Tuesday, June 19, 2012

E-health records shambles about to befall us

The British experience of a similar scheme should be a warning.  The Brits have spent many years and billions of pounds on a similar scheme and still have not got it working properly.  And the British habit of "losing" masses of people's data is unlikely to be much different here.  Anybody with medical records that might embarrass them should avoid this thing like the plague.  I am going to register, however, just to see how it all goes.  I like a laugh

The national electronic health record database to be launched on July 1 has both medical and security experts calling for better e-health controls.

Australia has no co-ordinated approach to e-health safety and security – and with the national Personally Controlled Electronic Health Record (PCEHR) just weeks away, the risk of a safety crisis is growing daily.

People who choose to register for a PCEHR from July 1 will have access to a range of their medical data from Medicare, and over time also doctor's summaries, pathology results, scans and prescriptions.

"I would rest more comfortably if DOHA [the Department of Health and Ageing] was more pragmatic about the risks involved in accessing personal health records," says Graham Ingram, who heads the information security emergency response centre AusCERT.

"At the moment DOHA is saying, don't worry, the transactions are secure. They are not highlighting the risks that are associated with accessing your information over the internet from a compromised machine."

Ingram wants DOHA to "drop the blanket assurance" that the PCEHR records are safe and says that the risk of identity theft is high, adding DOHA can't guarantee the security of records accessed on a private machine or through an internet café, for example.

A very public security breach occurred last month when DOHA's eHealth education website was defaced by a team of hackers known as 'LatinHackTeam' on May 17.

The hack involved a defacement to publiclearning.ehealth.gov.au. Defacements are the digital equivalent to a protest graffiti. In this case it included a homepage change with text celebrating it.

The changes were quickly removed from the DOHA site. A copy of the hack was documented on the Zone H defacements website.

IT security consultant Chris Gatford of HackLabs said the hack showed a critical security process, that should have blocked access to external editing of the site, wasn't followed.

Gatford said vulnerabilities could include a coding error, a software patch not applied or having no process to detect security vulnerabilities – all standard basic security processes that should be integral to such a major project.

Professor Enrico Coeira is the co-author of a paper published in the Medical Journal of Australia in April which calls for better clinical safety governance for e-health.

His collaborators on the paper include Dr Mukesh Haikerwal who heads Clinical Leadership, Engagement and Clinical Safety at the National E-health Transition Authority (NEHTA), which is spearheading the implementation of the PCEHR.

The writers call for the establishment of an independent, national, expert-based body to oversee e-health clinical safety governance, with the capacity "to investigate, analyse and act upon significant risks in the system."

The wide range of clinical software in existence throughout the health system is unregulated and unmonitored and the authors cite studies in e-health safety in Australia showing evidence of "past harms and future risks".

"It's important not to confuse safety and security," says Coeira.

"E-health security is about stopping people inadvertently or deliberately having access to information they are not supposed to, whereas safety is about whether a person can be harmed because information is wrong, or not delivered, or delivered to the wrong person."

Coeria says safety and security issues stretch beyond the issue over the vulnerability of the PCEHR records.

"E-health in the form of clinical software is being used everywhere right now – by every GP, every pharmacist, and every hospital – and it is entirely unregulated," Coeira says.

He says that without strong standards in place, something as simple as a flawed clinical software update could change the medication information in the clinical health records of a number of patients, unintentionally risking widespread harm.

"We know from research in other countries, that things can go wrong and patients can get hurt. We are not saying the PCEHR is unsafe. We are saying, we don't have any idea. And there is no national approach to governing how it is done, monitoring what goes on, and recording and responding to any problems."


HIV positive dentist claims Dental Board of Queensland 'contravened his human rights' by preventing him from conducting 'exposure prone dental' work

A human right to infect people with AIDS?  This is an offensive politically correct absurdity

A DENTIST who is HIV positive claims the Dental Board of Queensland has "contravened his human rights" by preventing him from conducting "exposure prone dental" work.

The Queensland Civil and Administrative Tribunal, in a just published four page written decision, has given the green light to the dentist, know only as "M", to take action against the Board under the Anti-Discrimination Act 1991.

QCAT senior member Clare Endicott said she was satisfied M be given an opportunity to establish if his complaint was a "contravention of his human rights."

"M is a dentist who is HIV positive," she said.  "The Dental Board of Queensland has directed M not undertake exposure prone dental procedures in accordance with one of its policies.  "M contends that the application of that policy contravenes (the Act) and as a result constitutes unlawful discrimination.

"This case involves very grave matters with implications that could have wider consequences than those immediately affecting the parties."

QCAT has already ruled the conduct of the Board in this case did not constitute "unlawful indirect discrimination", but has yet to decide if it was "unlawful direct discrimination."

The Board had submitted the application by M was "vexatious, misconceived, lacking in substance and an abuse of process."

Ms Endicott said the Board conceded it had discriminated against M, but submitted it was exempt from consequences under sections of the Act.

She said M opposed the Board's application to bring an early end to proceedings, saying he wanted to adduce evidence to refute the reliance of the Board's "statutory defences".

"Both M and the Dental Board should have the opportunity to have their arguments about this complaint considered by the tribunal," Ms Endicott said.

"The implications (of this matter) have a bearing on how the instrumentalities of the State, including the respondent Board as well as this tribunal, conduct themselves when dealing with the rights of individuals."

"I am satisfied that M must be provided with the opportunity to have a just determination of his complaint which alleges a contravention of his human rights."

On March 12, Ms Endicott refused an application by the board to bring an early end to the proceedings.


Coal hard light of day for dud Green/Left scheme

Kevin Rudd's decision to spend hundreds of millions of dollars on technology to capture and store carbon has failed to deliver.

They've conferenced in empire-style Parisian ballrooms and dined in Kyoto on food cooked by a genuine Iron Chef. But deeply disgruntled former staffers believe Australia's $300 million Global Carbon Capture and Storage Institute has not achieved very much.

In 2008 the then prime minister Kevin Rudd decided a fledgling technology called carbon capture and storage was the key to two of his government's big aims: joining a successful international fight to reduce global warming and continuing to be the world's largest exporter of coal.

In his grandiloquent style, he promised $400 million to a new not-for-profit company, the Global Carbon Capture and Storage Institute, which would get CCS up and running at home and also "lead the world".

The funding was pared back over time, but industry and government sources and former staff of the institute are frustrated that much of the $300 million spent on the institute has been "squandered".

Even the man appointed to haul it away from government hand-outs and into the world of commercial reality - Brad Page, the former head of the peak electricity industry body - concedes the original $100 million a year "seed funding" given to the institute was more that it knew how to spend.

"It's actually impossible to spend that amount of money responsibly," he tells The Sun-Herald.

But his predecessors tried, in lavish ways that raised the ire of senior bureaucrats and ministers. Since 2009, more than $235 million has been delivered to the institute, $122 million of it already spent and another $113 million in its bank account, beyond the reach of Treasury's razor, information provided at a Senate estimates hearing reveals.

Treasury managed to claw back more than $80 million of the promised $400 million before it was handed over. Only about $80 million remains to be paid over the next five years.

The institute has 78 staff, including nine permanent employees overseas - two in Washington, three in Tokyo and four in Paris. Former senior employees say its first chief executive, the British businessman Nick Otter, was paid well over $500,000 a year - more than the Prime Minister.

Page insists he has "no idea" what his predecessor was paid and his own salary is "nothing like that". The institute's five board members are paid from a budget of $400,000 a year and are entitled to first-class air travel.

The first members' meeting was in Canberra, where the institute is based, in early 2009. But its second, in November 2009, attended by more than 15 Australia-based staff, was in the luxurious ballroom of the InterContinental Hotel in Paris, opposite the Paris Opera and decorated in similar ornate style.

Both industry sources and former staff concede the jaw-dropping opulence sent "all the wrong messages" to the 180 members who attended.

"The spending was very difficult to justify," said one former employee.

And it did not end in Paris. In 2010 when they met in Kyoto, they enjoyed a dinner cooked by a celebrity Iron Chef ( the institute says his services were thrown in for no extra charge by the hotel).

Documents released under freedom of information show a staggering $54,257,000 was spent on "operational expenses" in the first two years.

The spending began before the institute even existed. Rudd - who decided at a G8 meeting in Japan in 2008 that the success of CCS was vital to Australia's interest - set it up on advice from Boston Consulting, rather than the public service, at a cost of $1.5 million. By September 2008, he summoned business leaders to Canberra for a 30-minute presentation unveiling his plan.

Many were nonplussed, unsure about its aims or how it would be different from the CO2 co-operative research centre set up under the Howard government ( with almost $50 million in federal funds), Dick Wells's National Low Emissions Coal Council ($400 million in federal funding) or another international body set up by the US, the Carbon Sequestration Leadership Forum.

"I still have no real idea how it will work or what it will do," one chief executive said at the time.

But the public service was already doling out $65 million to future institute "partners", including $21 million to the Asian Development Bank, almost $20 million to the International Energy Agency, $10 million to the Clinton Foundation headed by the former US president, and a grant to a body called the Climate Group to "advance" CCS. The Sun-Herald understands there is deep concern about what Australia is achieving from these contracts.

The institute was soon seeking global members and now boasts more than 300, including foreign governments, corporations, industry organisations and research bodies. There was no reason not to sign up. There is no joining fee.

In July 2009, the grand idea was paraded on the international stage, its reannouncement the key initiative at the G8 summit in L'Aquila, Italy. It was a heady moment for the Australian prime minister, who shared the podium with the US President, Barack Obama, the leaders of the developed world listening behind him.

At the time, Australia's $400 million was termed "seed funding" with hundreds of millions from other governments also anticipated. But it took years for the US government to come good with $1 million and the European Union has only this year contributed €3 million ($3.8 million) for the institute to take over work it had previously contracted elsewhere.

Its advisory panel included the world's best and brightest, among them former World Bank boss James Wolfensohn and influential climate economist Sir Nicholas Stern. Wolfensohn has since left.

Despite all its money, it took the institute some time to clarify exactly what it would do to meet its ambitious brief. At its inception, a spokesman for Rudd said the institute would not "actually fund demonstration projects overseas" but would "provide expertise … and research".

However, in its first report to the Minister for Resources, Martin Ferguson, revealed under freedom-of-information laws, the institute said it was planning to "make approximately $50 million per annum available to support a substantial portfolio of CCS projects around the world".

And in a letter to Ferguson in February 2010, institute chairman Russell Higgins wrote proudly that the initial offer to support international projects received an "extremely encouraging" response. The institute had received requests from overseas projects asking for a total of $500 million of Australia's money. So far, the institute has spent $37 million on projects, mostly overseas. Several have failed. Only about $6 million has been spent on projects in Australia.

A total of $8 million was spent on a single CCS plant proposed by the energy company Tenaska, in Texas. In a recent report, Tenaska conceded it was still unable to bridge a "financing gap" required before the project could proceed because the US government had not provided any assistance. Internationally, the only CCS projects working on power plants are where the injected carbon dioxide serves an additional revenue-raising purpose - helping to recover more oil deposits from underground.

"They thought they could purchase an acceleration of projects overseas, but it was clear from the start that even though we had a lot of money, doing that would cost a lot more money than we had," the former employee says.

Peter Cook, the former head of the research centre CO2CRC and a professorial fellow at the University of Melbourne, says Australia should have used its money to make sure at least one domestic carbon capture and storage project was built to prove to investors that the technology worked at commercial scale.

"Some of the other countries must think we are wonderfully generous, but I believe we could be getting a lot more bang for our buck," he said.

Page says the institute's function is now "knowledge sharing" - to make sure each new project around the world does not repeat the mistakes of the last. He says the money was initially paid to overseas projects to begin building up the institute's publicly available "knowledge bank", but from now on it will commission specific research and will no longer fund projects on the ground.

As the government funding runs out, Page's job over the next two years "is to develop a strategy for the future … where our services are attractive enough to be paid for by our customers." It will almost inevitably involve fewer staff and pared back operations.

But the main knowledge being "shared" is that, like all low-emission technologies, CCS is more expensive than coal, and therefore (unless it can make a revenue stream through enhanced oil recovery) it requires upfront capital assistance from governments, and ongoing subsidies while a carbon price remains low.

The institute itself came to this conclusion after its first global "audit", released in October 2009 and Page concedes this remains the reason for slow progress on CCS around the world.


Is the easy ride finally over for Qld bureaucrats?

PREMIER Campbell Newman has given his strongest indication yet of the number of jobs that will be shed from the public service to save money.  Responding to a question from Opposition Leader Annastacia Palaszczuk in Parliament today, Campbell Newman said Labor had employed 20,000 more public servants than the State could afford.

"Labor was paying those 20,000 by borrowing, by incurring debt," said Mr Newman.  "We're going to fight as hard as we can to save those jobs (but) we've got a terrible job ahead of us to get the State's finances back on track."

His revelation comes after threats of strike action by public service union Together Queensland, in response to the government's new pay offer to core public servants of a 2.2 per cent rise and a freeze on promotions.

Together secretary Alex Scott said the "outrageous offer" was the lowest the Newman Government had made to public servants since taking office on March 24.

Just days after the sobering Commission of Audit report, the State's 60,000 public servants have been offered 2.2 per cent annual pay rises and the prospect of no extra cash for promotion in the next three years.

The offer also removes from the public service award "any provisions impeding managerial prerogative", a move the union says will "abolish consultation in the workforce and silence workers".

Alex Scott from Together Queensland, which represents more than 38,000 public servants, said it was an "outrageous offer" that would leave most workers financially worse off.

If an agreement cannot be reached, the public servants can take the matter to the Queensland Industrial Relations Commission, which last year granted police a substantially higher rise than they were originally offered.

But the Newman Government has legislated to try to prevent that happening again, requiring the independent umpire to take into account the State's financial position in wage cases.

The law changes have prompted criticism of the Government from unions, which claim the amendments water down the commission's independence.

Although public servants cannot take industrial action until the current agreement ends on July 31, Mr Scott said it was an avenue they would explore.  "We're working through the mechanisms and clearly the feedback from our members is that they're insulted by this offer," he said.

"It seems to be designed to inflame the public sector and makes a mockery of Campbell Newman's assurances prior to the election, that the public service had nothing to fear from an LNP government."

Mr Scott said it was clear the timing of the offer, just days after the Costello Commission of Audit report, was intended to "scare workers into accepting".  "Nurses got 3 per cent, teachers have been offered 2.7 per cent, medical officers 2.5 per cent and now public servants 2.2 per cent," Mr Scott said. "They're using the Commission of Audit report to try to bully and intimidate workers."

The report found the public sector had grown to represent 4.5 per cent of the population in June last year, compared with 4.1 per cent in June 2000.

"If the size of the public sector had remained at the same per cent of the population, employee numbers would be around 18,500 lower and expenses around $1.5 billion lower," the report noted.

Minister assisting the Premier Glen Elmes said based on the report's findings, it was clear everyone had a part to play in tightening the belt.


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