Grahame Grieve Points Out That The Architecture Of The myHR Is Fatally Flawed And Needs Change!

 Grahame Grieve posted this a day or so ago - and remarked to me that the audience here would expect me to repost it for their consideration and discussion!

Argonaut in Australia, and the MyHR

Posted on October 17, 2017 by Grahame Grieve

Project Argonaut is coming to Australia. That is, at least one major US EHR vendor is planning to make their SMART-on-FHIR EHR extension interface available in Australia during 2018 (discussion about this at Cerner Health Conference where I was last week). HL7 Australia will work with them (and any other vendor) to describe what the Argonaut interface looks like in Australia (short answer: not much different: some different patient extensions, a few terminology changes (not RxNorm), maybe a couple of extensions on prescriptions for Reg24 & CTG). Also, HL7 Australia will be planning to engage with Australian customers of the US EHR vendors to help build a community that can leverage the capabilities of the SMART on FHIR interface.
This is a big deal for Australian EHR vendors that compete with the US vendors – they better start offering the same capabilities based on the same standards, or one of their key market advantages will be consigned to the dust of history. They’ll also find themselves competing with established SMART on FHIR Application vendors too. So I look forward to good engagement with Australian companies as we flesh this out (I know at least one will be deeply involved).
This also offers us an opportunity to consider what to do with the MyHR. The government has spent a great deal of money on this, and results have been disappointing. (Yes, the government publishes regular usage stats which show continuous increase, but these are not the important usage metrics, and they’re not the kind of stats that were hoped for back when we were designing the system). And it’s hardly popular amongst the typical candidate users (see, for example, AMA comments, or for more color, this or even David More’s blog).
But I’m not surprised at this. Back when it was the pcEHR, the intentions were solid, and though the original timeline was impossibly tight, it came together in an amazingly quick time (kudos to the implementers). But as it came together, I knew it was doomed. This is inevitable given it’s architecture:

Salient points about this architecture:

• The providers push CDA documents to the central document repository
• Patients can view documents about them
• Patient’s can write their own documents, but providers won’t see them
• Patient’s can exert their control only by ‘hiding’ documents – e.g. they can only break the flow of information (reminder, the internet age treats censorship as damage and routes around it)
• Clinicians can find and read documents
• Each document is it’s own little snap shot. There’s no continuity between them, no way to reconcile information between them
• There are no notifications associated with the system

You can’t build any process on that system. You can’t even build any reliable analysis on it (stakeholders worried about the government using it for secondary data analysis shouldn’t, in general, worry about this, it’s too hard to get good data out of most of the CDA documents). These limitations are baked into the design. That’s why I went and developed FHIR – so that when the full reality of the system become evident, we’d have a better option than a document repository.
Well, 10 years later, and we’re still trying to load ever more use into the same broken design, and the government sponsors are still wondering why it’s not ‘working’. (at least we stopped calling it the ‘personally controlled’ EHR, since it’s the government controlled EHR). And as long as it exists and is the focus of all government efforts to make digital health happen, it will continue to hold up innovation in this country – a fact which is terribly evident as I travel and see what’s happening elsewhere.
But it doesn’t have to be like this.
The MyHR is built on a bunch of useful infrastructure. There is good ideas in here, and it can do good things. It’s just that everything is locked up into a single broken solution. But we can break it up, and reuse the infrastructure. And the easiest way I can see to do this is to flip the push over. That is, instead of the source information providers pushing CDA documents to a single repository, we should get them to put up an Argonaut interface that provides a read/write API to the patient’s data. Then, you change the MyHR so that it takes that information and generates CDA documents to go into the MyHR – so no change needed to the core MyHR.
What this does is open up the system so all sorts of innovation, the most important of which is that the patient can authorise their care providers to exchange information directly, and build working clinically functional systems (e.g. GP/local hospital, or coordinated care planning), all without the government bureaucrats having to decide in advance that they can’t be liable for anything like that. That is, an actually personally controlled health record system not a government controlled one. And there’s still a MyHR for all the purposes it does exist for
This alternative looks like this:

All the providers – even the MyHR – put up the same Argonaut interface.
The salient features of this architecture:

• The providers make healthcare information services available using an Argonaut interface (including write services)
• Patients can control the flow at the source – or authorise flows globally through myGov (needs new work on myGov)
• Systems can read and write data between them without central control
• The MyHR can pull data (as authorised) from the sources and populate the MyHR as it does now
• Vendors and providers can leverage the same infrastructure to provide additional services (notifications, say)

The patient can exert control (either directly at the provider level, or through mygov as an OAuth provider) and control the flow of information at the source – they can opt-in or -out of the myHR as appropriate, but they can also share their information with other providers of healthcare services directly. Say, their phone’s very personal health store. Or research projects (e,g, AllofUs). Or, most importantly and usefully, their actual healthcare providers, who can, as authorised by the patient, set up bi-directional flows of information on top of which they can build better coordinated care processes.
These features lead to some important and different outcomes:

• Clinical Trials and companies can innovate to build distributed care models that provide a good balance between risk and reward for different populations (instead of the one-size suits bureaucrats that we have now)
• Patient’s can control the system by enabling the care flows that they want
• Clinicians can engage in better care processes and improve their process and outcomes (though the US process shows clearly that things get worse before they get better, and you have to plan for that)

This isn’t a small change – but it’s the smallest change I know of that we can make that preserves the MyHR and associated investment, and gives us a healthcare system that can innovate and build better care models. But I don’t know how we’ll think about getting there, given that we’re still focused on “make everyone use the MyHR”.
Note: Adapted from my presentation yesterday at the HL7 Australia Meeting

Here is the link to the original blog:

http://www.healthintersections.com.au/?p=2720

To me this is spot on but it is my view there are additionally some other issues that add to the 'fatally flawed' case. Among these I would highlight that you can't build a system for both patients AND docs and that any secondary system is intrinsically dangerous because of synchronisation and currency issues. I hope the ADHA is listening!

Enough said - this is Grahame's blog!

Comments welcome!

David.

The Minister Responsible For The NBN Is In Cloud Cuckoo Land On How It Is Going!

From Wikipedia:

Cloud cuckoo land refers to a state of absurdly, over-optimistic fantasy or an unrealistically idealistic state where everything is perfect. Someone who is said to "live in cloud cuckoo land" is a person who thinks that things that are completely impossible might happen, rather than understanding how things really are. It also hints that the person referred to is naive, unaware of realities or deranged in holding such an optimistic belief.

Mitch Fifield penned to following for the AFR:

• Updated Oct 9 2017 at 11:01 AM

NBN critics 'disconnected from reality': Communications Minister Mitch Fifield

by Mitch Fifield

Clickbait headlines like "NBN slower than Kenya, ex-Soviet bloc" might be eye-grabbing, but they're completely disconnected from reality.

In a case of "lies, damned lies, and statistics", the article published in The Australian Financial Review (October 5) repeats a number of misleading claims about Australian broadband speeds – including the howler that Australia's internet is slower than Kenya's.

The facts tell a very different story. Kenya has a broadband penetration rate below 2 per cent – meaning that 98 per cent of people living in Kenya have no access to a fixed broadband connection.

Contrast this with the National Broadband Network rollout in Australia, which will connect 100 per cent of Australian premises by 2020. Today, the NBN already passes 6.4 million Australian premises and close to 3 million premises already have an active connection – compared to fewer than 200,000 premises in Kenya that can access broadband at all.

If Australia's global broadband ranking was judged solely on 2 per cent of Australian premises in the wealthiest, most densely-populated areas, we'd shoot up the charts – but this completely misses the point.

The National Broadband Network rollout has the objective of making high-speed broadband available to 100 per cent of Australian premises.

The 98 per cent of Kenyans without any access to broadband at all would no doubt take issue with the fatuous claim that Kenya is somehow better off than Australia.

It's a cute coincidence that Kenya has fewer than 200,000 premises with access to high speed broadband, because that's how many premises in Australia had access to the NBN after two terms of Labor government and $6 billion sunk into the rollout of Labor's slow, expensive fibre to the premises network.

'Faster, more affordable rollout'

After four years of the Coalition's faster, more affordable NBN rollout, the NBN is now being made available to around 150,000 new premises every single month.

And it's worth mentioning that the report which ranks Kenya's sub-200,000 broadband users above Australia is mostly measuring non-NBN connections in Australia, given that the majority of Australian households are yet to transition to the NBN.

As more homes disconnect from old ADSL services and get on the faster NBN, expect Australia's average internet speeds to climb.

The article claims that internet speeds make it "tougher for workers to move from major cities and ease pressure on house prices in Sydney and Melbourne". This argument misses the point that the rollout of the NBN is more advanced in regional areas than major metropolitan areas, thanks to the Coalition's decision to prioritise regional areas which had typically languished with poor connectivity.

The rollout in regional Australia is more than two-thirds complete, and the fixed wireless technology often used in regional outskirts offers broadband speeds of up to 50Mbps, soon to be 100Mbps – much faster than ADSL services available in cities.

The article goes on to claim that Australia's internet speeds "makes it harder to boost productivity". The reality is that the best way to improve productivity is to roll out the network faster – not to roll out a gold-plated all-fibre NBN.

The Coalition's NBN is due to be complete by 2020, giving 100 per cent of Australians access to the productivity benefits of high-speed broadband at affordable prices.

No need for all-fibre switch 

Were Australia to revert back to an all-fibre rollout, parts of Australia would be waiting until 2026-28 to have access to high-speed broadband – in the meantime they would be expected to languish on pre-NBN technology – hardly providing a boost to productivity.

The article repeats another great furphy of the NBN debate – that nations around the world are rolling out fibre-to-the-premise networks. Nothing could be further from the truth.

Nations around the world are overwhelmingly rolling out a mix of technologies to deliver high-speed broadband in the most economically pragmatic fashion.

Fibre to the premises might make sense in city-states like Singapore and Hong Kong where almost the entire population lives in high-rises. But for the rest of the world a mix of technologies is enabling people to connect to high-speed broadband faster and at lower cost.

The Coalition's NBN is one of the greatest corporate turnaround stories in recent memory. From a network that had just 51,000 active users in 2013 to almost 3 million users in 2017, the NBN doubled its footprint in the past year and will do so again in the coming year.

While Labor's plan would have taken six to eight years longer and cost an additional $30 billion to complete, the Coalition's NBN will stop household internet bills from rising by up to $43 per month. There's not much point rolling out the world's fastest broadband network if nobody can afford the monthly bills.

The Coalition is the only party that can be trusted to improve Australia's internet speed ranking – by getting the NBN connected to as many Australians as quickly as possible.

Mitch Fifield is the Minister for Communications

Here is the link:

http://www.afr.com/technology/web/nbn/nbn-critics-disconnected-from-reality-fifield-20171006-gyw1y6

No mention of all the complaints, problems and difficulties many are having and no recognition that even the PM admits there are a number of issues to be addressed:

See here:

Malcolm Turnbull defends NBN rollout, says comparison to Kenyan internet is 'rubbish'

Tim Biggs

Published: October 6 2017 - 12:11PM

Prime Minister Malcolm Turnbull has said he is "keenly aware" of the pain and disappointment NBN installations are causing the public, but says the issues are related to marketing and customer service, not the network's technology itself.

"[NBN Co has] got to improve the installation experience. That's a people management, a process management issue. And they're getting on top of that", Mr Turnbull said in an interview with 3AW's Neil Mitchell, adding that complaints about poor installation experiences were one of the two areas causing the majority of the strife.

The second, he said, was that retail service providers were "not buying enough capacity" to deliver the speeds they are promising to consumers.

"People are being told by the telecom retailers that they're going to get speeds which are not being delivered at peak times. And we've got a number of changes to ensure that that problem doesn't continue", Mr Turnbull said.

Lots more here:

http://www.smh.com.au/technology/technology-news/malcolm-turnbull-defends-nbn-rollout-says-comparison-to-kenyan-internet-is-rubbish-20171005-gyvimf.html

Its more than the installation experience, it the total user operation experience and total missing of reasonable expectations! Even the PM agrees more work – not denial – is needed. Kenya references are a distraction - the actual shambles of a roll-out is not!

Cloud Cuckoo Land is spot on to describe the Ministers pathetic attitude I reckon!

Ba humbug!

David.

This Is A Sensible Decision You May Have Missed. A Good Idea I Believe!

This popped up last week:

Why Australians won't use myGov to opt out of e-health records

By Justin Hendry on Oct 10, 2017 6:30AM

Govt builds separate portal.

Australians that choose to opt-out of the My Health Record will do so through a standalone portal and not via the myGov online service portal, the Australian Digital Health Agency has revealed.

The e-health record operator has created the opt-out portal to remove the need to force individuals to register for a myGov account.

It was first tested during the opt-out trials in the Northern Queensland and Nepean Blue Mountains Primary Health Networks last year, at a time when myGov was plagued by complaints about its reliability and usability.

myGov has since undergone a $50 million overhaul by the Department of Human Service, Australian Taxation Office and the Digital Transformation Agency to address concerns about usability on mobile devices and offer simpler navigation.

A spokesperson from the ADHA told iTnews that the opt-out portal was created to “provide a direct process for people whose sole desire for interaction with government services is to opt-out, whereas myGov’s purpose is to provide simple and secure access to government online services”.

“Consumers are required to go through sign-up process in order to be authenticated every time when accessing myGov, which is a barrier for people wanting to opt-out [of a My Health Record],” the spokesperson said.

The spokesperson also noted that evaluations of the standalone opt-out portal during the opt-out trial had found it to be “cost effective” and “easy to use”.

The ADHA is now planning to use the portal in the shift from opt-in to opt-out e-health records next year.

Lots more here:

https://www.itnews.com.au/news/why-australians-wont-use-mygov-to-opt-out-of-e-health-records-474785

Given all the leaks and breaches going on at present I would be going to the site in a flash!

David.

We Seem To Be Having More Than Our Fair Share Of Data Breaches And Leaks! All Is Not Well!

First this appeared:

Corporate tech giant leaves secret data exposed to public internet

Ben Grubb

Published: October 11 2017 - 12:58PM

A world-leading corporate consultancy and technology outsourcer left at least four cloud-based storage servers unsecured and publicly downloadable, exposing secret data, authentication credentials, certificates, decryption keys, customer information, and more data that could have been used to attack both the provider and its thousands of clients.

Fairfax Media can reveal that Accenture — one of the world's largest corporate consulting and management firms that has offices across Australia, and is also behind the national e-health record system — inadvertently allowed files belonging to its clients to be publicly available.

While there is no evidence to suggest that Australia's e-health system was compromised by Accenture's unsecured servers, Fairfax Media can reveal that data belonging to ASX-listed Caltex Australia was exposed as part of the huge trove of highly sensitive information left unsecured.

At a size of 137 gigabytes, one exposed data set contained large information dumps that included credentials, some of which appear to be for Accenture clients. IT company UpGuard, founded by Australians and based in Mountain View California, revealed the breach on Wednesday in a blog post and told Fairfax Media that Caltex Australia data was exposed.

"This cloud leak of Accenture's internal data, including access credentials that could potentially have been used to attack clients, highlights the sad truth of cyber risk in 2017: nobody is safe," UpGuard co-CEO Mike Baukes told Fairfax Media.

"If the biggest corporations on Earth cannot keep critical internal data from being exposed due to internal misconfigurations, this has got to tell you something about how unequipped most enterprises are to effect cyber resilience across their IT operations, and secure not only the data of other major corporations but, inevitably, of the individual customers most victimised by data exposures."

While many of the passwords contained in the exposed data were hashed — or mathematically transformed into an alphanumeric string — a collection of nearly 40,000 plaintext passwords was found present in one of the database backups. Access keys for Enstratus, a cloud infrastructure management platform, were also found exposed, potentially leaking the data of other tools coordinated by Enstratus. Information about Accenture's ASGARD database, as well as internal Accenture email info, are also contained in a set of the data.

Accenture behind Australia's e-health system

Most concerning about the exposure is the fact that Australia's Department of Health and Ageing selected Accenture to design and implement Australia's Personally Controlled Electronic Health Record (PCEHR) system in August 2011. The initiative spans all Australia-based health systems and enables patients to manage care and records.

Fairfax Media does not suggest that Australia's e-health record system has been breached.

Australia's electronic health record system is opt-out, with Australians having to manually remove themselves from it if they don't want a health record that is accessibe by many Australian health professionals and available via the online myGov portal.

Asked whether Accenture should be trusted with Australia's e-health record system given the exposure, an Accenture employee who declined to be identified said simply: "No."

Lots more here:

http://www.smh.com.au/technology/consumer-security/corporate-tech-giant-leaves-secret-data-exposed-to-public-internet-20171011-gyyijb

Then we had a Defence Contractor spring a leak!

Hacked Aussie Defence firm lost fighter jet, bomb, ship plans

By Ry Crozier , Stuart Corner on Oct 12, 2017 7:03AM

Reconstructing 30GB breach of highly sensitive documents.

A hacked Australian Defence subcontractor lost 30GB of highly sensitive documents on projects including the Joint Strike Fighter (JSF) program and the P-8 Poseidon “submarine killer” plane, as well as detailed designs of Australian Navy ships.

The government only disclosed the hack on Tuesday and has so far offered scant details.

But the Australian Signals Directorate (ASD) yesterday revealed a far more detailed post-mortem of its investigation into the hack in a presentation to the AISA national conference in Sydney.

ASD incident response manager Mitchell Clarke revealed that the attacker managed to gain “full, unfettered access to the environment” of the victim.

It is believed the attacker was “an APT [advanced persistent threat] group or nation state group”.

The ASD dubbed the attacker “APT Alf” after the Alf Stewart character in Australian soap opera Home & Away. “He’s just an angry dude,” Clarke said.

The victim was described as an Australian aerospace engineering firm “four levels of subcontracting down” from primary contractors to local and US Defence agencies, including Boeing and Lockheed Martin.

It was unclear exactly who the subcontractor had been working for.

The company had been vetted to work on US military projects through a scheme known as International Traffic in Arms Regulations (ITAR), though Clarke noted the vetting process is not particularly thorough.

Most of the 30GB of data that APT Alf managed to exfiltrate related to high-profile allied Defence projects.

The data included sensitive details of the Joint Strike Fighter (JSF) project being pursued by the US and its allies, including Australia.

The hacker also gained access to details of Lockheed’s C-130 planes, the Boeing P-8 Poseidon plane which is used for “long-range anti-submarine warfare”, Boeing’s Joint Direct Attack Munition (JDAM) smart bombs, and of “a few Australian naval vessels”.

“We found one document that was like a wire diagram of one of the Navy’s new ships,” Clarke said.

“You could zoom in down to the captain’s chair and see that it’s one metre away from the [navigator’s] chair – all very good exfil for the actor.”

What follows is a detailed account of what is known about the breach, from the perspective of the ASD who – along with CERT Australia – was jointly involved in forensic investigation of the hack, and in helping the victim to secure its network.

Disbelief

Both ASD and CERT Australia were tipped off to the incident by an undisclosed “partner organisation” at the start of November 2016, though the actual infiltration happened in July that year.

“The partner knew about the activity in July; it just took them a long time to go through the legal and regulatory processes to tell us,” Clarke said.

Vastly more here:

https://www.itnews.com.au/news/hacked-aussie-defence-firm-lost-fighter-jet-bomb-ship-plans-475211

And we had the responsible Minster tell us some stats with 15% more cyber incidents (that we know about) than last year:

National Press Club Address - Silent Dangers - Launch of the Australian Cyber Security Centre’s 2017 Threat Report

Release Date:  10 October 2017

Today, business for cybercriminals is booming.

People are falling for online scams, email phishing, identity theft, credit card fraud, and ransomware at an alarming rate.

Yet these crimes continue to fly under the public radar.

This must change.

Last time I spoke at the National Press Club on cyber security, I highlighted the real threats to our national interest. I stated that cyber espionage is alive and well. I told you that threats to our Government systems and critical infrastructure were real. I warned that the risk of cyber terrorism will become a reality in a few years’ time.

All of this remains true.

Today, in launching the Australian Cyber Security Centre’s (ACSC) 2017 Threat Report, I would like to highlight how cyber security is not just the business of national security but something that must become second nature to all Australians.

Cyber security is not just the domain of our intelligence agencies or our Defence Forces to protect against stolen secrets and cyber-attacks.

Cyber security is as relevant for mums and dads, small business owners and local communities to keep their data, their money, and their identities secure.

This ACSC 2017 Threat Report is important because it gives us a clear understanding of the state of the cyber risks to our nation and to our local communities.

It allows us to see what we are doing right, what needs to be addressed and the priorities we need to immediately focus on.

The ACSC in the last 12 months has identified 47,000 cyber incidents, a 15 percent increase on last year.

Over half of these incidents were online scams or fraud, which saw an increase of over 22 percent.

In contrast, only one instance of cybercrime has fallen, the prevalence of illegal or prohibited material. This is down 3.1 percent.

Lots more here:

https://ministers.pmc.gov.au/tehan/2017/npc-launch-australian-cyber-security-centre-2017-threat-report

It is hard to believe that it is not on for one and all and that the Government really has a balloon like problem with one leak being fixed as two others appear!

The sooner sensitive information is made much more distributed and better managed – to reduce the scale and frequency of attacks the better – and don’t even think of trusting Government with any more data than you have to!

These two articles explains why.

First:

How prepared is your practice for cyberattack?

Authored by Hugo Wilcken

Issue 39 / 9 October 2017

IN May of 2017, Britain’s National Health Service was hit by a particularly virulent cyberattack. Within just hours, thousands of computers and medical devices – including magnetic resonance imaging scanners, theatre equipment and blood storage refrigerators – had been contaminated by a virus known as WannaCry, triggering a digital lockdown to prevent further spread. Patient records were compromised and the problem became so serious that some hospitals had to turn away non-critical emergencies and divert ambulances to unaffected emergency departments, often many miles away.

WannaCry was what is known as ransomware, or a virus that typically encrypts a computer’s entire hard drive and then asks the user for a ransom fee to unlock it. Selling ransomware is one of the fastest growing businesses in the darker reaches of the internet, and while health care providers are by no means the only victims, they are a particular target.

“In the United States, around 88% of ransomware attacks have been against health care providers,” Dr Zubair Baig, a senior lecturer in cybersecurity at Perth’s Edith Cowan University, told MJA InSight.

Dr Baig, who is the co-author of a recent article on security attacks on electronic health systems, said that the most important thing health organisations can do to counter the threat of ransomware attacks is to craft a document that clearly explains to health practitioners what to do and what not to do when they receive suspect emails.

“It could be an email that appears to come from a legitimate source, but turns out not to be. If it has an attachment and you can’t verify the email’s legitimacy, do not open the attachment and report the incident to the IT department of your organisation,” Dr Baig said.

Ransomware is one of the greatest cybersecurity threats for health care providers, but it’s not the only one. A Viewpoint just published in JAMA outlines a number of other issues, including theft of patient medical information, denial-of-service attacks which freeze networks, and the hacking of medical devices such as insulin pumps or pacemakers.

Clinicians must practise “cyber hygiene”, writes the New York-based Dr Mark Jarrett. This includes changing passwords on a regular basis, ensuring software is up to date, and installing cybersecurity software. Doctors should never assume that just because their practice is small, that they will not be a target of hackers or malware.

“The promise of improved care from a digital world will be broken, and patients could be placed at risk if cybersecurity is not made a priority issue.”

But, according to Dr Bernard Robertson-Dunn, an electronics engineer who chairs the Health Committee of the Australian Privacy Foundation, cybersecurity is not just an issue of greater vigilance on the part of health care providers. It’s also about how digital infrastructures are designed in the first place.

He points to the Australian government’s controversial My Health Record as an example of how not to digitally store and transmit patients’ records.

“The problem is that the government has implemented a system where if doctors want to share medical data, they first have to give them to the government, which centralises all the data. That creates a honeypot that is very attractive for hackers to hack into,” Dr Robertson-Dunn said.

“You don’t want centralised data, because they’re too vulnerable to hacking and, in any case, it’s unnecessary. The information should stay with the people who create and need it, and it should be shared among them.”

More here:

https://www.doctorportal.com.au/mjainsight/2017/39/how-prepared-for-cyberattack/

and second here:

The feds have caught data fever but does the public share the enthusiasm?

by
Stephen Easton

10.10.2017

The federal government is clearly sold on big data and is combining massive stores of sensitive public information. It needs to bring the public along but while privacy concerns abound, there’s little sign that many Australians share the enthusiasm.

The federal government is increasingly keen on big data, whether it’s used in academic research, private business or its own bureaucracy, but appears unsure of how to bring the public with it and establish confidence that it can be trusted to balance the benefits with risks to privacy.

A lot of people in government, business and research are very clear on the value of big data and keen to maximise its value by combining and sharing as much of it as possible to create the largest possible statistical resources.

This value is often explained in general terms as though it were self-evident that statistics are good, so more accurate and insightful statistics can only be a good thing. This generally fails to excite the general populace about the potential of valuable social and economic insights or useful new apps that rely on openly shared data.

At the same time, concerns about the erosion of individual privacy that has occurred at an accelerating pace over the past 20 years have grown and are now widely held. The level of concern, expressed dramatically through last year’s Census boycott movement, outweighs the level of explicit enthusiasm for big data analytics.

The Commonwealth has a growing list of data-related projects and is trying to sell their expected benefits. Assistant Minister for Digital Transformation Angus Taylor, who recently announced the Digital Transformation Agency had taken over responsibility for the “high value” data.gov.au and NationalMap platforms, plays the unofficial role of chief data evangelist.

Lots more here:

https://www.themandarin.com.au/84593-government-is-sold-on-data-integration-but-needs-to-bring-the-public-along/

The right to simply be left alone is sure under attack in good old OZ!

David.

Weekly Australian Health IT Links – 16th October, 2017.

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

A quiet week on the surface but it seems all sorts of things are going on under the radar. You can mine for clues as to what is happening in the following!

-----

https://www.themandarin.com.au/84593-government-is-sold-on-data-integration-but-needs-to-bring-the-public-along/

The feds have caught data fever but does the public share the enthusiasm?

By Stephen Easton

10.10.2017

The federal government is clearly sold on big data and is combining massive stores of sensitive public information. It needs to bring the public along but while privacy concerns abound, there’s little sign that many Australians share the enthusiasm.

The federal government is increasingly keen on big data, whether it’s used in academic research, private business or its own bureaucracy, but appears unsure of how to bring the public with it and establish confidence that it can be trusted to balance the benefits with risks to privacy.

A lot of people in government, business and research are very clear on the value of big data and keen to maximise its value by combining and sharing as much of it as possible to create the largest possible statistical resources.

-----

https://www.itnews.com.au/news/why-australians-wont-use-mygov-to-opt-out-of-e-health-records-474785

Why Australians won't use myGov to opt out of e-health records

By Justin Hendry on Oct 10, 2017 6:30AM

Govt builds separate portal.

Australians that choose to opt-out of the My Health Record will do so through a standalone portal and not via the myGov online service portal, the Australian Digital Health Agency has revealed.

The e-health record operator has created the opt-out portal to remove the need to force individuals to register for a myGov account.

It was first tested during the opt-out trials in the Northern Queensland and Nepean Blue Mountains Primary Health Networks last year, at a time when myGov was plagued by complaints about its reliability and usability.

-----

https://www.oaic.gov.au/media-and-speeches/news/new-my-health-record-resources-released

New My Health Record resources released

Monday, 09 October 2017

We have published new resources to assist healthcare providers understand their privacy obligations under the My Health Record system.

My Health Record is an Australian Government initiative to provide secure online summaries of individuals’ health information. A My Health Record allows an individual’s doctors, hospitals and other healthcare providers to view the individual’s health information, in accordance with their access controls. Individuals are also able to access their record online.

As the independent regulator for the privacy aspects of the My Health Record system, the OAIC is working with the health sector as it prepares for the system to become opt-out by the end of 2018.

The resources are:

• Guide to Mandatory Data Breach Notification in the My Health Record system
• Ways you can protect patient privacy when using the My Health Record system
• Handling personal information in the My Health Record system
• My Health Record Data Breach Response Plan (PDF 356KB)

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http://www.healthcareglobal.com/technology/australia-invests-13mn-new-medical-technologies

Australia invests $13mn in new medical technologies

By Catherine Rowell . Oct 09, 2017, 5:46AM

Australia is looking to invest $13 million in three new medical technologies to support those with long-term mobility issues and chronic conditions, such as back pain. Part of its $500 million Biomedical Translation Fund (BTF) the investment will see $250 million of Commonwealth funding “matched by private investors,” according to the company website.

The co-investment venture capital programme will aim to support local health companies in Australia who are working to develop medical technologies and support economic growth. It is the main focus of President Malcolm Turnbull’s National Innovation and Science Agenda.

“This vital funding will support researchers when they need it most – for clinical testing, developing prototypes and other requirements before a high potential product or service can come on the market,” Minister for Health and Sport Greg Hunt has said.

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http://medicalrepublic.com.au/digital-crossroads-no2-collaborate-fail/11402

13 October 2017

Digital crossroads No2: ‘Collaborate or fail’

Posted by Jeremy Knibbs

Collaboration is the new black, suggests Australian Digital Health Agency CEO Tim Kelsey.

It’s 10.14am and I’m about to be late for a catch up with Tim Kelsey, the CEO of the Australian Digital Health Agency (ADHA). I can’t find the Flying Egg Cafe. If I miss him, that’ll be it for another couple of months. He’s a truly busy man.

I’ve given up and I’m standing in the middle of the courtyard where the shop should be, despondent. I feel a little like I’m the has-been rock journo in Almost Famous and I’ve just missed Russell, the lead singer of the up-and-coming band, Stillwater.

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https://ministers.pmc.gov.au/tehan/2017/npc-launch-australian-cyber-security-centre-2017-threat-report

National Press Club Address - Silent Dangers - Launch of the Australian Cyber Security Centre’s 2017 Threat Report

Release Date:  10 October 2017

Today, business for cybercriminals is booming.

People are falling for online scams, email phishing, identity theft, credit card fraud, and ransomware at an alarming rate.

Yet these crimes continue to fly under the public radar.

This must change.

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http://www.theaustralian.com.au/national-affairs/health/medicare-card-web-scare-triggers-security-crackdown-call/news-story/b80254dc84100306743ca7eac34ba7f9

Medicare card web scare triggers security crackdown call

• The Australian
• 12:00AM October 14, 2017

David Crowe

A security scare has triggered an official call for stronger checks on millions of Medicare cards in a clear warning to the Turnbull government about the threats to a vast system that pays $35 billion in benefits each year.

A high-powered government review is warning that access to personal card information has ­become too easy at a time of growing fears about payment fraud, identity theft and other “illicit ­activities” that leave taxpayers carrying the bill.

The report singles out the lax controls on government phone services that answer 588,000 ­requests every year for personal Medicare numbers, raising questions about the checks on those who gain access to the information.

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http://www.news.com.au/national/breaking-news/call-for-stricter-access-to-medicare-cards/news-story/1ffdcc24faed8277c7715d3c94990db6

Call for stricter access to Medicare cards

An independent report says health professionals should be required to get consent from their patients before being allowed to access their Medicare numbers.

Roje Adaimy

Australian Associated Press October 14, 20179:54am

Australians could be handed greater control over who can access their Medicare card details amid fears the information can be too easily obtained.

An independent report, released on Saturday, has suggested tighter security following a review ordered by the federal government in July after a small batch of card numbers were sold on the dark web.

It noted that while there had been no risk to patients' health records as a result of the sale, Medicare card numbers are susceptible to theft for identity fraud and other "illicit activities".

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https://www.computerworld.com.au/article/628424/department-human-services-plans-next-generation-virtual-assistants/

Department of Human Services plans next generation of virtual assistants

DHS uses virtual assistants to boost productivity, customer service

Rohan Pearce (Computerworld) 11 October, 2017 08:40

The Department of Human Services has revealed its plans for a next generation of virtual assistants.

DHS is planning to deploy ‘Oliver’ and ‘Argus’ (Gus), which the department says will have the ability “to capture and send information to other applications and assist in processing.”

Gus and Oliver will add to the ranks of virtual assistants already in use at the departments.

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http://www.smh.com.au/technology/consumer-security/corporate-tech-giant-leaves-secret-data-exposed-to-public-internet-20171011-gyyijb

Corporate tech giant leaves secret data exposed to public internet

Ben Grubb

Published: October 11 2017 - 12:58PM

A world-leading corporate consultancy and technology outsourcer left at least four cloud-based storage servers unsecured and publicly downloadable, exposing secret data, authentication credentials, certificates, decryption keys, customer information, and more data that could have been used to attack both the provider and its thousands of clients.

Fairfax Media can reveal that Accenture — one of the world's largest corporate consulting and management firms that has offices across Australia, and is also behind the national e-health record system — inadvertently allowed files belonging to its clients to be publicly available.

While there is no evidence to suggest that Australia's e-health system was compromised by Accenture's unsecured servers, Fairfax Media can reveal that data belonging to ASX-listed Caltex Australia was exposed as part of the huge trove of highly sensitive information left unsecured.

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https://www.medicalobserver.com.au/medical-news/psychiatry/government-launches-mental-health-portal

Government launches mental health portal

10 October 2017

A new federal government website aims to provide a one-stop shop for patients to access mental health services “before they reach crisis”. 

Head to Health is a gateway to 370 mental health services and resources including websites, evidence-based apps and online programs, as well as dedicated forums for patients and carers to share their experiences.

The website also offers resources on ‘meaningful life’, explanation of mental health conditions and a detailed list of service providers such as headspace, beyondblue and SANE Australia.

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https://www.medicalobserver.com.au/professional-news/practice-software-should-help-gps-refer-to-the-right-specialist

Practice software should help GPs refer to the right specialist

Dr Oliver Frank

13 October 2017

IMPROVING PRACTICE SOFTWARE

The Issue

The broad nature of general practice means that GPs need to make relatively small numbers of referrals infrequently to any one type of a wide range of other health professionals.  

As a result, GPs often have to search for appropriate health professionals for patients with particular types of problem or needs.  This is even more of an issue for GP registrars and GPs who are new to the practice. 

The address books in clinical software include health professionals to whom none or few patients have been referred.  Current workarounds include asking colleagues in the practice, and making notes that some clinical software packages allow in their address books.

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http://www.healthcareit.com.au/opinion/keeping-network-alive-through-247-care

Keeping the network alive through 24/7 care

George Wilson | 10 Oct 2017

n 2016, the NSW government allocated $400 million to support technology advancements in hospitals and health facilities, to ensure safer, higher quality and more efficient patient care. With technology being harnessed like never before, IT departments are experiencing unprecedented levels of demand and increasing challenges to ensure no disruptions are experienced. With increasing numbers of devices being added to hospitals every day, network monitoring is becoming incrementally important to ensure there are no interruptions to patient care. The fact is, when a patient is in a critical condition, every second counts; doctors, nurses and technology all have to work together with seamless precision.

As a result, the healthcare industry has recognised the need for improvement, and is undergoing a digital transformation to streamline treatment and patient care processes. Now, we’re witnessing a ‘digital first’ mentality taking over, as administrators switch from traditional paper methods to digital channels.

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https://www.itnews.com.au/news/nib-eyes-e-health-to-draw-under-30s-to-insurance-475352

Nib eyes e-health to draw under 30s to insurance

By Staff Writers on Oct 13, 2017 12:20PM

Welcomes discounts but says more needed.

Private health insurer nib believes getting more young people enrolled in insurance could be achieved with greater digitisation of the way health services are managed and consumed.

The insurer welcomed a package of reforms announced by health minister Greg Hunt this morning that aim to simplify private health insurance and improve affordability.

One of the measures will see people aged 18 to 29 offered discounted hospital insurance premiums.

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https://ajp.com.au/news/health-record-secure/

Is My Health Record secure?

Sheshtyn Paola — 11/10/2017

While the perception that e-health records are not secure persists among many health professionals, we look at the measures that have been put in place over the past few years

Back in 2012, an expert security organisation warned Australians not to opt in to the national e-health record system, at the time called Personally Controlled Electronic Health Record (PCEHR).

The Australian Computer Emergency Response Team (AusCERT) warned that users faced the risk of identity theft due to insufficient security protections.

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http://www.healthcareit.com.au/article/electronic-medical-record-blamed-death-41-year-old-wa-man

Electronic medical record blamed in death of 41-year-old WA man

Lynne Minion | 09 Oct 2017

Over-reliance on the electronic medical record at Perth’s Fiona Stanley Hospital has been blamed in the death of a 41-year-old man from a serious adverse drug reaction, the West Australian Coroner has found.

Jared Olsen died on 5 March 2015, weeks after being prescribed an immunosuppressant medication, 6-Mercaptopurine (6-MP), to treat his Crohn’s colitis.

Coroner Ros Fogliani found that blood tests ordered at FSH on 8 February had determined Olsen was unable to metabolise 6-MP due to two non-functioning copies of the TPMT gene. PathWest had uploaded the “critical” results into the FSH iCM electronic record system on 19 February 2015, with a red flag indicating an abnormal result.

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http://medicalrepublic.com.au/believe-not-day-discharge-summaries-gps/11313

11 October 2017

Believe it or not! Same-day discharge summaries for GPs

Posted by Julie Lambert

A Queensland hospital service is aiming high with a “real-time” policy to send discharge summaries to GPs on the same day that patients leave the hospital.

The Sunshine Coast Health and Hospital Service plans to introduce the zero-delay target on October 16 with the objective of ensuring continuity of care as patients move from the acute setting to primary care.

A document circulated by GPs on Twitter, which appears to be part of a poster campaign for the no-delay target, bears the slogan: No summary. No discharge!

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https://healthengine.com.au/

HealthEngine launches Medication Manager to improve patient medication literacy and continuity of care 

Perth, Australia — 12 October 2017: HealthEngine, Australia’s largest online healthcare marketplace, today announced the launch of a new service, Medication Manager.

Through the HealthEngine app, Medication Manager allows patients to monitor their daily medication, get reminders when to take their prescribed doses, and be prompted to re-book doctors appointments before their script runs out. The opt-in service also allows patients to monitor their medicine and record feedback from medication that can be shared with their GP.

“At HealthEngine, one of our core focuses is to enable patients to take more control and responsibility of their health. Medication Manager is our latest step in this journey,” said Dr Marcus Tan, CEO and Medical Director of HealthEngine. “When juggling multiple medications, it can be difficult to keep up with where you’re at. Medication Manager helps patients stay on top of their medication, which in turn ensures their quality of care is improved.”

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http://www.theaustralian.com.au/business/technology/fitbit-ionic-is-a-dream-come-true-for-poor-sleepers/news-story/477cba5e4726406d365b9659b0d2eee2

Fitbit Ionic a dream come true for poor sleepers

• The Australian
• 12:00AM October 10, 2017

Chris Griffith

Three hours 44 minutes average sleep. That’s all I’ve been getting for weeks, maybe months. I knew I was a light sleeper, but it took wearing Fitbit’s Ionic smartwatch to quantify how light.

Talking sleep quality is overdue in the health debate, which usually concentrates on other worthy aspects such as activity and nutrition. But it’s a particularly big problem among older people, busy folk and of course the parents of newborns.

Many readers of The Australian in government, business and politics snugly fit the sleep-deprived demographic.

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https://www.computerworld.com.au/article/628377/national-security-contractor-network-compromised/

National security contractor’s network compromised

Details of contractor hack revealed

Rohan Pearce (Computerworld) 10 October, 2017 10:32

Australia’s cyber security minister Dan Tehan will today reveal details of an attack on an Australian company that has contracting links to national security projects.

In November last year, the Australian Cyber Security Centre became that “a malicious cyber actor” had compromised the network of the company, the minister assisting the prime minister for cyber security said in remarks prepared for a National Press Club address later today.

Analysis by the ACSC confirmed that the attacker successfully obtained “sustained access to the network for an extended period of time and had stolen a significant amount of data”.

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http://www.theaustralian.com.au/national-affairs/chinese-launched-cyber-attack-on-aussie-defence-contractor/news-story/5e1b524688bc9a493ac79bfc0212a4f1

Chinese launched cyber attack on Aussie defence contractor

• The Australian
• 12:00AM October 10, 2017

Greg Brown

A “malicious” cyber hacker has stolen “significant” data from an Australian defence contractor as the government warns that infrastructure is being targeted by increasingly sophisticated cyber criminals.

Today the the federal minister responsible for cyber security, Dan Tehan, will reveal a hacker had ­access to the network of a small defence contractor for an ­“extended period of time” before ­security authorities became aware of the breach last November.

The Australian understands the hacker was based in China.

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http://www.healthcareit.com.au/article/gp-booking-app-online-healthcare-behemoth-healthengine-continues-its-growth

From GP booking app to online healthcare behemoth: HealthEngine continues its growth

Lynne Minion | 10 Oct 2017

HealthEngine continues to solidify its place as Australia’s leading online healthcare booking platform with the addition of one of the nation’s largest dentist communities to its roster.

Over 1800 practices registered with dental management specialist Prime Practice will be assisted to transition to the digital platform, increasing the options available for customers from 700.

The partnership is part of the broadening of HealthEngine’s focus from GP appointment bookings to its evolution as an “online healthcare marketplace” representing related industries keen to connect.

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https://www.computerworld.com.au/article/628323/nt-health-seeks-cio-after-moo-departure/

NT Health seeks CIO after Moo’s departure

Department of Health advertises for chief information officer to replace Stephen Moo

Rohan Pearce (Computerworld) 09 October, 2017 13:04

The Northern Territory’s Department of Health has formally begun seeking a new chief information officer after Stephen Moo resigned from the position.

Moo resigned last month, with the NT Police confirming it had received a referral from the department relating to the former CIO. It is understood that no charges have been laid in relation to the referral.

The department says it is offering an executive contract of up to four years and a salary of $226,126.

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http://www.mq.edu.au/newsroom/2017/10/11/nhmrc-funding-success-to-deliver-world-leading-oncology-digital-health-and-patient-safety-research/

NHMRC funding success to deliver world-leading oncology, digital health and patient safety research

11 October 2017

The Australian Institute of Health Innovation in the Faculty of Medicine and Health Sciences at Macquarie University has been awarded more than $7.3 million in grants from the National Health and Medical Research Council (NHMRC), announced today.

Among the grants are two Centres of Research Excellence, two Partnership Projects, and an Early Career Fellowship award.

In total Macquarie as a whole has been awarded more than $8 million in grants.

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https://www.medicalobserver.com.au/professional-news/recent-hospital-gp-discharge-tragedies-are-just-the-tip-of-iceberg

Recent hospital-GP discharge tragedies are just the tip of iceberg

Dr Justin Coleman

11 October 2017

COMMENT

Change is moving at a glacial pace, writes Dr Justin Coleman.

When coroners in two states point their fingers hospital discharge summaries, as happened last week, you just know it's time for another annual round of ‘we’re improving our discharge systems’ claims.

Having lived as a GP through 20 such annual cycles of improvement, it’s no wonder we have reached a point where discharge summaries are ‘timely, relevant and succinct’ ... Yep, I remember reading one of those back in June.

Hospitals have robust systems for ensuring adequate clinical handover from ED to the ward, from one medical team to another, and even one shift to the next.

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http://medicalrepublic.com.au/platform-delivers-care-less-paperwork-gps/11285

9 October 2017

Platform delivers more care, less paperwork for GPs

Posted by Flynn Murphy

An online medical platform which lets GPs work in aged care facilities and other settings without being tied to a physical practice has been named Telstra’s Australian Business of the Year.

Founded by Adelaide GPs Troye Wallett and Sebastian Rees, the technology, called GenWise Health, saves doctors time, earns them extra cash and provides peer support, the developers said.

In return for a fifth of their billings, the “virtual clinic” also allows GPs to work during the hours they prefer.

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http://www.smh.com.au/comment/the-surveillance-state-is-here-already-we-must-pause-and-rethink-what-this-means-20171010-gyxu2v.html

The surveillance state is here already. We must pause and rethink what this means

Nicholas Stuart

Published: October 11 2017 - 12:15AM

Have no doubts: you are being observed. Malcolm Turnbull's move to create a massive, facial-recognition database of every Australian over 18 is merely a desperate catch-up measure. Even once this is implemented, the government will still lag way behind private companies (like Facebook) in the surveillance stakes. Our politicians are only just now, finally and belatedly, groping their way towards an incomplete understanding of the new, enormous power conferred by the internet.

Start with the grid. The enormous development of computing power means the analogue world in which we grew up is being translated into a digital one. We've embraced this wholeheartedly. Whether it's the ability to share baby photos with grandparents in another state or trace our friends' movements across the world, instant communications allow us to flourish, extending our contacts and interactions.

And each and every movement leaves a small, electronic trail, stretching out through the ether ...

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http://www.healthcareit.com.au/article/significant-cyber-security-failures-government-contractors-myhr-data-remains-safe

Significant cyber security failures by government contractors, but MyHR data remains safe

Lynne Minion | 12 Oct 2017

The federal government agency responsible for the roll out of the My Health Record claims Australians’ health information is safe in the wake of a massive data exposure by the company contracted to secure MyHR against cyber attack.

Global professional services company Accenture inadvertently exposed at least four cloud-based storage servers, leaving the contents unsecured and publicly downloadable. But the Australian Digital Health Agency said its data remains secure.

“There has been no impact on the My Health Record system following media reports of an alleged data breach at Accenture in the United States,” an ADHA spokesperson told Healthcare IT News Australia.

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https://www.doctorportal.com.au/mjainsight/2017/39/how-prepared-for-cyberattack/

How prepared is your practice for cyberattack?

Authored by Hugo Wilcken

Issue 39 / 9 October 2017

IN May of 2017, Britain’s National Health Service was hit by a particularly virulent cyberattack. Within just hours, thousands of computers and medical devices – including magnetic resonance imaging scanners, theatre equipment and blood storage refrigerators – had been contaminated by a virus known as WannaCry, triggering a digital lockdown to prevent further spread. Patient records were compromised and the problem became so serious that some hospitals had to turn away non-critical emergencies and divert ambulances to unaffected emergency departments, often many miles away.

WannaCry was what is known as ransomware, or a virus that typically encrypts a computer’s entire hard drive and then asks the user for a ransom fee to unlock it. Selling ransomware is one of the fastest growing businesses in the darker reaches of the internet, and while health care providers are by no means the only victims, they are a particular target.

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http://www.afr.com/technology/web/nbn/nbn-critics-disconnected-from-reality-fifield-20171006-gyw1y6

• Updated Oct 9 2017 at 11:01 AM

NBN critics 'disconnected from reality': Communications Minister Mitch Fifield

by Mitch Fifield

Clickbait headlines like "NBN slower than Kenya, ex-Soviet bloc" might be eye-grabbing, but they're completely disconnected from reality.

In a case of "lies, damned lies, and statistics", the article published in The Australian Financial Review (October 5) repeats a number of misleading claims about Australian broadband speeds – including the howler that Australia's internet is slower than Kenya's.

The facts tell a very different story. Kenya has a broadband penetration rate below 2 per cent – meaning that 98 per cent of people living in Kenya have no access to a fixed broadband connection.

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http://www.theaustralian.com.au/opinion/nbn-price-of-connectivity-will-only-prove-painful-for-taxpayers/news-story/4d4b3db025f50b698feae625d8a6a945

Why the NBN is a fiscal debacle

• The Australian
• 12:00AM October 9, 2017

Adam Creighton

The National Broadband Network got personal last week. I ­joined the 2.98 million households that have signed up to an “NBN” plan only to find the service appalling.

Not being much of a “web surfer”, and erring on the frugal side, I went for the $50-a-month “hassle-free” plan from ­Belong, an internet service provider owned by Telstra.

“Hassle-free” is not quite accurate. Yesterday the download speed was 6.5Mbps (about half the advertised “up to 12Mbps”). That’s the average achieved by Turkey, Chile and Mexico four years ago, when the average in Japan and Switzerland was 15Mbps. And that’s when it works.

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https://www.computerworld.com.au/article/628574/government-details-5g-strategy/

Government details 5G strategy

5G working group to bring together government and industry

Rohan Pearce (Computerworld) 13 October, 2017 10:55

The federal government will convene a working group to assess issues and opportunities for the adoption of 5G.

The group, that will bring together government and industry, will help ensure that regulatory settings across a range of industries are primed for the rollout of the new mobile standard once it’s finalised by the International Telecommunication Union.

A directions paper released by the Department of Communications and the Arts outlines a four-pronged strategy to prepare Australia for the rollout of 5G.

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Enjoy!

David.