E-health records risk patient safety: MSIA

The Medical Software Industry Association (MSIA) has claimed there are systemic problems with the government's e-health identifier specifications that risk patient safety and has called for an overhaul to the National E-Health Transition Authority (NEHTA).
Written by Josh Taylor, Contributor

The Medical Software Industry Association (MSIA) has claimed there are systemic problems with the government's e-health identifier specifications that risk patient safety and has called for an overhaul to the National E-Health Transition Authority (NEHTA).

Speaking before a Senate hearing today, MSIA president Dr Jon Hughes said that a fundamental flaw exists with the specification of the Health Identifiers used for e-health records, which surfaced when a person was issued with a new identifier by Medicare to, for example, correct a date of birth or changing the gender. In this case, there is no way for Medicare to inform all health organisations using the e-health record system to update their records accordingly.

"Consequently, it becomes impossible to validate that identifier against the service; both the new identifier and the old identifier will fail validation," Hughes said. "It means that any health record based on that health identifier as the key to that record will no longer be usable and hence any information within the PCEHR [personally controlled electronic health record] will disappear. That has significant consequences in patient management."

He said the specification is "inadequate, poorly designed and unsafe", and that Medicare had seen the scenario he'd described a number of times in the trial of e-health records, but had not released this information to the industry.

In order to allow time to fix this up, Hughes suggested delaying the full implementation of the e-health record system, scheduled to occur by 1 July, and instead just offer a document-sharing system to doctors.

"The current implementation program is extremely complex. A feasible solution for the first of July could simply contain images of the reports that are currently generated by various health systems."

"The doctor would read the report online, on his computer, just like he would read a fax."

There were also security issues with the software commonly used to connect different patient record systems with one another. In the organisation's written submission to the inquiry, MSIA pointed out issues with what it called "parasitic" third-party software that may be used to aggregate the data from one e-health management system to another that uses different software. The MSIA alleged that this software is open to being maliciously exploited because it often suffers from buffer overflows.

At the heart of all of the problems with the e-health roll-out, Hughes blamed mismanagement by NEHTA.

"NEHTA has become what I would classify as a toxic workplace," he said.

"The CEO of NEHTA admitted that their turnover rate for staff was 30 per cent per annum, which is extraordinary. Our information is that in the current financial year, this has climbed closer to 40 per cent."

He said there have been losses from NEHTA's management in the four crucial areas of standards, security, terminology and safety over the last six months. He claimed the standards manager came home from an overseas trip to find she no longer had a job, the national authentications services manager "was dismissed summarily" with rumours of bullying involved, the terminology manager had a similar dismissal before Christmas and the manager of clinical safety left NEHTA a few weeks ago "in a distressed state".

Hughes added that the clinical document architecture area of NEHTA had also lost three out of five technicians in the last four months.

"There have been serious concerns about how NEHTA is functioning internally," he said. "There are concerns about the competence of NEHTA personnel. The people in charge of the roll out of the IT implementations have no experience in either IT or Health."

Hughes said NEHTA could not be improved "without removing the cloak of secrecy and lack of accountability" that currently protects it from public scrutiny, as it does not fall under Freedom of Information laws that apply to other government entities.

"There needs to be a formal inquiry into why things have gone so badly. [The government must] replace, restructure or supplement NEHTA with an e-health management team that has a proven record. MSIA proposes that an industry-led taskforce could provide the capability."

As the government was expected to save billions per year when the e-health system was in place, Hughes also said that the clinicians and technology companies supporting those clinicians should receive some funding to get the system in place.

"A sustainable outcome in the long term depends on healthcare providers ... being paid a fair reasonable fee for helping to develop the nation's e-health resource and for that fee to be partially spent on the technology that makes that happen. Without that the solution will wither and die," he said.

NEHTA is also set to testify this afternoon about its efforts on the e-health records.

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