[LINK] Building the Australian National Health Network

Steven Clark steven.clark at internode.on.net
Sun Mar 14 13:29:27 AEDT 2010


On 14/03/2010 11:21 AM, Jan Whitaker wrote:
> At 10:55 AM 14/03/2010, Tom Worthington wrote:
>
>   
>> Not quite. NEHTA seems to be more like the Communications Alliance
>> <http://www.commsalliance.com.au/>, in that it is creating standards by
>> consensus between the parties involved. NEHTA does not appear to have
>> the authority, nor then multi-billion dollar budget needed to 
>> implement a national system.take aprt
>>     
> They are private company owned by COAG, not an industry alliance. 
> They have a mulitmillion dollar budget to set the foundation as you 
> say. The government hasn't approved the next stages for EHRs, as 
> Nehta keeps telling us as they and government press for their 
> legislative changes.
>
> I do NOT want health funding dependent upon participating in EHRs or 
> such a network at all. It is NOT the primary purpose of health 
> services. Such a network or information is a single element of a 
> complex system of healthcare delivery. Medical services have been 
> delivered since the beginning of the country without such a network in place.
>   

Indeed. Such a requirement would stall the whole thing at implementation ...

Concerns about ownership of records, (self-)censorship of notes,
availability when parts of the system fail, cost of implementation and
maintenance at the health care delivery end ...

> BTW, there already is incentive funding for electronic upgrades of 
> practices and hospitals already. Can't recall the program, but it's 
> there and has been for a few years. According to recent testimony, 
> 98% of practices are computerised now. Some say 100%.
>   

My local GP has five computers in his practice: and he's a sole
practitioner. If he were in legal practice, he'd probably get away with
2-3 machines (and a similar reduction in support staff.)

The computer is a boon for bureaucrats. And most of what I've seen of
this, and other, systems proposed and put in place by governments, it's
about making the bureaucrats job easier, not the end users. Health care
providers hardly need *more* burdens put on their capacity to deliver -
and not just in hospitals.

>> The NHN could provide open source software and a hosted systems, for 
>> those who wanted to use them, as well as standard interfaces. The 
>> minimum a doctor, or hospital, would need to use the system would be 
>> a smart phone with a web browser. They would not need any special 
>> software or hardware. The system would also provide online training, from simple introductory materials, all the way up to accredited vocational and tertiary courses.
>>     
> And this is not a good idea either from a security standpoint and for 
> standards requirements. Above is a very simplistic perspective of an 
> extremely complex problem that those of us who have been studying it 
> for many many years consistently point out.

The privacy issues are legion as well - not only are individual patient
records involved, but health practitioner's as well. The chilling effect
on note-making when they *might* be read by a third party should not be
underestimated. What you commit to a record is very different if you
think someone else might read it: not only do you write them
differently, but *what* you write and *how* your write it changes as well.

The capacity for professional notes to be a learning mechanism, for
example, is huge - but only if a practitioner is free to write notes
*for* themselves. If someone is looking over your shoulder, you will be
far less speculative, far less self-critical.

>  The practice systems aren't 'just a web browser' nor should they be. They are medical record-keeping systems, prescription systems, referral systems, and based on health informatics standards for doing that. It is a 
> specialised field, with defined messaging security and format for 
> information exchange. Just having an agreed vocabulary is a 
> challenge, let alone the range of data formats.
>   

Oy vey.

> I'll leave it there. I don't have time to go through this design 
> debate for the umpteenth time.
>   

As Prof Graham Greenleaf has recently commented, this proposed system
looks a whole lot like the shelved identity card systems - a system for
collecting together information about individuals as much as it might be
one for improving the accessibility and availability of healthcare records.

-- 
Steven R Clark, BSc(Hons) LLB/LP(Hons) /Flinders/, MACS, Barrister and
Solicitor
PhD Candidate, School of Commerce, City West Campus, University of South
Australia
/Finding a Balance between Privacy and National Security in Australia's
ePassport System/
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