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."

Monday, January 27, 2020

Weekly Australian Health IT Links – 27th January, 2020.

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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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The fiasco that is the #myHealthRecord gets a going over by the Guardian this week among all sorts of stories on the progress of secure messaging and the fragile nature of our high tech infrastructure.

We also have a breaking story coming on police access to PBS / MBS data.

See here:

https://www.theguardian.com/world/2020/jan/27/australian-government-secretly-releasing-sensitive-medical-records-to-police 

It is also a bit of a worry that the lost the ACT Emergency Web-Site just as a fire was approaching!
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My Health Record: almost $2bn spent but half the 23m records created are empty

The Australian government has spent $1.97bn since the system was introduced as the e-health record in 2009
A decade since it was first announced, the federal government has spent close to $2bn on its troubled My Health Record system, and half of the 23m records created lie empty almost a year after the government made the system opt-out.
The former Labor government first proposed the e-health record system in 2009 as a means for patients, doctors and specialists to share patient history, X-rays, prescriptions and other medical information with ease.
The system was first launched in 2012 with little fanfare and very little uptake. In 2016, it was reported that after four years, only around 4 million people had created a record, and even fewer had actually had any information put in it.
The Coalition government then attempted to salvage the system by rebranding it to My Health Record and moving to make it opt-out in 2018, but the opt-out time period was extended to the start of 2019 amid concerns over security and law enforcement access to the records.
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Media release - Secure messaging standards to be mandatory

20 January 2020: State, Territory and Commonwealth Governments have released a joint statement in support of new standards for secure messaging, stating that the standards will be mandatory in future procurement for applicable systems.
The joint statement was shared with industry at a workshop in December 2019 which was attended by over 50 representatives from clinical and secure messaging software suppliers, governments and clinical representatives.
The Australian Digital Health Agency has been working with industry and governments over a number of years to achieve interoperable secure messaging across different systems – necessary to accelerate use of electronic messaging over fax machines and paper transmission.
The workshop launched the approach to national scaling for a consistent, standards-based approach to secure messaging across Australia, to enable healthcare providers to communicate effectively as part of the National Digital Health Strategy 2018-22.
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ADHA's work to get off fax progressing with standards agreed on

The agency responsible for oversight of My Health Record is looking to move the industry onto more modern ways of communicating.

By Asha Barbaschow | January 20, 2020 -- 03:52 GMT (14:52 AEDT) | Topic: Innovation
The Australian Digital Health Agency (ADHA) has been working on new standards for secure messaging, coming to an agreement with industry and government on what this should look like.
"The Australian Digital Health Agency has been working with industry and governments over a number of years to achieve interoperable secure messaging across different systems -- necessary to accelerate use of electronic messaging over fax machines and paper transmission," the agency responsible for My Health Record wrote.
The standards [PDF] will be mandatory for the future procurement of applicable systems, with the ADHA saying the success of the Secure Messaging Program will play an imperative role in achieving the Australian National Digital Health Strategy's key priorities for 2022.
The 2019-22 strategy has seven key priorities: To have health information available whenever and wherever it is needed; allow for health information to be exchanged securely; for that health information to be comprised of high-quality data with a commonly understood meaning; better availability and access to prescriptions and medicines information; digitally-enabled models of care; a workforce that uses digital health technologies to deliver health and care; and a "thriving digital health industry delivering world class innovation".
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Security problem not so intractable

State, Territory and Commonwealth governments are supporting new standards for secure messaging, saying that the standards will be mandatory in future procurement for applicable systems

The joint statement was shared late last year at a workshop attended by representatives from clinical and secure messaging software suppliers, governments and clinical representatives.
The Australian Digital Health Agency says it has been working with industry and governments over several years to achieve interoperable secure messaging across different systems, which it says is necessary to accelerate the use of electronic messaging rather than fax machines and paper transmission.
The workshop launched the approach to national scaling for a consistent, standards-based approach to secure messaging across Australia, to enable healthcare providers to communicate effectively as part of the National Digital Health Strategy 2018-22.
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Secure messaging standards to be mandatory in Australia

ADHA has been working with industry and governments over a number of years to achieve interoperable secure messaging across different systems.
January 20, 2020 03:12 AM
State, Territory and Commonwealth Governments in Australia released a joint statement in support of new standards for secure messaging, stating that the standards will be mandatory in future procurement for applicable systems.
The joint statement was shared with industry at a workshop in December 2019 which was jointly organized by the Australian Digital Health Agency (ADHA) and Medical Software Industry Association. The workshop was attended by over 50 representatives from clinical and secure messaging software suppliers, governments and clinical representatives.
The workshop launched the approach to national scaling for a consistent, standards-based approach to secure messaging across Australia, to enable healthcare providers to communicate effectively as part of the National Digital Health Strategy 2018-22.
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Remote Central Australian communities empty as Telstra outages shut down essential services

24 January, 2020
Widespread Telstra outages in several Aboriginal communities in a remote area of Central Australia are shutting down stores, putting lives at risk and preventing people from accessing their money, according to community members.

Key points:

  • Up to 2,000 people were affected by a Telstra outage that lasted more than 48 hours
  • Community members were forced to leave town because they could not buy food
  • Telstra says the problem was due to a mains power outage as well as faulty hardware that had to be replaced
The region north-west of Alice Springs is home to 2,000 people and in the past week has experienced outages lasting more than 48 hours.
Telstra has told the ABC that the problem has been resolved, but in Arlparra — one of the Aboriginal communities affected — store manager Annie Bremmer said her business had been without internet access since Wednesday.
Many members in the community have their income managed by Centrelink through the basics card, which allows people to send money directly to approved stores.
But without internet, retailers are unable to access these transfers.
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'No one would know about my cancer': Doctors shun My Health Records

By Melissa Cunningham
January 19, 2020 — 12.22pm
Michael Higgins dreaded being struck down by a serious illness, so he was happy to be on the national $1.7 billion My Health Record system.
The 67-year-old's worst fears were realised when he was diagnosed with terminal cancer that had spread from his bowel to his liver last year.
The retired teacher logged into his digital health records to try to comprehend his grim diagnosis.
He was shocked to discover his medical records had not been updated, despite the scheme being rolled out almost a year ago.
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Doctors spend 16 mins in each patient's e-health record

One third of their time is spent on chart review, reveals the US study of 155,000 medics including GPs
17th January 2020
Doctors spend an average of about 16 minutes in every patient's e-health record to review charts, document diagnoses and treatment plans and to order tests, a US study finds.
The researchers examined approximately 100 million patient encounters with about 155,000 doctors from all specialties, including GPs, from 417 community-based health systems.
They collected data on every keystroke, mouse click and second of time spent on various tasks in e-health records programs throughout 2018.
The amount of time that providers spent using e-health records to support the care delivery process was a concern for the healthcare system, not only for cost related to patient care, but also because of doctor burnout and job dissatisfaction, the researchers noted in the Annals of Internal Medicine.
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New fee website shows NSW pays up to 40 times more in out-of-pocket costs

By Nigel Gladstone and Rachel Clun
January 20, 2020 — 12.00am
Private health patients in NSW are paying up to 40 times more in out-of-pocket costs than patients in other states for the same procedure.
While the federal government's new $7.2 million fee transparency website does not name individual specialists or list their fees, it reveals shocking disparities between what patients with private health insurance pay across the country and within Sydney.
In NSW, the average gap between the fee charged by a specialist and the Medicare benefit plus private health insurance benefit for cataract surgery was $650, compared to $30 in Tasmania. For hip replacements, NSW residents paid an average of $1800 to cover the gap between doctor's fees and any rebates, while those in Western Australia paid $170.
There were stark differences in out-of-pocket costs between public health networks within NSW and Sydney as well.
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Data#3, Fujitsu, NTT named biggest govt winners of 2019

By Brendon Foye on Jan 22, 2020 12:35PM
Australia's Federal Government always spends bucketloads on IT and plenty of it goes to channel companies.
Which is why CRN has again, for a second year, we’ve sifted through the contract records for IT projects in order to assess just what Canberra spent, and with whom.
Our analysis spans contract notices published on the AusTender website from 1 January 2019 to 31 December 2019 across four categories: information technology broadcasting and telecommunications; domestic appliances and supplies and consumer electronic products; electronic components and supplies; and engineering and research and technology-based services.
Our standard disclaimer: Given the nature of how contracts are publicised on the AusTender website, our results aren’t necessarily definitive. However, CRN is confident that these figures will provide a useful depiction of the biggest winners in Canberra for 2019. You can check out our 2018 analysis here, or the Q4 analysis here.
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23 January 2020

Amazon puts its foot in the pharmacy door

Posted by Penny Durham
The powerful Pharmacy Guild may have met its match in internet behemoth Amazon, which looks poised to enter the Australian market just in time for the introduction of electronic prescribing.
While regulations still exist to protect the status quo, one industry expert predicts the US giant will overcome them and that community pharmacies could lose up to 20% of their PBS business.
MedAdvisor CEO Robert Read says the online retailer, which this month filed “Amazon Pharmacy” as a trademark with IP Australia, is looking for a new market to roll out its PillPack business, which it bought for more than $1 billion last year.
PillPack takes a user’s prescriptions, sorts and bundles the medications into daily packages and home-delivers them.
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DTA tries to shake off Australia's chequered digital ID past

By Justin Hendry on Jan 20, 2020 1:12PM

Turns attention to marketing Govpass ahead of full launch.

With the first real test for Australia’s Govpass digital identity scheme just around the corner, the government agency in charge has turned its attention to marketing the $200 million-plus project.
The Digital Transformation Agency is appealing to the market for a comms strategy to inform the public about the program, as it prepares to ramp up the number of services accessible using Govpass.
“The next stage of digital identity will see a broader rollout of more services to more people,” a brief on the digital marketplace states.
“The program needs to expand its approach to communication significantly, to inform all Australians about what it is and isn’t – highlighting potential benefits its offers for everyone”.
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AWS outage cripples ACT Emergency Services Agency website as Canberra bushfire rages

By Julian Bajkowski on Jan 23, 2020 6:00PM

Wobble drags on through Thursday

The ACT Government’s Emergency Services Agency (ESA) has attributed a website outage that hit in the middle of a rapidly escalating bushfire between Canberra Airport and Queanbeyan to Thursday’s AWS outage in Sydney.
Capping off an already bad day for AWS after significant availability problems hit its Sydney region, the ESA took to twitter to redirect Canberrans to Facebook and local media to obtain current information on the fire hitting the national capital that remains at a watch and act level.
The outage hit as Canberra Airport was shut to commercial traffic because of the fire, with residents around Oaks Estate warned to get out of the road of the oncoming blaze after two fires merged and engulfed a rubbish tip.
It is still unclear why the ESA website was hit by a single point of failure, however the blaze, known as the Beard fire, is burning close to the industrial suburb of Fyshwick which houses several data centres.
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Red Cross goes offline in bid to protect staff after security incident

Sunday, January 26, 2020

Is There Any Real Clarity As To Just Where Australia Is With Secure Clinical Messaging?

This release appeared a few days ago.

Media release - Secure messaging standards to be mandatory

20 January 2020: State, Territory and Commonwealth Governments have released a joint statement in support of new standards for secure messaging, stating that the standards will be mandatory in future procurement for applicable systems.
The joint statement was shared with industry at a workshop in December 2019 which was attended by over 50 representatives from clinical and secure messaging software suppliers, governments and clinical representatives.
The Australian Digital Health Agency has been working with industry and governments over a number of years to achieve interoperable secure messaging across different systems – necessary to accelerate use of electronic messaging over fax machines and paper transmission.
The workshop launched the approach to national scaling for a consistent, standards-based approach to secure messaging across Australia, to enable healthcare providers to communicate effectively as part of the National Digital Health Strategy 2018-22.

The workshop was jointly chaired by Ms Bettina McMahon the soon to be interim CEO of the Australian Digital Health Agency, Ms Emma Hossack Chief Executive Officer, Medical Software Industry Association (MSIA) and Dr Nathan Pinskier GP and former Chair of the RACGP Expert Committee – eHealth and Practice Services.
Ms Bettina McMahon said “Many people across industry, governments and peak associations have been working with us since our first meeting in December 2016 to solve what some were describing as an intractable problem. We’ve had quiet confidence that we could co-produce specifications and standards with industry and professionals, try them out in early implementations, and get to a point where Australia’s customers of these systems would require their use.
“We’re now at that point – with Governments confirming that future procurements will reference the standards as mandatory requirements.
Once again government, the health sector and the software industry have come together to address a key priority in the National Digital Health Strategy. It is this level of cooperation and shared insights that will let us achieve the benefits of digital health.”
Ms Emma Hossack said “There is work underway on a standards framework, trust framework and federated directory solution which is marvellous. We have consensus that these will be developed collaboratively and in keeping with the broader digital health interoperability approach. Whilst this can’t be rushed, we are optimistic that future development will occur through agreed standards, validation and conformance which is good news for all Australians using the health system.”
Dr Nathan Pinskier said “In the last three years, we have witnessed a significant level of industry collaboration and commitment in order to resolve a major deficiency in healthcare secure messaging being the lack of seamless interoperability between disparate software products. In this new decade of 2020, this collaborative program is now poised to deliver tangible benefits to both healthcare providers and their patients.”
A Communique on the outcomes of the workshop was released that describes the steps that will be taken to support national scaling of standards-compliant systems.
The Communique acknowledged the work done with industry to co-develop standards which were tested and refined through proof of concept implementations, the balloting of standards where appropriate, and the provision of financial support to industry to implement these standards.
ENDS
Here is the link:
Here is the link to the Communique:
The key bits (extracted) were:
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Government commitment to interoperable secure clinical messaging

The State, Territory and Commonwealth governments issued a joint statement emphasising their commitment towards an interoperable secure messaging service.

National scaling approach

An approach for national scaling was discussed that encompasses the following initiatives:
1.       Develop a secure messaging governance framework
2.       Develop secure messaging use cases
3.       Develop standards and a standards framework
4.       Implement a federated directory solution
5.       Develop a trust framework
6.       Support change and adoption across the health sector
7.       Develop a framework of levers

There was support to continue work underway, especially for initiatives 2, 3, 4 and 5. Attendees recognised that there is more work to be done on these before commencement of work on the other initiatives.

Attendees agreed that the standards framework and governance arrangements should not be developed in a vacuum, bespoke to secure messaging. A collaborative, not “top down”, approach was endorsed for development in this space. The governance arrangements should be consistent with the broader digital health interoperability approach.

Flexibility in mindset and pragmatism in approach were endorsed as the means for achievement of the goal – not aiming for perfection but reflective of current approaches in software and practice. We will develop high-level criteria that define what success looks like. We will consider this over the next six months and agree next time we meet.

Workflow

Attention needs to shift to usability and workflow for end users. Now that barriers to interoperability at the technical layer are largely addressed, with the exception of financial and business models, the success of national scaling is dependent on the experience of clinicians using secure messaging solutions.

Attendees agreed that user experience design work is best done by industry in conjunction with end user stakeholders. It was acknowledged that the Agency could assist this important work through facilitation of collaboration across industry and professional associations. The Agency would also have a role with provision of enabling services, such as test environments.

Directories

Attendees acknowledged the critical importance of directories in achieving secure messaging interoperability. There was a recognition of the need to continue work on federated directories, and that the success of our efforts will impact workflows and usability. It was also noted that directories should be open rather than closed federations.

Priorities

Momentum for change and adoption should be created by selecting a use case and a timeframe for achievement of the most widely used message type occurring via secure messaging by a set date. Attendees supported the Agency proposing a use case (e.g. referrals or discharge summaries) to be primarily electronic by a specific point in time, with various change and adoption levers applied in support.

The Agency will consult on a suitable use case and timeframe by April 2020.

Success criteria will be defined along with the timeframes for them to be met. Once these criteria have been met, a plan for national adoption will be developed.

Looking to the future

Attendees recognised the plans underway to achieve interoperability across a broad range of healthcare systems, and their relevance to the goal of seamless national secure clinical messaging.
Incremental improvements towards interoperability in secure messaging were acknowledged and supported as an approach to date, but the next iteration is now approaching where systems will exchange data through APIs rather than the current transport protocols. Some software organisations are already investing in this capability, so there will be a time when these new technical methods will supersede current methods.
There is a desire to develop for the future, not just for legacy systems. As we move to new methods including more use of FHIR-based APIs –development should occur through a pathway of agreed standards, validation and conformance criteria. Clarity in respect of quality control measurements and monitoring will be an essential part of this progress.
It was generally agreed that previous approaches have not progressed as quickly or as smoothly as anticipated. In the meantime the digital health environment has continued to develop. The new methods that are emerging will be well suited to the contemporary environment, and these too will be covered by a framework to avoid silos and the mistakes of the past.
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Even odder is this:
Secure Message Delivery
Secure Message Delivery (SMD) is a set of specifications that were developed collaboratively by the digital health community, including NEHTA (which transitioned to the Australian Digital Health Agency on 1 July 2016), Standards Australia, desktop software vendors and secure messaging service providers. This set of specifications defines an approach to digital health communication using widely supported IT industry standards.
The SMD specifications support the secure delivery of messages containing clinical documents and/or other information between healthcare providers, either directly or through one or more messaging service providers.
In addition to having a secure messaging connection, sending and receiving clinical systems need to be conformant to message format specifications. The Agency has defined Clinical Document Architecture (CDA) specifications for Referrals, specialist letters, discharge summaries, event summaries and shared health summaries. This allows the exchange of these document types using secure messaging.
Over time, the Agency and other bodies may define specifications for additional document types. The Australian secure messaging standards provide a general purpose secure web service protocol for the delivery of business service messages from one healthcare provider organisation to another.
The secure messaging standards are:
  • AS 5552-2013 -eHealth Secure Message Delivery (SMD)
  • AS 5551-2013 eHealth XML Secured Payload Profiles (XSP)
  • AS 5550-2013 eHealth Web Services Profiles (WSP)
The SMD standard makes use of the XSP and WSP standards. These standards supercede the following older Australian secure messaging specifications:
  • ATS 5822-2010 eHealth Secure Message Delivery (SMD)
  • ATS 5821-2010 eHealth XML Secured Payload Profiles (XSP)
  • ATS 5820-2010 eHealth Web Services Profiles (WSP)
All existing SMD implementations are based on the older ATS 5822-2010 and its related XSP and WSP specifications. The Agency has published a conformance assessment scheme and conformance test tools for ATS 5822 and conformance to ATS 5822 is required for the Department of Health's Practice Incentive Program eHealth Incentive.
Here is the link:
So all the standards are dated 2013 or earlier and all the current implementations are based on 2010 standards which need updating! Also the move to APIs seems to make some of this moot. Also where are the working large scale pilot implementations?
As far as I can tell there are really a lot of words and spin but no substantive progress.
If I have got this wrong please let us all know! Smoke and mirrors I suspect.
David.

ps. I have to note, sadly, just how uncritical the techpress is of these ADHA releases. A bit more digging all round - rather the press release re-writes - would be good!

It also makes it tricky to demand compliance to our Standards if they are not proven and working does it not?

D.

AusHealthIT Poll Number 511 – Results – 26th January, 2020.

Here are the results of the poll.

Do The Distortions, Untruths And Propaganda Mediated By Social Media Pose A Real Threat To Our Social Coherence, Democracies And Way(s) Of Life?

Yes 57% (64)

No 42% (47)

I Have No Idea 1% (1)

Total votes: 112

An interesting quite split result with a reasonable majority thinking that social media, in their present largely unregulated form, are a real threat.

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

A very reasonable turn out of votes.

It must have been a very easy question as only 1/112 readers were not sure how to respond.

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

David.