Balneus

Australian Lefty on Politics, Governance, Science and Info Management

2020 and HealthBook – Aaaaaarrrrggggghhh

Posted by Dave Bath on 2008-04-20


I’m worried!  A "Healthbook" (like Facebook, but for health data of individual Australians) is one of the big ideas mentioned in the preliminary 2020 report.

What were they smoking?!?

Personally, I’d veto such an idea until medical datasets within hospitals and government agencies are managed correctly.  AccessCard has been put on hold because near universal incompetence in agencies makes it impossible for them to manage such information properly.  This "HealthBook" is an order of magnitude more difficult.

In all of the states, and federally under both Howard and Rudd, there has been no demonstration that any politician with any clout has any understanding of information management issues, apart from an ability to give sound bites the public might like, and open chequebooks to the large consulting firms.

Before even thinking about creating a HealthBook (I can see large consultancies drooling at the mouth for a chance to write a sloppy RFI and get the contract), let’s tidy things up.

  • Computer logins within hospitals should be for individuals, rather than allowing open slather to results using username=pathology and password=results, or something similar which is pretty close to universal practice in every major hospital.  This means that any system with medical data should meet at least DSD ACSI 33 standards for information classification and protection, including password cycling.
  • Get any health-related body totally hooked up with something like COAS (Clinical Observations Access Service from the OMG Healthcare taskforce), HL7, and proper identity management, and preferably the Eclipse Open HealthCare Framework.
  • Let DSD and ANAO audit all information management systems before hooking them up.

I’m looking forward to reading deeper into who made these suggestions and what they indicated were the stumbling blocks… if such stumbling blocks were indeed recognized.  When we can get even close to implementing the appropriate technology in a network that only connects to health providers and governments, then, and only then, should we think about connecting this to the public.

I wonder how many advocates for HealthBook were opposed to AccessCard and oppose an Australian ID card?  If there are any, they are probably in favor of a larger population while banning sex.

And if we can get the infrastructure in place, a HealthBook site will be nearly superfluous, just a small add-on to the system we should have.

Yeah, I’m almost expecting the next page I look at to talk about getting Australia’s role in the world improved by solving the Middle East crisis with the assistance of the Tooth Fairy.


See Also:

  • If you want the lowdown on eHealth, how other countries do it right, and how Australian governments at all levels of all parties haven’t got a clue (except to throw big bucks to large corporations and get NOWHERE), I recommend browsing through the AusHealthIT blog, unless you’re likely to slash your wrists or pull your hair out when you see how hopeless we are.

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3 Responses to “2020 and HealthBook – Aaaaaarrrrggggghhh”

  1. danny said

    Likewise, moi, so on Sunday morning I posted on the ABC’s 2020 live resident blog…
    http://blogs.abc.net.au/events/2008/04/2020-humour.html#comments

    “Catrina….Could you please find / tell who (in the health group) is proposing setting up HealthBook
    ie a FACEBOOK for medical purposes.
    It is mentioned by ANNE KELSO (from QIMR, same as MICHAEL GOOD, topic chair, interview them together?) in the streaming video put up from yesterdays sessions. )
    How do they suggest it works?
    How could it fit in with the eHEALTH platform,which MUKESH HAIKERWAL, (same group, ex-AMA) knows about? Could it be part of implementation of the MEDICAL ASEAN Anne Kelso also mentions? Whose idea is the Medical asean thing?
    Thanks.
    Posted by: Danny | 20 April 2008 at 09:43 AM ”

    Enrico Coiera | 20 April 2008 at 04:48 PM replied “The idea for a facebook for health is something we are working on at the University of New South Wales – see http://www.unsw.edu.au/news/pad/articles/2008/jan/Social_network.html

    FRom there its a quick google to
    “$1 million dollar grant to create ‘Facebook’ for better health”
    http://www.chi.unsw.edu.au/CHIweb.nsf/page/News

    Check out “Architecture for Knowledge-Based and Federated Search of Online Clinical Evidence” from (Professor Double Dr.) Enrico et al: I’m convinced the whole HB idea didn’t just get found in a BnB fortune cookie on the weekend.

    Note the .nsf filetype of the CHI url: spawn of Lotus Notes = IBM, and indeed Big Blue gave CHI the Reference Site treatment, and worry not, eclipse is not unknown there
    (google: eclipse site:chi.unsw.edu.au), likewise hl7, snomed etc.

    So, please, read up, chase the citations, and conferences, see if it doesn’t look like the real deal, In fact, as you so rightly observe, the healthbook thing is but one aspect, …perhaps they’re actually working on “the system we should have.”?
    Cheers, danny

  2. Dave Bath said

    Danny,

    You are correct about the availability of technical solutions, but it is the governance, not the technology, that raises my objections.

    I /do/ know something about things like HL7, SNOMED, ICHI and ICD, going back as far as MUMPS back in the 80s. I blitzed pathology at uni, and have worked in biomedical computing, including management of medical records, pharmaceutical QA, computer assisted diagnosis and have a fairly good understanding of risk management, especially how it applies to information management and technology.

    I’m actually in favor of allowing patients to nominate which health professionals can view their medical records (including withdrawing consent). I’m fully aware that technical components are already available to implement such a system.

    However… the problem is the cavalier approach of managers who write the contracts to implement and maintain technical systems to manage information properly, even to the minimum standards of the PSM, and even within their own internal networks, let alone between agencies and especially across networks to the outside world (e.g. private practice and the public).

    If they cut corners any worse, our (mis)managers would be going through lamposts, fences, and only stop once they’d driven through the loungeroom.

    Apart from DSD, AGIMO and NAA, it’s almost impossible to find an Australian agency that understands what is required, and that wetware is the real stumbling block. If we were as anally retentive about process as the Nordic Nanny states, I wouldn’t have a problem.

    This week’s expose of Victoria’s work-cover authority responding to a guy who’d asked for his own records by sending the records of a number of unrelated people demonstrates my point. Centrelink and immigration departments federally, police (certainly in Victoria) have made heaps of clangers in this area too – and I’m not talking decades ago.

    It’s possible that a healthbook system could be implemented by 2020, but the real change required is in the culture of our senior mismanagers. To fix this will take a generation of managers who have been raised to love rigor – something sadly lacking in our education system from primary to post-graduate.

    At the moment, decent practitioners of the rigorous arts stay away from management, because what agency and commercial heads want in managers are yes-men prepared to compromise professional principles. I cannot see this changing in under a decade, and contracts/RFIs/RFQs shouldn’t even be developed before this is fixed.

    Consider an absolute requirement for such a system: nationwide foolproof identity management. Until such a system can be used as the basis of all legal documents in place of signatures, then there is no way we can use it for a system that provides nationwide exposure of more important and private health details.

    I’d recommend that you do as you suggest, chase citations and read the gories of reports: but in government auditor reports about information management system culture (more correctly the lack of it) in this country.

    (P.S: You mention Anne Kelso. Her dad was my mum’s O&G, and I was at school with her brothers – not a dumb family)

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