Updated Sat at 2:21pm
The activation of new facial recognition camera systems in Perth and Brisbane has raised concerns about how the technology is being quietly introduced by Australian governments as a way of monitoring their citizens.

Key points:

  • Facial recognition technology will be trialled by the City of Perth for 12 months
  • If successful it could be expanded to all 480 CCTV cameras in the city's network
  • But legal experts question whether it is an effective crime reduction tool
The technology was recently rolled out on the west and east coasts with little, if any, consultation with the public the government plans to watch.
Legal experts now say the public must be engaged in a debate about whether they want this powerful technology and how it could affect them in their day-to-day lives.
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Comments welcome!
David.

Monday, June 17, 2019

Weekly Australian Health IT Links – 17th June, 2019.

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

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A very news free week other than for the sad demise of Bridget Kirkham – always a driver of Digital Health activity for good.
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Paramedics to transfer medical records en route to hospital