Both the Medical Software Industry Association (MSIA) and the Australian Privacy Foundation have criticised the private corporation established by the federal and state governments to roll out the federal government's proposed electronic health records. They have told a Senate inquiry hearing in Canberra that personally-controlled e-health records should not go live on July 1 as planned.
According to MSIA president Jon Hughes the industry has lost confidence in the ability of the National eHealth Transition Authority (NEHTA) to deliver the program. “There is evidence of a lack of probity, ineffective governance and an inability to deliver targeted programs… The program risks falling into disuse from the very first day of live operation,” he said.
They argue that the federal health department has not provided the support needed to maintain the e-health records in the longer-term. It wants a pared-back system to be delivered from July 1 this year with a second-stage release to follow in mid-2013 when more functions have been finalized.
Vincent McCauley, MSIA's national e-health implementation coordinator, told the community affairs legislation committee that NEHTA had become a “toxic workplace” with rumours of bullying and morale at an all time low. A number of senior managers had lost their jobs over the last six months in “extraordinary circumstances”, Dr McCauley told the inquiry. “There are concerns about the competence of the NEHTA personnel. The people in charge of the rollout of the IT implementations have no experience in either IT or health.”
The medical software industry is so concerned it wants a Senate committee to subpoena all NEHTA patient safety assessments. “There needs to be a formal inquiry into why things have gone so badly wrong,” Mr Hughes said, adding the corporation should be replaced, restructured or supplemented with an industry-led taskforce.
Mr Hughes said from July 1 medical documents should simply be uploaded to e-health records as scanned PDF rather than being reformatted because that relies on “a high degree of standardization” which doesn't yet exist. Different computer systems is hospitals, pharmacies and GP clinics weren't yet using the same language, although that was a “laudable goal”, he said.
Dr McCauley told the committee if data was reformatted as envisaged it could create havoc when it came to listing medications on e-health records because the so-called Australian medicine terminology still had serious issues. “That medication list (on records) is going to become a major ‘mish-mash’ of sources of information from different people in different places describing the medication using different names and it's going to be extremely confusing.”
The Australian Privacy Foundation chair Roger Clarke says NEHTA and the health department have excluded consumer and privacy advocates from any meaningful consultation. He said a “super bureaucrat” had been put in charge of the entire undertaking and the governance arrangements were therefore “entirely inappropriate”. “We do not believe there should be a commencement of operation with the current governance arrangements,” Dr Clarke told the committee hearing.
Dr Vince McCauley raised concerns around the accuracy of the IHI or the individual health identifier due to the instance in which they can change under certain circumstances, and the further affects it will then have on the PCEHR. In a senate hearing into the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, NEHTA chief executive, Peter Fleming, admitted there were occasional instances which produced duplicate identifiers. “Very occasionally, there is the instance of having two numbers,” Fleming said. “Medicare has a process for identifying that, rectifying it with the individual involved and I stress that is only caused by an occasional manual error. There is a small possibility that something may be keyed in incorrectly. But Medicare, the IHI system operator, have very advanced processes to identify that, and rectify it,” he said.
The National eHealth Transition Authority and the federal health department will give evidence at the hearing later on Monday. Every Australian has already been assigned a 16-digit identification number but they won't automatically get an e-health record when the system starts on July 1, the government says. They would have to opt to participate.
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