Holiday reading: Acute Care ICT & eHealth

Pulse+IT is taking a break from daily news reporting for the festive season but will return on Monday, January 5.

If you are after some holiday reading, you may like to review our 2014 Acute Care ICT & eHealth magazine online below. This and other editions of Pulse+IT are available via the ‘Magazines’ menu at the top of this site, and also via the Issuu app for iOS and Android devices.

NSW eHealth plan finalised with release of rural strategy

Improving rural eHealth has been named as one of three strategies to implement the NSW government’s new rural health plan, with an experienced IT manager appointed as director of eHealth NSW’s rural eHealth program.

The five-year rural health plan is aligned with the statewide health plan released earlier this year as well as the Blueprint for eHealth in NSW released late last year.

The blueprint led to the establishment of a dedicated eHealth NSW division within NSW Health in June this year and a recommendation to appoint a rural eHealth director within it to oversee the implementation of the rural and remote NSW eHealth part of the strategy.

The new director of the rural eHealth program is Kerri Ryan, who previously spent almost nine years with NSW Health as manager of clinical applications support. This role saw Ms Ryan responsible for service delivery of NSW Health’s statewide clinical systems, including the patient administration system, the electronic medical record, community health information systems and the HealtheNet PCEHR system.

The NSW rural health plan includes three directions – healthy rural communities, access to high quality care for rural populations and integrated rural health services – implemented through three strategies – workforce enhancement, boosting health infrastructure and research and improving rural eHealth.

In the plan, the NSW government says it is investing $48 million from currently funded programs to improve eHealth in rural health services, as laid out in the blueprint.

The rural eHealth program has been set up to coordinate the implementation of eHealth solutions into the six participating rural local health districts (LHDs): Northern NSW, Mid North Coast, Western NSW, Far West, Southern NSW and Murrumbidgee.

The LHDs have agreed to pool resources and solutions as well as funding.

The main projects include:

NSW is also developing a Hospital Pharmacy Product List to deliver a single list of pharmaceutical products with standardised descriptions and setting the foundations for the 10-year, $170 million electronic medication management program.

The NSW government is also developing a monitoring and evaluation framework to track progress in achieving the plan’s goals, which will be linked with the monitoring and evaluation of the state health plan.

The Ministerial Advisory Committee for Rural Health established last year and co-chaired by Lismore-based trauma surgeon Austin Curtin and parliamentary secretary for regional health Melinda Pavey will meet twice a year to provide advice on the implementation of the plan.

Closing the Gap dashboard to help indigenous health outcomes

The Improvement Foundation (IF) has added a new Closing the Gap dashboard to its online quality improvement portal qiConnect.

The new dashboard, combined with IF’s Closing the Gap: Measure and Act initiative, is available for free to general practice users.

The dashboard enables GPs to see at a glance how many of their patient population are recorded as identifying as Aboriginal or Torres Strait Islander as well as a range of other data relating to the patient group.

This data includes the number of Aboriginal and Torres Strait Islander patients who have had a health assessment in the last 12 months, how many have a diagnosis of diabetes recorded, and how many with diabetes have had a blood sugar result recorded in the past 12 months.

GPs can also see a comparison to the practice’s non-indigenous data, and to a national average achieved through the other practices participating in IF’s qiCommunity.

The idea is to identify where services can be improved for indigenous patients using established and reliable measures developed through IF’s Australian Primary Care Collaboratives program, which is focused on diabetes and health checks.

The dashboard supports IF’s Closing the Gap: Measure and Act initiative which is aimed at helping general practices to better respond to specific Aboriginal and Torres Strait Islander health issues.

The initiative is open to any general practice or Aboriginal community controlled health organisation.

AIIA special interest group gets set for new year

The NSW Healthcare special interest group (SIG) of the Australian Information Industry Association (AIIA) has chosen a new chair and set out its priorities for 2015.

The SIG, which among other events staged the widely reported eHealth NSW forum earlier this year, will be chaired by Berne Gibbons, managing director of Slainte Healthcare.

Former co-chairs Bruce Pedersen of The Checkley Group and Richard Hutchinson of Emerging Systems will continue to help run the SIG as events co-deputy and marketing deputy chair respectively.

Ms Gibbons will be responsible for leading the SIG and sitting on the AIIA NSW council, as well as reviewing the goals and strategies for the group.

Mr Pedersen will share the deputy chair – events responsibility with Cameron Cumming of Lexmark and will help to coordinate and organise four events for the SIG per year.

Mr Hutchinson’s role as deputy chair – marketing is to facilitate better communication for members of the SIG and increase membership awareness.

Damien Margetts of Fuji Xerox will take on the role as deputy chair – membership and will be responsible for boosting member involvement and introducing new members.

Two member representatives have also been chosen in Rob Samuel of ConsultPoint and Fiona Stuart of HP.

Singapore to link aged care to NEHR via IT enablement program

Singapore will link 36 aged care facilities to its National Electronic Health Record (NEHR) and integrated referral management system through its new $S6.5 million Nursing Home IT Enablement Program (NHELP), which uses technology from Australia’s Leecare Solutions.

Singapore’s Agency for Integrated Care (AIC) announced yesterday that the new program will allow aged care facilities to subscribe to the NHELP IT system as a service. According to the AIC, It will be connected to the NEHR and will ensure timelier flows of residents’ electronic health information between different care institutions and participating nursing homes.

The system involves Leecare’s full Platinum 5.0 suite suite, including Platinum 5.0 clinical care and lifestyle, P5 Med medication management, P5 Exec operational management and P5 finance.

It also includes programs from two of Leecare’s partners, AGHRM’s payroll solution and TimeTarget for rostering.

As Platinum 5 is web-based, aged care staff will be able to view or update their residents’ medical records from any device. It will also be able to facilitate care planning for residents based on their medical history and records, and through electronic tracking of the care plan help nursing homes achieve continuous improvement of quality care.

Leecare’s system is able to send reminder alerts to staff on ongoing tasks and care assessments to be done and will automate the submission of data to Singapore’s Ministry of Health for funding purposes.

So far, nine aged care facilities have committed to participating, with the AIC hoping to roll it out to 36 of the country’s estimated 70 nursing homes by 2017. The first facility will go live in February next year.

AIC CEO Jason Cheah said the organisation would work with participating facilities to integrate their existing processes into the IT system.

“I am confident that such an IT-based system will gain greater traction with more nursing homes progressively,” Dr Cheah said in a statement. “AIC will support the sector in the implementation of the NHELP IT system to encourage its smooth adoption.”

An IT help desk and hotline will be set up so that participating nursing homes can seek advice on using the system. The AIC is collaborating with network services and systems integrator T-Systems Singapore on the project.

Singapore’s NEHR is a provider-controlled national record that consolidates data and records of each encounter with healthcare providers. It includes a summary care record for each patient including problem lists, medications, hospital discharge and event summaries, as well as referrals and care plans.

The architecture was designed by Accenture, which also built Australia’s PCEHR.

First point of call for secure identity management

Healthdirect Australia has contracted Brisbane-based identity and access management firm First Point Global to design a secure, centralised identity management solution for its cloud-based health portal platform, which includes the National Health Services Directory (NHSD), My Aged Care and a number of information services and telephone hotlines.

The solution is currently live for a range of Healthdirect’s application programming interfaces (APIs), and will provide the identity and access management (IAM) and security foundations for the government-funded organisation’s websites and information portals as they expand and mature. Healthdirect is currently exploring options to provide cloud-based video as well as telephone consultations for its health advisory services.

The My Aged Care website recently began publishing maximum accommodation prices for aged care providers as well as a fee calculator for residential aged care.

First Point Global has recommended a mix of open source and commercial-off-the-shelf technologies for the solution, which covers access request management, password management, authentication and authorisation – including web access control and single sign-on – as well as access management for the APIs and a range of data protection and security technologies.

The company says the advantages of this approach include a better experience for users, easier compliance with legislation, consistency of policy enforcement, and the ability for users to manage their private data irrespective of where it is stored.

Healthdirect requires rigorous security standards as it provides public-facing government services such as My Aged Care as well as the NHSD, which provides public information on locations and contact details for healthcare services including GPs, community pharmacies and hospitals.

It is also being integrated with the PCEHR and the Healthcare Identifiers (HI) Service. As such, Healthdirect Australia needs to comply with the security standards mandated by the government’’s Information Security Manual (ISM) standard and the Protective Security Policy Framework (PSPF).

Part of the tender requirements were that the chosen solution provider would adopt an open source-first policy, where proven open source software can reduce costs.

““As far as possible we prefer to adopt open source first if it is viable to create as much leverage as we can out of taxpayers’’ dollars,”” Healthdirect Australia CIO Anton Donker said.

““We also prefer to engage with specialist service providers like First Point Global, rather than very large scale commercial vendors.””

The access management system for the health portal platform is focused on authentication and identity federation services. End users are given the option to authenticate using social sign-on, or via username and password to the Healthdirect Australia identity store.

A security gateway that enforces access management policy for Healthdirect’s APIs, including the NHSD, is also part of the solution, as is secure management of encryption keys for sensitive information.

Kangaroos through the windscreen: the case for rural telehealth

Rural general practices looking to get in on the telehealth boom should remember to keep the technology simple, develop relationships with specialists and use telehealth to not only improve patient care but for clinical training as well, telehealth advocate Ewen McPhee believes.

Dr McPhee, who runs the Emerald Medical Centre in central Queensland, says his practice regularly does between 10 and 15 video consultations on any one day but has not had to invest in high-tech equipment. Telehealth is a sustainable business for the practice as there is funding through the federal government’s telehealth incentives program, but the prime reason the practice offers telehealth is for better access to care for its patients.

Dr McPhee told an Australian College of Rural and Remote Medicine (ACRRM) webinar yesterday that the need for patients to travel long distances to see specialists is why telemedicine can be such an effective solution, for some but not all health-related problems.

Telehealth also offers teaching practices like his the opportunity to provide GP registrars with more advanced clinical training and the opportunity to sit in on specialist consultations. Practice nurses, nurse practitioners and allied health professionals also stand to benefit, he said.

Dr McPhee presented the webinar with his wife Wendy, who is also the practice manager. Emerald Medical Group has eight GPs on staff along with up to five GP registrars at a time, including rural generalists attached to Emerald Hospital who are based at the clinic during their rotations. Dr McPhee has visiting rights at the hospital for his obstetric patients.

The practice has been doing telemedicine in some form or another for a decade, but in the last 18 months has geared up its offering and now actively promotes it, to the point of putting a line on every specialist referral saying the practice is telehealth-enabled and would be happy to facilitate a telehealth consultation. While the practice is kept busy with GP telehealth consults, it is nurse-led consultations that are really taking off.

Dr McPhee said he advocates for telehealth because it is easy to use and can improve retention rates for rural clinicians, but also because it can reduce costs, both to the patient and the healthcare system.

“We’ve no doubt that distance creates barriers to care and this leads to poorer outcomes and increased costs,” he said. “The fact is a lot of those increased costs with the problems of accessing care for rural people are hidden and they are not measured. A lot of cost is borne by rural and remote people in accessing care that our city cousins simply don’t have to do.”

He said while there had been a lot of debate about security issues, particularly the lack of security offered by Skype –which most specialists prefer to use – these issues are dwarfed by the benefits telehealth offers.

“It only takes one kangaroo through a windscreen to really justify telemedicine, and to be honest on some of our roads, it is more likely that you’ll get a kangaroo through your windscreen than have a terrorist from Al-Qaeda listening in on your consult about your haemorrhoids.”

He is also an advocate for the benefits telehealth brings to rural practitioners themselves and in promoting rural practice.

“We have a number of general practice registrars and medical students attached to the practice, and we are actively engaged in supporting them with doing telemedicine,” he said. “There are a number of reasons for that. You can enhance rural retention through being the eyes and the ears and the hands of remote specialists. You can support and enhance clinical skills, and you can be – by beaming in your specialist or the clinician – a source of mentorship, back-up and pastoral care for very isolated clinicians.

“And for us, it has created some really close relationships between specialists and GPs, that we are enhancing the understanding of our specialist clinicians and basically giving them an understanding of the rural and remote context under which we live and work.”

The wider use of telehealth is now opening up in Queensland through measures such as the uncapping of the amount of telehealth that can be provided through rural hospitals by Queensland Health, as well as the establishment of new programs like the telemedicine emergency support unit (TEMSU) which seeks to provide a link between very isolated clinicians such as nurse practitioners in remote clinics with a regional doctor or emergency medicine physician.

“What we are seeing in central Queensland now is the ability for a regional doctor to talk with a remote nurse or a remote practitioner and manage a problem in a local context in a local facility,” he said. “[That means] no longer needing to rely on emergency medicine physicians in major metropolitan hospitals, but really developing that local context. That is a really exciting aspect of telemedicine – not only are we linking remote specialists but we are also linking clinicians together in the bush.

“We must still seek to understand its appropriateness, must seek to understand its cost effectiveness and must seek to understand its scope of clinical practice … but the fact is that I’ve been doing telehealth for probably 10 years and certainly Queensland Health has been doing it for longer than that. Clinical consultations at a distance is all it is and for our context it works very well.”

Keep it simple

Emerald Medical Group uses a range of technologies, all of them relatively inexpensive and readily available. It uses simple desktop PCs with over-the-counter cameras, and is enabled with both 4G and ADSL internet connections.

Telstra’s 4G works surprisingly well, Dr McPhee said. It was made available in Emerald in mid last year, and when Pulse+IT spoke to him at the time, he was using a 4G dongle on his MacBook Pro to access his case notes and anaesthetic notes when he was in theatre.

“Hospitals have Wi-Fi but they don’t like GPs getting onto it – it’s like they have state secrets or something – so we use the 4G dongle for that and also ward rounds,” he said.

“Basically it means you can RDP back to your surgery database, do your case notes and you’ve got the ability to send your case notes back. What I’ve been trialling lately is using the 4G iPad for RDP access back into the surgery for after hours on-call. That seems to be working reasonably well. It’s easier using iPads – you just flick them on and it’s quite easy for people to remain connected and to talk.”

That said, he is still a keen advocate for the NBN. Before the change of government, Emerald was successful in its bid to build a GP super clinic, and while funding for that has been guaranteed by the new health minister, Dr McPhee said the NBN would be critical for its operation.

The copper wire network in Emerald isn’t the greatest and the super clinic will be built out of town, so he is hoping the fibre network can still be hooked up.

In the meantime, 4G and ADSL are adequate for this practice’s telehealth needs, which includes Skype to talk to private specialists and Cisco’s Jabber to connect to clinicians in public hospitals on the Queensland Health network. Dr McPhee told the webinar that the ACRRM telehealth provider database had “tremendously enhanced” the ability to find and connect with a range of specialists.

The practice also uses store and forward to interact with Telederm, the ACRRM teledermatology service run by Brisbane-based dermatologist Jim Muir.

From a practice manager’s perspective, billing and scheduling is not as difficult as many fear, Mrs McPhee told the webinar. She said it was originally planned to enable telehealth in each doctors’ consulting room as that would be the most convenient, but that hasn’t turned out to be the case.

“What we found was that the doctor wasn’t always ready at the same time that the patient and the specialist were ready,” she said. So the practice has set up two dedicated rooms for telehealth that can also be used for other purposes when not occupied.

“At the time that the consultation is due to start, one of our nursing staff takes the patient into that room, makes sure that it is working and that everything is good to go, and then as soon as the specialist is ready, the consultation can start,” she said.

“The doctor in our practice can come in when they are available and we’ve found this works really well because the specialist is able to come on as soon as they are ready and we don’t have that whole problem of everyone running late.”

The nursing staff are very comfortable with sitting in on the consultations, but the doctors are encouraged to also sit in as it can be a learning experience for them. They can also be called upon to assist the patient in interpreting what the specialist is saying and hear the specialist’s advice for follow-up.

“We have found that a bit of nagging has been necessary to get telehealth happening at times, particularly into the Queensland Health network,” Mrs McPhee said. “We had one patient who was being asked to drive from Emerald to Rockhampton so that they could sit in on telehealth with a doctor in Brisbane.

“We thought that was silly as that’s a six-hour round trip to sit in on a conference by telehealth, so with a bit of persistent nagging, Queensland Health came on board and we ended up doing a three-way telehealth with the nurse in a clinic in Rockhampton, the specialist in Brisbane and the patient in Emerald. That worked really well and now that they have seen we can do it, it is happening more and more.”

Billing and scheduling

While Emerald Medical Group didn’t get into telehealth for the money – Mrs McPhee said it was purely for the patients and helping them get the best care possible – it has been financially rewarding through the various telehealth incentives.

Megan Keaney, an acting assistant secretary and medical adviser with the Department of Health’s medical specialist services branch, who also participated in the seminar, said that while the onboard incentives will cease on June 30, the regular telehealth MBS item would continue. She also clarified that the telehealth items would not attract the proposed $7 co-pay, should it begin as planned from July next year.

Mrs McPhee said the fact that there was funding available for both the nurses’ and the doctors’ time was important. “[The incentives] do make it easier to convince doctors to take time out of their normal consultations because they do get paid for it,” she said.

“Once they’ve done one or two they can see the advantages of it and they are actually going looking for more things that they can do by telehealth, because they get more feedback from the specialists and they feel much more part of the whole patient care than they do when the patient has to go away to see the specialist.

“Another thing that has been a major advantage for our practice is the fact that if we do telehealth there are people able to participate in the consultations that normally wouldn’t be able to for patients from a rural area.

“We are able to have school teachers come in and take part in the telehealth consultation with the paediatrician, extended family members are able to come in, and the savings in travel and time away from work all makes sense. We are very happy to keep on doing telehealth because it works really well in our practice.”

Dr McPhee said what he would like to see is telehealth normalised and made relevant to day-to-day clinical practice.

“With apologies to Forrest Gump, you need to keep it simple,” he said. “Certainly in Queensland Health there is a lot of very expensive video conferencing suites gathering dust on boardroom walls. What we need to do is deliver simple, effective means of consultation.

“We are nothing special and we are no IT experts. It’s really a matter of just doing it. For your basic face-to-face video consultation, it really works well.”

Dr McPhee said he was enthusiastic about the direction Queensland was taking with telehealth in developing a comprehensive process of joining public and private providers together.

“[And we are] starting to think about how we can support our allied health and our nursing professionals in the most rural and remote locations,” he said. “It’s a real watch this space.”

ACRRM has posted the webinar on YouTube, with discussion relating to the webinar taking place at the ACRRM eHealth website.

Hambleton confirmed as next NEHTA chair, Halton leaves DoH

Former AMA president Steve Hambleton has been confirmed as the new chairman of the National E-Health Transition Authority (NEHTA), taking over from businessman David Gonski.

As reported yesterday, Mr Gonski has stood down from the role after six years. In a statement, NEHTA said its constitution meant he was not eligible for a third three-year term.

Dr Hambleton was a member of the review panel established to inquire into the design and roll-out of the PCEHR, which recommended that NEHTA be dissolved and a new agency created in its place that reported directly to the Standing Committee on Health (SCoH), which comprises the state and federal health ministers.

NEHTA said the clinical expertise and leadership Dr Hambleton will bring to the role “will be vital in ensuring that eHealth becomes widely adopted in clinical settings across Australia”.

Long-standing Department of Health secretary Jane Halton is also leaving her position to take up the high-profile role of secretary of the Department of Finance.

“Sleepwalking into catastrophe” with myGov and the PCEHR

eHealth security experts have reacted with dismay to revelations in the Sydney Morning Herald about a basic security flaw in the myGov website that potentially opened up sensitive personal information, including health information held on the PCEHR, to malicious attacks.

myGov is a single sign-on gateway for consumers to access a number of online federal services, including Medicare, Child Support and the PCEHR, and is soon to also be used by the Australian Taxation Office to file electronic tax returns.

Last month, SMH journalist Ben Grubb wrote several stories about the potential weaknesses in the myGov website, prompting a Wollongong security researcher and entrepreneur called Nik Cubrilovic to take a closer look.

What Mr Cubrilovic found – detailed in full on his website – was a very common cross-site scripting flaw that allowed him to easily gain access to another person’s myGov account and from that to access other linked accounts. A video showing how easy it was to hack the site is available on the SMH website.

Trish Williams, an associate professor and eHealth research group leader at Edith Cowan University’s School of Computer and Security Science and chair of HL7 Australia, said cross-site scripting was a very common method that works by capturing information from cookies or other web session information.

“A cookie is just a text file and when you go to a certain website, it retains on your computer some information about what you’ve done,” Dr Williams said. “It is not necessarily your log-in details but some of the connection details. Cross-site scripting code uses known vulnerabilities in web-based applications. A cookie is just a text file so it doesn’t do anything on its own. However, cross-scripting allows malicious content to capture and use this information.”

Dr Williams said cross-site scripting was not an individually targeted method but was more an opportunistic way to potentially hack a site. The problem with it affecting single sign-on sites like myGov is that you then have access to a whole range of other sites, including the PCEHR.

“If I can get into myGov and use that, it automatically authenticates to the other sites,” she said. “That is the beauty of having single sign-on: from the user’s point of view you don’t have to remember all of your other passwords. But this vulnerability gives you access to a whole range of things.”

Mr Cubrilovic wrote on his website that the flaw now seems to have been fixed, but both Dr Williams and security expert Steve Wilson, vice-president and principal analyst at Constellation Research, say that this just shows the site wasn’t built using good security protocols in the first place.

“It is a fairly basic security issue so they probably should have done better testing, but that is an after-the-fact thing,” Dr Williams said. “They should have been more aware of the basic security issue in the first place. This is a common problem because security is seen as an add-on, whereas if it had a better quality process in development, those issues would not have been in there in the first place.”

Mr Wilson said the situation was appalling. “This is supposed to be a government single sign-on solution to accessing what are your most important and sensitive government dealings, and it is not fit for purpose,” he said.

“It shows no sign of the careful design that should go into the master key for all of your government digital assets.”

Mr Wilson said talk of patching vulnerabilities and fixing problems as they arose was not good enough.

“[A] government system like this has a risk assessment and a privacy impact assessment that goes with it, it’s got a detailed design process, there are design teams and architecture teams, and then there are reviews and then there is testing,” he said.

“There are four or five points at which this sort of thing should have been headed off at the pass, and it was not. Colossal weaknesses have got through four or five stages. We need a really deep review of the system.”

Single sign-on is often seen as a user-friendly way for average consumers to access information, and even though anecdotal evidence suggests the myGov website has proved quite difficult to people wanting to sign up to the PCEHR, most security experts believe two-factor authentication is essential to protect personal data such as healthcare information.

Mr Wilson said it is possible to find a balance between convenience and security, but serious two-factor authentication is a must. Using extra authentication like SMSs can be difficult, but he believes we are close to having passkey-type security available through mobile phones.

“Instead of messing around with SMSs we should be using digital signature capabilities on the phone, we should be using NFC (near field communication), we should be using SIM card security,” he said.

“I’m staggered. We have a single sign-on solution for government that is much weaker than what internet banking was 10 years ago. There’s no second factor in sight. I’d like to see them use SIM cards or to use smartcards. You could use NFC smartcards that you wave in front of your phone or your tablet and it is rock solid, it is world’s best practice security.”

While the Department of Human Services (DHS) issued an assurance to Mr Cubrilovic that it “takes the security of its digital services extremely seriously” and that “myGov users can be confident that their personal information and records are in very safe hands”, this has been widely derided by security experts.

Mr Wilson described the situation as bizarre, and said that while the government’s digital first policy was a good one, as was the recommendation of the Commission of Audit to make digital the first point of call for consumer dealings with the government, Australia simply does not have the infrastructure to cope. And when it comes to the most personal information, security was not being taken seriously enough.

“We are just sleepwalking into catastrophe with myGov and the PCEHR,” he said. “There is no room for error. The surprising thing about the Royle review [into the PCEHR] is how naïve it is with respect to security. You have to assume that security is imperfect and you make policy based on that, but you can’t make eHealth policy based on blind faith that the security is okay because there’s no room for error.”

Opt-out PCEHR

The recommendation in the Royle review to make the PCEHR an opt-out system, which the Consumers Health Forum, the Australian Medical Association and Health Minister Peter Dutton all strongly support, will bring security issues such as this to fore. However, Dr Williams said it didn’t matter whether the PCEHR was opt-in or opt-out – the security measures should be identical.

“When you talk about opt-out it just means they will automatically be more registrations in the first instance,” she said. “That does not mean that there will be any more usable clinical records. It does not mean that your health summary is there, nor does it guarantee its use; it just means that you have a registration.

“The delivery of the PCEHR is not necessarily the problem here. We do not actually have to change the model for that delivery but I dare say from the things that have happened and from a security perspective, they should look at having a different method of access. This is only the user access … as clinical access is through different portals, and you’d hope that the security for all of the other portals is different.”

One problem facing the industry – and one voiced off the record by many software developers working in eHealth – is that no one actually knows how secure those other portals are.

“Nothing is going to be 100 per cent secure ever,” Dr Williams said. “If you have large corporations like Google who have security issues then who are we to think everything is going to be completely secure? But you can definitely have something that’s a bit more secure than what they’re talking about at the moment.

“One problem is that they won’t tell you. I was on the original committee that looked at the risk assessments for the PCEHR; however, as soon as this engagement activity was complete, they would not tell those involved in that work what had been done or how the security is ensured.”

Dr Williams said it was possible to set up a new, more secure system for the PCEHR and that it is possible to build a population-level eHealth record that has proper security, but Mr Wilson said he would not recommend retrofitting the existing system.

He said he did not see any evidence that the PCEHR itself was robust, as shown by the cases of incorrect information that has been inadvertently added to the wrong patient’s record, such as incorrect PBS data.

“I do think you can have a population-scale health record,” he said. “They seem to be able to do that in Scandinavia, but with the Royle review, if people want to make a parental decision on behalf of the entire population that you will be in by default, they need to make it opt-out grade.

“We need proper two-factor authentication for every single access to the system and you need two-factor authentication for patients. And you need a system that doesn’t upload medication records for the wrong people. There’s much more to this than just building a portal in front of the existing PCEHR.”

The Department of Human Services has been approached for comment.

Inner-city Melbourne hooks up to health pathways

Victorian Health Minister David Davis will next week officially launch HealthPathways Melbourne, a web-based system that provides GPs with clinical guidance on specific health conditions and referral options to local heath services from one portal.

HealthPathways are an increasingly popular method being used in Australia and New Zealand to help GPs manage common conditions, to easily refer to local specialists and allied health professionals, and to link up with hospital-based services.

They have been used in the Hunter New England region since 2011 and in western Sydney for the last year. Other regions introducing similar systems include Victoria’s Barwon area and the NSW central coast.

Based on a system first developed in New Zealand’s Canterbury district and to a lesser extent the UK’s Map of Medicine, they are designed to provide GPs with condition-specific specialist advice that may assist in developing more accurate pre-referral work-ups. Each pathway contains clinical information and referral information designed for the local health system.

The establishment of HealthPathways Melbourne has been co-ordinated by Inner East Melbourne Medicare Local (IEMML) and Inner North West Melbourne Medicare Local (INWMML), with local GPs acting as clinical editors for each pathway.

Pathways have been designed for diabetes, hepatitis B, hepatitis C, fatty liver disease, coeliac disease in adults and in children, and back pain, with further work planned for this year for cardiovascular, dermatology, COPD and mental health.

According to Brunswick West GP and INWMML HealthPathways clinical editor Debra Wilson, the pathways had been developed for the local system by working with GPs, specialists and other health providers in the region, all of whom have expertise around managing a particular health condition.

“The resulting pathway condenses not only clinical guidance but also a range of detailed local information that ensures the GP can find the best service or referral point across the whole local health system,” Dr Wilson said.

“Just as importantly, HealthPathways Melbourne has been designed to allow any health professional that uses the system to provide feedback and suggestions. That means we can continually improve and update individual pathways over time.”

INWMML CEO Christopher Carter said the portal would also help GPs to link up to the 150 or so outpatient clinics in the region.

“Victoria has 86 different hospital networks with a large number of different referral points covering a range of specialist hospital departments,” Associate Professor Carter said.

“The feedback we get from hospitals and from GPs is that by reducing unnecessary referrals and ensuring the right tests and investigations are done beforehand we can cut down on delays in people getting appropriate and well-targeted specialist support.

“The pathways also include guidance information for patients so that they can be better informed about what they can do to better manage their health.”