This seems to be something of a perpetual emotion machine. First Karen Dearne runs yet another shock, horror yarn in The Australian in which the usual headline-seekers make sensational comments like [Geoffrey Sayer] “the health identifiers system may sit idle for years” because it lacks key components, and that “patients’ lives would be lost due to delays in getting the system into GPs’ hands” and [Vince McCauley] there are “serious concerns about the reliability of the identifier service”, encouraging Karen to declare in print that ,”The $90 million Health Identifier system intended to help save patients’ lives is sitting idle as key components do not exist. And there are no plans in place to make the service available where it is most needed – in GPs’ offices.”
Anyone who knows anything at all about the system would be aware that both those claims are complete balderdash.
But over on his I Hate NEHTA blog, David More gets out his own egg-beater, and under the laborious heading “It Does Not Seem To Be Going Very well. NEHTA’s HI Service Seems To Be Stalled and May Not Be Safe” declares “What is new here is that direct from the ‘horse’s mouth’ we are hearing of a serious fracture between the Medical Software Industry and NEHTA. No doubt there will be all sorts of denial and spin put on this report and I can assure you – knowing those involved – that they would not have made these comments to the Australian unless the level’s [SIC] of unhappiness were pretty extreme.”
I’ve just had an unsolicited comment from a discussion of the article by some independent ehealth experts not associated with NEHTA or the MSIA: “Geoff’s ‘debacle’ line is not justified based on what Vince says. All of his comments could be refuted or minimised. Conclusion: another hysterical, unhelpful Dearne beat up.”
But something David More wrote has me wondering just what the agenda is. The way he put it was,”Nicely in time to throw a tiny spanner in the Gillard Election Plans we have [The Australian's story].” Is that the real intention? Is it part of some weird attempt to wring something out of the government at a sensitive time? If so, it sounds misguided to me.
{ 11 comments… read them below or add one }
The intention is that Health Identifiers are to make a real difference and is a population wide initiative that will under pin the eHealth agenda – yet a best guess it that we will be years away from levels of 95% plus coverage and use of HI in all health communication exchanges – the level we will need to get the desired benefits that will reduce the negative consequences of miss-identification. For those familiar with population health the desired coverage levels of HIs in exchanges is like the concept of herd immunity in vaccine use.
Charles as a learned Journalist (you seem to have the pedigree) you would know that things in quotations are supposed to be direct quotations. You would also know that many journalists, reporters and editors tend to add to the text to make the quotations tell the story. You will note that debarcle is not in quotes. To be fair though for the report in the Australian I will stand by my quotes in quotation marks in the story.
While you have a perchance to the use of unnamed sources – but reliable one’s you assure us – who know the real story – I only have my experiences to go by; I use evidence and facts; I use my name; I don’t rely on unnamed MSIA spokes people; I have spoken publicly; I invite criticism of the arguments in these forums; and I have sat in many NEHTA engagement sessions, read documents and made submissions.
Maybe I have missed something but the following describes the current status for the HI Service:
1. The HI Patient identifiers have been populated in the Medicare database.
2. Patient identifiers can be accessed by telephone to Medicare – less than 100 have been requested. No B2B or Health Provider Online Services (HPOS) channels are yet available for electronic access.
3. Population of the Provider Identifiers (HPI-I) has been delayed due to delays at APRA – it is now likely that this data will not be loaded until at least mid-August. Timeline has slipped.
4. Forms to register for a Health organisational identifier are available from the Medicare web site but no applications have been received.
5. The next release of the service is on track for September but will not include support for software vendors to be able to access the live service as negotiated by MSIA and included in the final legislation and regulations. These additional facilities are still being specified by NeHTA. Documentation for transitional arrangements is being completed by NeHTA.
6. The Medicare developer’s environment for HI has been deployed but the test cases required for Notice of Integration (NOI) testing have not yet been finalised. They will be supplied for review to MSIA “in the near future” once they have been signed off by NeHTA – this has been promised for 2 months.
7. Medicare has only recently supplied a revised copy of the Developer agreement for HI which incorporates some of the requested changes as per the principles agreed at the MSIA CEO’s forum. However, it is not able to be shared that with the vendor community until it is approved by the Medicare executive. It still does not address a number of significant issues which will require further negotiation with DoHA, so it is still some way from being a document that MSIA could recommend anyone signing. However, due to the delays, we will be discussing with Medicare possible interim arrangements for access to the HI developer environment.
8. The operating agreement between Medicare and NeHTA has not yet been signed.
9. NeHTA have completed a safety evaluation of the HI service but it will not be released – so we can’t be sure what safety issues are identified and what will be dealt with.
10. NeHTA hope to have a conformance/compliance/accreditation plan for HI available by end of November. It is a plan not a working CCA.
11. NeHTA hope to have meetings with relevant primary care stakeholders sometime in the next 6 weeks to discuss starting to prepare a sector HI implementation plan. They have not yet contacted the relevant stakeholders.
12. The National Authentication Service for Health (NASH) has not yet been approved by the NeHTA Board and Medicare certificates will be used to access the service in the Developer environment. This may require issue of new PKI certificates depending on the functions being implemented.
So in response to your commentary:
“Anyone who knows anything at all about the system would be aware that both those claims are complete balderdash.”
Not sure who is spinning the crap Charles – but then I am not sponsored for my commentary – a cheap shot I know – on par with your “usual headline-seekers” discrediting attempt.
Thanks Geoff
That’s all very useful.
While acknowledging predictions are almost invariably wrong, is it likely that next year we will see medical practitioners sending data tagged with a HI?
David
“Anyone who knows anything at all about the system would be aware that both those claims are complete balderdash.”
So are you going to substantiate this claim in light of the material presented by the MSIA or should we just assume you are a one-eyed hypocrite minus the facts?
Re David Guest question:
Let’s say we can work through the listed issues raised before Christmas this year; developer agreements sorted; CCA in place; will to do something is there; etc – that would mean a vendor can integrate the HI Service into their product.
I would not be very surprised if at least a single vendor didn’t have a go – I also would not be very surprised that some customer site/s of this vendor would implement the enhanced product.
Can this enhanced product then send data tagged with a HI for a customer site who has implemented it? I suspect it will on average.
Can the intended recipient site (who has a different clinical system on average to the sender site) handle the HI to match against HI’s they already have; or if it is a new patient, add them to their system with the HI tag attached, and confirm that it really is their HI? I suspect it won’t on average.
Under the proposed plan I would argue that there will be quite different probabilities of this occurring in relation to different sectors (e.g. hospitals, GPs, pathology, radiology, specialists, pharmacy, age care, allied etc) and the intersecting points. Furthermore, given it is multiplication of the probability of both ends (e.g. 0.30 at both ends) of the exchange – the net probability is much less (e.g. 0.30 x 0.30 = 0.09 or 9%) – until you get to much higher coverage levels.
“Anyone who knows anything at all about the system would be aware that both those claims are complete balderdash.
But over on his I Hate NEHTA blog, David More gets out his own egg-beater, and under the laborious heading “It Does Not Seem To Be Going Very well. NEHTA’s HI Service Seems To Be Stalled and May Not Be Safe” declares “What is new here is that direct from the ‘horse’s mouth’ we are hearing of a serious fracture between the Medical Software Industry and NEHTA. No doubt there will be all sorts of denial and spin put on this report and I can assure you – knowing those involved – that they would not have made these comments to the Australian unless the level’s [SIC] of unhappiness were pretty extreme.”
Charles:
I don’t hate NEHTA, I just would like some real delivery of what is promised. Also no-one pays me. I actually do this because I care what happens the the Australian Health System and the infrastructure it needs.
In the light of the recent comments on your blog are you prepared to withdraw the remarks made about Karen Dearne and myself – or do we need to let the court of public opinion expose you for what you seem to be?
At this point graceful withdrawal looks pretty good!
What you really should do is just send NEHTA’s money back and then research the issue sufficiently deeply to be able to form a serious independent view on all this.
Remember I am both a medical graduate and a PhD who has spent since 1987 in the e-Health space. I know what I am talking about, largely, do you? I know I am not anywhere near infallible but I have spent a long time giving this honest thought – and no one has paid me a cent for this work – can you grasp it might just be that as both the Boston Consulting Group and Deloittes have said – serious change at NEHTA is needed?
David.
Geoff Sayer, armchair Dave & Karen Dearne have an amazing ability to totally distort the facts to suit their own vested interests.
Geoff takes a vendor centric view of the world. Tell us President Geoff what’s your real agenda? Will you support and deliver national standards including SMD or are you really hellbent on protecting your the existing lock down messaging model?
Also tell us why you have chosen to abuse your privileged access to confidential information by publishing on line and constructing your own myopic of the world? It doesn’t inspire any confidence. Feeling a bit out of the loop Mr President? I’m not surprised. Given your behavior is there any wonder that no one with real skin in the game wants to engage with you? Think about it Mr President!
Armchair Dave is still trapped in the previous century. In case you haven’t caught up Armchair, the BSG report is 3 years old and NEHTA has actually undergone change. You clearly aren’t aware of this because you aren’t involved. When was the last time you got out amongst the people, met the players, presented at a conference, networked the room. Some time back you say, I thought so. Yesterday’s man, yesterday’s ideas. According to you the HI bill is still before the parliament waiting for the next sitting. And by the way check facts – Gill Carter departed from NEHTA a year ago and was replaced fairly soon afterwards. Missed that one also! Even your bog is outdated and dysfunctional.
Come clean armchair Dave, what’s your real agenda? Frustrated and pissed off that you’re not involved? All that expertise going to waste. What a shame! Hey Armchair a word of advise, either get involved or get out. Your credibility is at stake. You know what they say, if you can’t manage a blog……
As for Karen D well the less said the better. Low level negative journalism on the back half of the lowest circulation daily paper. I place more credence in my local paper. According to Karen no one ever does anything right. Nothing is ever delivered on time. Everyone’s on the gravy train. It’s all one big junket. Every Dearne story is the same, same, same. Well Karen, I’m sorry to say no Walkleys for you.
So I’m wondering who should be apologising for distorting the agenda – those that support national e-health infrastructure development or those that choose to oppose and criticise at every turn?
Thank heavens we at least have informed and balanced alternative perspectives provided by people like Brendon Wickham.
With the division network about to be recast, it’s not surprising division folks are vocally supporting NEHTA…after all if you get moved on from the divisions, who other than NEHTA would hire you?
Hello “The ewatcher”
What I surprise you construe the President of MSIA displaying a vendor centric view of the world. It is a vendor organization. However, if you actually examine the arguments re the HI Service you would see that it is a population health view of the world. Let’s make it easy to understand – patient health, safety and quality. HI identifiers will work when we have them tag to our healthcare information and more importantly when information and is able to be consumed. We have argued that unless we get to a critical level that are not going to deliver the levels of benefits that were used to get the legislation up in the first place. So yes it is myopic – it is about HIs – and yes this will only work if all vendors are involved.
Re release of confidential information – the information was not confidential. If you were a member of the MSIA that information was shared a couple of weeks ago as part of our clearing house role.
Now regarding your dig at me and my employer – different topic to the one being discussed – but in the spirit of the rights of individuals to use pseudonym HIs in healthcare I will respond. HealthLink has taken part in the SMD process to date putting technical expertise on the table. We have invested considerable staff time and money to date with no return. But that is a business decision we have taken. We have looked at changing our technology and the pros and cons of that through the Connectathon process. No we weren’t ticked off but out of the list of vendors who signed up to PIP Working Group we are not alone. HealthLink has also argued from day one that interconnecting is not interoperability. We have also argued that CCA is critical to ensure it all works. We have also said that procurement processes will drive the uptake. Those procurement processes are starting with the release of the NT WSMA v2 tender. So if we don’t change and all the procurement forces align with SMD then we will be in trouble but that is what a free market is about. Given SMD is a competitive landscape and plenty of competitors want HealthLink’s skin in the game – isn’t that good for the market place and ultimately the end user?
Hello ewatcher.
Until you tell us your name, allegiances, agenda and who pays you you are just another propaganda pusher.
Sorry it is just gutless to yell and scream abuse at people but then to hide behind anonymity. Your facts are also wrong!
David.
NO! Your facts are wrong!
David,
One might also point out that it is poor form to invoke ones credentials or experience to bully over an opposing argument. It is more constructive to answer each disputed point with a clear rebuttal.
I think the negative commentary is unhelpful, unjustified and getting in the way of progress. The ehealth efforts need criticism that’s constructive, like Media Watch, not destructive, like a roughhousing session of parliament Question Time.
Ok, sure, the last decade or two have raised our hopes with many promises that end up being scattered to the wind. But Australia is not alone. All other countries that have made the effort have a similar record of failures. Besides, there has been, slow, progress (even HealthConnect delivered some benefits).
Health informatics is a relatively young discipline. And it is still an emerging one, still finding its feet. This is partly because it is multi-disciplinary. The knowledge and perspective of the sociologist is just as important, perhaps more so, than the computer scientist. No single person can claim to be an expert on all aspects of health informatics. Therefore, we should have collaboration between different knowledge bases, and welcome differing viewpoints, regardless of where they come from, as long as they are sincere.
It’s rather like the early days of science. The philosophical societies were collections of passionate individuals who met to debate (vigourously) and share ideas. In those days many were so-called amateurs, and many of the great scientific discoveries would not have happened without their input.
Perhaps the field of health informatics is rather like those days. The nature of the beast, the hugely complex and varied problems, can only be tackled effectively by encompassing different perspectives and experiences.
Most importantly, its time we roll up our shirt sleeves and start working together. We have a Strategy to follow. Let’s stop trying to make out that those tasked with implementing it are incompetent. They’re not, it’s just that the challenges are so big.
Cheers,
Brendon