Monday, 16 May 2016

Weekly Australian Health IT Links – 16th May, 2016.

Weekly Australian Health IT Links – 16th May, 2016.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

A very quiet week indeed with possibly the biggest news being the formal announcement of the ADHA start date and the WA budget finding a little funding for e-Health in a very tough Budget.
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Cash-strapped WA govt finds $60m for e-health

Revenue drop devastates in the west.

By Paris Cowan
May 13 2016 6:31AM
The WA government has managed to scrape together roughly $60 million for e-health projects and another $13.7 million to upgrade its licensing and registration database in a budget described as the toughest the state has ever seen.
The state government has seen its revenue fall 22 percent since 2014-15 due to the drop in commodity prices coupled with reductions in GST income.
It is facing a debt balance close to $40 billion and no prospect of a return to surplus until 2019-20.
But it has still managed to gather together some modest funding for its struggling IT functions.
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Australian health sector an easy target for cyber criminals, says IBM

A push to encourage greater adoption of electronic health records has raised the spectre of online record theft

According to IBM’s 2016 Cyber Security Intelligence Index, there has been a clear shift recently in online targets, essentially away from credit cards and toward health-related data.
IBM has worked with small suburban medical and dental centres in Australia, which have become a particular target for ransomware.
Glen Gooding, an executive from IBM’s Security Services (ANZ), said health records were “an important way to extract money by taking on the persona of someone else”.
He added health-focused organisations were often an easier target than financial sector businesses, many of which have implemented more robust information protection systems.
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Online pharmacy “safe list” needed

Charlotte Mitchell
Monday, 9 May, 2016
WITH only a minority of online pharmacies considered legitimate, experts are now debating how to address the growing problem of substandard and counterfeit medications.
Dr Conor Hensey from the Department of General Medicine at the Royal Children’s Hospital in Melbourne told MJA InSight that Australia must set up a safe list of online pharmacies to help protect consumers from the dangers of counterfeit drugs.
“This way, consumers would have easy, reliable access to a list of authorised websites and be able to refer to this resource prior to purchasing medications online.”
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Online pharmacies: Australia needs ‘safe list’

Substandard and counterfeit medicines, and online pharmacies which aren’t legitimate, are a serious and growing problem, say experts.

Australia needs to set up a “safe list” of online pharmacies in a bid to protect consumers from potentially dangerous medicines, says Dr Conor Hensey from the Department of General Medicines at the Royal Children’s Hospital in Melbourne, in MJA InSight.
Dr Hensey says that this would allow consumers easy, reliable access to a list of authorised online pharmacies, which they could refer to before buying medicines online.
Dr Hensey co-authored a report published this week in the MJA, examining the Australian perspective on counterfeit drugs.
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Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Transfer Day Notice 2016

I, Sussan Ley, Minister for Health, specify that, under subsection 73(1) of the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016 (the Rule), the day to be the transfer day for the purposes of Part 11 of the Rule is 1 July 2016.
Dated   5 May    2016
SUSSAN LEY
Health Minister
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Vic govt's new strategy hopes to end IT project woes

Will it be enough?

By Paris Cowan
May 12 2016 12:32PM
The Victorian government is hoping a transparent IT projects dashboard, a technology education program for executives, and an army of independent auditors will protect it from future embarrassing and expensive technology catastrophes.
Special Minister for State Gavin Jennings today unveiled the Victorian Labor government’s first whole-of-government IT strategy, focused on open data, shared solutions and rebuilding the state’s internal technology skills.
Implicit in the plan is an infamous track record of IT failures in a particularly disaster-prone public service.
Most recently, former officials of the Department of Education have been dragged to the state’s corruption watchdog over serious allegations of mismanagement and conflicts of interest behind the $180 million Ultranet schools intranet scheme.
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GuildCare announces new Telehealth Module

Pharmacy Telemedicine has arrived: in a joint initiative by the Pharmacy Guild of Australia and Telstra Health, pharmacy customers can now access a GP conveniently from their local community pharmacy.

ReadyCare is a purpose-built telemedicine service where pharmacy customers can talk to a doctor in Australia by phone or video 24/7.
ReadyCare is not about a pharmacy competing with local GP services – it is about community pharmacies facilitating access to a quality telemedicine service at times and in areas where a patient’s access to local GP services are limited or not available.
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Report suspected fraud, misconduct or non-compliance

Fraud against government programmes and business disadvantages Australians who rely on the effective and efficient delivery of services.
Page last updated: 28 January 2016
The Australian Government Department of Health is committed to preventing the occurrence of fraud in all areas of business administered by the Department. A robust fraud control environment supports the aim of the Department in creating better health and wellbeing for all Australians.
The following section provides information on raising concerns with the Department about our programmes, with links to the appropriate resources for submitting your tip-off information.
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News in brief

Monday, 9 May, 2016
The role of the doctor as an expensive problem-solver may become redundant in the future, according to health experts commenting in the New Zealand Medical Journal. The authors believe that over the coming years, artificial intelligence (AI) will diagnose most health problems and even decide what treatment the patient should have. The health experts say that humans would continue to be an important part of health care delivery, but in many situations they would only be trained to fill the gaps where artificial intelligence is less capable. “Human doctors make errors simply because they are human, with an estimated 400 000 deaths associated with preventable harm in the US per year,” the authors wrote. “Furthermore, the relentless growth of first world health care demands in an economically-constrained environment necessitates a new solution. Therefore, for a safe, sustainable health care system, we need to look beyond human potential towards innovative solutions such as AI. Initially, this will involve using task-specific AI as adjuncts to improve human performance, with the role of the doctor remaining largely unchanged. However, in the longer term, AI should consistently outperform doctors in most cognitive tasks. Humans will still be an important part of health care delivery, but in many situations less expensive, fit-for-purpose clinicians will assume this role, leaving the majority of doctors without employment in the role that they were trained to undertake.”
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Latest technology news across the sector

In this wrap:
  • NSW Government announces eHealth strategy
  • South Australia’s Clevertar begins diabetes trials in the US
  • Australian startup CliniCloud partners with American telehealth provider

NSW Government announces eHealth strategy

At last week’s CeBIT Australia conference NSW Minister for Health Jillian Skinner announced the state’s eHealth strategy for the next decade.
The strategy will see a digitally enabled and integrated health system, with a focus on delivering patient-centred health experiences with quality health outcomes, and builds on the government’s existing blueprint.
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A go-to app for kidney disease

9 May 2016
CKD-Go! was created by Dr Priyanka Sagar and Dr Angus Ritchie of Concord Repatri­ation General Hospital, Sydney, and draws information from the handbook Chronic Kidney Disease Management in General Practice, produced by Kidney Health Australia. 
Opening the app, the user sees a home menu offering a ‘CKD calculator’ or ‘more information’. The calculator allows development of a personalised action plan based on a patient’s eGFR and urine albumin:creatinine ratio. Entering these details stratifies risk and includes prompts for absolute cardiac risk calculation, lifestyle modification, blood pressure monitoring, etc. 
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MEDIA RELEASE
For immediate release

Red Cross releases new app to protect its life-saving emblems

A new phone app has been released to help protect the life-saving red cross emblem from illegal use.
“Red Cross is releasing The Emblem App on World Red Cross Red Crescent Day to remind people that a red cross on a white background means ‘don’t shoot’ in war and armed conflicts. It shows that impartial help is available for anyone who needs it,” said Judy Slatyer, CEO of Australian Red Cross.
“This app gives the Australian community the ability to safeguard the red cross emblem by reporting misuse. Every time the red cross is misused, even by mistake, its real meaning is diluted and this can cost lives.
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Making sense of consent and health records in the digital age

May 8, 2016
There are few more potent touchstones for the public than the protection of their privacy, and this is especially true with our health records. Within these documents lies information that may affect your loved ones, your social standing, employability, and the way insurance companies rate your risk.
We now live in a world where our medical records are digitised. In many nations that information is also moving away from the clinician who captured the record to regional repositories, or even government run national repositories.
The more widely accessible our records are the more likely it is that someone who needs to care for us can access them – which is good. It is also more likely that the information will might seen by individuals whom we do not know, and for purposes we would not agree with – which is the bad side of the story.
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Claims budget cuts undermine effectiveness of Privacy Commissioner

Savage funding cuts to the Office of the Australian Information Commissioner (OAIC) have undermined the ability for the Privacy Commissioner do his job effectively, according to the Australian Privacy Foundation (APF).
The APF warns that the “long delays” in the handling of privacy complaints, and the large backlog of unresolved matters, have earned the OAIC a poor reputation – “and now it will get worse”.
Under the Federal Government’s Budget announced on Tuesday, the APF says funding for the OAIC had been slashed and “resources that should be spent on privacy will now be burnt on FOI matters”.
As the APF points out, the cuts in the OAIC’s budget come despite the fact that when the OAIC was created in 2010, it was given less funding than had been originally indicated.
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Privacy concerns in the healthcare sector

Australia May 4 2016
The past few years have seen multiple “privacy insurance” policies come on to the Australian market, with policies tailored to the needs of both SMEs and large corporates. The healthcare sector is at particular risk of privacy breaches and resultant regulatory action and claims, but it is not clear that this has led to an increased uptake of privacy insurance policies in the sector.
Insureds operating in the health sector tend to hold highly-sensitive personal information. They are also subject to onerous regulation.
Their employees, however, fear that their privacy protections are not up to the task. A 2010 US benchmark study on patient privacy and data security by Ponemon Institute found the three key causes for privacy breaches were:
  • Unintentional employee action;
  • Lost or stolen computing devices; and
  • Third-party errors.
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GPs to take their privacy medicine

Australia’s family doctors are to improve their privacy practices following an assessment by the Office of the Australian Information Commissioner (OAIC) that found that many practices could be improved.
According to Acting Australian Information Commissioner, Timothy Pilgrim, the nation’s peak medical groups have lined up to support OAIC in improving the privacy practices in general practitioner (GP) clinics.
Mr Pilgrim said he appreciated that many GP practices were small to medium-sized businesses and so practical, industry-relevant support was an effective way to improve privacy outcomes for practices and patients.
“I welcome the fact that the Australian Medical Association (AMA), the Royal Australian College of General Practitioners (RACGP), the Australian College of Rural and Remote Medicine and the Australian Association of Practice Management have come together with the OAIC to provide practical support to their members to deliver open and transparent privacy policy.
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Here's how to stop Google seeing your private medical history

May 4, 2016, 7:22 PM
Last week, New Scientist reported that the NHS has given Google access to approximately 1.6 million patient records in order to help the internet giant develop an app to monitor possible kidney failure.
The data includes the names and medical histories of every patient who has stayed in Royal Free, Barnet and Chase Farm hospitals in London overnight or attended A&E in the last five years.
If you’re one of those people and you’re not comfortable with Google having access to your patient records then by law you have the option to opt out.
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Enjoy!
David.
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This Might Be A Wild Guess But I Suspect ADHA Has An Interim CEO.

This Might Be A Wild Guess But I Suspect ADHA Has An Interim CEO.

From this it rather looks like Mr Richard Royle is in place until 30/11/2016.

Australian Digital Health Agency 




The Australian Digital Health Agency is part of the Health portfolio, and functions in an executive management capacity. 
 
The Australian Digital Health Agency (the Agency) is governed by a skills-based Board which will be responsible for deciding the Agency’s objectives, policies and strategies, and for ensuring the proper and efficient performance of the Agency’s functions. The Agency is the single accountable organisation for national digital health systems in Australia.
Location: 
ACT
Email: 

Current board appointments


Position
Appointee
Gender
Start date
End date
Chairperson
Mr James Birch
Male
20/04/2016
20/04/2019
Member
Mr Robert Bransby
Male
20/04/2016
20/04/2019
Member
Prof Johanna Westbrook
Female
20/04/2016
20/04/2019
Member
Mr Michael Walsh
Male
20/04/2016
20/04/2017
Member
Dr Bennie Ng
Female
20/04/2016
20/04/2019
Member
Ms Stephanie Newell
Female
20/04/2016
20/04/2019
Member
Mr Stephen Moo
Male
20/04/2016
20/04/2017
Member
Ms Lyn McGrath
Female
20/04/2016
20/04/2019
Member
Mr Paul Madden
Male
20/04/2016
20/04/2019
Member
Dr Elizabeth Deveny
Female
20/04/2016
20/04/2019
Member
Dr Eleanor Chew
Female
20/04/2016
20/04/2019
CEO/Executive Director/Managing Director
Mr Richard Royle
Male
04/05/2016
30/11/2016
Here is the link:
The dates for the apparent CEO role seem to run from just before the Caretaker Convention took hold and runs for about six months. I wonder what Mr Moo and Mr Walsh did to only get one year appointments?
Looks like they (the Board) struggled to find a full-time CEO. Maybe no one really wanted to take it on with the smell of death around the myHR?
Any other clever explanatory  ideas welcome!
David.
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Sunday, 15 May 2016

New Jersey Confidential: the Almost Secret Membership of the RWJ Barnabas Health Board

New Jersey Confidential: the Almost Secret Membership of the RWJ Barnabas Health Board

A Hospital System Tries to Hide its Board of Trustees

The US Internal Revenue Service mandates disclosure of the membership of boards of trustees of non-profit corporations.  Nonetheless, as reported by New Brunswick (NJ) Today, the leadership of the newly formed RWJ Barnabas Health system has been doing their best to keep the membership of its board of trustees secret.

The new organization created to function as the state's largest hospital chain is refusing to tell the public who serves on their Board of Trustees,...

To elaborate,

The two hospital networks officially combined to form a new conglomerate, the state's second largest employer, in a deal that was finalized on March 31.

But since then, the new group has refused to identify its board members, after stalling for nearly two weeks.

'Thank you very much for your interest. It is a policy at RWJBarnabas Health not to share the names of the Board of Trustees" read a peculiar April 12 email response from an anonymous address affiliated with Barnabas, B4@barnabashealth.org.

The anonymous email address has not responded to follow up inquiries from this newspaper, including one urging them to make the 'smart choice' and 'be transparent.'

This goes against at least the spirit of the law.

'If the organization has been recognized by the IRS as tax-exempt under one of the subsections under 501(c), there are a number of documents that organizations must make available that would include board lists,' said the leader of the Center for Non-profits.

The initial application, and the three most recent annual filings, must be made available for inspection or copying by members of the public at their place of business, according to the IRS.

In general, any organization that files a Form 990... must make its three most recent Form 990's and its Form 1023 available for public inspection without charge at its principal place of business,' reads the Center's website.

'All parts of the return, schedules and attachments must be made available during regular business hours at the organization's principal office and at any regional offices having 3 or more employees.

There is an exception to the requirement if a non-profit chooses to make the documents widely available by posting them on the internet.

The anonymous email address that cited the policy of having a secret board, and the media contacts listed on the press release announcing the merger between RWJ and Barnabas, have not responded to questions about whether their healthcare organization is in compliance with the IRS rules regarding making the forms available to the public.
This obviously also is a remarkable rebuff to those in health care who advocate maximum transparency.

A Futile Attempt at Secrecy

Some good investigative reporting by New Brunswick Today penetrated the flimsy veil set up by hospital system leadership. The system chairman turns out to be one Jack Morris:

Documents provided by the NJ Department of Treasury show that controversial developer Jack Morris was made the Chairman of the RWJ Barnabas board.

Morris is a close friend and ally of former State Senate President and convicted felon John Lynch, Jr., who ruled New Brunswick as Mayor from 1978-1990, and some contend still is a key player in statewide politics.

Morris had previously served as Chairman of the Robert Wood Johnson University Hospital (RWJUH) Board of Directors. Morris is also tied to Cooper Hospital Chairman George Norcross, the state's most notorious unelected political boss.

The vice-chairman is actually Marc Benson.

another real estate mogul was named the RWJ Barnabas board's Vice Chair, according to the documents, which were filed with the State Treasurer in November 2015, nearly half a year before the merger was finalized.

Marc Berson founded the Millburn-based 'Fidelco Group' in 1981, a 'private investment owner-developer of residential, commercial, retail, and industrial properties in New York, New Jersey, Florida and Ohio,' according to a press release announcing his election as Chairman of the Barnabas Health Systems board in 2014.

As for the rest of the board, they are,

The other 18 secret board members are:

Robert L. Barchi, (Rutgers University, New Brunswick)
 James C. Salwitz, MD (Robert Wood Johnson University Hospital, New Brunswick)
Murdo Gordon (Bristol-Myers-Squibb, Princeton)
Susan Reinhard (AARP Public Policy Institute, Washington, DC)
Nicholas J. Valerani (West Health Institute, La Jolla, CA)
John A. Hoffman (Wilentz, Goldman, & Spitzer, Woodbridge)
Alan E. Davis, Greenbaum (Rowe, Smith & Davis LLP)
Robert E. Margulies, Esq. (Margulies Wind, Jersey City)
Kenneth A. Rosen (Lowenstein Sandler PC, Roseland)
 Lester J. Owens (J.P. Morgan Chase, New York, NY)
James Vaccaro (Manasquan Savings Bank, Wall)
Albert R. Gamper, Jr. (Caliber Home Loans, Inc., Far Hills)
Anne Evans-Estabrook (Elberon Development Corporation)
Gary Lotano (Lotano Development, Inc., Toms River)
Steve B. Kalafer (Flemington Car and Truck Country, Flemington)
Brian P. Leddy (former Chairman of RWJUH Rahway, Cranford)
Joseph Mauriello (formerly of KPMG, Chester)
Richard J. Kogan (formerly of Schering-Plough Products, Inc., Short Hills)
Why the Futile Effort to Make Board Membership Secret?

It is certainly striking that a big non-profit hospital system would try to conceal the membership of its board of trustees.  One might think the leadership should be proud of the board members, and the board members would be happy to advertise their community service.

This did not seem to be the case here.  Once more we see how the new overlords of health care reflexively seem to choose secrecy over transparency, deliberately creating the anechoic effect which we have frequently discussed.

Perhaps the board wanted to avoid undue attention to the political connections of its new chairman, one of which  was to a"convicted felon," and another of which was to Mr Norcross, whose apparent conflicts of interest in his role in the governance of a former UMDNJ hospital were discussed here. Parenthetically, an article in NJ.com on the merger noted that this new hospital system is a descendant of the now dissolved University of Medicine and Dentistry of New Jersey, UMDNJ (look here), an organization whose extensive troubles kept Health Care Renewal very busy in past years.

Perusing the list of the members of the board reveals two people with pharmaceutical connections that could be conflicts of interest, a few people with health care affiliations, but no obvious affinity for the patients and public in New Jersey whom the new hospital system is supposed to serve, and many lawyers and business people with no obvious affinity for the values of health care professionals.

However, as summarized by the National Council for Nonprofits,

the board of directors have three primary legal duties known as the 'duty of care,' 'duty of loyalty,' and 'duty of obedience.'

...

In sum, these legal duties require that nonprofit board members:

Take care of the nonprofit by ensuring prudent use of all assets, including facility, people, and good will; and provide oversight for all activities that advance the nonprofit’s effectiveness and sustainability. (legal 'Duty of due care')

Make decisions in the best interest of the nonprofit corporation; not in his or her self-interest. (legal Duty of loyalty')

Ensure that the nonprofit obeys applicable laws and acts in accordance with ethical practices; that the nonprofit adheres to its stated corporate purposes, and that its activities advance its mission. (legal 'Duty of obedience')

So it is not obvious that these board members are particularly familiar with the nuances of the mission of a large academic hospital system, which includes delivering excellent patient care that puts individual patients first, particularly ahead of board members' self interest, and of its academic role, seeking and disseminating the truth.  One wonders what sort of governance this sort of board will provide.  Maybe the hospital leadership wanted to forestall such questions by keeping board membership as obscure as possible.

Speaking of the anechoic effect, while the new RWJ Barnabas Health system will be a very major player in NJ health care, and while trying to keep the board members of a non-profit health care system is rather a remarkable action, so far, only one local newspaper, and now your humble blogger seem interested.  This is yet another example of the anechoic effect.

Comments

We have been writing now for a long time about the tremendous and growing dysfunction of US health care.  Some now obvious reasons for its problems are poor leadership of ever larger and more powerful health care organizations, and failure of existing governance bidues to exercise stewardship over these organizations.  We have discussed numerous previous problems with boards of trustees of non-profit health care organizations here.  We have noted that board member may have conflicts of interest, and are often rich business executives who may be more interested in preserving the power and wealth of their fellow executives, including those generic managers who know often run large health care organizations, than defending vulnerable patients.  These problems are compounded by the anechoic effect: information and opinions which might offend those currently in power and who stand to benefit most from the current system is kept very quiet, treated as a taboo subject, that is, made to have no echoes.  This new case again suggests that these problems are not going away.

How many times must we say this?....   True US health care reform would vastly increase transparency, not just of prices, but of leadership and governance.  True US health care reform would put the operation of US health care organizations more in the hands of people who have knowledge and experience in health care, and are willing to be transparent and accountable to support health care professionals' values.  Furthermore, oversight and stewardship of these organizations should represent the patients and public which the organizations are supposed to serve. 


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Enrico Coiera Discusses The Consent Models In The Era Of Digital Health Records.

Enrico Coiera Discusses The Consent Models In The Era Of Digital Health Records.

This appeared as a blog last week:

Making sense of consent and health records in the digital age

May 8, 2016
There are few more potent touchstones for the public than the protection of their privacy, and this is especially true with our health records. Within these documents lies information that may affect your loved ones, your social standing, employability, and the way insurance companies rate your risk.
We now live in a world where our medical records are digitised. In many nations that information is also moving away from the clinician who captured the record to regional repositories, or even government run national repositories.
The more widely accessible our records are the more likely it is that someone who needs to care for us can access them – which is good. It is also more likely that the information will might seen by individuals whom we do not know, and for purposes we would not agree with – which is the bad side of the story.
It appears that there is no easy way to balance privacy with access – any record system represents a series of compromises in design and operation that leave the privacy wishes of some unmet, and the clinical needs of others ignored.
Core to this trade-off is the choice of consent model. Patients typically need to provide their consent for their health records to be seen by others, and this legal obligation continues in the digital world.
Patient consent for others to access their digital clinical records, or e-consent, can take a number of forms. Back 2004, working with colleagues who had expertise in privacy and security, we first described the continuum of choices between patients opting in or out of consent to view their health records, as well as the trade-offs that were associated with either choice [1].
Three broad approaches to e-consent are employed.
  1. “Opt Out” systems; in which a population is informed that unless individuals request otherwise, their records will be made available to be shared.
  2. “Opt in” systems; in which patients are asked to confirm that they are happy for their records to be made available when clinicians wish to view them.
  3. Hybrid consent models that combine an implied consent for records to be made available and an explicit consent to view.
Opt in models assume that only those who specifically give consent will allow their health records to be visible to others, and opt out models assume that record accessibility is the default, and will only be removed if a patient actively opts-out of the process. The opt-out models maximises ease of access to, and benefit from, electronic records for clinical decision making, at the possible expense of patient privacy protections. Opt-in models have the reverse benefit, maximising consumer choice and privacy, but at the possible expense of record availability and usefulness in support of making decisions (Figure 1).
There is much more to be read here:
The last two paragraphs seems to cover a lot of ground. To quote:
“So, whilst we need to be clear about the risks opt in versus opt out, we should also recognise that it is only half of the debate. It is the mechanism of governance around the consent model that counts at least as much.
For consumer advocates, “winning the war” to go opt-in is actually just the first part of the battle. Indeed, it might even be the wrong battle to be fighting. It might be even more important to ensure that there is stringent governance around record access, and that it is very clear who is reading a record, and why.”
In reading the article I think the thing that is missing is the recognition of the importance of individual attitudes and history in all this and in the debate about what consent model is appropriate.
Many individuals have widely divergent life stories and these stories and their life experience can have a major impact on their comfort with a consent model and their preferences.
Individuals also vary greatly in their attitudes to disclosure of, and trust with, their personal information with some adopting a highly disclosive approach and others the reverse - often related to their individual experiences and illnesses.
Taken overall, and recognising the critical importance of governance and technical security, I think it unlikely agreement is ever likely to be reached unless we can properly response in the individual’s level of trust, personality and the risk of discrimination, shaming and embarrassment should their information be disclosed.
Given the importance of the proper protection of information the individual wants to keep to themselves, we need to develop systems that meet these needs.
David.
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AusHealthIT Poll Number 320  – Results – 15th May, 2016.

AusHealthIT Poll Number 320 – Results – 15th May, 2016.

Here are the results of the poll.

How Satisfied Are You With The Recent Federal Budget As Far As Health Funding Is Concerned?

Very Satisfied 1% (1)

Neutral 25% (29)

Not Satisfied At All 63% (72)

I Have No Idea 11% (13)

Total votes: 115

Pretty clear outcome and a vote of no-confidence in the Budget as far as health is concerned.

Great turnout of votes as well!

Again, many, many thanks to all those that voted!

David.
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