s NEHTA E-Health ID - Looking Like a Big Mess So Far. | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2009         Volume. 1 No. 2   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July edition of i2P, and of course, the first week of the new financial year.

Note that we are developing a new range of categories for you to follow e.g. health politics, hospital news, an expanded IT offer and we will be developing the category of anti-ageing medicine

Also, out of interest, could I refer you to the e-publications category located immediately below our columnists. If you click on the link contained there, you will find a range of e-publications that are recommended reading.

The first publication noted is the Pharmacist Activist written by Dr Daniel A. Hussar of the faculty of the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He is a pharmacy advocate.

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Recent Comments

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I’ve seen the future…….and I’m not happy, Jan!

Chris Wright

The ubiquitous Mrs Wright, in her quest to unearth a new erotic shopping experience, ushered this writer to a new Coles store located at the all very nice and leafy suburb of Ivanhoe in Melbourne recently.
This is contemporary retailing at its best, no doubt influenced by the gurus at Westfarmers and the rapidly changing retail climate in Australia, which of course involves the future of Pharmacy in some way….but more about Pharmacy later.

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Pharmacists losing their mojo

Neil Retallick

I read some market research recently that ought to concern community pharmacists across the country, as well as the Pharmacy Guild of Australia.
Groups of average Australians were brought together for a series of focus groups to discuss the community pharmacy landscape as they see it.
Some of the feedback was disconcerting.

Comments: 3

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Has the horse bolted?

Ken Stafford

Some twenty years ago uneasy tremors were running through hospital pharmacy here in Perth. Hospital management had suggested to one of my fellow Chief Pharmacists that the hospital needed a total parenteral and intravenous additive service (IVAS) .
When it was pointed out that this would be very labour intensive and the pharmacy did not have sufficient staff to provide it, the comment was that “nurses would be happy to run such a service”.

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Independent Pharmacist Practitioners

James Ellerson

In the region where I practice, GP’s are reluctant to comply with a patient request for a Home Medication Review.
The stock standard phrase is “I can do that for you” and so in frustration a patient will turn to me, in a professional, or quite commonly in a social setting, and asks if it is possible for me to perform a review without the doctor’s involvement.

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Disgraceful – discuss

Pat Gallagher

Disgraceful – discuss
The newspapers have been chock-a-block the past few days with dire tales but true about the black hole we are about to enter with the insane policy to re-regulate the ‘workplace’ to suit the union paymaster cliques.
While I never voted for Keating I did admire him a little bit this morning when I read a quote of his from the bad old days.
He said to some union goose: “you are carrying the jobs of (100,000) dead men around your shoulders”.
Giving a dead hand to this union unfettered power play will ensure that the nation will soon look like NSW; where the government is actually the plaything of a few loosely combined public ‘service’ union mugs.
Depending on how large your pharmacy is, in terms of overall staffing, you will soon be touched by the coming dead hand of the new/old order.

Comments: 3

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UK Dispensing Errors Under Review

Staff Writer

The recent furore in the UK over pharmacist Elizabeth Lee receiving a conviction for a criminal offence and subsequently a suspended jail sentence, has really lit a fire under the imbalances that exist when a pharmacy dispensing error is made.
The dispensing pharmacist or the supervising pharmacist under current UK legislation, has been made to bear the brunt of legal responsibility, with pharmacy owners escaping with little pain.
According to an article in PJ Online "In many cases, all that the employer needs to establish is that he had standard operating procedures in place and that the employee or locum had simply not complied with them. In these cases, the employer can walk away leaving the employee or locum to face the, often damaging, consequences".
There is now a rush in the UK to have current legislation amended to reflect a more proportionate responsibility for all parties involved.

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A New Ministery - Indigenous, Rural and Regional Health

Staff Writer

The appointment for the first time of a Minister for Indigenous, Rural and Regional Health and Regional Service Delivery is an important strategic recognition of the special needs and circumstances facing people in Australia's rural and remote communities.
People in the bush will expect this position to be part of a permanent increase in the Government's commitment to rural communities.
In welcoming Minister Warren Snowdon to the new position, Dr Jenny May, Chairperson of the National Rural Health Alliance (NRHA), said the appointment will be important both for substantive policy reasons and to boost the place of rural issues on the political agenda.

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NZ fish killed by water quality

Staff Writer

The following news item was recently published in Science Alert. It would seem that the pristine environment of New Zealand is under attack. The reasons are similar to those findings in Australia surrounding the protection of the Great Barrier Reef.

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New theory for global diabetes epidemic

Staff Writer

A new "fertility first" hypothesis published this week by a group of international experts in the American Journal of Human Biology, proposes that the global epidemic of Type 2 diabetes has its origins in the struggle, over millennia, to sustain human fertility in environments defined by famine.
A surprising and important implication for us in the modern world is that this hypothesis gives cause for optimism that the modern epidemics of diabetes and cardiovascular disease will diminish.
Source: Sydney University

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Immune system key discovered

Staff Writer

A team of Monash University researchers has discovered the importance of a protein, which could improve the way the drug interferon is used to strengthen the human immune system.
Published online in the prestigious journal Immunity, the findings show that the protein promyelocytic leukemia zinc finger (PLZF) is a key player in the body's immune response to disease, increasing our understanding of the function of the immune system.(Source: Science Alert )

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Political suspicions raised as China cracks down on bogus online health info

Staff Writer

China is notable for its authoritarian approach to the Internet and other forms of media communications.
Restrictions on Internet activity may have some long-term implications for Australia, particularly as these restrictions are intruding into the health arena.
Source: Tech.Blorge

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Senior Pharmacists - A Valuable Resource

Staff Writer

Little thought seems to have occurred in maintaining and supporting mature aged pharmacists in the workplace.
Given that this group of pharmacists is the one with the "corporate memory" of the profession, with many having started life as compounding pharmacists and counter-prescribers, there is a wealth of untapped intellectual resource that could be internally utilised in mentoring or even training pharmacists in how to sell a professional service.
This group of pharmacists is concerned with the development of retail clinics proposing to do almost exactly what they were successfully doing 30-40 years ago.
What went wrong?

Well, there is plenty of evidence to illustrate that the process of commoditising medicines is the primary reason for this loss, because if you strip everything out of a process to sell at the cheapest possible price, you get a barren professional offering
Source: Science Alert

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Terry White Makes a Move

Staff Writer

Introduction:

It is clear that the Terry White pharmacy group is on the move with the recent purchase of Pharmacy Direct and a restructure of its own management. Terry has had a distinguished pharmacy career and his stewardship will see possibly the strongest pharmacy group in Australia emerge He is opening up the opportunity for equity for senior members of his management team.
The following excerpt extracted from pharmacy media reports explains the process.

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NEHTA E-Health ID - Looking Like a Big Mess So Far.

Dr David More

articles by this author...

From a Medical IT Perspective: I am vitally interested in making a difference to the quality and safety of Health Care in Australia through the use of information technology. There is no choice.. it has to be made to work! That is why I keep typing. Disclaimer - Please note all the commentary are personal views based on the best evidence available to me - If I have it wrong let me know!

Visit my blog http://aushealthit.blogspot.com/

This blog has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on how things are progressing in e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

NEHTA E-Health ID - Looking Like a Big Mess So Far.

NEHTA, with very considerable public funding, has now been developing the UHI service for almost 3 years, having initially been funded to undertake the work in around August 2006.

The following very interesting and carefully researched article appeared yesterday.

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Medicare the base for e-health IDs

Karen Dearne | 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 Governments

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 surveillance.

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.

Read much more detail here:

http://www.australianit.news.com.au/story/0,24897,25679209-15306,00.html

The way this whole project is being run reveals frankly an astonishing level of arrogance and failure of technical and public consultation.

NEHTA apparently believes Privacy Impact Assessments should be kept from the public. This is clearly an absurdity and deserves condemnation.

NEHTA has not even got to the stage of even the draftest of legislation which they admit will be needed. With the present government turmoil and hostile Senate what chance of legislation, which seems to be likely to be privacy invasive, getting through in other than geological time?

NEHTA apparently plans to have an operational service available at the beginning of 2010. What seems to be missing are the technical specifications that people who will use the service will need to develop to in order to use the service once it is operational. We have lots of business specifications but not much in the way of technical specifications.

See here for the presently available documents.

http://www.nehta.gov.au/connecting-australia/e-health-id

(Note in passing how most documents are nearly 2 years old!)

I wonder does NEHTA have a plan to pay software developers to interface with their service or is that another unexpected cost they plan to impose.

On the basis of what we all know about the data integrity of Medicare Identifiers who would trust this to be used to assemble and manage a clinical record. I certainly would not. The Medicare ID databases are just not ‘fit for purpose’ in this context (creating an aggregate trustworthy EHR). What is going on here is that we will very possibly wind up with a less than satisfactorily robust individual identifier and over time it will fall into disuse as it causes more misidentification and problems than it is worth.

I am sure additionally NEHTA has vastly underestimated the complexity and cost of issuance, maintenance and deletion of certificates and tokens to 500,000 health professionals. Frankly that is a huge task which is not done properly will also cause more problems than it is worth.

I also wonder who is going to pay to operate this service in the longer term and at what stage will the users be charged a fee for use to recover ‘costs’.

NEHTA needs to get the PIAs, Technical Specs and Draft Legislation out pronto so their plans can be reviewed and assessed publicly to prevent any continuing waste of money and effort. Sneaking around fobbing people off with vague details and timelines is really not good enough.

We need identifiers I believe to make patient records work optimally – but not developed in secret like this.

David.

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