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."

Friday, January 27, 2012

The Approach Being Adopted To Health Information Sharing Being Adopted by Hong Kong.

The following highly relevant article appeared a week or two ago

"New and improved" data protection regime? Hong Kong government launches public consultation on e-health record sharing

On 12 December 2011, the Hong Kong Food and Health Bureau launched a two-month public consultation on the Legal, Privacy and Security Framework for a territory-wide patient-orientated Electronic Health Record (eHR) Sharing System as part of a proposed reform of the Hong Kong healthcare system.    
What is eHR sharing?
An eHR is a record in electronic format containing health-related data of an individual. It is anticipated that the eHR Sharing System will provide an essential infrastructure for access and sharing of patients' health data by authorised healthcare providers in both the public and private sectors. The goal is to facilitate seamless interfacing between different healthcare providers, enable more efficient treatment and diagnosis and reduce duplicative diagnostic tests and data gathering.
The Legal, Privacy and Security Framework (the Framework)
Whilst the proposed eHR Sharing System provides functional benefits, it also raises privacy concerns. To address these, and recognising that the nature of patients' health data and their sharing by healthcare providers would require more specific and further safeguards on privacy and security, the Government plans to legislate specifically a framework for the eHR Sharing System to complement and supplement the Personal Data (Privacy) Ordinance (Cap. 486) (PDPO), where there are currently general safeguards for personal data privacy applicable across all sectors.
Key Principles of the Framework
The following key principles are proposed to be adopted in the Framework:
  1. Information to be provided to patients: Healthcare providers shall provide an information notice to each patient setting out the scope, purpose and use of eHR, the rights of patients, privacy and security safeguards, and must not share any patient's health data to anyone without the patient's consent (see below).
  2. Patient's consent: Participation in eHR sharing shall be strictly voluntary and must be based on express and informed consent. In relation to such consent:
    1. A patient giving consent must give either: (i) a time-limited one-year rolling consent which will lapse after one year from the date when the healthcare provider last provided care to the patient; or (ii) an open-ended consent that will continue to remain valid until expressly revoked by the patient.
    2. For minors below the age of 16 and mentally incapacitated persons, consent shall be given by substitute decision makers (SDMs), e.g. persons with parental responsibilities over the subject minors and other immediate family members of patients.
    3. If a patient is referred by provider A to provider B for healthcare, provider A may specify the part of eHR where provider B will have access to.
    4. Only under exceptional circumstances and in strict compliance with the PDPO, such as in an emergency, may access to the eHR of a patient be allowed without his/her prior consent.
    5. A patient may withdraw from eHR sharing and revoke his/her consent at any time. In such circumstances, the data will be "frozen" from access and archived for a specified period (see Retention of eHR data below).
  3. Access to and Use of eHR Data: Only those health data falling within the pre-defined scope for eHR sharing will be accessible by other healthcare providers under the eHR Sharing System for the primary purpose of enhancing the continuity of care for patients. As a specific exemption to be prescribed under the future eHR legislation, it is proposed that eHR data may be used for public health research and disease surveillance as a secondary purpose, subject to different levels of approval by the relevant authorities depending on whether patient-identifiable eHR data is used.
  4. Retention of eHR Data: As a general rule, eHR data of patients shall be kept within the eHR Sharing System for as long as they continue to participate in eHR sharing. For patients whose consent has lapsed or has been revoked, their data on the eHR Sharing System shall be "frozen" for three years, during which only the subject patient or eligible persons may access the relevant data; and for patients who have passed away, ten years, during which only the administrator / executor or persons authorised by the Court may access the relevant data. Immediately after the "frozen period", the eHR data shall be de-identified and retained in the system for potential secondary usage only.
  5. Data Access and Correction by Patients:
  6. Identification, Authentication, Access Control and Security:
  7. Criminal Sanctions
More here:
There is a fully detailed web site explaining the consultation to be found here
There is an Executive Summary (.pdf) of 19 pages which makes the plans pretty clear.
The access and ID controls are to be based on the National ID smartcard system which is already operational.
Reading the documents this is a ‘patient-orientated’ record system which is voluntary to join but is not patient controlled in the sense meant in Australia.
It is worth having a look at the documents as they clearly have given the whole thing a very considerable amount of thought and are moving in a measured and careful pace.
David.

Thursday, January 26, 2012

The Truth Is Now Out - More Than 97% Of The Population Will Not Get Anything From The PCEHR By July 2012.

The following appeared today - Australia Day no less!.

Long road ahead for e-health records

  • by: Karen Dearne
  • From: Australian IT
  • January 26, 2012 7:37AM
The Health department spent $142 million on e-health activities in the last financial year around one-third of a total $424m spent on health IT projects over the past 10 years.
Spending more than doubled during 2010-11, up from $60m a year earlier, reflecting a ramping up of work on the Gillard government’s $500m personally controlled e-health record program to meet its July 1 launch.
But documents released today show that while individuals may be able to register for a PCEHR from that date, national usage of the system is not planned in the foreseeable future.
“The first release of the PCEHR system (will) deliver the core functionality required to establish a PCEHR system that can grow over time,” the Health department says.
“Once the design of the national system has been completed, an assessment of the 12 e-health (lead implementation) sites will be undertaken and a transition plan developed for integration to the national PCEHR system.
“This will allow early adoption for individuals participating in the (lead) sites from July 2012, including the capability to target about 500,000 people enrolled in those sites.”
Work on interfacing with GP desktop systems has stopped at most trial sites after the National e-Health Transition Authority discovered software vendors had been given specifications that are incompatible with those used for the national infrastructure build; NEHTA is yet to provide further information about the problems
According to the department, 23 new technical specifications were required to support the PCEHR system, with only four complete and fully tested.
“The remainder will be completed and tested by the end of December 2011,” it says in documents published yesterday.
Lots more details here:
All this does is confirm what most observers have known for ages!
All the answers to many, many questions are here:
Here is the response from DoHA to a Senate Estimates Question to confirm (with a few slippery words) the OZ headline.
Senate Community Affairs Committee
ANSWERS TO ESTIMATES QUESTIONS ON NOTICE
HEALTH AND AGEING PORTFOLIO
Supplementary Budget Estimates 2011-2012, 19 October 2011
Question: E11-490
OUTCOME 10: Health System Capacity and Quality
Topic: EHEALTH – PERSONALLY CONTROLLED ELECTRONIC HEALTH RECORD
MILESTONES
Written Question on Notice
Senator Boyce asked:
What will have been achieved by 30 June 2012 with regards to eHealth and the PCEHR in Australia?
Answer:
The first release of the personally controlled electronic health record (PCEHR) system delivers the core functionality required to establish a PCEHR system that can grow over time. The first release will ensure that all individuals seeking care in the Australian healthcare system will have the option to register for a PCEHR from July 2012.
Once the design of the national system has been completed, an assessment of the 12 eHealth sites will be undertaken and a transition plan developed for integration to the national PCEHR system. This will allow early adoption of the PCEHR system for individuals participating in the eHealth sites from July 2012, including the capability to target approximately 500,000 individuals enrolled in those sites.
The Department has also engaged a National Change and Adoption Partner (NCAP) to develop a national change and adoption strategy and delivery plan; to undertake a range of engagement and communications activities across the health sector to encourage uptake of the system by health professionals and consumers. The NCAP is working in collaboration with health care professionals, software vendors, National E-Health Transition Authority and the Department to successfully deliver the PCEHR Program, including training materials and guidelines.
----- End Answer.
The population of Australia is 22, 813,571 at present according to the ABS. So only about 2.2% will, if they are lucky see anything other than a registration screen by July, 2012.
The second part of this report quoted above is found in this answer:
Senate Community Affairs Committee
ANSWERS TO ESTIMATES QUESTIONS ON NOTICE
HEALTH AND AGEING PORTFOLIO
Supplementary Budget Estimates 2011-2012, 19 October 2011
Question: E11-474
OUTCOME 10: Health System Capacity and Quality
Topic: EHEALTH – AMA AND LACK OF SUPPORT
Written Questions on Notice
Senator Boyce asked:
a) The AMA has made it very clear they cannot support the proposed system as it does not, in their view, improve on what we have now and that, as presently designed, could create serious risks to patient health. Surely this must be of great concern to NEHTA when a body such as the AMA believes this to be the case, so how does NEHTA respond to such concerns?
b) How can NEHTA possible answers such concerns when so many of the key technical standards of the PCEHR have not been completed or adequately tested?
Answer:
a) The Department of Health and Ageing and the National E-Health Transition Authority (NEHTA) have ongoing consultation with Australian Medical Association to ensure that the feedback of their members is taken into account in the development of the personally controlled electronic health records (PCEHR) system.
b) To support the PCEHR system 23 technical standards are required. Four are complete and have been fully tested, the remainder will be completed and tested by the end of December 2011. Review processes for the standards include ‘tiger teams’ which bring together clinicians, software developers, standards representatives and informaticians to review and improve the specifications.
Each stage of the development process for the PCEHR technical specifications require clinical governance and safety processes to be followed. NEHTA’s Clinical Safety Unit (CSU) is fully embedded into all areas of NEHTA's product development and oversees clinical governance at NEHTA. The CSU is supplemented through NEHTA’s Clinical Leads.
The CSU addresses safety by working across the work programs in NEHTA to provide certainty to medical software developers, end-users and policy makers. It is a legitimate expectation of Vendors that products developed by NEHTA are safe and have Clinical Utility.
Any clinical safety findings as a result of reviews of specifications and standards are included in the overall review outcomes and mitigations are recommended for inclusion as part of any proposed drafting changes in the specifications, or in the form of implementation guidance to mitigate the risks.
----- End Answer.
Every one now knows this is just untrue. The Tiger Teams have by no means finished the work and testing has meant that many Wave sites have been discovered to be in need of a pause for a month or two while someone works out what Standards and made up Specifications are to be used.
By their own words the entire thing is just a total shambles that will deliver less than 3% at best of what was trumpeted only 18 months ago.
See the Australian article for an amazing breakdown of what has been spent on e-Health, since 2011, by the Commonwealth.
In passing has anyone else heard of job losses in the much touted but very quiet Clinical Safety Unit recently?
David.

Wednesday, January 25, 2012

More Evidence Regarding The Usage of Health Portals. They Need More Work and They Need To Be Really Useful.

The following report alerted me to an interesting paper.

Online portal adoption lower than expected in study of older patients

By danb
Created Jan 20 2012 - 12:17pm
Researchers have called the effectiveness of web-based interventions in healthcare into question on the heels of a study showing limited use of such features by patients, according to a study [1] published this month in the Journal of Health Communication.
The study consisted of 130 women considered to be at average risk for colorectal cancer (CRC). The women, mostly between 50 and 59 years old, were given access to a web portal with information pertaining to screening for the disease, including associated benefits and risks. The site also contained hot links to websites with additional CRC information such as the American Cancer Society, the National Cancer Institute, the Centers for Disease Control and Prevention and the Journal of the American Medical Association's Patient Page, among others.
Of the women who participated in the study, 83 percent indicated that they spent, on average, one hour per day on the Internet.
While the study's authors expected use of the portal to be high, only 32 patients (24.6 percent) actually logged onto the site, with a majority of those (26) only logging on once.
More here:
Here is the abstract to the full (free) paper.

Build It, and Will They Come? Unexpected Findings From a Study on a Web-Based Intervention to Improve Colorectal Cancer Screening

Free access
DOI: 10.1080/10810730.2011.571338
Available online: 04 Jan 2012

Abstract

Given the extensive use of the Internet for health information, Web-based health promotion interventions are widely perceived as an effective communication channel. The authors conducted this study to determine use of a Web-based intervention intended to improve colorectal cancer screening in a population of women who are at average risk and noncompliant to current screening recommendations. The study was a randomized controlled trial designed to compare the effectiveness of colorectal cancer screening educational materials delivered using the Internet versus a printed format. In 3 years, 391 women seen for routine obstetrics/gynecology follow-up at 2 academic centers provided relevant survey information. Of these, 130 were randomized to the Web intervention. Participants received voluntary access to a password-protected, study-specific Web site that provided information about colorectal cancer and colorectal cancer screening options. The main outcome measures were self-reported and actual Web site use. Only 24.6% of women logged onto the Web site. Age was the only variable that differentiated users from nonusers (p = .03). In contrast, 16% of participants self-reported Web use. There was significant discordance between the veracity of actual and self-reported use (p = .004). Among true users, most (81%) logged on once only. These findings raise questions about how to increase use of important health communication interventions.
Full paper here:
Again we have a study where motivation and actual preparedness to engage need to be really fostered - and if they are not the outcomes described above are seen.
The old ‘build it and they will come’ does not seem to apply to the web and health advice and information, without some defined additional need for information.
Of course, given that a near to 'content-free' portal is likely to be all the PCEHR actually delivers by June 30, 2012 this paper takes on considerably more relevance. That older citizens do not engage all that well is also a pretty big issue
David.
p.s. Happy Australia Day!

D.

NEHTA Is Offensively Silent On Just What The Problems Are With The PCEHR. I Wonder Just Why That Is?

A couple of quotes from yesterday.

NEHTA presses pause on e-health records

The implementation was stopped after internal checks detected issues in the specifications
..... (most of article deleted)
When contacted by Computerworld Australia, NEHTA declined to comment on the reasons for the delay in funding or whether the delay would cause any setbacks to the project going live by 1 July.
DoHA had not replied at the time of writing.
and here:

Specification issue halts health software

ZDNet Australia made a number of queries about how the issue with the specifications had been created, and what the situation means in real terms for developers; however, NEHTA declined to comment further.
So just why are the technical sites not told just what is actually wrong?
You can read the official NEHTA statement (obfuscatory though it is) here:
Here is what is said:

NEHTA pauses implementation in pilot sites

24 January 2012. National E-Health Transition Authority CEO, Mr Peter Fleming has announced that following a detailed internal review and analysis, NEHTA is temporarily pausing implementation of Primary Care desktop software development around its specifications for the eHealth pilot sites.
"Our specifications are subject to rigorous assessment processes and this has highlighted some technical incompatibilities across versions. We have identified problems with the specifications and have made the decision in order to avoid any risks," Mr Fleming said.
The pilot sites were established to test and deploy software and eHealth capability in real world healthcare settings prior to the introduction of the personally controlled electronic health record system. While the pilot site and national infrastructure projects have operated in parallel, neither is a critical dependency for the other project.
This pause will impact work currently being undertaken by The Primary Care eHealth Network Sites (Metro North Brisbane Medicare Local, Inner East Melbourne Medicare Local, Hunter Urban Medicare Local and Accoras (Brisbane South). Greater Western Sydney, St Vincent's, Calvary, Cradle Coast, NT and Mater will be impacted on the primary care elements of their projects. This issue should not impact delivery by Medibank, FredIT and JEHDI.
NEHTA is acting after internal checks detected issues in the latest release of its specifications in November 2011.
"This is about quality control to ensure absolute confidence in the software being used in the eHealth pilot sites. One of the reasons for having these sites was to test software and 'iron out the bugs' prior to the national infrastructure go live," Mr Fleming said.
The changes required to be made to specifications will be completed over coming weeks and are expected to be finalised mid to late March. As the scope of changes is being determined NEHTA is working closely with the sites to verify all activities and target completion dates.
"In large projects of this scale it is not unusual for problems of this type to arise. We are working to manage this situation to ensure the programme is delivered."
"We remain committed to these sites and to progressing the national eHealth programme," Mr Fleming said.
ENDS
So just where are the technical details of what is wrong, how long it has been present, what is needed to fix it, and so on.
This is a public organisation that is basically saying ‘up-yours’ to the Clinical Health IT Community and the public in general.
Is their CEO just too high and mighty to respond to a concerned and interested media?
Along with their paid spruikers we hear nothing but spin from this frankly awful and non-transparent organisation.
Just dreadful!
David.

Tuesday, January 24, 2012

More On The Possible Risks Associated With EHRs. The US AMA Releases a Report!

The following appeared a week or so back on one of our favourite topics.

EHRs Linked to Errors, Harm, AMA Says

Clinicians can introduce errors when they copy and paste sensitive patient data into electronic health records, according to AMA research.
By Ken Terry,  InformationWeek
January 13, 2012
A new AMA report on patient safety in ambulatory care finds that safety problems are widespread but that little is known about which problems cause the most harm. Among the uncertainties cited by the AMA researchers is the contribution of electronic health records (EHRs) to patient safety.
"The use of electronic health records has the potential to improve patient safety and early research shows some promise, but these systems have also been linked to errors and harm," the report says. "It is not yet clear how many providers will adopt these systems, nor the extent to which health IT will improve patient safety in ambulatory care versus generating new types of errors."
The report cites studies indicating that EHRs encourage providers to "copy and paste" clinical data and that they support "automatic behavior" rather than careful reasoning and analysis. Poorly designed systems with hard-to-use interfaces, data entry errors, and software configuration issues can also endanger patients, the report noted.
David Classen, MD, a consultant to the AMA on the report, told InformationWeek Healthcare that the researchers took no position on EHRs, pro or con.
"That study was looking at the evidence from a scientific point of view and finding there is still very limited evidence that EHRs improve the safety of care in the average doctor's office," noted Classen, who is also a CSC consultant and an associate professor of medicine at the University of Utah School of Medicine.
Most safety studies, Classen pointed out, have been conducted in large healthcare systems and academic medical centers. That's true, for example, of studies showing the positive effects of electronic prescribing and test ordering in ambulatory care settings. "So we really don't know what's going on in the regular physician's office."
More is found here:
This is the link to the AMA report:
The additional information panel contains a link to the full report:

Top six errors in outpatient care

A decade of research shows that these errors are the most widely documented in ambulatory care, leading to hospitalizations, complications, minor physical harm, psychological harm, lost patient pay, physical injury and death.
  • Medication errors such as prescriptions for incorrect drugs or incorrect dosages.
  • Diagnostic errors such as missed, delayed and wrong diagnoses.
  • Laboratory errors such as missed, delayed and wrong diagnoses.
  • Clinical knowledge errors such as knowledge, skill and general performance errors on the part of physicians and other clinicians.
  • Communication errors such as doctor-patient communication errors, doctor-doctor communication errors or other miscommunications between parties.
  • Administrative errors such as errors in scheduling appointments and managing patient records.
Source: "Research in Ambulatory Patient Safety 2000-2010: A 10-year review," American Medical Association, December 2011 (www.ama-assn.org/resources/doc/ethics/research-ambulatory-patient-safety.pdf)
With this we also had a contribution on how to use EHR’s more safely.

CCHIT chair: Tips to use EHRs to improve safety

By mdhirsch
Created Jan 18 2012 - 9:37pm
How well can your EHR system protect patients from substandard patient care? Evidently quite a bit, according to Karen Bell, chair of the Certification Commission for Health Information Technology (CCHIT).
Bell, citing a recent report from the Institute of Medicine (IOM) calling for better patient safety in HIT, notes that providers should consider patient safety when evaluating and using EHR systems. While there is no one assessment tool that providers can use to test EHRs regarding safe care, providers can take practical steps to see if their EHRs include the most up-to-date functions and features to improve patient safety--and to check whether the providers are using them.
Bell's checklist is an excellent resource for providers shopping for and implementing EHR systems.
......
To learn more:
- here's Bell's
full list [1] of suggestions
- read the IOM
report [2] (.pdf)
More here:
and almost in the same breath we have this.

EHRs lacking in adverse drug event detection

By mdhirsch
Created Jan 18 2012 - 9:32pm
Many studies confirm that electronic health records enhance patient care, reduce costs or provide some other benefit. But sometimes a study reveals that EHRs--and, fact, the studies testing the EHR systems--have design flaws.
That's the conclusion of a recent study of EHR adverse drug event (ADE) detection systems published by the Journal of American Medical Informatics Association. ADEs, adverse patient outcomes caused by medications, are common and difficult to detect, and occur in 6.5 percent of hospitalized patients, which makes them a major threat to patient safety.
The researchers theorized that electronic alerts to detect ADEs showed promise, since they would be faster, cheaper, objective and more accurate than other detection methods, such as manual chart review. The study analyzed prior studies of electronic systems that automatically screened for ADEs from hospital pharmacy, laboratory, radiology and administrative departments.
The results were not positive. Electronic detections were only 50 percent accurate, and for some EHRs "quite low," according to the researchers.
......
To learn more:
- read the study's
abstract
More here:
Here is the direct link to the abstract:
The abstract conclusion is pretty worrying:
“Conclusion
Several factors led to inaccurate ADE detection algorithms, including immature underlying information systems, non-standard event definitions, and variable methods for detection rule validation. Few ADE detection algorithms considered clinical priorities. To enhance the utility of electronic detection systems, there is a need to systematically address these factors.”
All in all these studies and articles continue to re-enforce the view that just implementing technology is not of itself a ‘good thing’. Much more careful thought, design and evaluation of all interventions is required before mega adoption.
PCEHR Program are you listening? On the basis of what we have seen today I suspect not!
David.

And It Seems It Just Gets Worse and Worse With the PCEHR. Not It Is Not Properly Safe!

The following appeared  a few hours ago.
2012-January-24 | 08:04 By: Dr Eric Browne
Australia is poised to produce a system of Personally Controlled Electronic Health Records (PCEHRs) from July 2012, some 6 months from now. According to the recently published Concept of Operations, each person’s PCEHR will comprise a set of electronic documents, the majority of which are to be based on HL7′s Clinical Document Architecture (CDA), in the form of “health summaries”, discharge summaries, referrals, and the like. Having studied both the HL7 specifications in detail as well as dozens, if not hundreds of examples of CDA documents from around the world over the past 5 years, I have come to the conclusion that there are significant safety and quality risks associated with relying on the structured clinical data in many of these electronic documents.
So concerned am I by this issue that I am notifying key stakeholders and urging all individuals and organisations who take safety and quality of clinical data seriously, to investigate this issue thoroughly before committing to any further involvement with the PCEHR system being rushed through by the federal Department of Health and Ageing.
One major problem with HL7 CDA, as currently specified for the PCEHR, is that data can be supplied simultaneously in two distinct, yet disconnected forms – one which is “human-readable”, narrative text displayable to a patient or clinician in a browser  panel;  the other comprising highly structured  and coded clinical “entries” destined for later computer processing. The latter is supposed to underpin clinical decision support, data aggregation, etc. which form much of the justification for the introduction of the PCEHR system in the first place. The narrative text may appear structured on the screen, though is not designed for machine processing beyond mere display for human consumption.
Each clinician is expected to attest the validity of any document prior to sharing it with other healthcare providers, consumers or systems, and she can do so by viewing the HTML rendition of the “human-readable” part of the document ( see the example discharge summary at http://www.healthbase.info/cda_challenge/sample/sample.html ). However, the critical part of the document containing the structured, computer-processable data upon which decision support  is to be based is totally opaque to clinicians, and cannot be readily viewed or checked in any meaningful way. Moreover, I know of no software anywhere in the world that can compare the two distinct parts of these electronic documents to reassure the clinician that what is being sent in the highly structured and coded part matches the simple, narrative part of the document to which they attest. This is due almost entirely to the excessive complexity and design of the current HL7 CDA standard.
It seems to me that we are in grave danger of setting in train a collection of safety and quality time bombs, spread around Australia in a system of repositories, with no understanding of the clinical safety, quality and medico-legal issues that might be unleashed in the future.
As an illustration of the sort of problems  we might see arising, I proffer the following. I looked at 6 sample discharge summary CDA documents  provided by the National E-health Transition Authority recently. Each discharge summary looked fine when the human-readable part was displayed in a browser, yet unbeknownst to any clinician that might do the same, buried in the computer-processable part, I found that each patient was dead at the time of discharge. One patient had been flagged as having died on the day they had been born – 25 years prior to the date that they were purportedly discharged from hospital! Fortunately this was just test, not “live” data.
A second example is the sample electronic prescription document that has been provided with the package of NEHTA specifications currently being “fast-tracked” through Standards Australia to become standards for electronic transfer of prescriptions in Australia. Again, this Level 3 HL7 CDA document contains separate “human-readable” and coded, structured sections,  with no connection between the two. The former looks somewhat like a computer-generated printed prescription ( as shown at http://www.healthbase.info/scratch/ePR_rendered.html ). The computer processable, coded entries in this sample both contradict and also contain additional information to the human-viewable part, yet these coded entries are opaque to clinicians. Again, this was just example data, but the principle remains the same. Clinicians cannot see what is in the coded parts of the document.
I contend that it is nigh on impossible with the current HL7 CDA design, to build sufficient checks into the e-health system to ensure these sorts of errors won’t occur with real data, or to detect mismatch errors between the two parts of the documents once they have been sent to other providers or lodged in PCEHR repositories.
This situation must also be of potential concern to patients considering opting in to the PCEHR system. Consumers have been led to believe that they will be able to control what data is sent to the PCEHR and who can see it. But if neither they, nor their healthcare provider can view all the data to be sent and stored in the new system, then how can they possibly have confidence that they will be “in control” of their data?
Surely this must ring alarm bells to all involved!
To allay the concerns raised here, NEHTA should provide an application, or an algorithm,  that allows users to decode and view all the hidden, coded clinical contents of any of the PCEHR electronic document types, so that those contents can be compared with the human-readable part of the document.
The post is found here and is reposted with permission:
I really don’t need to say anything. Dr Eric Browne has said it all!
David.

As I Warned Yesterday The Wheels Have Just Come Off! NEHTA Has Proven Itself To Be Incompetent!

This appeared this morning.

E-health key trial halted by specifications glitch

MOST of the trial sites for the federal government's electronic health record project have been taken offline after it was discovered they were working to different specifications than the planned national model.
The National E-Health Transition Authority (NEHTA) halted the rollout of primary care desktop software at 10 trial sites on Friday blaming incompatibility with the national specifications.
It is the latest blow for the Personally Controlled Electronic Health Record (PCEHR) project, which has attracted $466 million in federal funding over two years and is considered vital to efforts to combat preventable and chronic disease.
The national specifications were updated in November and the problems, which have not been detailed, affect most of the Wave 1 and Wave 2 sites: Metro North Brisbane Medicare Local, Inner East Melbourne Medicare Local, Hunter Urban Medicare Local, Accoras in Brisbane South, Greater Western Sydney, St Vincent and Mater Health Sydney, Calvary Health Care ACT, Cradle Coast Electronic Health Information Exchange in Tasmania, the Northern Territory Department of Health and Families, and Brisbane's Mater Misericordiae Health Services.
Only the Medibank Private and Fred IT group sites are unaffected. The Defence Department's Joint e-Health Data and Information also appears to be safe.
NEHTA is expected to renegotiate contracts, keen to salvage what it can from the trial, and determine how to migrate data across to the national system which is due to go live on July 1.
A NEHTA spokesman would not answer specific questions about the issue, but confirmed it was "pausing implementation of the primary care desktop software development".
"NEHTA is acting after internal checks detected issues in the latest release of its specifications in November 2011," he said.
"This is about quality control to ensure absolute confidence in the software being used in the e-Health pilot sites. One of the reasons for having these sites was to test software and "iron out the bugs' prior to the national infrastructure going live."
More here:
What is going on here is utterly predictable when you have a whole series of pilots based on different technologies being conducted in isolation and then expected somehow to magically form a coherent national system.
With all those well paid architects NEHTA should have known this - I have been saying it for years - and really it is an example of utter planning failure.
NEHTA has just managed to prove itself to be utterly incompetent and is becoming the instigator of yet another failing over-reaching national e-Health Program.
The wise men who said you should learn to walk before running where spot on!
As for delivering a system that actually does anything useful by June 30 - dream on!
David.

Monday, January 23, 2012

Weekly Australian Health IT Links – 23rd January, 2012.

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

The biggest news of the week has been the release of what is now 33 submissions to the Senate Enquiry on the PCEHR. I suspect there are more to come as we have yet to hear from the AMA or any of the State Governments so far (as of Sunday 22/1)
Go here to read them.
I suspect the next few weeks are going to be very interesting with the Senate Enquiry and the new Federal Health Minister really getting down to work after the summer holidays.
There are all sorts of rumblings about further issues (delays and whatever) on the PCEHR so that front will deserve close watching.
Apparently we are moving into the Year of the Dragon in the Chinese calendar. I wonder what that presages for the year coming.
From one site we have this:
Chinese New Year is on 23rd Jan. 2012
“Expect this to be a very energetic year, filled with optimism, power and entrepreneurship. However, the year is of water dragon, which means that even the most powerful will give a patient hearing to the weaker, and will try to see through their point of view. Better alliances and decision will take place.”
Sounds hopeful!
-----

Parents want to see health files

Andrew Tillett Canberra, The West Australian January 15, 2012, 8:46 am
A family group has attacked plans to allow children as young as 14 to stop their parents from accessing their personal electronic health records.
Patients will be given the option of signing up for the electronic records from July in one of the Gillard Government's key health reforms.
The records are designed to keep details of a patient's medical history together, making it easier for GPs, specialists and other health workers to share information, see past treatments and drug prescriptions and potentially reduce medical errors.
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Australian Privacy Foundation slams e-health system

THE $500 million personally controlled e-health record system is a document viewing service, not a patient care system, and it is unclear whether any benefits will be available following its July 1 launch, the peak privacy body says.
"The Australian Privacy Foundation asks how the system, which cannot uniquely identify individuals and simply permits document transmission and viewing, will be used for patient care benefit at all," the APF says in its submission to the Senate inquiry into the PCEHR legislation and related matters.
"We question marketing efforts to convince patients and providers otherwise."
The APF says that neither the main bill nor the associated regulations detail what e-health services will actually be achieved by the launch date.
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Personally controlled electronic health records bills introduced into parliament

From July 2012, Australians will have the opportunity to access their health records in a single view, where and when needed, and irrespective of the location of the consumer, healthcare provider or record.     
This is the first time that this type of service has been made available in Australia and it is set to transform how healthcare is delivered nationally.  The Australian Government has invested over $467 million in the first release of the system.  Health records will be collected from various existing repositories around the country, then uploaded to the consumer in a single view, if the consumer chooses. 
Key concerns arising from the system are the potential risks to an individual's privacy and the security of their health records.  In her second reading speech to parliament, the then Minister for Health and Ageing, Nicola Roxon, addressed the issue:
'Australians rightly do not want their privacy threatened.  They do not want one single massive data repository for all their records.  They also want the right to participate, but not be forced to do so.  That is why we are designing this project to take heed of privacy from the ground up. 
We are establishing new consent settings for sensitive information and auditing that does not currently exist for any individual's record.  It is how our system will strike the right balance between security and access.  Many of these protections are about ensuring that patients have the same protections over the access to digital records that they do over paper based records.'
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E-Health vetting plan abandoned

THE Gillard government has abandoned any intention of creating an independent oversight body for the future operation of its controversial personally controlled e-health record system, due to launch on July 1.
Instead, the official operator of the $500m nationwide network will be the Secretary of the federal Health Department – mooted in legislation currently before parliament as an interim position until key governance issues can be resolved, including greater public accountability.
A broad range of bodies, including the Consumers Health Forum, the Australian Privacy Foundation, the Pharmacy Guild, the Royal Australian College of General Practitioners, the Royal Australian and New Zealand College of Radiologists, the Medical Software Industry Association and individual vendors have called for the establishment of a broad-based new PCEHR governance structure.
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Feds address PCEHR privacy issues

The federal government has begun addressing a series of key changes to the personally controlled electronic healthcare record in the wake of a privacy audit.
The audit, conducted by Minter Ellison Lawyers and Salinger Privacy, was completed at the end of 2011 and commissioned by the federal health department.
Of the 112 recommendations made for managing identified privacy risks, the government fully accepted 75, with a further 20 accepted in principle, and 6 accepted in part. A slim 8 recommendations made by the auditors were not accepted.
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Healthcare identifier upgrade ordered for e-health record system

MEDICARE will be paid $34 million to upgrade the 18-month-old and still barely used Healthcare Identifier service to support the Gillard government's $500m personally controlled e-health record system.
The money will also allow Medicare to "build a PCEHR-conformant repository to potentially hold Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, Australian Childhood Immunisation Register and Australian Organ Donation Register data".
The HI service, which cost $90m to build and was “launched” by former health minister Nicola Roxon on July 1, 2010, has lain largely idle due to a lack of interest from health providers. To date, it has only been used in limited pilot projects at sites trialling the PCEHR program.
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Rush to deliver e-health eating $1m a day

THE Gillard government is "burning $1 million a day" to deliver its personally controlled electronic health record system on time and is sending coding work to India in the process.
The National E-Health Transition Authority head of PCEHR implementation, Andrew Howard, said the Accenture consortium was "on track" to deliver a key part of the program's national infrastructure by February 1.
That should set the scene for delivery of an operational system by the July 1 deadline, he said.
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Plan forgets patients, says AMA

Ellen Lutton
January 22, 2012
ANNA BLIGH'S radical plan to abolish the maligned Queensland Health has been slammed by the Australian Medical Association of Queensland for ignoring basic patient services.
The Premier yesterday unveiled details of her government's plan in what she said was the largest decentralisation of the public sector in the state's history.
The shake-up was fast tracked after a former Queensland Health executive claiming to be a Tahitian prince embezzled more than $16 million from the department.
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Doubts over opt-in e-health scheme

DOCTORS and consumer groups have warned that the federal government's $466 million scheme to introduce electronic health records this year is likely to be hobbled by low take-up rates, and have called for basic changes to keep the scheme on track.
 In a submission to a Senate inquiry on the legislation for the program, due for launch in July, the peak patient representative body says the current requirement for Australians to sign up to the personally controlled electronic health records (PCEHR) scheme - rather than be automatically enrolled unless they opt out - means "a large portion of the general public will not immediately sign up".
The Consumers Health Forum, one of several organisations that have lodged their comments on the draft laws, say the resulting low take-up "may result in a low level of confidence in the system and lack of critical mass to ensure its success".
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NK v Northern Sydney Central Coast Area Health Service (No. 2) [2011] NSWADT 81

This is the first time that the maximum award for compensatory damages has been made    
The ADT has ordered the respondent to pay $40,000 compensation to the applicant after an earlier decision ([2010] NSWADT 258) which found that the respondent had breached sections 16 and 17 of the PPIPA and numerous Health Privacy Principles (HPP) including:
  • HPP 3 - collection of information was to be from individual concerned;
  • HPP 4 - individual was to be informed of certain matters when their information was collected from a third party (in this case another hospital);
  • HPP 5  - the applicant's health information should have been kept secure, inaccurate information was provided by the nurse;
  • HPP 9  - officers of the respondent failed to check the accuracy of the information; and
  • HPP 10 - the applicant's health information was used for a purpose other than for which it was obtained and the nurse disclosed the information to the HR Manager without the applicant's consent.
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Two-year delay on implant register

Amy Corderoy
January 20, 2012
THE federal government has been sitting on recommendations for nearly two years for a register which could accurately record who has been implanted with potentially faulty or dangerous medical devices such as the recalled breast implants.
The Therapeutic Goods Administration has said there is insufficient evidence to recommend Australian women with Poly Implant Prostheses (PIP) implants have them removed as only 37 ruptures have been reported from more than 9000 implants - but it does not routinely collect information on faulty devices.
European countries have increasingly recommended women have the implants removed because of an increased rupture risk. The French PIP producer is accused of using an industrial rather than medical silicone, and its implants have been linked to a rare form of cancer called anaplastic large-cell lymphoma.
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Real gains via virtual pastimes

VIDEO games generally get a bad press - think teens slumped over a screen rather than out playing sport - but some positive health-related benefits are emerging.
Exercise games played on Nintendo's Wii or Microsoft's Kinect for Xbox are getting elderly people up and moving at residences such as Berala on the Park, a private aged-care facility in Sydney's south.
Chief executive Linda Thomson says residents regularly compete in Wii bowling and tennis tournaments. "I have to admit the Wii sat in the box for a while, but it's well used now," she says.
What's more, there's even a tantalising chance the next generation of these interactive consoles will help reduce demand for scarce health and aged-care resources.
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Melbourne 16 January 2012
MEDIA RELEASE

Broadband solution to help meet health care’s “greatest challenge”

The treatment of chronic illness in Australia has taken a major leap forward today with the announcement that the Commonwealth will support

an online service for assisting doctors and patients to better manage diabetes.   
cdmNet, a new health care service delivered over the internet, was announced today as a key  IT infrastructure component for the Commonwealth’s Diabetes Care Project. The project is an element of the Australian Government’s efforts to reform the primary health care system and the treatment of Australians living with chronic illness.
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Indigenous plea for NBN in remote areas

THE National Congress of Australia's First Peoples has demanded the National Broadband Network be rolled out to remote communities as a priority.
The taxpayer-funded Aboriginal body has also demanded that traditional welcome-to-country ceremonies be made a bigger practice for the commonwealth.
In its submission to Arts Minister Simon Crean's cultural policy review, the congress says it is concerned that emerging technologies are being applied in ways that are "not inclusive of all communities, in particular those which are disadvantaged by poverty and remoteness".
The submission warns that, if it continues, the situation will accentuate the gaps between Aborigines and Torres Strait Islanders and other Australians.
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Privacy Commissioner issues new Public Interest Determinations for the collection of health data

In Public Interest Determination (PID)12A, the Privacy Commissioner has given general effect to the specific PID 12 to allow doctors to collect health information about a third party, without the third party's consent, while PID 12 is in force (5 years from 11 December 2011). The purpose of the exempt practice is to enable the collection of information (normally from the patient about their family members) to compile a family, social and medical history for patients for the purpose of properly diagnosing and treating them.
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Planck orbital observatory completes cosmic survey in search of 'Big Bang'

  • From: AFP
  • January 17, 2012 7:38AM
A 900-MILLION-dollar orbital observatory has completed the biggest-ever search for remnants of the "Big Bang" that created the Universe, the European Space Agency has said.
The main instrument on the Planck observatory failed on Saturday when -- as expected -- it ran out of coolant, ending a mission that had lasted twice its 15-month operational design, ESA said in a press release.
"Planck has been a wonderful mission; spacecraft and instruments have been performing outstandingly well, creating a treasure trove of scientific data for us to work with," Jan Tauber, the agency's chief scientist for the Planck project, said.
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Enjoy!
David.