[LINK] Unable to Register for a e-Health Record

[Bernard Robertson-Dunn]

On 10/02/2013 12:47 PM, Jan Whitaker wrote:
> At 12:15 PM 10/02/2013, Kim Holburn wrote:
>
>> I was trying to get some information from medicare a few months ago
>> and they told me I now had to create an Australian Government login
>> which I did because I couldn't get the information without it but I
>> really don't like the idea of having one single login for all
>> government departments.
> nope, I can understand that. It's a 'national ID' by default.
>
> The security is managed OK from my understanding of how it was to be
> handled,

Security is always touted as being an issue and the government claims 
that it is being adequately managed. However, security is not the core 
issue.

I've been thinking a lot about problems and solutions lately and have 
come to a number of conclusions.

The first is that IT is just a solution, what really matters is the 
problem. When governments talk about implementing things like the PCEHR, 
it would be really nice if they explained what problem they are solving 
(hint, it's an information problem, not a technology problem). They 
haven't done so far, other than spouting motherhood.

The second is that every solution will create new problems and in some 
cases change the original problem. In the case of the PCEHR they are 
making access to people's health information very much easier. The new 
problem is how to control that access. In the case of the PCEHR, the 
claim is that the citizen can control who accesses their eHealth record. 
Unfortunately, what they have implemented can't do that. For a start all 
they can control is who logs in to the system and what records they 
access. They can't control who looks at the screen, or who talks to who
about what they find out - in spite of legislation.

And what is worse is that health information that was scattered all 
around the place is now in one place and under the control of the 
government. Nowhere in any of the system specs have I seen does it say 
how the citizen can prevent the government from accessing their health 
information. The so-called audit logs only show which health 
professionals have viewed the record. AFAIK, the system help desk and 
the system operator (in this case DoHA - the government) can see 
anything unaudited.

So the situation, as seen by the citizen, is having their health 
information in many places and maybe it's difficult to see all of it. Is 
that a problem? Probably not much of a problem for the citizen, not if 
they go to one doctor. Maybe if there is an emergency. But the new 
situation, of having everybody's health information in a central 
location, certainly solves some big government problems, only a few of 
which relate to improving health outcomes.

If they really did want to improve health outcomes, they wouldn't have 
gone for a system that is designed to capture everybody's data. (I know 
it's opt-in - but it's designed as a national system). They would have 
gone for a system that addressed the needs of those people who would 
benefit from an eHealth record. I just wonder who they are and how they 
would benefit. Those who have serious health problems are probably 
closely engaged with a range of health professionals. Health people 
don't need a health record. That just leaves those people who are 
suddenly becoming in need of health care. Not a lot at any one time 
probably.

With thh PCEHR, the government will be able to see things they couldn't 
previously get at. The government will be able to match more data across 
departments (Tax, Centrelink, Education). Health data is probably more 
pervasive than these other data sources. The government will see good 
longitudinal data on individual patients. They will see data on healthy 
people. All freely accessible & without the patient's knowledge. The 
main beneficiaries being (as Roger pointed out) bureaucracy, research 
and insurance. Only very few patients. $1billion and counting is a lot 
of money to spend on only a few. And it's not as though it is a vote 
winning strategy. Something doesn't make sense.

The single government login, as Jan points out, is a virtual ID system. 
Not that they need it. They can achieve exactly the same result through 
data matching. We saw what Google knows about internet users, the 
government has far more identifiers available to it. Government IT, as a 
solution, has created new problems - unfortunately, they are problems 
for citizens, but the citizens are not aware of the problems or their 
consequences.

What is troubling is that I have no idea what the government is actually 
trying to do. Their defence of the PCEHR is so shambolic that it is 
difficult to work out if it is incompetence or a conspiracy.

I do hope some decent questions get put to the government next week at 
Senate Estimates, although, given DoHA's disrespectful and arrogant 
track record in answering previous questions, I won't be holding my breath.

I'll stop ranting now, it's not good for my health and I wouldn't want 
to be fronting up to a public hospital real soon now. (I hope I'm only 
joking)

-- 

Regards
brd

Bernard Robertson-Dunn
Sydney Australia
email: brd at iimetro.com.au
web:   www.drbrd.com
web:   www.problemsfirst.com
Blog:  www.problemsfirst.com/blog