‘Flawed’ privacy in Queensland Health’s electronic medical record, expert says
An Australian Medical Affiliation Queensland letter to Queensland Well being director-general Michael Walsh, dated September 2018 and seen by Brisbane Occasions, warned that clinicians had been severely involved in regards to the statewide entry.
“Clinicians are involved that write entry to treatment charts outdoors their quick hospital may end up in opposed occasions,” the letter reads.
“For instance, a physician from Princess Alexandra Hospital had prescribed heparin on a affected person in Mackay ICU who was additionally on different blood thinning brokers, ensuing within the affected person bleeding and coming to hurt.”
The letter says the Mackay Hospital’s treatment security committee had been “inundated with incidents” as a consequence of difficulties prescribing drugs similar to insulin and heparin, a blood thinner, via the built-in digital medical report (ieMR), and different drugs have gone lacking from the system.
In a single occasion a clinician calling the ieMR helpline as a result of oxytocin “went lacking from the system” was advised to prescribe an alternate drug, when there was none out there.
“System huge ‘upgrades’ have additionally resulted in alerts to all ieMR websites about affected person security dangers on the treatment module and an order to revert to utilizing paper with little discover,” the AMAQ letter says.
The letter cites an alert issued on April 11, 2018, which warned of pressing affected person danger.
‘It has a scarcity of correct oversight’
The state’s ieMR challenge started in 2011, when a contract was signed with US medical know-how big Cerner to buy its Millennium software program “off the shelf” and modify it because it was put in in every public hospital.
A Brisbane Occasions investigation has revealed severe security dangers within the software program, with clinicians, well being our bodies and unbiased consultants repeatedly voicing considerations to the federal government.
Blood samples have been left within the unsuitable check tubes, check outcomes have gone lacking within the software program, and affected person knowledge has been added to the unsuitable affected person data within the years because the program was put in.
State Opposition Chief Deb Frecklington stated the LNP believed the built-in digital medical report program must be halted till points had been resolved.
However Well being Minister Steven Miles stated the LNP wanted to clarify why a 2014 report commissioned through the Campbell Newman authorities that held severe warnings in regards to the challenge was not heeded.
In 2014, an independent consultant report stated the software program may trigger issues for Queensland Well being much like the 2011 payroll debacle, when 1000’s of hospital workers went with out pay for months after a brand new IT system went dwell, triggering a fee of inquiry.
A Queensland Well being normal supervisor requested that the 2014 ieMR report be modified to take away these warnings.
Dr Rimmer stated the December 2018 Auditor-Normal’s report – cited by Queensland Well being because the roadmap for the way forward for this system and described by Mr Miles on the time of its launch as a “large tick” for the ieMR challenge – raised “enormous points”.
“The present method appears very flawed, and it’s offering very huge entry,” he stated.
“It has a scarcity of correct oversight, it appears inadequate that they’re merely relying upon disciplinary measures for particular person workers for such a system in place.
“There’s an actual failure there to know what opposed impacts may happen.”
The Auditor-Normal’s report discovered the ieMR was typically enhancing affected person well being and hospital efficiency however had points significantly in its future prices and highlighted considerations in regards to the huge entry and “weaknesses” in password controls.
Workers who left the organisation may nonetheless be capable of entry knowledge utilizing their logins for a number of months, and the Auditor-Normal discovered dormant accounts “may very well be exploited by inside customers”.
Hospitals had been “anticipated to observe entry logs” however that course of “depends closely on co-operation from workers assigned the accountability”, the Auditor-Normal discovered.
Citing worldwide digital medical report failures similar to in Singapore, the place the HIV standing of greater than 14,000 folks was leaked on-line in January after its nationwide digital medical report was hacked, Dr Rimmer stated he puzzled in regards to the authorized and moral implications of the ieMR challenge for Queensland Well being.
Any clinician can edit any affected person’s report
Thus far the ieMR is put in in 9 Queensland hospitals, with Ipswich Hospital the most recent to go dwell in December 2018.
Dr Rimmer stated the ieMR challenge gave the impression to be experiencing related points to different large authorities digital know-how applications, such because the federal 2016 “census fail”, the Centrelink “robo-debt” scandal and the controversial My Well being File.
The federal authorities’s My Well being File sparked severe considerations after it was revealed each Australian must decide out in the event that they didn’t need all their delicate medical knowledge saved in an internet report.
The built-in digital medical report challenge is particularly designed to permit all clinicians in any respect public hospitals each learn and write entry to affected person data, permitting clinicians to log in remotely and edit data.
It additionally connects on to My Well being File and permits clinicians to see a sufferers’ medical data and add check and imaging outcomes and discharge summaries to the nationwide database.
Any affected person who enters a Queensland public hospital with the ieMR put in may have a report mechanically created for them.
A Queensland Well being spokesperson stated solely authorised Queensland Well being workers may entry a affected person’s digital medical report.
“Medical data is protected by strict laws and built-in safety measures to stop unauthorised entry,” the spokesperson stated.
Dr Rimmer stated on each a state and federal stage there wanted to be a severe reconsideration of how affected person confidentiality and well being privateness had been dealt with.
“There appear to be enormous gaps between the aspirations to have seamless bureaucratic IT techniques and the very ugly actuality of what’s happening,” Dr Rimmer stated.
A Queensland Well being spokesman stated the built-in digital medical report had improved affected person security and hospital effectivity.
“The current Queensland Audit Workplace report into digital hospitals, launched simply final month, confirmed the digital hospital program is enhancing healthcare and affected person outcomes,” the spokesperson stated.
“Affected person security has markedly improved because the built-in digital medical data was first rolled out.
“It has lowered the typical size of keep, unplanned readmissions, and the variety of severe falls and strain accidents.”
Minister typically ‘lack technological experience’
By 2025 the division needs 27 hospitals to have the ieMR put in and totally operational, by which period the challenge is predicted to price $1.2 billion.
Dr Rimmer stated a “political drawback” with the implementation of such whole-of-government digital well being IT initiatives was the minister in cost typically lacked technological expertise.
“Typically it’s handed from one minister to the following; we’ve had a sequence of individuals serving a few phrases as well being ministers in Queensland for some time,” he stated.
Mr Miles is the most recent minister to supervise the built-in digital medical report challenge after taking on from Cameron Dick in 2017.
Earlier well being ministers overseeing the digital transformation of Queensland Well being had been Stephen Robertson, Paul Lucas and Geoff Wilson underneath the ALP Bligh authorities, adopted by Lawrence Springborg underneath the LNP Campbell Newman authorities.
Ms Frecklington stated the rollout of the ieMR must be halted till points had been resolved.
“We’ve seen a $256 million price blowout and clinicians’ considerations have been ignored by the Labor Well being Minister,” Ms Frecklington stated.
“This has all of the hallmarks of Labor’s well being payroll debacle besides worse – affected person security is in danger.”
Mr Miles stated the LNP wanted to clarify why the 2014 report was buried.
“Since coming to authorities Labor has made adjustments to the LNP’s program to handle a number of the considerations I perceive are on this secret LNP report,” he stated.
“A more moderen report, the Queensland Audit Workplace (QAO) report launched in December 2018, confirmed the digital hospital program is enhancing healthcare and affected person outcomes.
“The report discovered the digital program contributed to a major improve in early identification of deteriorating sufferers, a lower in emergency affected person readmissions, workers can entry medical data sooner and affected person data are extra legible.”
Mr Miles stated Queensland Well being was “constantly in search of methods to enhance the system”, which included common session with workers and stakeholders.
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Lucy is the city affairs reporter for the Brisbane Occasions, with a particular curiosity in Brisbane Metropolis Council.