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, December 31, 2019

Commentators and Journalists Weigh In On Digital Health And Related Privacy, Safety And Security Matters. Lots Of Interesting Perspectives - December 31, 2019.

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This weekly blog is to explore the larger issues around Digital Health, data security, data privacy, AI / ML. technology and related matters.
I will also try to highlight ADHA Propaganda when I come upon it.
Just so we keep count, the latest Notes from the ADHA Board are dated 6 December, 2018! Secrecy unconstrained! This is really the behaviour of a federal public agency gone rogue – and it just goes on! When you read this it will be well over 12 months of radio silence, and better still the CEO, COO and the Chief of Staff have also gone.  I wonder will things improve now?
Note: Appearance here is not to suggest I see any credibility or value in what follows. I will leave it to the reader to decide what is worthwhile and what is not! The point is to let people know what is being said / published that I have come upon.
Oh, and Happy New Year!
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Inside Australia's race to build a viable quantum computer

Quantum computing promises to change everything about the way we live, and two Australian universities are taking very different paths in search of the elusive prize.
John Davidson Columnist
Dec 27, 2019 — 12.07am
On an overcast morning midway through last decade, then Prime Minister of Australia, Malcolm Turnbull, stood at a podium in the Sydney suburb of Kensington, claiming to be at the very "cutting edge of the new age of computing".
The podium stood in front of a $25 million extension that had just been added to the Centre for Quantum Computation at the University of NSW, where scientists led by an English physicist who would go on to become the Australian of the Year, Professor Michelle Simmons, were trying to build a world-beating quantum computer.
"You’re not just doing great work, Michelle, you're doing the best work in the world," the Prime Minister enthused. “You're not just . . . determining the direction of computing for Australia, you are leading the world.”
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Human Rights Commission wants privacy laws adjusted for an AI future

It is one of 29 proposals that the commission has proposed as it seeks to address the impact of new technologies, such as artificial intelligence, will have on human rights.
By Aimee Chanthadavong | December 17, 2019 -- 02:55 GMT (13:55 AEDT) | Topic: Innovation
The Australian Human Rights Commission has called on the Australian government to modernise privacy and human rights laws to take into account the rise of artificial intelligence (AI) as one of 29 proposals put forward in its Human Rights and Technology discussion paper.
"We need to apply the foundational principles of our democracy, such as accountability and the rule of law, more effectively to the use and development of AI," Human Rights commissioner Edward Santow wrote in his foreword in the discussion paper [PDF].
"Where there are problematic gaps in the law, we propose targeted reform. We focus most on areas where the risk of harm is particularly high. For example, the use of facial recognition warrants a regulatory response that addresses legitimate community concern about our privacy and other rights.
"Government should lead the way."
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The world is reeling from a Zucker punch

Ten years ago, the pace of technology, particularly in social media, was a trickle; now it’s a toxic torrent.
No one was prepared for just how damaging Facebook, and social media more broadly, would become.
The 2010s will likely be remembered most for the tech giants’ outsized influence on our lives and our collective inability to rein them in. Social media has disrupted democracy, dumbed down discourse and come at a cost to civil society that we can’t even yet fully understand.
The tech titans’ mysterious algorithms — of which we know virtually nothing — morphed across the decade from mere recommendation engines to the mastermind of what we see and read every day. In contrast to a newspaper editor or a TV news director selecting what stories were most important for people to read — even if they wouldn’t necessarily be popular — a non-human algorithm instead would pick what was most likely to gain clicks, “likes” and engagement.
What started as platforms promoting connectivity evolved into damaging tools for division and dumbed down debate over the past decade, says tech reporter David Swan.
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California gets tough on data privacy breaches

History does not repeat but sometimes it rhymes. So, it seems, do efforts to protect netizens’ privacy. The European Union led the world with its General Data Protection Regulation, which came into force in May 2018. That law shook up internet giants and global advertising firms, both of which had previously used — and at times abused — consumer data with little oversight.
On December 11 India’s government introduced a bill that would force firms to handle data only with consumer consent and give the authorities sweeping access to them. The same day Prime Minister Scott Morrison promised a review of privacy laws and said the competition authority will monitor how advertising is done on digital platforms.
But the most important piece of legislation rhyming with GDPR right now is the California Consumer Privacy Act, which comes into force on January 1. To online businesses, it jars.
The Californian law copies some of the GDPR’s provisions. It gives consumers the right to know what online information is collected about them and how it is used, permits them to demand that their data be destroyed and to sue companies for data breaches.

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Ethical machine learning: the Australian government’s official AI ethics framework

On 7 November 2019, the Australian Federal Government’s Minister for Industry, Innovation, and Science, Karen Andrews, announced the Australian government’s official AI ethics framework.
This is a voluntary set of parameters for businesses and organisations when designing, developing, integrating, or otherwise using artificial intelligence.
The framework reduces to eight principles, and we replicate below the summary from the Department of Industry, Innovation, and Science’s website:
Principles at a glance
  • Human, social and environmental wellbeing: Throughout their lifecycle, AI systems should benefit individuals, society and the environment.
  • Human-centred values: Throughout their lifecycle, AI systems should respect human rights, diversity, and the autonomy of individuals.
  • Fairness: Throughout their lifecycle, AI systems should be inclusive and accessible, and should not involve or result in unfair discrimination against individuals, communities or groups.
  • Privacy protection and security: Throughout their lifecycle, AI systems should respect and uphold privacy rights and data protection, and ensure the security of data.
  • Reliability and safety: Throughout their lifecycle, AI systems should reliably operate in accordance with their intended purpose.
  • Transparency and explainability: There should be transparency and responsible disclosure to ensure people know when they are being significantly impacted by an AI system, and can find out when an AI system is engaging with them.
  • Contestability: When an AI system significantly impacts a person, community, group or environment, there should be a timely process to allow people to challenge the use or output of the AI system.
  • Accountability: Those responsible for the different phases of the AI system lifecycle should be identifiable and accountable for the outcomes of the AI systems, and human oversight of AI systems should be enabled.
More questions are raised by the framework than answered. We deal with some immediately obvious issues below.
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Biometrics critical to countering terror threats

The incoming government brief from the Department of Home Affairs reveals the organisation’s increasing reliance on biometric data to detect and respond to what it calls “threats within the immig­ration program”.
The department uses bio­metrics collected from visa applications in Australia and 46 other countries to detect “persons of concern”.
People applying for a visa to Australia from those countries will have a photo of their face taken and their fingertips ­recorded on a digital finger ­scanner.
The millions of biometrics collect­ed are checked against existin­g data holdings and other databases run by Australia’s M5 immigration partners, Canada, New Zealand, Britain and the US.
The brief said “intelligence sharing with law-enforcement agencies and Five Eyes partners had strengthened” since the ­establishment of the Department of Home Affairs.
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ACCC prods tech titans on media content deal

Facebook and Google have been urged to reach an agreement quickly and in “good faith” with traditional media companies or face intervention by the competition watchdog, including imposition of a mandatory code.
A letter from Australian Competition & Consumer Commission chairman Rod Sims to the local chief executives of Google and Facebook, obtained by The Australian, told the US tech giants to advise the ACCC by the end of January “the broad subjects proposed for negotiation, the potential format of commitments so they are ­enforceable”.
The letter, which mandates a detailed timeline for negotiations including a full draft agreement for the ACCC’s perusal by Oct­ober, follows the Morrison government’s endorsement of a raft of ACCC recommendations to rein in the tech giants’ market power in local digital markets, including a voluntary code.
 “It will be important to progress negotiations in good faith and as expeditiously as possible in order to meet these deadlines, noting that the government has indicated it will consider options, including imposing a mandatory bargaining code, if a suitable outcome is not reached within the expected timeframe,” it said.
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Police using facial recognition cameras at Victoria's busiest stations

By Farrah Tomazin
December 25, 2019 — 11.45pm
Victoria Police is quietly using facial recognition technology to identify criminal suspects at 85 of the state's busiest police stations.
A month after body-worn cameras came under the spotlight, police figures reveal that another form of camera technology known as iFace has been rolled out at key stations.
The system uses biometric software to identify suspects by comparing still images against Victoria Police’s mugshot database of known offenders.
But secrecy surrounds the network, its use and how many times people have been mistakenly flagged as potential criminals. Facial recognition technology has proved significantly inaccurate in overseas jurisdictions.
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Advance Care Planning and My Health Record Community Workshop

Are you good to go?

Thursday 6 February 2020
10:00 AM - 2:00 PM

You are invited to a FREE interactive community workshop on advance care planning and My Health Record.
Comment – sick tag line above….ich!
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2019 CEO survey: Data in driver’s seat for top execs

ACCC chief Rod Sims will increasingly use control of data as a key metric in deciding whether a merger breaches competition rules — and this year’s business leader survey shows data use has gone from theory to fact.
The survey of 73 business leaders shows increased use of artificial intelligence, with Magellan’s Hamish Douglass saying: “Magellan uses data science and machine learning to improve many processes in our business.”
CBA’s Matt Comyn said the bank was “using analytics to help our 7 million digitally active customers better understand and manage their finances, or to connect them with a range of benefits they may be entitled to.”
QBE’s Pat Regan said: “Things like artificial intelligence and robotics are helping speed up claims-handling and strengthen our fraud detection capabilities, for example. We’re using data better and exploring more ways that we can better capture that to deliver more tailored customer solutions.”
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Media Release: My Health Record sees a 62 per cent increase in general practitioners viewing documents

Created on Monday, 23 December 2019 ADHA Propaganda
According to data released by the Australian Digital Health Agency (the Agency), general practices increasingly lead the way in using My Health Record, with usage (viewing and uploading) rising substantially since March 2019.
In data released in December as part of a refreshed My Health Record statistics dashboard, general practices averaged around 200,000 My Health Record views per month throughout September and October, a 62 per cent increase since March this year.
  • Since March, monthly cross-organisation views have increased by 140 per cent.
  • General practices are viewing the most documents uploaded by other healthcare providers, and the documents they upload are most frequently viewed by other healthcare providers (including other general practices).
  • 90 per cent cent of general practices are registered for My Health Record, with 71 per cent using the system as at November 2019.
  • General practices are one of the leading healthcare provider groups in both registration and usage, along with pharmacies (90 per cent registered and 69 per cent using) and public hospitals (94 per cent of beds registered).
  • General practices also upload between 2 and 3 million documents to the system every month.
Dr Harry Nespolon, President of the Royal Australian College of General Practitioners, said general practitioners may be more inclined to use My Health Record because of the nature of their work.
“Many general practitioners are treating patients with complex or chronic conditions, so they need to be able to make decisions that are informed by a wider view of a patient’s health.
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Comments more than welcome!
David.

Monday, December 30, 2019

Weekly Australian Health IT Links – 30th December, 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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Not surprisingly a very quiet week with just a few interesting items popping up.
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Health documents reveal patient harm linked to Queensland's new medical record system

Exclusive by state political reporter Josh Bavas
24 December, 2019
Almost 100 cases of patient harm have been linked to Queensland's new electronic medical record system in just over a year, including instances of patients being administered incorrect doses of drugs.

Key points:

  • Documented cases include child given 10 times the amount of insulin they were prescribed and a patient administered morphine in milligrams, not micrograms
  • One patient in severe pain was unable to be given pain relief because of a 'computer system failure'
  • Queensland Health says the Integrated Electronic Medical Record (ieMR) is working well
On one occasion late last year, a child at Queensland Children's Hospital was mistakenly given 10 times the amount of long-acting insulin they were prescribed.
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Credit card and other details of Perth rental applicants may have been public for 21 months

By Hamish Hastie
December 24, 2019 — 3.05pm
Information such as credit card details and birth certificates uploaded during tenancy applications may have been published on the website of a Perth property management business for up to 21 months, a warning to clients has revealed.
On Monday Perth-based Primus Realty emailed 750 of its clients warning that tenancy application information collected via its website from March 2018 to December 12, 2019 may have been made public.
The tenancy information may have been online for up to 21 months.
The information could include sensitive identifying information such as names, birthdays, addresses, telephone numbers, driver licences, passports, birth certificates and even Medicare numbers.
Worryingly, financial documents may have also made it online including credit card details, bank statements, proof of income and bills.
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Website to compare medical specialists' costs to go live without key details

By Dana McCauley
December 27, 2019 — 10.00pm
The Morrison government's $7.2 million specialist fee transparency website is set to go live in the coming days, but will not detail individual doctors' fees – as initially promised – or enable patients to determine their out-of-pocket costs.
The website, promised by Health Minister Greg Hunt before the federal election in response to concerns about overcharging by some specialists, will give an average cost of a range of procedures and will not detail how much each health fund will pay towards each procedure.
Mr Hunt pledged in March to deliver a searchable website listing individual specialists' fees for specific services to help patients avoid "bill shock" and crack down on doctors charging egregious out-of-pocket sums, but the project has been hampered by a lack of co-operation from doctors.
The minister initially said the website would go live by January 1 with individual fee information to be provided by obstetricians, gynaecologists and cancer physicians.
National Association of Specialist Obstetricians and Gynaecologists president Gino Pecoraro said of the hundreds of doctors in the field he had spoken to about the website over the past nine months, "not one" had indicated a willingness to publish their fees.
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Government funds new efforts to bolster political parties’ cyber security

New program launched in wake of parliament hack

The Department of Finance will administer a new program to help political parties better improve the security of voter information that they hold.
Funding of $2.7 million was allocated in the Mid-Year Economic and Fiscal Outlook 2019-20, building on a 2017-18 budget measure that earmarked $300,000 to the four largest parliamentary parties to help boost security.
In early 2017 the government revealed plans to help political parties strengthen security in the wake of state-sponsored hackers penetrating a server belonging to the Democratic National Committee in the US.
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Advance care directives frequently written by someone other than the patient

About 18% have been completed by someone else, survey shows
27th December 2019
Nearly one-fifth of advance care directives for end-of-life care are completed by someone other than the patient, putting their legal validity in doubt, a new survey has revealed.
Last year, researchers examined the health records held at 15 GP clinics, 27 hospitals and 58 aged care facilities.
Among the 4200 patients aged over 65, they found 1100 had a written advance care directive.
In most cases, the directives can only be treated as legal documents when written and signed by the individual when they have decision-making capacity.
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HISA and ACHI vote ‘Yes’ to unite and form a new organisation

Making history!

HISA and ACHI members and Fellows have voted ‘Yes’ to unite and form a new peak body for digital health.
The proposal to merge and form a new organisation has been passed by a majority vote with more than 89% of members and Fellows voting for the merger.
The Australasian Institute of Digital Health will be launched on 24 February 2020.
HISA and ACHI members and Fellows will be the inaugural members of the Digital Health Institute which will be accepting new members from all sectors of healthcare after it is launched.
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App gives foster kids chance to report abuse

Children and teens in foster care and group homes will be able to report abuse or ask for immediate help on a phone app that for the first time connects them directly to their case worker and emergency contacts.
Western Australia is the first state or territory in Australia to trial the newly developed MyView app as part of the state’s response­ to the 2017 Royal Commission into Institutional Res­ponses to Child Sexual Abuse.
In the farming and mining region­ of Murchison, north of Perth, the McGowan Labor govern­ment is giving mobile phones to foster kids and others aged 10-17 in out-of-home care so they can use the app.
In the city of Rockingham on the fringe of Perth’s southern suburbs­, children and teens who already have phones have started taking part in the trial.
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Apple Watch Health app cuts through the noise

By Alice Clarke
December 26, 2019 — 4.22pm
When the new updates for Apple’s Health app for iOS and WatchOS were announced at WWDC, I was pretty sure that the new Noise app would become one of my favourite features of the Apple Watch. But what I didn’t realise was just how much it would become a part of what I do every day.
The Noise app sends a notification if your environment is unhealthily loud.
As a kid, I needed several surgeries to be able to hear properly. And then, as a teenager, I became a drummer, much to my doctor’s exasperation, yet managed to maintain my now above-average hearing due to my parents’ insistence that I wore ear protection during practice and whenever I went to gigs. So, I guess it makes sense that I’m more concerned about noise levels than most.
The app works by having the watch sample background noise every 30 seconds using the second microphone introduced to the Apple Watch from Series 4 (2018’s model), and processes it on the device. It doesn’t record, share info, or listen to what’s being said: It just tells you how loud the environment is. If it’s been at 90dB or above (or a custom level you’ve set) for more than three minutes, it’ll send an alert to let you know.
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Open banking reforms delayed as security tests drag on

By Clancy Yeates
December 22, 2019 — 11.55pm
The consumer watchdog will spend more time ensuring a new financial data-sharing regime is resilient against cyber security threats, after technical hiccups delayed the launch of open banking by six months.
In a disappointing development for fintech firms, the Australian Competition and Consumer Commission pushed back the start date for the government's open banking reforms on Friday from next February to July.
The Australian Competition and Consumer Commission has delayed the start of open banking. Credit: Michel O'Sullivan
The change will hold back the plans of neobanks keen to entice big bank customers who are willing to share their data, but the ACCC said the rollout had proven more complex than it had expected and that trust in the system was vital.
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‘Step up’ face data checks at borders

Australia’s immigration watchdog has warned the Morrison government that greater use of biometric facial recognition technology and matching of data held by friendly nations and security partners is needed to counter a heightened vulnerability to terrorism and organised crime.
In a detailed brief handed to Home Affairs Minister Peter Dutton after the May election, the Department of Home Affairs laid out a case for upgrading its capabilities in biometric analysis, warning that the immigration program was under significant pressure.
The department argued strongly for an overhaul of its ­information technology infrastructure, saying the system was unable to cope with demand. It said the department’s legacy IT systems were “ageing and failing”.
 “Current systems were designed and built to accommodate much smaller volumes and a less sophisticated risk environment,” Home Affairs said.
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Canberra forecast 5,400 small business cyber health checks, but only 35 happened

Despite the federal government expecting over 5,000 cyber health checks of Australian small businesses, only 35 have happened so far.
By Chris Duckett | December 19, 2019 -- 01:19 GMT (12:19 AEDT) | Topic: Security
When it announced its Cyber Security Strategy in 2016, the Australian government set aside AU$136 million for numerous activities, including a threat information-sharing portal, increasing the government's cybercrime intelligence and investigation capabilities, and grants to small businesses to boost their security.
More than three years after it made the announcement, the Department of Industry, Innovation, and Science has laid bare in responses to Senate Estimates questions on notice how few small business cyber health checks were completed.
"Based on the available funding, the government forecast up to 2,400 Small Business Health Check services in year three of the Strategy (2018/19) and 3,000 services in year four of the Strategy (2019/20)," the department said.
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Alcidion signs contract for medications management solution

Highlights:
·         Contract for ~A$1.9 million signed with Dartford and Gravesham NHS Trust in the UK for medications management
·         As announced July 2019, Alcidion was selected as preferred provider for the solution, following a competitive tender process
·         Alcidion will implement the Better OPENeP electronic prescribing and medication management solution at Dartford and Gravesham NHS Trust
Melbourne, Victoria – Alcidion Group Ltd (ASX:ALC) announces that an agreement has been reached with Dartford and Gravesham NHS Trust, UK, to implement the OPENeP Electronic Prescribing and Medications Administration (ePMA) system produced by Better. Total value of the contract is £1.02 million (~A$1.9 million) to be recognised over six years.

The agreement follows Alcidion’s award as preferred provider by the Trust, a status previously announced in July 2019 and subject to final approval by the Trust and successful negotiation of terms.

Alcidion was appointed as a reseller and implementer of the OPENeP solution in April 2019 for the UK, Australia and New Zealand health sectors.  This project will represent Alcidion’s first implementation of OPENeP.
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Australia's newest internet connection lands in Sunshine State

December 23, 2019 — 7.03pm
This fibre-optic cable at Maroochydore will bring download speeds of 36 terabits per second to Queensland within 60 days.
By mid-2020 it will be transferring commercial data.
The fibre optic telecommunications cable being connected at Maroochydore.
After five years, Australia's newest telecommunications link from Asia and the US landed on Monday, promising faster internet connections to the country's east coast by mid-2020.
Singapore-based telecommunications company RTI Connectivity – the technology partner in a five-year $35 million Sunshine Coast and Queensland government project to bring a new data source to Australia – delivered a 550-kilometre cable connecting an existing Japan-to-Sydney undersea cable to the beach at Maroochydore.
"It enables 36 terabits [per second], which is more capacity than all of the capacity combined that goes into Sydney today," RTI Connectivity chief executive Russ Matulich said.
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Daniel was overseas when he was alerted to an intruder - it was the NBN


Sunday, December 29, 2019

The EHR Reporting Team At Kaiser / Fortune Strike Again!

Here is the article.
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Electronic Health Records Creating A ‘New Era’ Of Health Care Fraud


The federal government funneled billions in subsidies to software vendors who overstated or deceived the government about what their products could do, according to whistleblowers.
 Derek Lewis was working as an electronic health records specialist for the nation’s largest hospital chain when he heard about software defects that might even “kill a patient.”

The doctors at Midwest (City) Regional Medical Center in Oklahoma worried that the software failed to track some drug prescriptions or dosages properly, posing a “huge safety concern,” Lewis said.

Lewis cited the alleged safety hazards in a whistleblower lawsuit that he and another former employee of Community Health Systems (CHS) filed against the Tennessee-based hospital chain in 2018.

The suit alleges that the company, which had $14 billion in annual revenue in 2018, obtained millions of dollars in federal subsidies fraudulently by covering up dangerous flaws in these systems at the Oklahoma hospital and more than 120 others it owned or operated at the time.

The whistleblowers also allege that Medhost, the Tennessee firm that developed the software, concealed defects during government-mandated reviews that were supposed to ensure safety.

Both CHS and Medhost have denied the allegations and moved to dismiss the suit. The motions are pending. Last month, Department of Justice lawyers wrote in court filings that they were still investigating the matter and had not yet decided whether to take over the case.

The lawsuit is one of dozens filed by whistleblowers, doctors and hospitals alleging that some electronic health records (EHR) software used in hospitals and medical offices has hidden flaws that may pose a danger to patients — and that a substantial chunk of the $38 billion in federal subsidies went to companies that deceived the government about the quality of their products, an ongoing Fortune-KHN investigation shows. The subsidies were designed to persuade hospitals and doctors’ offices to install software that would track the medical history of every patient and share the information seamlessly with other health care providers.

But the software makers allegedly gamed the system, repeatedly. Three major EHR vendors have made multimillion-dollar settlement deals — totaling $357 million — over Justice Department investigations which include allegations that they rigged or otherwise gamed the government’s certification test. At least two other companies are under investigation.

Beyond those cases, federal officials have paid hundreds of millions of dollars in subsidies to doctors and hospitals that could not show they were even qualified to receive them, according to federal officials. Nearly 28% of doctors and 5% of hospitals who attested to meeting government standards later failed audits. Federal officials told Fortune and KHN that they have clawed back $941 million in improper subsidies.

“We’re entering an entirely new area of health care fraud,” John O’Brien, senior counsel with the Department of Health and Human Services Office of Inspector General, said in a July 2017 video announcing a $155 million False Claims Act settlement with eClinicalWorks, one of the nation’s leading sellers of EHRs for physicians.

The concern is not just over wasteful spending of tax dollars. EHRs monitor the medicines people take and their vital signs, so software glitches that prevent doctors from accessing files quickly, that mix up patients or send vital test results to the wrong file can contribute to serious injuries, or even deaths.

In March, Fortune and KHN revealed that thousands of injuries, deaths or near misses tied to software defects, user errors and other problems have piled up in various government-sponsored and private repositories.

“Ultimately, it’s about patients getting the right care,” Andrew Vanlandingham, the HHS inspector general’s senior counselor for health information technology, said in an interview. He said that investigators are “gearing up” for more scrutiny of the important industry, including closer monitoring to make sure that records software is safe.

The Justice Department accused eClinicalWorks, an EHR company whose medical software is used by 130,000 providers, of rigging the government’s certification test, claims the company has denied. eCW settled the case for $155 million in 2017.
 Leaping Into The Digital Era

In 2009, Congress committed billions of dollars in economic stimulus funds to bring the era of paper medical records to a close. Officials hoped to cut down on medical errors caused by illegible paper records and draw on the power of massive troves of medical data to drive down the cost of health care and help develop improved treatments for disease.

The hastily devised plan offered Medicare doctors and other medical professionals up to $44,000 and $64,000 in subsidies if they bought the software and accepted patients on Medicaid, the federal health care program for low-income people.

The money was intended to help them pay vendors to install EHRs in their offices. Hospitals, which required more sophisticated and costlier software, could receive millions in subsidies, based on the number of inpatients treated. To give them a nudge, officials warned doctors and hospitals that failure to wire up would trigger gradual cuts in their Medicare payments. EHR vendors had to meet certification standards set by the HHS Office of the National Coordinator for Health Information Technology, or ONC.

Providers had to attest that their EHR software could perform a variety of functions, which the government described as making “meaningful use” of the technology.

Certification was essentially an open-book test in which the government gave vendors the questions in advance — for instance, the names of 16 or so drugs the system would have to prescribe electronically to pass. The Justice Department has alleged that some vendors simply doctored their software to pass the test — for example, programming the required codes for just the specified 16 drugs they would be tested on, rather than all medicines — as officials had expected.

Frank Poggio who recently retired from a 45-year career in health technology, saw the cases of fraud coming, he said, because the tests “were superficial, and if you wanted to game it, you could game it.”

Poggio said there were many weaknesses in the system that allowed a vendor to show a “prototype” as opposed to live software.

Dr. Scott Monteith, a Michigan psychiatrist who served as an early certification juror, said he saw some limitations firsthand. He said one vendor took 30 minutes to produce a list of patients who had diabetes and also smoked, data he figured any computer program should be able to spit out in seconds. The vendor passed.

“That’s an example of how poorly thought-out the whole thing was,” said Monteith, who noted he was then, and still is, a big booster of EHRs.

Jeffery Daigrepont, a senior vice president at Coker Group, a firm that advises health providers on business decisions, said the government erred by handing out too much money in the early stages of the program, when many doctors and hospitals had not yet done much more than agree to participate.
“It was an upside-down pyramid,” he said. “You got the bulk of the money for doing the least amount of effort.”

Dr. John Halamka, a physician and Harvard Medical School professor who chaired the ONC standards committee, which wrote the certification rules, defended the process.

“The only problem [with certification] is that it presupposed that the product the vendor certified would be the same product they sold,” Halamka said. “It presupposes that people will go into the certification process and participate in good faith.”

That did not always happen in the rush to snatch up subsidy dollars, according to the whistleblowers’ suits. The Justice Department case against eClinicalWorks, which has 130,000 providers, accused the company of rigging tests to win certification, claims the company has denied. The company did not respond to numerous requests for comment.

The government accused Greenway Health, a Florida-based EHR developer with 75,000 providers, of doing the same thing. The DOJ’s complaint included a number of instant-message exchanges between Greenway employees in which they allegedly discuss their plan for gaming the certification process by “shortcutting some functionality” of the software. In February, Greenway Health settled with the government for just over $57 million without admitting wrongdoing.

The whistleblower case filed by Lewis and former co-worker Joey Neiman accuses the CHS hospital chain of submitting more than $385 million in false claims for EHR stimulus payments between 2012 and 2014.

 The government accused Greenway Health, a Florida-based electronic health records company, of gaming the government’s certification process. In 2019, the company settled those allegations for $57.25 million without admitting wrongdoing.
 Visiting the Oklahoma hospital as part of a troubleshooting team in June 2015, Lewis heard that physicians worried flaws in the system could result in patients being sent home “with the wrong drugs, doses or instructions,” according to the suit.

Things got so bad that local doctors were threatening to admit patients elsewhere unless the hospital fixed the software problems, according to the suit.

In a statement, CHS said it had “complete confidence” in its records systems. “The allegations made in the lawsuit against our hospitals are completely without merit,” the company said. Medhost denied its software has flaws, noting in its statement: “Hundreds of facilities have successfully used our software over the years and continue to do so today.”

Few in the industry seemed surprised by such allegations. When news of the eClinicalWorks case broke, Farzad Mostashari, who led the ONC from 2011 to 2013, tweeted: “Let me be plain-spoken. eClinicalWorks is not the only EHR vendor who ‘flouted certification/misled’ customers. Other vendors better clean up.”

The Electronic Health Record Association, a trade group that represents more than 30 vendors, did not respond to a request for comment. However, vendors have argued that they faced a tangle of regulations that required them to meet constantly shifting standards that government officials often could not explain.

ONC officials declined to answer written questions. But in a statement, ONC said it takes steps to ensure that products “are safe for patients and usable by providers.”

System Glitches And Accusations Of ‘Gaming’ The System

While the ONC sets the standards, the federal Centers for Medicare & Medicaid Services (CMS) had the job of paying doctors and hospitals that attested to meeting the “meaningful use” criteria. As of September 2018, CMS had paid out $38.4 billion in these funds.

In 2012, CMS hired accounting firm Figliozzi and Co. of Garden City, N.Y., which audited almost 50,000 medical professionals. Nearly 28% failed, despite the fact that they had previously attested to meeting the standards. Hospitals did better, posting a 5% failure rate. CMS officials said they have recovered some $941 million in these improper payments. The losses to the Treasury are likely far higher because only 14% of the medical professionals and 40% of the hospitals receiving payments were audited.

Michael Arrigo, who has served as an expert witness in health IT-related fraud and medical malpractice cases, said that in some cases EHR vendors misled hospitals about the challenges of replacing paper records with computers.

Others rolled the dice, apparently hoping the program was so large and complicated that they were unlikely to be targeted for audit. “Sometimes [providers] got away with it until a whistleblower found out,” Arrigo said.

Reviewing state and federal court filings, Fortune and KHN found more than two dozen cases, many filed by hospitals against vendors, which depict chaotic EHR installations and safety concerns as they pursued meaningful-use dollars.

Parrish Medical Center, a 210-bed public hospital on Florida’s Space Coast, is one. In December 2010, the Titusville hospital contracted with McKesson’s Enterprise Information Solutions. One of America’s largest companies, McKesson said its product would be easy for doctors and nurses to learn and help them “deliver high-quality, safe patient care.”

But the deal collapsed, prompting a bitter court battle in which the hospital repeatedly assailed McKesson’s competence. For instance, the hospital alleged that bugs in the software caused it to create more than one record for the same patient, a flaw dubbed a “major safety issue.”

An expert hired by Parrish said he contacted eight other hospitals, including three in Florida, which had dumped McKesson due to what he called “poor or unsatisfactory customer service.”
The medical staff at one of those hospitals was “up in arms” because it took 63 mouse clicks to look up a patient’s lab results, according to the expert’s report.

Parrish later signed on with another EHR vendor and the suit has since been settled. Both Parrish and McKesson declined to comment for this story. McKesson sold its health IT business to Allscripts in October 2017. Earlier this year, Allscripts reported to the Securities and Exchange Commission that government attorneys have requested documents from the company as part of an investigation into McKesson’s certification.

In another lawsuit, Weirton Medical Center, a hospital in West Virginia, stated in a court filing that it submitted “inaccurate” meaningful-use data to the government ― though it blamed the vendor. The hospital alleged the system failed to identify a patient who was critically ill and in the hospital. The hospital declined to comment to KHN and Fortune about the case, which has been settled.

Hamstrung By Technology?

ONC officials said they keep no log of complaints they receive.

A study published in JAMA this month found that 40% of the software that ONC singled out for post-marketing review had flaws that could lead to patient harm, including inaccurate drug codes, information displaying incorrectly and decimal points gone missing.

That’s “a concerning number, and we have to do something to address that,” said researcher Raj Ratwani, the director of the MedStar Health National Center for Human Factors in Healthcare and a co-author of the study. These systems were used in 786 hospitals and by 37,365 provider organizations, according to Ratwani, who said there’s no way to know how many defects have been fixed.

ONC has “decertified” about 100 pieces of once-approved software products. But most were tiny market players that had few or no users and went out of business. PlatinumMD, which had just 48 “meaningful” users, is an example. In a 2014 whistleblower lawsuit, San Diego urologist Dr. Scott Brown alleged that PlatinumMD filed for $18,000 in subsidies on his behalf even though it had not yet fully installed his EHR. In February 2016, the defunct company’s owners settled the case without admitting liability by paying the government $180,000.

Another 132 government-certified products have been flagged for corrective action due to “non-conformities.” As for the technology that the government alleges was fraudulently certified, it’s still used in health care settings across the country.

While those vendors faced multimillion-dollar settlements and now must operate under the oversight of a government monitor, their technology was not taken off the market. Nor were they dumped by many customers who, for the most part, however dissatisfied, were stuck with it.

ONC seemed to acknowledge that decertifying a large vendor would cause a major disruption, noting in an October 2016 regulation: “Our first and foremost desire would be to work with developers to address any problems.”

In the regulations, ONC cited the costs medical providers would face should their EHR vendor shut down as ranging from $33,000 to as much as $650 million.

“It is very difficult to switch product,” said Steve Waldren, chief medical informatics officer for the American Academy of Family Physicians. “You couldn’t just go down the street and pick up another EHR, put it in and move your data over.”

He noted that beyond the considerable cost of the technology, providers would have to take time to learn a new system.

“ONC does seem to have a stance that removing some of these players from the market would be very disruptive,” said Brad Ulrich, a Tennessee health IT expert. “They are almost too big to fail.”

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 Here is the link:

https://khn.org/news/electronic-health-records-creating-a-new-era-of-health-care-fraud-officials-say/

Enjoy.

David.

AusHealthIT Poll Number 507 – Results – 29th December, 2019.

Here are the results of the poll.

Do You Believe The Commonwealth Government SHOULD Continue To Invest Large Amounts Of Funds ($100M+p.a.) In The #myHealthRecord Going Forward?

Yes 2% (2)

No 98% (82)

I Have No Idea 0% (0)

Total votes: 84

Well that was pretty clear. Most believe the Government should stop it before they go blind. Sad that so much of our money is just being wasted!

Any insights on the poll welcome as a comment, as usual.

A very reasonable turn out of votes given the Holiday season.

It must have been a very easy question as 0/84 readers were not sure how to respond.

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

David.