Last week I published an article which seems to have provoked more than a little discussion!
The original – and the record setting 20 comments - can be found here:
http://aushealthit.blogspot.com/2009/07/nehta-tries-to-fudge-it-again-when-are.html
I have to say I was somewhat surprised at the reaction.
There was a similar comment I found here about my key concerns.
E-health plan lacks detail
Elizabeth McIntosh - Friday, 24 July 2009
EXPERTS have welcomed the release of draft proposals for patient and professional identifier numbers, but have argued key information is missing from the government plan.
Released by the Australian Health Ministers’ Advisory Council, the proposals outline the creation of 16-digit identifiers for each individual, healthcare professional and healthcare organisation in the country.
The system, developed by the National E-health Transition Authority (NEHTA), has been lauded by the authority and the Federal Government as a means to improve patient care and reduce preventable errors, such as incorrect prescribing.
The Government plans to roll out the identifiers – via Medicare Australia – beginning next year.
More here:
http://www.medicalobserver.com.au/News/0,1734,4982,24200907.aspx
For those wanting to see the AHMAC communiqué that triggered much of my comments and discussion go here:
The core of this is that the Medicare eligible population are about to have a new 16 digit identifier created for them and that this is be used to identify health documents.
In summary I asked to see the evidence that what was planned was necessary and the right way to go, remarking, in passing, that I had seen no public documentation that explained, in detail, what was planned and how it was planned to work, provided an option analysis of what approaches could be adopted and explained why what was planned was the selected path, and provided the costs and benefits and Privacy Impact Assessment of the plans.
As I read the comments it seems people have divided almost down the middle with one view being essentially –Look you nitwit, we need this, it is a great idea, we are committed to it, we are sure all the problems will be solved and it will save lives and money. Can you please just take it, on faith or whatever, that Medicare and NEHTA will do a fine job and it will all be a splendid success.
Others seem to have reflected my rather more cautious and sceptical view that maybe it would be useful if the various documents supporting what is being done could be made public to permit discussion analysis and an informed view to be reached.
Well since at least one correspondent has asked us what we want to know. See here:
Anonymous said...
DM: Who, of those reading here, other than the
DM: NEHTA staff, know the technical details of how
DM: it will work, etc.
It’s not like this is any great secret... what is it you are wanting to know then?
DM: And who knows the approach being adopted is
DM: the best one?
AHMAC, NCIORF, NHHRC, COAG etc etc. Do you think they are all conspiring together to allow a not fit for purpose approach to be funded and implemented?
DM: Who has the evidence the CDMS is fit for
DM: this purpose.
What is your evidence is that it will not be fit for purpose (refer list of gateway approval organisations above)?
DM: The design needs to be privacy driven from its
DM: initiation.
Again what evidence is there that this is not the case (again refer list of gateway approval organisations above).
From this I can only assume this individual knows all we need, while noting a touching faith in acronyms to see us right!.
What I would like to see would include:
1. The Business Case and Option Analysis for the Project and the Design that been apparently settled upon.
2. Adequate technical development specifications and interface specifications of what is being built (Given it is to be live in less than a year that must exist by now) to allow reasoned assessment
3. An answer to what plans there are for piloting etc to ensure all works as desired at a reasonable scale before final roll out.
4. A detailed and current concept of operations – or equivalent.
5. A current Privacy Impact Assessment of the proposal that is being built.
I look forward to links to this material so the discussion can be happily resolved and we can all be assured this will turn out as we hope.
The information could be popped up here and we could all then browse and e-mail in our comments – if any.
http://www.nehta.gov.au/connecting-australia/e-health-id
There looks to be plenty of room!
While browsing I did note this:
e-Health ID
The first requirement of any e-health system is the ability to uniquely identify and authenticate everyone involved in a single healthcare transaction. This includes the person receiving healthcare, the person administering healthcare, the place where healthcare is given and all people accessing health information systems.
The e-health ID Services will uniquely identify all parties involved in a healthcare transaction ensuring there is no misunderstandings about who health information belongs to. e-health ID Services enable healthcare providers to be assured that the information they need relates to the right person, has gone to the right place and was received by the right person.
Once the health information is exchanged it is also important to ensure only those authorised have access to it. Therefore Australia’s e-health system will be underpinned by a simple yet secure authorisation service for healthcare providers and healthcare administrators, using the best technology available.
End quote.
It seems to me NEHTA sets the bar here as to what is to be achieved! Note words like ‘no misunderstandings’ – i.e. very low error rates at worst – and ‘healthcare providers to be assured that the information they need relates to the right person, has gone to the right place and was received by the right person’. We wait to be convinced this will be achieved. I for one will retain a sensible scepticism unless trusted with a few more details! It is easy to say ‘oops’ after the event!
With the history of large scale projects in the public sector being as it is, it would seem to me a little transparency now might just save a big mess later.
David.
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