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Australia Struggles with Rollout of National Electronic Health Record System

900,000 Australians have opted out of the nation’s new digital electronic health record system due to privacy and security concerns plaguing the My Health Record database

Countries around the world continue to attempt creating a single national electronic health record (EHR) system. And though billions have been spent, success remains elusive. Australia (AU) also has joined the club of nations struggling to launch a shareable digital health record system. But though the country does have a national healthcare system, a significant number of Aussies have declined to participate in a national EHR system as well.

Privacy and Security the Biggest Challenge

In February, Dark Daily reported that Australia’s largest pathology laboratories signed agreements with the Australian Digital Health Agency (ADHA) to join the nationwide EHR project. And that, though they praised the potential of the AU’s My Health Record, a doctors’ advocacy organization also voiced concerns about functionality, interoperability, and added burden placed on providers.

My Health Record is a 16-year $2 billion (AU) project to create a digital database that contains the medical health records for nearly all of the country’s 24.7-million citizens. But the system’s rollout has been far from smooth. As of September 12, roughly 900,000 Australians had opted out of the program, which has been plagued by privacy and security concerns, ZDNet reported.

The developments in Australia concerning the effort to implement a single electronic health records system for patients are useful for those pathologists and medical laboratory managers who want to position their labs to support services like these. Australia is not the only country that faces challenges in the implementation of a single, nationwide EHR.

“Even though most Australians will likely end up having a My Health Record by the end of the year, it doesn’t mean the government can declare victory by any means,” wrote Contributing Editor Robert Charette in IEEE Spectrum. “Its e-health record system must quickly prove more beneficial and easier to use for healthcare practitioners and individuals than is currently the case, while avoiding any significant data breaches or privacy leaks. Otherwise, it will continue its past history of being ignominiously ignored until the system eventually suffers a slow, and very costly, death.”

Flawed and Unsecure

Technical glitches marred the mid-July start of the government’s opt-out period, but the biggest issues facing My Health Record are its ongoing privacy and security difficulties. The Australian Privacy Foundation (APF) argues My Health Record is a flawed “summary system” that offers minimal value to consumers or healthcare providers while exposing Australians to potential security breaches.

“The risks to your privacy, confidentiality, and information security need to be balanced by the value of any of your health records,” APF states on its website. “In our assessment, because it is not really your health record but a less-reliable copy, the My Health Record has little value for either your clinicians or you as a patient: you both need the real thing. This means the risks to you may be high enough to question whether My Health Record is worth it.”

Not only have privacy advocates questioned My Health Record’s threat to information security and confidentiality, the former head of the federal agency tasked with building the system also has questioned the security of the online system.

Paul Shetler, a citizen of the UK and former Chief Digital Officer of the AU government’s Digital Transformation Agency (DTA), told the Australian Broadcasting Corporation he would “probably” withdraw from My Health Record if he were an Australian citizen. One of the main issues is My Health Record’s privacy settings automatically provide general access to all information within the record unless consumers take the time to set access codes to restrict access. (Photo copyright: diginomica.)

Stuck in a Time Warp

My Health Record does provide consumers with the ability to set controls that restrict access to their records. However, according to another ZDNet report, of the 971,252 records created during the EHR’s trial period, only 214 access controls were set. Of that number:

  • 196 records had a code applied to the entire record;
  • 10 had individual documents locked down with a code; and,
  • eight had both record and document codes applied.

Grahame Grieve, Principal at Health Intersections, argues My Health Record is stuck in a time warp—a system built on technology that was state of the art in 2007—but that has not kept pace with technological advances during its years of development.

“In the last decade, there’s been a lot of change, smart phones, etc., and we’re all used to the way the Web works: a set of federated systems that act together to serve us,” he wrote in a statement to the Australian Senate committee tasked with investigating issues with My Health Record. “But the My Health Record is still frozen as if all this hasn’t happened: inconvenient, inflexible, with poorly controlled information access rules … Australia is lagging behind other countries which are prototyping innovative digital approaches to solve healthcare problems.”

According to IEEE Spectrum, the “political firestorm” that greeted the program’s nationwide launch caused the Australian Digital Health Agency to extend the opt-out period an extra month, to November 15, 2018. Doing so buys the government more time to pass legislation aimed at fixing other issues related to the 2012 My Health Record legislation, ZDNet noted.

In July, ZDNet reported My Health Record legislation would be amended to strengthen privacy provisions to ensure no health record can be released to police or government agencies, for any purpose, without a court order, and that those who cancel their My Health Record will have their record permanently deleted from the system.

The Australian Healthcare and Hospital Association (AHHA) and other healthcare associations have praised the e-Health initiative and urged consumers to opt-in to the system.

“The advantages of having your medical history in the one place, both for consumers and healthcare providers, are numerous,” then-AHHA Acting Chief Executive Linc Thurecht claimed in an AHHA statement. “Apart from convenience, the potential benefits include better coordination of care among multiple healthcare providers, better informed decisions on healthcare that involve both the patient and the healthcare provider, reduced duplication of diagnostic tests, fewer adverse drug events, and reduced hospital admissions.”

Other Failed National Health Systems

Australia, however, is not alone in hitting e-Health speedbumps. The United Kingdom in 2016 pulled the plug on the National Health Services’ initiative following a review into concerns over privacy, lack of informed consent, and the sharing of medical data with drug and insurance firms.

And in Singapore, the government recently halted plans to have all healthcare providers upload data to the new National Electronic Health Record System after hackers stole the personal info of 1.5 million SingHealth patients in the nation’s worst cyberattack.

Meanwhile, in the United States the debate over national healthcare and protected health information (PHI) security is ongoing, and lessons like these from around the globe illustrate that solutions are not yet on the horizon.

Finding answers to consumers’ legitimate privacy and security concerns will be increasingly important for medical laboratories that will be called on to deliver more value to healthcare networks, and be required to share patient data with other healthcare providers to do so.

—Andrea Downing Peck

Related Information:

900,000 Australians Opt-Out of My Health Record

My Health Record: Former Digital Transformation Head Raises Concerns About Security of Online System

Australians Say No Thanks to Electronic Health Records

My Health Record Access Controls Used on 214 Times in Million Record Trial

Opt-Out Period for My Health Record Officially Extended Until November 15

My Health Record Brings Many Benefits

Personal Info of 1.5M SingHealth Patients, Including PM Lee, Stolen in Singapore’s Worst Cyber Attack

Australia Moves Closer to Nationwide Electronic Health Record as Nation’s Leading Pathology Laboratories Join Initiative

California Company Creates ‘Uber for Blood’ to Speed the Transport of Life-Saving Medical Laboratory Supplies and Blood Products in Rwanda

High-flying service expected to take flight in other African countries this year, as Tanzania announces launch of ‘world’s largest’ drone network for medical supply and clinical laboratory specimen deliveries

Anatomic pathologists and medical laboratories know that blood is a scarce and life-saving commodity. This is especially true in developing countries. Rising to that need, a California-based logistics company is using drones to provide on-demand access to vital blood supplies in Rwanda and Tanzania, creating a so-called “Uber for blood” delivery service that is poised for deployment to other regions in Africa as well.

Silicon Valley Start-up Zipline is an American automated logistics company based in California that transported more than 5,500 units of blood in 2017 to 12 regional hospitals from a base in the east of Rwanda, reported The Guardian.

The high-flying Silicon Valley startup began operating in the African nation in October 2016 and has cut blood delivery time from four hours to an average of about 30 minutes! Shipments arrive by parachute, dropping within a narrow target landing zone.

Though the Rwandan government, which is funding the project, has not officially released data quantifying the drones’ impact, the fixed-wing drones (called Zips) have been credited with reducing deaths due to malaria, childbirth, and other medical emergencies.

World’s Largest Drone Delivery Network

In August, Zipline announced plans to launch what it claims is the world’s largest drone delivery network in partnership with the government of Tanzania, a country of 56 million people. Zipline will open four distribution centers in the country during the next four years, with the first drones taking to the air in the first quarter of 2018 from the Tanzanian capital city of Dodoma, according to Cargo Forwarder Global (CFG), a cargo and logistics industry news website.

“Every life is precious. The government of Tanzania through the Ministry of Health, Community Development, Gender, Elderly and Children, has made great achievements in improving health services including the availability of medicines in all public health facilities,” Mpoki Ulisubisya, MD, Permanent Secretary of the Tanzania Ministry of Health, stated in a press release. “Our vision is to have a healthy society with improved social well-being that will contribute effectively to personal and national development; working with Zipline will help make that vision a reality.”

Zipline co-founder and CEO Keller Rinaudo (above) speaking at a 2017 TEDTalk on partnering with Rwanda and Tanzania to deliver life-saving medical supplies—including blood and medical laboratory products—by drone up to 500 times each day. Click on image above to view video. (Photo copyright: TEDTalk.)

Zipline co-founder and CEO Keller Rinaudo (above) speaking at a 2017 TEDTalk on partnering with Rwanda and Tanzania to deliver life-saving medical supplies—including blood and medical laboratory products—by drone up to 500 times each day. Click on image above to view video. (Photo copyright: TEDTalk.)

Each of the four distribution centers will be equipped with up to 30 drones, capable of making 500 on-demand delivery flights per day. Drones will provide access to more than 1,000 clinics, many of which lack well-functioning supply chains due to surface roads that “become increasingly bumpy and eventually impassable, particularly during the rainy season,” the CFG website reported.

“We strive to ensure that all 5,640 public health facilities have all the essential medicines, medical supplies, and laboratory reagents they need, wherever they are—even in the most hard-to-reach areas,” Laurean Bwanakunu, Director General of Tanzania’s Medical Stores Department, said in a news release. “But that mission can be a challenge during emergencies, times of unexpected demand, bad weather, or for small but critical orders. Using drones for just-in-time deliveries will allow us to provide health facilities with complete access to vital medical products no matter the circumstance.”

According to Zipline, health workers at remote clinics and hospitals text orders to Zipline for the medical products they need, which are stored in distribution centers. Within minutes, a Zipline Distribution Center can pack and prepare blood and other stored medical products for the 60-mph flight to any delivery site within a 93-mile round trip.

A Zipline worker technician launches a drone in Muhanga. (Photo copyright: Stephanie Aglietti/AFP/Getty Images. Caption copyright: The Guardian.)

A Zipline worker technician launches a drone in Muhanga. (Photo copyright: Stephanie Aglietti/AFP/Getty Images. Caption copyright: The Guardian.)

In a CFG statement, Keller Rinaudo, Zipline’s co-founder and Chief Executive Officer, said the expansion to Tanzania will make East Africa a world leader in drone logistics.

“Millions of people across the world die each year because they can’t get the medicine they need when they need it,” noted Rinaudo. “It’s a problem we can help solve with on-demand drone delivery. Now African nations are showing the world how it’s done.”

Rinaudo told IEEE Spectrum that Zipline expects to expand its operations to several other countries in 2018, though he did not specify where Zips will be flying next. He said the next generation of Zips will be able to fly longer distances, carry larger payloads, and make more deliveries per day.

“Rwanda has shown such remarkable success that a lot of other countries want to follow in its footsteps,” noted Rinaudo. “The problems we’re solving in Rwanda aren’t Rwanda problems, they’re global problems—rural healthcare is a challenge everywhere.”

Drones Delivering Medical Laboratory Specimens Globally

Africa is not the only part of the world where drones are taking flight to deliver blood and medical laboratory specimens. Johns Hopkins University Medicine researchers set a record in America for the longest distance drone delivery of viable medical specimens when its test drone traveled 161 miles across the Arizona desert, an event that Dark Daily reported on in November.

And in Switzerland, an eight-hospital medical group in Lugano partnered with Swiss Post (Switzerland’s postal service) and transportation technology manufacturer Matternet of Menlo Park, Calif., to successfully use drones to transport medical laboratory samples between hospitals, as noted in another Dark Daily report.

As drone technology improves, use of UAVs to transport blood and medical supplies and clinical laboratory specimens from point A to point B will likely become commonplace. They soon could be overflying a neighborhood near you!

—Andrea Downing Peck


Related Information:

‘Uber for blood’: How Rwandan Delivery Robots Are Saving Lives

Tanzania Announces World’s Largest National Drone Delivery Network Partnering with Zipline

Tanzania on Way to Becoming Drone Champion

Zipline Expands its Medical Delivery Drones Across East Africa

Johns Hopkins Test Drones Travels 161 Miles to Set Record for Delivery Distance of Clinical Laboratory Specimens

Drones Used to Deliver Clinical Laboratory Specimens in Switzerland