Reported in Australian IT October 13, 2009, it appears that Australia is adopting a new ehealth national strategy. NEHTA is the Australian National eHealth Transition Authority and plays a role similar to Canada Health Infoway.
Australia is moving towards a "person controlled" electronic record - read (Personal Health Record - PHR) vs. a single national e-health record for every Australian. Necessary requirements in order to make this happen include a robust set of standards, a complete and accurate patient and provider registry (so that you can find the right doctor and associate that doctor with the right patient - a pre-requisite for the efficient sharing of information) and the ability to securely send a message between two systems or individuals. (This does not mean a secure network, as there are many other ways to transmit information securely over the regular internet using tools such as PKI - Public Key Infrastructure).
GOOGLE, Microsoft and other new providers will host Australians' electronic health records as the federal and state governments back away from funding a nationwide scheme. National E-Health Transition Authority chief executive Peter Fleming said the original vision of a single e-health record system had been abandoned in favour of "person-controlled" records that could be adopted more quickly. The Council of Australian Governments is yet to make a decision on the business case for individual e-health records put to it by NEHTA a year ago, but Mr Fleming said the health ministers were pushing the organisation to take "a far more commercial approach". Governments change direction on health e-records | Australian IT.
In an article published today in The National Post entitled 'The e-health trade-off', columnist Colby Cosh questions the role of Canada Health Infoway in terms of 'goading' Ontario to follow in the footsteps of Alberta's technological forwardness.
"What Ontarians may not have noticed is that Alberta's Auditor-General issued his annual report earlier this month, and it had a chapter on EHRs. What was the secret of relatively rapid EHR adoption out West? One answer might be "Surreal amounts of money." The Alberta A-G reported that his much less populous province has spent at least $615-million on electronic records, and that's just centralized investments; it doesn't include purchases by regional health boards. Another answer might be "Carelessness about trifling details, like patient privacy." The audit found, for example, that because of poor user-access management, 158 terminated Alberta health workers still had accounts they could theoretically use to tap into the NetCare database of medical records. Moreover, the NetCare installation in Edmonton was hit with a Trojan computer virus in May, compromising the records of up to 11,582 patients. No, being an early adopter isn't all peaches and cream."
What should we be doing in Canada with respect to the national eHealth strategy? Is the Canada Health Infoway Blueprint sufficient to achieve adoption and use of EMRs, EHRs and hospital based clinical information systems? Should the focus be on getting EMR adoption by physicians as a top priority? (as has occurred in many nations around the world) Canada is still very much a laggard in the adoption of EMRs - soon to be overtaken by the US with their huge push to get EMRs into the hands of >300,000 primary care providers.
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I think that the Infoway blueprint can support a federated architecture in which information lives in various systems including EMRs. The focus, to date, has been on a top down implementation. This approach is not, in my view, a reflection of the architecture but, rather, a strategy decision regarding priorities.
Michael Martineau
Posted by: Michael Martineau | October 14, 2009 at 06:17 AM