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, December 17, 2009

The Press Release You Put Out When You Have Essentially Nothing to Say.

This arrived via the NEHTA RSS yesterday.

Northern Territory pushes the button on new e-health messaging system

15 December 2009. A new e-health messaging system is now in operation in the Northern Territory.
A national consortium of health organisations this week pushed the button on an innovative secure messaging delivery system in the Northern Territory which aligns with emerging national e-health standards.

The system, known as the Web Services Messaging Application or WSMA, uses new web-services technologies to send health information between different clinical software systems. It is based on a first generation messaging specification, drafted by NEHTA earlier this year, which is the front-runner to a national specification for secure messaging delivery currently pending release.

Sponsored by the Northern Territory Department of Health and Families (DHF), with software developed by local IT firm Diverse Systems Consulting, the project has been a joint initiative of the National E-Health Transition Authority (NEHTA), General Practice Network NT, and commercial software vendors Communicare Systems Pty Ltd and PEN Computer Systems Pty Ltd. The new system is part of the Northern Territory’s ongoing program of e-health innovation aimed at improving clinical information exchange and service delivery, particularly for patients in remote areas.

The WSMA application is designed to securely and efficiently transfer thousands of electronic messages a day containing critical healthcare information used to update the records of approximately 40,000 people who have already registered for the Northern Territory’s eHealthNT Shared Electronic Health Record service.

Under a self-assessment process a Declaration of Conformance was issued to affirm WSMA’s compliance with NEHTA draft specifications. Future WSMA releases are expected to undergo formal testing under a new national software conformance assessment scheme, specifications for which will shortly be released by NEHTA for industry comment.

Integrated within the established clinical software packages offered by PEN and Communicare, WSMA will be used in most of the Territory’s Aboriginal community controlled health clinics, public hospitals and a growing number of urban general practices.

NT DHF Chief Information Officer Stephen Moo said that, through its eHealthNT program, the Territory was committed to building state-of-the-art e-health solutions in line with NEHTA standards.

Design work has already commenced for the next generation of WSMA to be commissioned once the final NEHTA specification has been released. Future plans include developing NEHTA compliant eReferrals and eDischarge Summaries, enabling clinical information exchange between healthcare providers in the Northern Territory and providers in South Australia and Western Australia.

Test messages have already been successfully sent from SA Health systems to NT DHF systems demonstrating the e-health vision in action with information flowing seamlessly between interoperable systems in conformance with a national standard.

Read the full release (with contact details) at the NEHTA site:

http://www.nehta.gov.au/media-centre/nehta-news/576-nt

This release is really a classic ‘red rag’ to a tired old bull!

What it tells us is that the NT Health Department have had some vendors build a system based on what is thought will be NEHTA Standards (Those are not yet done.) and that this has been given a great new acronym (WSMA).

We are then told WSMA has been designed to do something – not that it is not actually doing it yet.

Also we are told that this trial implementation has been integrated with some community service software providers and that WMSA will be used within them.

We are then told further design work is underway for the actual working and standardised WMSA.

We are then delighted to be told that with test messages already sent (content totally un-specified) they are “demonstrating the e-health vision in action with information flowing seamlessly between interoperable systems in conformance with a national standard”. Now that is grand and wonderful is it not?

The obvious thing that is required here is that this release should have happened when there were some actual runs on the board and that attached to the release were some concrete technical details as to what has actually been achieved, how well it is working, what issues and leanings etc have been achieved.

To date not one of the 40,000 souls mentioned seem to have benefited from all this. When that happens is the time for the release!

The bottom line is to ‘toot you horn’ when you actually have something real to toot about!

This blatant chase after good PR is both transparent and unseemly. Note this is not to at all diminish or discourage what NT, Health and its partners are trying to do, but rather to condemn the publicity seeking nonsense coming from NEHTA.

David.

Wednesday, December 16, 2009

Weekly Australian Health IT Links - 14-12-2009

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article.

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http://www.zdnet.com.au/news/hardware/soa/WA-Health-issues-4-million-Cisco-contract/0,130061702,339299989,00.htm

WA Health issues $4 million Cisco contract

By Josh Mehlman, ZDNet.com.au
10 December 2009 05:17 PM

The Western Australian Department of Health is upgrading its networks and has issued a two-year, $4 million tender for Cisco switches and systems integration services.

The request for tender seeks a single company to supply Cisco switch infrastructure and associated management systems, and systems integration services for the equipment supplied. The equipment supplied must be from Cisco for "interoperability and Standard Operating Environment reasons".

-----

http://www.itwire.com/content/view/29980/127/

NBN to drive critical mass for new apps: Conroy

by James Riley

Friday, 11 December 2009

Australia does not have the critical mass of connections that would allow for the natural development of emerging applications in areas like e-health, education and business productivity and required Government intervention, Communications Minister Stephen Conroy said.

The massive Government investment in the National Broadband Network was an enabling investment in the broader economy, and in social service delivery, Senator Conroy said.
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http://www.australiandoctor.com.au/articles/4F/0C06624F.asp

E-health system still short on detail

8-Dec-2009

By Sarah Colyer

FRUSTRATION is mounting at the Federal Government’s lack of detail on how an e-health system will work, after a vague announcement at yesterday’s Council of Australian Governments meeting.

In a communiqué from yesterday’s meeting, COAG “affirm[ed] its commitment to the introduction in 2010 of national healthcare identifier numbers”.

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http://www.theaustralian.com.au/australian-it/nbn-co-down-the-wrong-path-cisco/story-e6frgakx-1225809283038

NBN Co down the wrong path: Cisco

  • Andrew Colley
  • From: Australian IT
  • December 11, 2009 8:50AM

NETWORKING experts have discussed concerns that the national broadband network will put the nation on a $43 billion path "back to the future" by returning incumbent telcos to dominant market positions.

Cisco Australia chief technology officer Kevin Bloch said that the NBN Co's minimalist approach to building the network would place an additional investment burden on access seekers that only dominant market players could bear.

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http://www.zdnet.com.au/news/software/soa/iSoft-looking-to-create-500-Aussie-jobs/0,130061733,339299986,00.htm

iSoft looking to create 500 Aussie jobs

By Suzanne Tindal, ZDNet.com.au
10 December 2009 05:43 PM

Australian-listed e-health company iSoft is considering upping its headcount in Australia by 500 people, hoping to increase the percentage of research and development workers it fields down under.

"We are looking for investment and I've asked for a significant amount of investment to put back into Australia," iSoft managing director Australia and New Zealand Denis Tebbutt said today at an Australian Information Industry Association event in Sydney.

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http://www.theaustralian.com.au/australian-it/regional-it-projects-get-265m-boost/story-e6frgakx-1225808993365

Regional IT projects get $26.5m boost

  • Fran Foo
  • From: Australian IT
  • December 10, 2009 11:54AM

PRIME Minister Kevin Rudd today unveiled seven projects that would receive a total of $26.5m as part of the $60m Digital Regions initiative.

The purpose of the program is to deliver better health, education and emergency services to regional, rural and remote communities.

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http://www.news.com.au/breaking-news/bionic-fingers-lending-a-helping-hand/story-e6frfku0-1225808800904

Bionic fingers lending a helping hand

  • From correspondents in London
  • From: AAP
  • December 09, 2009 8:39PM

THE world's first set of bionic fingers have been unveiled by scientists in Britain.

The lightweight motorised fingers, which cost up to STG45,000 ($80,585), are made out of plastic and give people with damaged hands the ability to pick up objects, write, grip and point.

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http://www.computerworld.com.au/article/329008/tony_who_budde

Tony who?: Budde

New shadow communications minister needs to engage with the industry, then get some policies

Tim Lohman 08 December, 2009 13:09

The first priority of the new shadow communications ministers, Tony Smith, should be to consult with industry and develop positive, constructive policies on the National Broadband Network (NBN), according to telecommunications analyst, Paul Budde.

Speaking to Computerworld, Budde said that former shadow communications minister Nick Minchin term had been characterised by politicking and a lack of engagement with the industry.

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http://abnnewswire.net/press/en/61905/iSOFT_Group_Limited_ASX:ISF_Launches_New_Aged_And_Community_Care_IT_Solution.html

iSOFT Group Limited (ASX:ISF) Launches New Aged And Community Care IT Solution

Sydney, Dec 9, 2009 (ABN Newswire) - iSOFT Group Limited (ASX:ISF) today announced the launch of iSOFT Aged Care - Enterprise Wide Health (EWH), an integrated management solution for aged and community care organisations.

iSOFT Aged Care is designed to support organisations of any size, including residential, long-term and community care, and retirement living. Enabling the delivery of improved and more efficient health care, the solution includes residential aged care and retirement components that manage care records, billing and financials, eBusiness and reporting requirements.

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http://www.computerworld.com.au/article/329210/isoft_won_t_take_hit_from_uk_contracts_ceo

iSoft won't take a hit from UK contracts: CEO

iSoft executive chairman and CEO Gary Cohen says little chance of NHS National Program for IT being scrapped

Trevor Clarke 09 December, 2009 16:49

ASX-listed healthcare software provider iSoft (ASX:ISF) has down played the possibility of taking a hit from possible changes to its lucrative UK contract for the NHS National Program for IT.

Comments from chancellor Alistair Darling ahead of the UK government's pre-Budget report this week suggested the 12.7 billion pound program could be scrapped.

Speaking to Boardroom Radio Australia iSoft executive chairman and CEO Gary Cohen, said the government had since clarified the chancellor's statements and that there was little chance of the program being binned.

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http://www.theaustralian.com.au/australian-it/three-way-struggle-for-bionic-eye-development/story-e6frgakx-1225807909793

Three-way struggle for bionic eye development

COMPETITION for a $50.7 million fund to develop a bionic eye has become a three-way tussle between Bionic Vision Australia, Swinburne University of Technology and a mystery suitor.

It is understood the Australian Research Council has short-listed a joint bid by Swinburne University and La Trobe University's Graeme Clark Hearing and Neuroscience Unit, and a second bid by Bionic Vision Australia backed by National ICT Australia and the University of Melbourne.

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http://www.computerworld.com.au/article/328860/consensus_reached_e-health_software_standards?eid=-255

Consensus reached on e-health software standards

National E-Health Transition Authority announces standards agreement

Georgina Swan 07 December, 2009 17:50

The move towards e-health standards has taken a significant step forward as industry groups join with the National E-health Transition Authority (NEHTA) to develop an approach for the standard assessment of medical software.

The four industry groups — the Medical Software Industry Association (MSIA), the Australian Information Industry Association (AIIA), the National Association of Testing Authorities (NATA) and the Joint Accreditation Scheme of Australia and New Zealand (JAS-ANZ) — have been working with NEHTA to define how software will be certified and the principles around compliance and conformance.

Note: Covered in earlier blog.

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http://www.newsmaker.com.au/news/2013

Australia’s Fragmented E-Health System in Limbo

Monday, December 07, 2009 - IQPC Australia

Sydney, Australia – Australia’s fragmented e-Health system has hit another barrier with reports claiming the governments have ‘changed direction’ on a national e-Health scheme.

NEHTA’s Chief Executive Peter Flemming said the original vision of having a single e-health record for each Australian had been abandoned by the Council of Australian Governments in favour of a ‘more commercial approach’.

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http://www.media.tas.gov.au/release.php?id=28578

Lara Giddings, MP

Minister for Health

Tuesday, 1 December 2009

NW Patients Linked to New Medical Records System

North West patients will soon be able to access health services across Tasmania without the need to repeat personal details every step of the way.

The North West Area Health Service has replaced its 20-year-old patient administration system with an up-to-date integrated statewide system.

The new system, launched at the Mersey Community Hospital today by Health Minister Lara Giddings, allocates each patient a single identification number which will apply across the State and lays the foundation for the introduction of the electronic patient record.

Note: iSoft are the software provider.

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http://www.nehta.gov.au/media-centre/nehta-news/571-snomed-ct

Health terminology for the Australian health sector launched

7 December 2009. NEHTA today launched the first release of SNOMED CT-AU®* to Australian licence holders.

SNOMED CT-AU is the Australian release of SNOMED CT (Systematized Nomenclature of Medicine-Clinical Terms) with additional customised content for the Australian healthcare market.

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http://www.theaustralian.com.au/australian-it/warning-on-self-diagnosis-via-the-net/story-e6frgakx-1225807584107

Warning on self-diagnosis via the net

RESEARCHERS have warned Australians risk becoming a "nation of cyberchondriacs", as doctors urge consumers against using the internet to diagnose and treat themselves rather than consulting a health professional.

According to a new study, more than one in four Australians who search online for health information believe they can use it to diagnose and treat themselves without the need for a doctor.

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http://www.theaustralian.com.au/australian-it/gov-20-unveils-draft-report/story-e6frgakx-1225807627091

Gov 2.0 unveils draft report

  • Fran Foo
  • From: Australian IT
  • December 07, 2009 10:01AM

THE public has been invited to comment on how federal government departments and agencies can utilise web 2.0 to their benefit.

They will have until December 16 to air their views on a 129-page draft report on web 2.0, including social networking tools and websites like Facebook and Twitter.

Also here:

http://www.smh.com.au/national/challenge-is-for-public-servants-to-shrug-off-their-instinct-for-secrecy-20091207-kffh.html

Challenge is for public servants to shrug off their instinct for secrecy

MATTHEW MOORE

December 8, 2009

THERE are two main recommendations in this report on how government should adapt to the internet era and one obstacle threatens both of them: public service culture.

Unless that culture changes, the report says, secrecy will remain the default position of government.

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http://www.smh.com.au/digital-life/mobiles/no-tumour-link-to-mobile-phones-says-study-20091204-kaqs.html

No tumour link to mobile phones, says study

December 4, 2009

A very large, 30-year study of just about everyone in Scandinavia shows no link between mobile phone use and brain tumours, researchers reported on Thursday.

Even though mobile telephone use soared in the 1990s and afterward, brain tumours did not become any more common during this time, the researchers reported in the Journal of the National Cancer Institute.

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http://www.smh.com.au/technology/technology-news/the-future-before-your-eyes-20091205-kc04.html

The future before your eyes

KELSEY MUNRO

December 6, 2009

IMAGINE a world where your contact lenses double as a personal computer display, superimposing information in front of you.

That virtual-reality dream, a staple of sci-fi movies, is a step closer thanks to the work of Seattle scientists who have been developing a prototype to generate images inside a contact lens. The information would appear about 50 centimetres from the user's eye.

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http://www.zdnet.com.au/news/business/soa/NSW-Health-CIO-leaves-role/0,139023166,339299849,00.htm

NSW Health CIO leaves role

By Suzanne Tindal, ZDNet.com.au
04 December 2009 12:58 PM

in brief: NSW Health chief information officer Mike Rillstone has made permanent his secondment as the chief executive of NSW Health's shared services area.

A spokesperson for NSW Health told ZDNet.com.au that Rillstone has now been appointed to the role of CEO Health Support Services. He stepped into that role in June as a six-month secondment while the department sought an executive to fill the position, which was vacant after the former chief executive John Roach became NSW Health's chief financial officer.

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http://www.techworld.com.au/article/329227/mozilla_thunderbird_e-mail_client_comes_tabs

Mozilla's Thunderbird e-mail client comes with tabs

Mozilla hopes to lure users away from Outlook with new search features

Mikael Ricknäs (IDG News Service) 10/12/2009 06:25:00

Mozilla Thunderbird 3 now has message archiving

Mozilla Messaging on Tuesday released version 3 of its Thunderbird e-mail client, which comes with a tabbed user interface and improved search features.

The support for tabs is inspired by the same tabs that have become a standard feature in web browsers and function in the same manner. For example, hitting enter or double-clicking a message opens it in a new tab.

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Enjoy!

David.

Medicare and Centrelink are to be Merged. Health Information Said Not to Be Involved.

The following, as a result of a National Press Club Speech today, was reported a few hours ago.

Medicare, Centrelink to be merged

By Online parliamentary correspondent Emma Rodgers

Agencies that have direct contact with the public, such as Medicare and Centrelink, will be merged into a "one-stop" shop under changes to the sector announced by the Government today.

In a major overhaul to the way health rebates and welfare payments are delivered, the Government will begin establishing offices around the country that will incorporate Medicare, Centrelink, the Child Support Agency and disability service organisation CRS Australia under the one roof.

Medicare and Centrelink will also be moved into the Human Services portfolio.

Announcing the reforms at the National Press Club today, Human Services Minister Chris Bowen said the changes will improve service delivery and reduce bureaucratic processes and duplication.

"The time has come to reassess whether we, the Government and the nation, are getting enough out of the Department of Human Services," he said.

"There is not enough coordination between our service delivery agencies.

.....

Mr Bowen has also been quick to reassure people that the changes are not about the collection of personal information in one central location.

"It is not a central database," he said.

"We will not house an individual's personal, sensitive information in one place, vesting all control with one body or one card."

The Department will work with the Privacy Commissioner over the reforms and Mr Bowen says health information will not be included in the shake up.

.....

Read the full report here:

http://www.abc.net.au/news/stories/2009/12/16/2773480.htm

If ever there was a set of changes where the devil will be in the detail this is it! Inevitably in a merged organisation there will be information flows that no one is aware of – some of which may, or may not, be seen as appropriate by those who are subjects of that information

I am sure these changes will suit some, but I wonder just how those with some of the more stigmatizing health issues will feel about Centre link employees also being in the same loop. Time will tell I guess.

David.

Tuesday, December 15, 2009

If This is True, And One Would Hope Not, I Wonder Does NEHTA Know About It?

The following appeared today in the West Australian.

ID plan to curb welfare cheats

ANDREW PROBYN and SHANE WRIGHT, EXCLUSIVE, The West Australian December 15, 2009, 2:45 am

The private details of every Australian will be held on a giant national database under a Federal Government plan for "virtual" national identity cards designed to crack down on welfare and medical fraud.

The West Australian understands Human Services Minister Chris Bowen will use a speech tomorrow to claim the idea will save Australians from the paperwork involved in applying for employment benefits, seeing a doctor or collecting child support payments.

But the concept, expected to anger privacy advocates, is effectively a re-birth of the Howard Government's controversial Access Card proposal that was killed by the Rudd Government as a $1.2 billion saving measure in its first weeks of taking office.

However, instead of issuing all Australians with new identity cards - as envisaged under the trouble-plagued Access Card and its earlier incarnation, the Australia Card - the Government will create "virtual" ID cards by centralising vast amounts of information already held by various human services agencies.

These include Medicare, Centrelink, the Child Support Agency, Australian Hearing and CRS Australia, which coordinates rehabilitation services for people with disabilities, injuries or other health conditions.

.....

Coupled with the proposed national electronic health records, which would allow the sharing of patient details between healthcare providers, the new e-identity database will be a powerful Government tool to track down welfare cheats and deadbeat parents attempting to avoid child support payments.

Consolidating Government information would also aid the fight against so-called "doctor shoppers" who move between bulk-billing GPs to get multiple prescriptions for pain-killers and other addictive drugs.

.....

Full Article Here:

http://au.news.yahoo.com/thewest/a/-/newshome/6585637/id-plan-to-curb-welfare-cheats/

There is some more coverage here:

Bowen to announce Government data reforms

By Brett Winterford

Dec 15, 2009 12:18 PM

Feds deny plans for another Access Card.

The Federal Minister for Human Services, Chris Bowen, will tomorrow make a speech that outlines reforms to Australia's welfare system expected to be underpinned by a major IT refresh.

While details are still scant, it is widely expected to include an announcement of some level of data sharing between Human Services departments - which includes Centrelink, Medicare, the Child Support Agency, Australian Hearing and CRS Australia.

An article in the West Australian today linked the pending announcement to scuttlebutt suggesting that the Rudd Government plans to implement a "virtual ID" card by centralising the databases across these departments.

.....

"That [West Australian] article is incorrect," the spokesman said. "There will be no Virtual ID card. The Government has no plans to create one central database across Government or store all data in one location."

The spokesman did not deny, however, that the announcement will involve some sharing of data between departments within the Human Services portfolio.

More here:

http://www.itnews.com.au/News/162925,bowen-to-announce-government-data-reforms.aspx

The possibilities are I think quite high there is the plan to use some sort of data matching approaches to improve services and reduce fraud – and that this will be without a card. It will be all “virtual”.

Amazingly one of the key systems – Medicare Australia’s Customer Data System is one of the 4 systems targeted and also the source of NEHTA’s IHI.

Of course the IHI is meant to have legislated protection – but the source for its information and for updates etc is now to be used for more general ID management – hardly a good look – and all too cute as well! I have a feeling this is a very bad case of the right and left hand not having a clue about what the other is up to.

Confusion about what is going on with all this has the real potential to derail the HI Service plans I suspect and someone needs – real quickly – to start getting a coherent overall plan together.

This has all the feel of the same sort of silliness and lack of communication that derailed the Access Card and the Australia Card.

The truth of the general thrust of these reports is somewhat confirmed by the fact that a 3AW host in Melbourne sought comments on what all this means from a colleague.

I await the speech tomorrow with considerable curiosity.

David.

Response From CeH to Blog Comments

I write in response to the blog comments following release of the letter to the PM.

In regard to whether or not to make the letter to the PM public – We certainly were of two minds. The BCA letter had been made public and it was the view of the last meeting of the CeH (referred to in the letter) that our support for the BCA position should be made widely known. We did delay its release and sought advice from participants prior to release. The view was that it must be made known to the members of the organisations involved. With so many of those we thought it was tantamount to being made public and so we did that. If there had been some indication from the PM’s office that they would prefer to enter into private discussions then we certainly would have respected that and in any event meant no disrespect by its release. We believe it is about building political support from the broader community which surely is helpful for such an important issue and when so much money is involved.

In regard to the reference to NEHTA: There is now a published NEHTA plan with measureable milestones. This is what has been asked for by David and contributors to the blog for a long time. There is also evidence of the Jurisdictions talking together and aligning better than they have in the past. These are worthy steps forward which deserve recognition – which is what the letter did. I do accept there is a level of frustration around the pace of progress.

In response to questions about the constitution and authority of the Coalition: As described in the letter to the PM, the Coalition formed to improve the strength and coherence of the health system’s voice on e-health issues. It is a loose coalition and is not legally constituted. To do so would have precluded a number of the organisations from participating. There is no elected spokesperson that can speak on behalf of all those organisations. More information is provided at www.ceh.net.au

What happened in relation to the letter was that at the last meeting of the Coalition (held 1st December) which was convened by HISA and well attended, there was consensus that a letter should be sent to the PM prior to the COAG meeting which was to be held on the 7th of December. A small group undertook to write the letter based on the discussions that had taken place at the meeting, to distribute it for comment and then to allow organisations to withdraw from the list for the letter if they felt they were not in a position to support it for whatever reason (one did).

This is what was done and why the letter talks about the consensus at the meeting. Because of the time frame there was not a lot of time for a different approach. It should be said however that there was strong support for both the action and the letter from the many that did respond on behalf of their organisations.

Michael Legg,

President HISA


Monday, December 14, 2009

Specific Disclaimer of CeH Views on NEHTA.

On Sunday I posted a blog suggesting the CeH letter to the Prime Minister was an unalloyed good.

I have learnt a lesson here. I had seen a range of circulated drafts but had not actually seen, and carefully reviewed, the final letter before posting.

This paragraph appeared late in the drafting and I did not notice it before I put the file up for downloading.

“We believe that the National E-Health Transition Authority (NEHTA) has shaped a coherent vision and roadmap and has defined several “Foundation Projects” that must be funded and implemented to provide a shared basis for success. The States and Territories are also progressively aligning with the NEHTA roadmap and its foundation projects. We also note growing support of the private sector; the Business Council of Australia has strongly supported action on e-health in their letter to you dated 21 October 2009, the content of which we endorse. Finally, there is widespread consumer acceptance of and desire for a health system transformed by e-health – an independent public opinion poll commissioned by NEHTA found that 82% of consumers say they would use an e-health record.”

For the record I totally support the CeH thrust in getting more attention on e-Health and supporting the funded implementation of the National E-Health Strategy.

I do not believe NEHTA has shaped a ‘coherent vision’ and I do not believe they understand what their role is in supporting health system reform and improvement. I have no idea just how many of the CeH members agree with this sentiment. As far as I can tell I was not asked but I could have missed it!

My view is that NEHTA is a dysfunctional disaster that has slowed e-Health progress in Australia a great deal – but all regular readers know that and the reasons why I feel this way.

I have posted earlier on the issue of NEHTA’s claim of total public support. See here:

http://aushealthit.blogspot.com/2009/12/more-evidence-regarding-silliness-of.html

I am sorry I did not check more carefully before putting this final version up for download. Excluding that paragraph the letter is good – with it – not so!

Sorry again! Running a blog like this is a learning experience!

David.

The NEHTA / Medicare Australia Health Identifiers Still have A Few Serious Issues To Address.

Late last week we had the release of the draft legislation for the National Health Identifier Service.

I have provided the links here to the documentation.

http://aushealthit.blogspot.com/2009/12/e-health-news-from-doha-new-draft.html

First of let me say that if what is proposed actually provides a robust, reliable and trustworthy, privacy protective identifier to permit the correct linkage of the various information components that may make up a lifelong patient electronic record and provide clinicians and consumers with certainty as to the provenance and ownership of the health documentation they are authorised appropriately to access, and essentially nothing else, then that outcome is almost certainly a very good thing.

Indeed right at the beginning the proposed legislation says (as its objective):

“3. Purpose of this Act

(1) The purpose of this Act is to provide a way of ensuring that a person who provides or receives healthcare is correctly matched to health information that is created when healthcare is provided.

(2) This purpose is to be achieved by assigning a unique identifying number to each healthcare provider and healthcare recipient.

The essence is that all this is to ensure ‘correct’ matching of records by allocation of a unique identification number.”

This, of course, brings us to the first set of issues.

First where is the practical evidence that the approach being adopted will work ‘correctly’? I assume by the use of the word correct we are talking of vanishingly small error levels.

Well, we all know the Medicare Australia databases have measurable error rates and we also know there are more Medicare Numbers out there than there are people entitled to have them so how can we know the system will be essentially error free?

My view is that we can’t. Without a large scale pilot of say 500,000 people we are only guessing. How many mismatched records does it take to cause a problem? I don’t know but it is not many.

Second to conduct a pilot of this scale all the systems that may need to embed the identifier will need to be modified, tested and operational so exchange accuracy can be confirmed. It’s a bit late to discover we have used a ‘trusted’ data source which turns out not to be quite trustworthy enough after the event!

Put bluntly this is a potentially expensive leap of faith that may turn out to not be quite ‘good enough’.

In the COAG explanatory document we have the following (Building the Foundations – Page 7):

“A Healthcare Identifiers Service (HI Service) is being designed and developed by the National E-Health Transition Authority (NEHTA) on behalf of all governments.

The HI Service will provide a national capability to consistently identify individuals and healthcare providers to facilitate reliable healthcare-related communication.

In 2007, NEHTA contracted Medicare Australia to scope, design, build and test the HI Service. The design of the HI Service draws on existing elements of Medicare Australia infrastructure including trusted personal information about individuals, consumer Medicare cards, information policies, and customer services such as shop front and online services. For these reasons it is proposed that Medicare Australia will be the initial operator for the HI Service for the first two years of operation.”

I can’t find a single word that suggests a feasibility study has proven all this will actually work as intended. It seems just to be assumed.

The planned time lines are explained in this article

NEHTA to test health ID this year

By Suzanne Tindal, ZDNet.com.au
02 October 2009 04:54 PM

The National E-Health and Transition Authority (NEHTA) has today released its strategy for 2009 to 2012, listing priorities and timelines to enable e-health, including developing an "office" model for health identifiers by December.

The strategy was formed considering the National E-Health Strategy written by Deloitte last year and the recent National Health and Hospital Reform Commission recommendations. NEHTA admitted that there had been a gap between what stakeholders expected of it and where the authority was heading. "As the organisation evolves it is important to ensure a foundation exists for 'what' the organisation has been put in place to deliver," it said.

There are four parts to the strategy: "urgently" developing the foundations to enable e-health, coordinating the progress of priority e-health solutions and progresses, accelerating adoption, and leading the progression of e-health in Australia.

The strategy will see an "office model" for the healthcare identifiers released by December this year. An early adopters release will follow in April 2010, followed by a later adopters release in July 2010.

NEHTA CEO said earlier this year that legislation to enable the use of individual health identifiers was unlikely to be passed until next year.

Lots more here

http://www.zdnet.com.au/news/software/soa/NEHTA-to-test-health-ID-this-year/0,130061733,339298878,00.htm

I don’t see any large scale validation or software modification phases – I wonder why?

This must also be a worry

COAG commits to health IDs in 2010

By Suzanne Tindal, ZDNet.com.au
08 December 2009 03:43 PM

The Council of Australian Governments yesterday confirmed the goal of introducing individual healthcare identifiers within the next year and vowed to put draft legislation on the table for consultation.

.....

However, the overall framework for e-health records remains unfunded. NEHTA's business case for the combination of the health identifiers into personally owned individual electronic health records was again not considered by COAG. NEHTA has been trying to get its business case considered since October last year.

Estimates say that the spend needs to be between $1.2 billion to $1.9 million to create a functioning e-health system.

More here:

http://www.zdnet.com.au/news/software/soa/COAG-commits-to-health-IDs-in-2010/0,130061733,339299911,00.htm

We might be creating all this and the big picture does not get proceeded with!

See here:

http://aushealthit.blogspot.com/2009/12/coalition-for-e-health-wrote-to-prime.html

The comments by experts reported here are also very interesting:

E-health identifiers ready

10-Dec-2009

By Sarah Colyer

BASIC privacy rules for Australia’s future e-health system have been laid out in draft legislation, but privacy experts are worried the Bill is too narrow in scope.

.....

Australian Doctor understands the identifiers are technically ready, and could come into use as soon as the Bill is passed.

But David Vaile, executive director of the University of NSW’s Cyberspace Law and Policy Centre, said the Bill was “contextless” and a “complete governance failure”.

“It’s almost as if they have deliberately tried to make the Bill impossible to comment on, because you can’t see the system it is a part of,” he told Australian Doctor.

The Bill did not answer whether the identifier could be used for financial monitoring, research or auditing, he said -– “things way beyond clinical care”.

He was also concerned that the legislation left some complaints to be dealt with in the Privacy Act, “which is encyclopaedic”.

Dr Juanita Fernando, chair of the health sub-committee of the Australian Privacy Foundation, raised concern that the Bill does not address incidental breaches of privacy; for instance, when doctors fail to log out of the e-health record properly.

More here (registration required):

http://www.australiandoctor.com.au/articles/3d/0c06633d.asp

The National Partnership for e-Health certainly is not reflective is quality governance in my view. See here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/docs/npa_e-health.pdf

Lastly for interesting takes on the matter we have this:

Govt wants to establish e-health system

December 11, 2009 - 12:09AM

AAP

Every Australian should be assigned their own electronic health record number by the middle of next year, with the federal government releasing the draft legislation establishing the system.

Introducing personal e-health records will slash $627 million off the health budget every year, according to the Australian Institute of Health and Welfare.

Federal Health Minister Nicola Roxon says a national e-health system will allow health providers to share patient records and improve care.

"Mismatching of patient information has been an acknowledged problem in the health system," she said in a statement on Thursday.

More here:

http://news.smh.com.au/breaking-news-national/govt-wants-to-establish-ehealth-system-20091211-kmi2.html

One can only be glad that someone knows exactly how much personal records will save. I am sure the AIHW would be surprised at the apparent precision of the estimate!

Note this link provides a very useful summary of what is planned:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr09-nr-nr230.htm

Even if the HI Service does deliver something that is fit for purpose, scales as needed and so on there are still some major issues to be sorted I believe.

These seem to me to fall into the categories of Implementation and Cost Issues.

Among the implementation issues are things like:

1. Addressing the education of public and providers as to what all this is about, what it means and so on.

2. Addressing the present lack of clarity as to who does what in the maintenance and updating of the HI Service. With 20+ million souls enrolled and 300,000 new ones a year being added this is a major task.

3. The issuance of the NASH provided smartcards for provider identification to the 600,000 or so health providers. (The cost in materials and effort of this will be non-trivial).

4. The lack or a ‘real’ implementation plan – 22 million people are not going to be using this service come July 1, 2010 take it from me!

Cost issues also exist I think.

1. NEHTA has a total of $218M to spend on this and all its other operations until June 2012 (from July 2009). Given NEHTA’s base running costs are about $35M p.a. (excluding consultants) that does not leave all that much to get all this going and then operate!

2. Who will pay the software developers to modify their systems to suit these identifiers or is it just something they have to do.

3. How is the work done in practices around the country for initial and confirmatory look ups of HI’s the be compensated?

I am sure there are all sorts of other issues – like just how likely is the legislation when passed going to suit what has been built – and guess what I now see the whole student sector is about to get an identifier to – approved at the last COAG!. We are all going to be numbered to death!

I will leave it to the lawyers and privacy experts to assure us all this is all OK but I have a feeling – from Prof. David Vailes comments – which I agree with on my reading – there are some problems here also.

I am not at all comfortable with the use of identifiers for such areas as research, management and disease surveillance without some actual consent from the patient involved. As for the old ‘and whatever the law requires’ should just not be there.

I also wonder how making provider details available without specific consent (say as is done in Skype) might not be a better idea.

I really don’t have a good feeling about all this. Too secretive, too un-consultative and too unproven are my takes for openers.

David.

Sunday, December 13, 2009

Health Department Secretary Feels the Heat of e-Health Inaction. About Time!

There was a Government sponsored conference on the National Broadband Network last week for 2 days.

The meeting web site is here:

http://www.broadbandfuture.gov.au/index.html

You can catch up with all the action - in a landmark for Australian Government openness - here:

http://www.broadbandfuture.gov.au/conference-program.html

Links are there to audio and video of all the sessions.

There is a just wonderful report of one of the four e-Health sessions.

E-health future on NBN derailed by lack of basics

Ry Crozier | Dec 11, 2009 9:32 AM

Passions spill over at broadband futures forum.

Frustration at perceived delays in implementing a national e-health agenda boiled over at the Government’s broadband future forum yesterday where a discussion on NBN possibilities could not get past basic issues like funding availability.

In a session where imaginations were supposed to run wild and free on the e-health applications made possible by the National Broadband Network, the whiteboard and butcher’s paper went unused.

Dialogue instead took for granted applications made possible by the NBN, such as human genome mapping, as issues of financial sustainability and scalability of more basic e-health proposals currently on the table took centre stage.

That prompted at least two delegates - including a representative of the CSIRO e-Health Research Centre - to pass comments that they “thought the purpose of this session was to look into the future of what we could do with the NBN.

“We seem to be having a discussion on what the issues are today. We need to challenge ourselves a little bit more,” the representative said.

The observation drew support from some delegates and defensive responses from some of the assembled panel of experts.

“The reason this group is about barriers is because there’s an element of frustration from a technology point of view,” said Adam Powick, a Deloitte partner and primary author of the national e-health strategy.

“Now that the technology is available, how do we break through? Right now we can’t share information between a hospital and GP [general practitioner] 100 metres away for God’s sake. We have to put in place the basic building blocks.”

Powick was supported by Department of Health and Ageing secretary and National E-Health Transition Authority (NEHTA) board member Jane Halton.

“We have to deal with some of the barriers in a way that respects they are real,” she said. “We have to work through [them].”

Dr Mukesh Haikerwal, a GP and professor at Flinders University’s school of medicine, stopped short of labelling the attitude of the room as “negativity”. But he recognised there was “more we can do."

He believed initiatives such as the future forum were a positive. “[By] pulling together people I think we can make this happen,” he said.

Budde’s burst

Tensions were raised from the first opportunity for audience participation as telecommunications analyst Paul Budde criticised the Government over what he saw as a lack of “high-level strategic policy” and frameworks on their part to drive the e-health agenda forward.

“Jane, let’s be honest. The problem is we don’t have good Government policy on e-health going forward,” Budde said.

“We [need to] start with a high-level strategic policy on what we’re going to do with e-health and set a framework so individual silo's point in the same direction. I think we need some leadership from the Government in setting some high-level policy.”

The suggestion immediately appeared to put the panelists on the defensive.

Dr Haikerwal pointed Budde to the national e-health strategy released by the Federal Government last week, while Halton told the packed room, “I think you’ve seen a significant level of leadership from the Government on this.

“NEHTA has been relentlessly swotting away, with some controversy I acknowledge,” she said.

“The bottom line is we do have a strategy. You can’t expect a revolution on this in 20 seconds.

“It does require a bunch of software [and funding] which we don’t have. We all acknowledge we could do more which is why we’re here.”

Powick acknowledged the “absolutely critical” importance of policy but believed the “bigger issue has been the readiness of the [health] sector to take it up.

“The current situation is diabolical,” Powick said, referring to issues of care professionals not being able to share records such as x-rays between facilities.

Heaps more fun here:

http://www.securecomputing.net.au/News/162575,ehealth-future-on-nbn-derailed-by-lack-of-basics.aspx

Of course Paul Budde is right! (Thanks Paul!) All we have officially is an unfunded 20 page summary National e-Health Strategy and a lot of people who are sick and tired of the obfuscation and delay! As I keep reminding people NEHTA has now been in operation over 5 years and really should have got more done, that makes a difference, before now. Hence the frustration.

Remember it is August 2008 when the National E-Health Strategy was finalised! (16 months ago – not 20 seconds)

If you want some real amusement watch the wrap up session given by the NEHTA CEO with the purpose of dragging together the 2 days of e-Health discussions.

The direct link is here:

http://webcast.viostream.com/?viocast=2251&auth=2e531774-16c7-4122-8bc5-84f09c057b0d

I heard the same platitudes and excuses, and the same list of issues and claims of progress, as I have been hearing for the last decade. Just absolute ‘baby steps’ forward and what progress there has been made has been almost in spite of Government policy on many occasions.

It really is time to stop the excuses. If the NBN is going to justify itself an upfront and serious investment is required in the leadership, policy and governance of e-Health in this country. Remember the NBN is said to be an 8 year program – I hope we can make some serious progress well before then. (I am not likely to last that long!)

David.