[LINK] Medicare the base for e-health IDs
brd at iimetro.com.au
Wed Jun 24 09:48:06 EST 2009
Medicare the base for e-health IDs
June 23, 2009
PATIENTS' medical records will be linked across health providers using
the present Medicare number and card, under the $98 million Unique
Healthcare Identifier (UHI) program being developed by the National
E-Health Transition Authority.
Few details of the planned UHI service have been revealed to date,
despite the January 2010 deadline for completion of the project's design
and build. The work has been directed by the Australian Health
Ministers' Council (AHMC) and funded by the Council of Australian
Although healthcare providers - doctors, pharmacists, community clinics
and hospital administrators, in both the public and private arenas -
will be issued with highly secure smartcards using PKI-based identity
verification, consumers' individual healthcare numbers (IHIs) will be
accessed by linking through the old Medicare number.
The stronger credentials for medical professionals will be managed
through the planned National Authentication Service for Health (NASH),
an extension of Medicare's existing arrangements to securely identify
doctors accessing the agency's systems for claiming or payment transactions.
Individual healthcare identifiers have been touted as a key building
block in the nationwide shift to e-health systems, with the free-flowing
exchange of people's health records set to revolutionise patient care
through improved safety and quality outcomes, together with greater
efficiencies, cost savings and a wealth of new opportunities through
telemedicine, remote monitoring of chronic disease and public health
Eventually, the plan is for each person to have an individual e-health
record, which holds their personal details; a summary health profile
that can be shared with the person's permission between treating
doctors; event summaries such as hospital discharge reports, care plans
and test results, and a self-care management record where people can add
their own material.
But consumer and privacy groups may be disappointed by the barebones
approach outlined to The Australian, in response to questions put to
NEHTA, Medicare Australia - which is creating the UHI system under
contract to NEHTA - and federal Health Minister Nicola Roxon.
It appears Ms Roxon has been mistaken in her recent comments that
patients will access their health records through a smartcard.
Instead, doctors or staff members will have to call up a person's shared
record via the Medicare number, together with the existing, additional
family member number.
"The IHI is simply an identifier that will facilitate the secure
transmission of health information," a NEHTA spokeswoman said. "The IHI
will predominantly be retrieved using an individual's Medicare number as
opposed to a 'look-up' system, but separate security and authentication
processes will be put in place regarding the actual use of the IHI in
relation to health records.
"If an individual does not have a Medicare card, their healthcare
provider will be able to use demographic information to obtain an IHI
from the service. A patient will normally be asked to provide only his
or her name and date of birth."
This approach assumes Medicare's well-publicised difficulties with data
quality - mailing out replacement cards to deceased persons,
duplications and other errors, and fake cards circulating in the black
market - have been fixed.
Another issue involves ensuring the proper separation of data in the new
registration and record databases from Medicare's financial transactions
and business operations.
The spokeswoman said Medicare's solution "will ensure that the correct
segregation of databases and systems occurs through appropriate security
"Effectively, there will be compliance, legislative and regulatory
drivers to ensure these two processes are both logically and physically
Healthcare identifiers were intended to minimise the risk of
mis-identification arising in e-health record systems, she said. Changes
of address, or the correction of errors, would need to be managed
through service operator channels.
Meanwhile, a spokesman for Human Services Minister, Chris Bowen,
confirmed the government does not have a Medicare smartcard project for
consumers under way.
"The Medicare card is an administrative token used to help administer
Medicare and its related programs, such as the Pharmaceutical Benefits
Scheme," he said. "The (present) card does this job efficiently and
effectively, and there is no requirement to convert the card into a
The spokesman said Medicare was doing the UHI work under contract, and
had no responsibility for decisions on design or formats.
"These decisions will ultimately by made by the various health ministers
guided by the broader work being done by NEHTA," he said.
A smartcard was only "one of many possible options for holding the UHI",
and the present work was intended "to keep those many these options
open", he said.
The NEHTA spokeswoman denied there had been delays due to decisions yet
to be made on key questions of storage arrangements for IHIs and access
mechanisms, and said the project would be ready on time, provided
consultations on policy issues, governance arrangements and new
supporting legislation were concluded promptly.
"By December, Medicare will have completed the capability to allocate
and manage the healthcare provider identifiers, and once the necessary
legislative framework is in place, operations can commence," she said.
"The identifiers will then be available from mid-2010, following
introduction of the necessary legislation."
Eventually, around 500,000 healthcare providers will have their e-health
transactions authenticated through the NASH, up from 50,000 using
Medicare's service today.
The AHMC announced in March that continuing consultation on identifiers
and privacy protections would occur later this year with consumer groups
and other stakeholders.
"A consultation process is currently being finalised," she said. "It is
expected this process may identify new issues related to UHIs, and these
will be addressed."
The spokeswoman said NEHTA would release a third, independent, Privacy
Impact Assessment report on the UHI scheme when it was completed;
neither of the two previous PIAs have been made public.
brd at iimetro.com.au
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