Public debate on the Victorian government’s plans for a health information sharing platform has restarted as the legislation from last year is reintroduced into Parliament, as we foreshadowed a couple of weeks ago. The nature of the debate is similar to last year, when the bill passed the lower house easily but became lodged in the entrails of the upper house and was unable to escape before the election was called.
It’s back now, and again sailed through the lower house before moving to debate in the upper chamber. A petition signed by 10,000 Victorians and submitted by Liberal Democrats MLC David Limbrick must be considered by law by his colleagues, and it appears highly likely that opposition members will submit amendments, including an opt-out provision and the ability for patients to find out who has been looking at their record, as detailed here by the ABC. AAP has also reported on some of the arguments against the bill, in particular the inability to opt out. Debate on the bill has since been adjourned for one week.
Meanwhile, we learned this week a little more about how the proposed system will work. The Victorian Department of Health took the first steps back in 2021 with a request for tender for a health information exchange to underpin the restructure of pathology services in Victoria. The COVID pandemic showed just how difficult it was to share pathology data across devolved services, so a tender was put out for an HIE to interface with what will be consolidated laboratory services and laboratory systems.
We missed it at the time but the tender was awarded to Altera Digital Health in a $9 million contract, which will see Altera – formerly part of Allscripts – roll out its dbMotion interoperability platform to bring those disparate systems together.
dbMotion has been widely implemented in Israel and the US, as well as Canada and the UK, and in Australia it’s used for South Western Sydney PHN’s innovative iRAD project, which lets data from general practices be shared with local hospitals, and vice versa. We must admit that when we read the tender in 2021 we expected one of the market leaders to win it – Dedalus (then DXC), Orion Health and InterSystems have very strong interoperability platforms – and we also thought Cerner and Epic would throw in their hats, as well as Telstra Health. Turns out that new players like Salesforce and Civica, both better know for their CRM capability, were having a look too.
The tender called for a commercial off the shelf solution that could be implemented reasonably quickly (and cheaply at $9m over five years), so dbMotion obviously ticked those boxes. What is interesting is that there was an obvious intention in the pathology HIE tender, the subsequent vendor briefing and from the department’s digital health roadmap to leverage the HIE for bigger purposes in future, including for the statewide health data sharing platform.
The tender required that the solution not just interface with the laboratory information systems but with all of Victoria’s PAS instances and its different EMRs. If that job is sorted for the pathology requirements, then it is well on its way to providing the foundation for the whole shebang. The question is, is dbMotion up to the job? We are certainly in no position to judge but we’d be keen to hear your thoughts. Send us an anonymous tip or comment anonymously below.
In other news, there has been a bit of action with one-off grants for general practices as part of the government’s Strengthening Medicare policy – the $220 million on offer for various purposes, including incredibly vague descriptions for digital health such as “software and hardware” – make this sound like nothing but the slush fund it will turn out to be. The very odd move by the federal Department of Health and Aged Care to nationalise the electronic prescription exchange market was also in the news, with the SMS subsidy for eScript tokens extended while the department continues its attempt to screw the electronic prescription fee down from 15c to 3c per script. Good luck with that.
There was also some interesting news on South Australia’s virtual stroke service for regional areas – we hear Queensland is also going to make some moves soon – and its home health monitoring service for rural and remote patients, which has gone 24/7. We’ll have some more on virtual services in SA and Queensland next week.
That brings us to our poll question for this week. We polled readers last year on what you thought about Victoria’s HIE plans. Readers were evenly split 55:45 in favour in early December. Here’s what you said then.
So, what are your thoughts now?
Do you think privacy concerns are being taken seriously enough in Victoria’s health information sharing bill?
Vote here and comment below.
Last week, we asked:
Are Tasmania’s statewide EMR plans on the right track? Most were happy with the plans: 71 per cent said yes, 29 per cent said no.
We also asked: if you chose no, what do you think could be done better? If yes, tell us why.
Public debate on the VIC HIE needs to balanced and consider the following facts:
1. Compared to the information being collected today during any episode of care in Victorian public hospitals, no additional information is planned to be gathered.
2. Any hospital using application services from Department of Health Digital Health branch already use a common data centre to store patient records.
3. Other states, such as WA, store patient records in a common database statewide by default. HIE is a productive step by a state department that operates in a challenging model of devolved governance. It brings Victoria up to speed with capability in or planned in other states (e.g. SDPR in NSW).
The continued, ill-informed political debate over HIE continues to hamper Victorian hospitals access to life saving data.
So, are privacy concerns being taken seriously enough in Victoria’s health information sharing bill?
Readers were pretty evenly split: 45 per cent said yes, 55 per cent said no. We also asked why you thought so. Here’s what you said.
– Make the data the property of the patient and fully controlled by the patient, NOT the institution/health service.
– Opt out and the ability to see who has viewed a person’s record
– Add an out provision – a normal digital health cost of doing business that respects human agency. The Bill is simply an underhanded way to mass billions records about people, even though nothing comes of amassing most if the data- i.e. research funding does not support projects on all health conditions, just cherry picks the ones that harness most political advantage, everything else is simply managed the way it has been managed for decades, no innovation at all.
– Make this opt in, or at least provide a simple avenue for opting out like was done with MyHealthRecord. I work in Digital Health, but no government should be able to insist that my health data be shared. With hacking at an all time high it won’t be long before scammers start targeting people with certain types of illness. For example, your record shows a cancer diagnosis. Next thing you know scammers are contacting you demanding $$$ for supposed cures! Don’t let this bill succeed!
– Forget the bill
– Opt out provision needed. Information on who has accessed information should be easily available to participants who have agreed to make their records available. Participants should be able to nominate/control who has access.
– Accessible (and requestable) audit trails. Some kind of controls around when a patient record can be accessed (eg link to hospital PAS with some kind of ‘is a current patient flag’)
– Patient ability to view their record is a good one. Otherwise, it goes on by fax now. What’s the difference?
– Allow opt-out of data sharing. Allow patient auditability of data sharing and health record interactions. Even the “clunky MHR” has been able to do this. The Medibank breach has shown that vulnerable patients should, rightfully so, be able to control their own information.