blog Hilarious news comes from the Federal Government’s flagship e-health conference in Melbourne this week, where Health Minister has revealed that part of Labor’s $466.7 million national e-health project will be spent on … an iPhone app for doctors. Quoth ZDNet:

The app is still in the development stage, but a demonstration of the app at the conference showed that doctors would be able to access a patient’s e-health record. The record could potentially contain information such as x-ray results or allergy details, depending on what the patient chose to provide.

Where do I even begin here? How about the fact that any iPhone application is ultimately only a window into the incredibly complex mishmash of technology platforms that constitutes Australia’s e-health systems — with a different set of them for every state, and sometimes even different sets within each state?

How about the fact that Roxon’s pimping of this iPhone app demonstrates incredibly naivity about the fact that it is Australia’s back-end e-health infrastructure that needs to be integrated and fixed in general, not the client architecture that the iPhone app represents? How about the fact that that iPhone app likely won’t be able to access even 10 percent of what it needs to, because of that mishmash of disparate systems?

How about the fact that the iPhone app presents potential security and privacy risks, because it will be able to be downloaded by anyone through Apple’s App Store, as the iPhone does not allow sideloading of applications? All it would take in this context is for a doctor’s credentials — or even the iPhone itself — for a patient’s privacy to be compromised.

Nicola Roxon, you are a goose. You know very little about e-health, and what you do know is plainly being fed to you by your departmental bureaucrats, who appear to be incompetent. Australia needs some serious action on e-health. You’ve proven Labor understands the need for capital injection in the sector; now let’s see you prove you know what that money should be spent on. Here’s a clue: An iPhone app is not the answer.

Image credit: Timeshift9, Creative Commons

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1. Michael H
   Posted 30/11/2010 at 5:42 pm | Permalink | Reply

   Two things.

   1) I would like to raise a point of order on behalf of Geese. They are useful animals and would not want to be associated with this joke of a Health minister.
   2) iPod/iPads? Pretty much every doctor on the known face of the earth already has a computing device on their desk, as well as every Specialist, emergency department, etc.

   Does Roxon seriously think it’s a smart use of already stretched health funds to require medical types to have another device to access information?

   Destroyed the smart card, destroyed any form of central repository and interchange standard to assist Medical software companies implement protocols/interchange methods for exchanging health records, and their agency is sitting on an whole of govt./citizenry SSO system to help it along that’s received sweet F.A. use outside Health and Ageing.

   Sorry Roxon, look forward to seeing the door hit your arse at the next federal election.

2. Simon Reidy
   Posted 30/11/2010 at 6:04 pm | Permalink | Reply

   I’m not necassarily agreeing or disagreeing with your comments as I know very little about E-Health, however what I would be interested to hear is what actual doctors think of this idea. Perhaps integrating systems together to be acccessible via a secure iOS platform (say what you will about iOS but it’s definitely the most secure and locked down mobile operating system) might actually be a good idea? Maybe this will be the catalyst for centralising important national patient data on the same system?

   From what I understand It’s already been established that the introduction of iPads into medical envionments is a success, so is it not sensible to have a dedicated mobile application available that is compatible with all iOS devices?

   As for security, how us the app availibility in the app store any different to a secure government page with username and password for access? Are they not both just front ends for access to data stored elsewhere?

   I’m not saying that it’s necessarily a sensible allocation of funds, nor am I arguing that there isn’t a ton of backend stuff to be fixed, but I’m simply putting forward a slightly more optimistic (possibly naive ;) ) perspective.

3. rech
   Posted 30/11/2010 at 8:29 pm | Permalink | Reply

   meanwhile in the real world…I work in an operating theatre with one computer, barely working, shared between two nursing teams, a surgical team, and an anaesthetic team…we have paper records that disappear into a scanning process and are unavailable in the meantime until they appear in the digital record and are not connected in any way to any other hospital or other medical practitioners…we don’t have a wireless network in any of my public hospitals at all…nor can we connect our own computer to the wired network.

   “centralising important national patient data on the same system?”
   As a doctor I would not be prepared to have my (unremarkable) medical information available to all of my coworkers and bosses, so I would refuse to release my information to the system. If this centralisation ever happens, you can bet that doctors and nurses with psychiatric or drug problems would be reluctant to seek medical help.

4. Simon Reidy
   Posted 30/11/2010 at 8:40 pm | Permalink | Reply

   Interesting points, albeit perhaps a little conservative, but they are still points I certainly hadn’t considered. As I said my post was admittedly a little naive and I wanted to hear from doctors like yourself what they thought of this idea.

   I must say though your particular operating theatre does sound rather archaic. My father works at the Royal Hobart Hospital (he heads up the research foundation which raises money for a wide variety of important medical research) and while its a little dated,the RHHS medical system is still all fully networked and secure wireless networks are everywhere. I should point out too that overall, Hobart Hospital is considered one of the oldest, most underfunded, hospitals of them all (thankfully to be partially resolved by an injection of funds recently secured by Andrew Wilkie).

   If Hobart is so backward with our hospital, and we still manage to have computer systems well in advanced of what you’re referring to, perhaps your sentiments on this app would not be be in line with all doctors? I would be interested in hearing from doctors who have actually seen this app (particular at hospitals where the iPad is already being used) and got to experience first hand any of its benefits.

   Perhaps it truly is a load of shit, but I’m trying to keep an open mind :)

   Thanks though for your input. Its interesting to hear diffrent perspectives on these things.

5. Mark Jones
   Posted 30/11/2010 at 10:40 pm | Permalink | Reply

   Hey Renai. As a colleague in journalism I respect your right to have an opinion about Roxon, and some of your technical points might have merit. But you’re off beam on this one. I’ve spent the day talking to very senior bureaucrats and smart health people at the conference, and you’d be hard pressed to find anyone who thinks an iPad is the silver bullet. Roxon included. There are much bigger fish to fry.

   Everyone in the health industry and government who’s worth their salt understands the complexity we face rolling out a viable ehealth system – that’s why we’re seeing federal funds being unlocked, and more will surely come. Is it perfect? Of course not, and I’m no apologist. But the iPad app, in my view, is simply an illustration of what can be done when the back end systems are complete. Meanwhile, almost every second doctor has or will soon have an iPad. So it’s all about encouraging innovation and creativity. Symbolism matters.

   As for Roxon’s competence, did you hear her speak? Everyone I spoke to on the ground at the conference was impressed by how well she understands her portfolio – she has developed a strong reputation in the health community, regardless of whether you agree with her brand of politics. So may I suggest your opinions simply don’t align with the health constituency.

   Mark Jones
   Editor, ehealthspace.org

   • Renai LeMay
     Posted 01/12/2010 at 10:26 am | Permalink | Reply

     Hi Mark,

     I’ve questioned the Minister’s office about this matter, and the Minister personally where I could, on the e-health issue for some years now, and Roxon (while capable in other areas) has never demonstrated that e-health to her was more than a passing fad she had to give the occasional speech on. In fact, for the first several years of Labor’s tenure in power in the Federal Government Roxon didn’t mention the word “e-health” at all.

     Happy for you to go back and look at the speeches. I remember at the time it was a victory for Karen Dearne at the Oz to get her to talk at all on the subject.

     Secondly, the public remains ignorant of almost every detail associated with the $466.7 million e-health medical records project the Federal Government is rolling out. What technology will be used? How will the various states and their own rollouts interlock together with it? Who will build the system — government or an external provider? What standards will it be based on?

     If you can answer all of these questions to the same level of detail that, say, the Australian Taxation Office could with its Change Program, or the Department of Immigration could with Systems for People, then I would be a happy man. Because right now the public knows very little about how that money is being spent, and (last time I asked her at a press conference), neither does Roxon, I believe.

     Cheers,

     Renai

     • Mark Jones
       Posted 01/12/2010 at 4:20 pm | Permalink | Reply

       Hi Renai, well I’m not taking political sides here. Again, all I can tell you is there were plenty of very senior people in health who told me she “gets it.”

       The issues are complex but some of the workshops I attended convinced me there is some measurable progress being made in areas like standards that you mention. It’s not sexy stuff, but if a GP’s PC doesn’t talk to a hospital mainframe because of dodgy standards then the whole thing is stuffed. Get the foundation right and the rest will follow. So I guess it’s a question of what you call “real action” on ehealth.

       As for the consumer angle, I’d agree, there’s a long way to go.

       cheers
       Mark

       • Renai LeMay
         Posted 01/12/2010 at 4:39 pm | Permalink | Reply

         Sorry — is there some implication that I am taking political sides? I think you would find that I am as hard on the Coalition as I am on Labor — or even the Greens, if it was warranted ;)

         I agree that there has been measurable progress on some fronts — but again, I think the big issue here is not being addressed. If you can give me a good idea of what the $466.7 million in funding is being spent on, then go for it. Until I have that information, however, I’m not going to be impressed by some standards work which has been going on for years.

         Most of the big work here appears to be being done by the states, not the Federal Government.

         It’s not enough to say that people believe that Roxon “gets it”. There needs to be evidence of that — as with all things.

         • Mark Jones
           Posted 02/12/2010 at 10:12 am | Permalink | Reply

           Nope, no political implications. I was talking about myself not being a Labor apologist.

           Re proof, just keep your eye on ehealthspace.org – we’re chasing case studies and writing pieces that document the progress in all its colours. :)

6. Simon Reidy
   Posted 30/11/2010 at 10:49 pm | Permalink | Reply

   And there we have it. I suspected there was another angle to this. The article came off as an insulting and angry right wing rant, and has just been confirmed as such.

   Health reform is surely no easy business, but I see the Labor government achieving far more than the Coalition ever did. Let’s just hope we don’t end up with more Liberal state governments next year, as Federal and state governments have enough difficulty cooperating when it comes to health as it is.

   • Renai LeMay
     Posted 01/12/2010 at 10:28 am | Permalink | Reply

     True, Labor is doing more than the Coalition in this area. But that doesn’t mean they’re doing a lot — and, as with many other Labor projects, it doesn’t mean they’re doing it transparently.

     • Simon Reidy
       Posted 01/12/2010 at 12:21 pm | Permalink | Reply

       “as with many other Labor projects, it doesn’t mean they’re doing it transparently.”

       I’m sick of hearing this kind of bullshit from the right. Are you suggesting the Howard government worked in an open and transparent manor? Because if you are, thats pretty funny!

       Governments have the right to retain at least some degree of secrecy with government projects, for a hole host of reasons, one of which is often national security, and of course another is to retain their edge of the opposition.

       “Transparency” as you put it already exists. There’s a nice open debating area we have called “parliament”.

       • Renai LeMay
         Posted 01/12/2010 at 2:11 pm | Permalink | Reply

         Firstly, I’m not “the right” ;) Personally, I’m economically conservative and socially liberal. Secondly, I’m definitely not suggesting the Howard Government was more transparent or that an Abbott Government would be better than Labor. But that doesn’t change the fact that Labor has had a history over the past few years in Federal Government of hiding things.

         Implementation study, NBN Co business case, data retention, filter reports … where do I start? E-health is another example.

7. Dave
   Posted 01/12/2010 at 12:06 am | Permalink | Reply

   I’ve worked in quite a few Melbourne hospitals. Most hospitals don’t even have wireless internet throughout. iOs app is putting cart before the horse. Hospitals can’t even receive electronic results and letters from doctors, radiology and pathology companies who work outside that hospital – I would waste 30min every clinic chasing down results not available on hospital PCs. Doctors have already purchased medical applications for private practice so it’s going to take ages to migrate everyone to new system. I expect I will just set up a VPN to access a practice computer from a portable device. Surely the simplest system would have been a java based app sitting on your medicare card that could open in any browser with appropriate security.