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Tuesday, July 3, 2012

You Really Would Think A Proven and Cheap E-Health Intervention Would Be Adopted By A Government Flailing Around For Success. Seems Not.

The following interesting and related articles have appeared recently.
First we have:

NICE launches BNF smartphone app

14 June 2012   Chris Thorne
The National Institute for Health and Clinical Excellence has launched a free version of the British National Formulary smartphone app for health and social professionals employed by NHS England.
The NICE BNF app has been developed to provide easy access to the latest up-to-date prescribing information from the BNF, the most widely-used medicines information reference guide used within the NHS.
The app is available to download for free via the Apple App Store and Google Play Store. Users will need their NHS Athens user name and password to activate the app and download the content.
The app provides direct offline access to the latest version of the BNF, giving a user access to BNF on their smartphone or tablet even when there is no internet connection available.
Lots more here:
Second we have:

Research fills in Map of Medicine

21 June 2012   Rebecca Todd
About half of GPs and a quarter of community staff are using the care pathways tool Map of Medicine, new research suggests.
Map of Medicine is a collection of evidence-based practice-informed care maps, rolled out to GPs and community users as part of the National Programme for IT in the NHS.
Stockport NHS Foundation Trust IT Services manager Colin Cohen has been studying the Map of Medicine project as part of a thesis for his doctorate.
Phase one of his research involved sending an online questionnaire to GPs and community health staff in NHS Thameside and Glossop, which showed that 55% of GPs used Map of Medicine and 28% of community staff.
A similar survey about a year before revealed the same results. Cohen was surprised at the level of usage and felt 55% was “better than I might have thought."
He explained that his area might have higher usage than others because Map of Medicine was given a “big push” about a year ago by the primary care trust.
Lots more here:
So here we have to widely used and influential clinical support applications of the sort we know can make a difference to the quality of care that simply we see no interest from our Government in doing something similar.
See this paper for evidence of how useful such resources can be:
The bottom line here is that provision of useful information at or near the point of care can make a difference - and although recommended in the 2008 National E-Health Strategy zilch has happened. Maybe a small investment here could distract a little from the train-wreck elsewhere?
Half a billion dollars on an unproven PCEHR and they won’t even do for lots less money what has been proven to work on a national basis.
Shame.
David.

Monday, July 2, 2012

We Are Seeing The NEHRS / PCEHR Introduction In Really Amazing Disarray. It Is Pretty Sad And Public Confidence Destroying.

I have to say I could not have made up just how the first few days of all this have unfolded!
As reported over the weekend there was a July 1 update on the www.ehealth.gov.au site late in the afternoon that provided a link to application forms. There was nothing provided that could be described as an on-line registration application.
Here is the link to that blog.
Then out of the blue we had a claim from a blogger (who is sponsored by NEHTA) that there was an on-line registration process via www.australia.gov.au.
You can read about this from this link.
Interestingly this route of access to the PCEHR System now seems to have been closed down - having been open for only a few hours.
Then, this morning we have had the following reports.

The federal government's e-health platform hacked at birth

THE federal government's e-health platform was hacked while being developed but the incident went undetected for several months.
The revelation comes after Accenture, the main contractor for the personally controlled e-health record program, delayed delivery, resulting in only 40 per cent of the system being ready by its July 1 launch date.
The hacking incident raises issues of reliability and security of the system as people start to register for an e-health record that would contain their personal details and health information such as medications, allergies and immunisation details.
The PCEHR is intended to be a secure electronic summary of people's medical history that is stored and shared in a "network of connected systems".
According to sources close to the Department of Health and Ageing, the hacking incident occurred while the PCEHR system was being built late last year, but Accenture discovered it only four months ago. The sources declined to be named.
Lots more details here:
and this report:

Answers to identity verification questions not sufficiently secure

THE security of the government's e-health records are under question a day after they were launched because those registering have to provide only a Medicare card number and names and birth dates of family members to verify their identity.
Security experts say answers to the identity verification questions are so widely known it would allow a person to set up an e-health record for someone else by telephone if they wanted to access that individual's health details, such as medication or medical procedures.
"My advice is not to join until the security issues have been resolved," said Graham Ingram, general manager of AUSCERT, Australia's emergency response team for computer security incidents.
More details here:
What is also interesting is that in the Application Guide On-Line Registration is an option provided.

eHealth registration guidebook

A guidebook is available to help you understand the eHealth record registration process. The document explains the terms used, your eHealth privacy safeguards, details about how your information is handled, and where and how you can apply for an eHealth record.
See page 10. Clearly it is not present on the site yet:
See here:
Even worse - consider this section of the written Application Form found here:
(Page 2)
Privacy
The System Operator, who is the Secretary of the Department of Health and Ageing, is collecting the information in this form to work out if it can register you and/or your dependant(s) for an eHealth record, and for managing your and/or your dependant(s) eHealth record if your application is accepted.
 If applicable, the information will also be used to work out whether you are an authorised representative for your dependant(s).
 If you are registered, the System Operator will collect other personal and health information about you and/or your dependant(s) when that information is uploaded by healthcare providers or by you, or where permitted by law.
This is authorised under the PCEHR Act and the Healthcare Identifiers Act 2010 (HI Act).
The System Operator usually gives some or all of this information to the following as part of the normal day-to-day operations of the eHealth record system:
  •  registered healthcare providers involved in your and/or your dependant(s) care where this is consistent with any access controls you set, or in the case of a serious threat to an individual’s life, health or safety or to public health or safety
  •  your nominated representatives, if you choose to have any, consistent with any access controls you set
  •  repository operators, portal operators and contracted service providers that are registered to participate in the eHealth record system
  • the Chief Executive Medicare as the service operator under the HI Act, and
  • the Australian Government Department of Human Services and, if applicable, the Department of Veterans’ Affairs.
Your and/or your dependants’ information may be given to some other entities but only where this is required or authorised by or under law. Where information is given to other entities, those other entities may collect, use and disclose that information as required or authorised under the PCEHR Act, the HI Act and other laws.
The information provided in response to parts of this form is collected by the System Operator on behalf of the Chief Executive Medicare (within the Australian Government Department of Human Services) or the Australian Government Department of Veterans’ Affairs. The collection of this information is authorised by the PCEHR Act and is for the purpose of the Chief Executive Medicare carrying out functions as a registered repository operator under the PCEHR Act.
The Chief Executive Medicare (as the service operator under the HI Act and, separately, the holder of Medicare and PBS records) may disclose information to the System Operator about you and your dependants to help the System Operator to make decisions about registration and authorised representatives. These disclosures are authorised by the HI Act and the PCEHR Act.
Further information about how personal information is handled in the eHealth record system is described in the Registration Booklet and Privacy Statement. The Privacy Statement can be accessed by you at www.ehealth.gov.au or you can request a copy by calling 1800 723 471.
----- End Extract.
If you go here to check the understand-ability of the above:
you get the following:
Indication of the number of years of formal education that a person requires in order to easily understand the text on the first reading
Gunning Fog index : 20.52
i.e. 6 years post high-school - i.e. 2 degrees or so!
So what we have so far is failed delivery on undertakings, irregular access routes to the PCHER system being made public and incomprehensible documentation needed for application.
And all this in just 3 days. I can’t wait for the next exciting instalment.
David.

It Seems The NEHTA Sponsored Blogger Has Been Told How To Apply On-line For A NEHRS / PCEHR When The Public Is In The Dark.


Go here to play with all the tricks. Multiple sites - have bills to hand and so on!


Pity the transparency is as one might expect. Zilch!

I look forward to hearing how people go! 

As I said 'Aggressively (Normal) User Hostile!

If true, I guess all this does show they have access to the various Medicare databases - if nothing else - and that at least a basic system is possibly in existence. Obviously the criticism stirred them along!

Maybe a visit to his site or two will cheer him up.

David.

Tuesday 1:30 pm update - the access window to the PCEHR System has apparently been closed. Looks like someone goofed big time!

D