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An implementation plan for a nationally consistent Electronic Oral Health Record (EOHR) will be presented to the country’s 20 district health board (DHB) chief executives by the middle of this year. Professional services organisation TAS is leading the implementation on behalf of the DHBs after recently signing a contract with the Ministry of Health. Chair of the EOHR programme board Robin Whyman is clinical director oral health at Hawkes Bay DHB. He says the programme started around 2015–16 because staff operating oral health services recognised that, while nearly all DHBs are using the same clinical system, differences in local implementations mean they are unable to get nationally consistent information out of it. “When trying to get information for a national picture of what’s going on in oral health and around service quality improvements, we were struggling to compare things and be confident we were interpreting things in the same way,” he added. All but two small DHBs are using Titanium Solutions and the remaining are paper based. A number of Māori health providers contracted to the DHBs are also using the software. The Titanium system contains critical information about the status of patients and treatments provided to nearly all children up to the age of 12 and some adults. However, each DHB has made its own decisions with the vendor, resulting in boards being on different versions of the software and two slightly different code sets for treatments being used. A Request for Proposal for a national EOHR system was released in November 2016, but the EOHR Programme Board recommended not to award a contract. Instead the programme team is working with Titanium to make improvements and move towards a nationally consistent system. “One of the early pieces of work is to work with the sector to allow a nationally agreed code set for the system,” Whyman says. “By having a consistent coding set and interpretation we believe we will start to have conversations about quality improvement, looking at outcomes of treatment and oral health status and how that’s linked to interventions put in place.” He hopes to have a national coding set in place and in use by mid-2019. Whyman says the board is also looking to develop regional groupings of DHBs using the same instance of the software. These will evolve over the next couple of years. “Part of the work of TAS is to work with the sector on the best way to do that,” he says. An implementation plan that’s “achievable within the resources of the DHBs” will be presented to the 20 DHB chief executives by the middle of this year for approval, he says. A TAS statement says a nationally consistent EOHR is expected to help improve New Zealanders’ oral health through improved capture and quality of oral health information. It says the programme of work underway will see DHBs implementing consistent business, system and information management processes. It will also enable DHBs to benefit from national economies of scale and achieve efficiency benefits. This article first appeared on eHealthNews.nz.

As the Federal Government today pushes the button to create My Health Records for every Australian who wants one, the industry has stepped out asking for more transparency around security and secondary use of the records to enable people to make more informed decisions about it. The industry has also voiced out about data de- and re-identification, a global approach to cybersecurity issues as healthcare digitises, information security requirements of the future and blockchain as a way to alleviate some of the challenges associated with the My Health Record system.   On 26 November 2018, the Federal Parliament passed legislation to strengthen privacy protections in My Health Records Act 2012 without debate or division. The new legislation means that Australians can opt in or opt out of My Health Record at any time in their lives. Records will be created for every Australian who wants one after 31 January and after then, they have a choice to delete their record permanently at any time. The date of 31 January follows much deliberation from the Federal Government to extend the opt-out date. Australians initially had until 15 October 2018 to opt out of the national health database, or a My Health Record was to be created for them by the end of that year. But following the opposition calling for an extension to the opt-out period, the public outcry against the potential for the data to be shared with police and other government agencies, a leaked government document detailing the Australian Digital Health Agency’s response to concerns and a raft of changes recommended by the Senate Inquiry into My Health Record, the Federal Government pushed this date back and relaxed its stance on when Australians can opt in or opt out of the system. Australian Academy of Technology and Engineering (ATSE) President Professor Hugh Bradlow said the collection of health data across the population will result in better health outcomes as it not only shows how effective interventions are, but also allows treatments to be personalised based on the experience of thousands of other patients. “New forms of measurement (based on artificial intelligence) will also give patients far more significant information about institutional performance, practitioner performance, the outcomes of specific interventions, etc.” he said. The Society of Hospital Pharmacists of Australia (SHPA) Chief Executive Kristin Michaels said the My Health Record debate highlighted the need for an integrated ehealth system, accessible only to health professionals and set up at the request of health organisations, for the benefit of all Australians. "All Australians, regardless of any illness or condition, deserve to get the highest-quality care,” Michaels said. “More often than many would think, patients are unable to explain the medicines they are already taking and for what conditions they are already being treated, particularly after a seizure or if unconscious. Many of these patients are unaccompanied. Sometimes this lack of information leads to errors that have serious impacts on people’s lives. “[Hence] hospital pharmacists have long called for a shared, electronic patient data system that links up a fragmented health system and empowers patients in their own care." THE ISSUE OF SECURITY However, University of Melbourne Department of Computing and Information Systems Cybersecurity Senior Lecturer Associate Professor Vanessa Teague expressed her concerns around the privacy implications of secondary uses of My Health Records not being accurately explained. "The My Health Record privacy policy says: ‘It is expected that most applications which are assessed will be for the use of de-identified data. This is where your personal details are removed from the dataset and you cannot be identified.’ Unfortunately, removing obvious personal details (such as name, location, and date of birth) does not securely de-identify the data,” Teague said. “Both doctors and patients can be easily and confidently identified in a dataset… In the case of patients, this means that a few points of information, such as the patient's age and dates of surgeries or childbirths, is enough to identify the person and thus, retrieve all their Medicare bills and PBS [Pharmaceutical Benefits Scheme] prescriptions for many years. “Easy and confident re-identification has been demonstrated on numerous other datasets that were shared in the mistaken belief that they were de-identified. It is probably not possible to securely de-identify detailed individual records like My Health Records without altering the data so much that its scientific value is substantially reduced.” [Read more: My Health Record system data breaches rise | Game changer: Creator of FHIR writes about approaching critical mass and a growing data sharing revolution] Teague said patients may choose to opt out of secondary uses of their data but are unable to make a “genuinely informed decision” if they are inaccurately told that their detailed record cannot be identified. “Even more importantly, those whose identifiable MBS [Medicare Benefits Schedule]-PBS records were already published in 2016 should be notified, because the earlier release could make re-identification of their My Health Records much easier,” she said. Harvard Medical School International Healthcare Innovation Professor Dr John Halamka also previously criticised the system for relying on outdated technology, saying that the $2 billion My Health Record was nothing more than “digitised paper” as it uses such “out-of-date” technology that crucial patient information on test results and diseases are unable to be read or shared by computers. University of Wollongong School of Computing and Information Technology Professor Katina Michael said health data breaches, for some, could have a huge impact. She used the recent example from Singapore, where 1.5 million Singapore health records were breached in a highly targeted effort on SingHealth. Among the breached health records was Singapore Prime Minister Lee Hsien Loong's personal records. “What does this tell us when one of the world's most advanced cybersecurity nations suffers such a large-scale attack? Plainly, that no one's personal information is safe, no matter the measures in place,” she said. "If we have learnt anything over the last four months, it is that electronic health records are hackable. We need not have to look too far to see that no system is impenetrable.” Michael also speculated that there is the possibility of a ramp up of blockchain initiatives to beef up on My Health Record security. “We will likely be told in the not too distant future that we wildly underestimated our security requirements and as such, must go one step further and protect our credentials,” she said. According to Professor Michael, this involves the implant of a 16-digit Personal Health Record (PHR) ID number into people that also reads vital signs while embedded. This technology then alerts first responders of ailments and medications without the need for the person to provide any information.     [Read more: Australia leads the world in personal control of electronic health records | Is the My Health Record technology out of date?] ATSE’s Bradlow said the industry needs to be “realistic” about it as the danger of data leaking due to cyber hacking is as true as hacking any other data system. “Let’s remember that many [healthcare professionals] have easy access to today’s paper-based health records – an electronic record is actually a step up in privacy. Within My Health Record, we can make it the default to require a patient access code,” he said. “A well-designed record system which is managed by a professional security organisation and has a clear audit trail, for example, provided by blockchain, can mitigate this risk significantly."

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Yesterday, Orion Health announced a commercial agreement with Abu Dhabi Health Data Services, a new project company established as part of the Public Private Partnership (PPP) between the Department of Health-Abu Dhabi (DoH) and Injazat Data Systems, a subsidiary of the Abu Dhabi government-owned Mubadala Investment Company, to deliver a Health Information Exchange (HIE) platform. The HIE will be known as "Malaffi" and is the first of its kind in the Middle East. "Malaffi" will provide a platform that will centrally store and enable the meaningful exchange of patient health information between healthcare professionals and will ultimately connect 2,000 public and private healthcare providers in Abu Dhabi. Officially launched last week on 23 January, “Malaffi” is initially joined by six Abu Dhabi healthcare organizations, including SEHA (Abu Dhabi Health Services Company), Cleveland Clinic Abu Dhabi, Imperial College Diabetes Centre, Healthpoint, United Eastern Medical Services (UEMedical) group and Oasis Hospital, Al Ain. The access to the centralised patient records will provide physicians with a tool to make well informed, fast decisions, enhance patient safety, reduce the duplication of diagnostic procedures and ultimately improve the quality of care and outcomes. “The Department of Health-Abu Dhabi has recognised the need to centrally and efficiently, store, exchange, and analyse the enormous amount of data that is being created in healthcare every day, and by using advanced technologies, such as Artificial Intelligence (AI) and machine learning, to drive the digital transformation of the healthcare system, for a happier and healthier Abu Dhabi. The partnership with Orion Health, will enable us to deliver a best-in-class HIE platform, that will guarantee the success of connecting all Abu Dhabi healthcare providers, and place Abu Dhabi on the top of the global map of successful HIE implementations," said Atif Al Braiki, CEO of Abu Dhabi Health Data Services. “Orion Health is delighted to be selected as the partner of choice, to deliver UAE’s first HIE platform,” said Ian McCrae, CEO of Orion Health.

New technology using AI to tell the difference between harmless moles and dangerous melanomas has hit the market. Created by FotoFinder Systems, Moleanalyzer pro is a portal that lets physicians confirm their skin cancer diagnosis using evaluation techniques, combining specialist expertise with AI and including the option of receiving a second opinion from international skin cancer experts. FotoFinder Systems Global Brand Director Kathrin Niemela told HITNA that the technology aims to aid skin cancer diagnoses. According to the Cancer Council Australia, every year skin cancers account for around 80 per cent of all newly diagnosed cancers in Australia, with GPs seeing more than a million patients per year for skin cancer. In addition, the Australian Government identified that there were 14,320 new cases of melanoma skin cancer diagnosed in 2018, accounting for 10.4 per cent of all new cancer cases diagnosed. “The earlier skin cancer is detected, the better the prognosis. The leisure behaviour of sunbathing in many parts of the world makes early detection of skin cancer more important worldwide,” Niemela said. FotoFinder Systems first calculates and compares size, diameter and structure of moles and quantifies their percentage deviations. Moleanalyzer pro works with deep learning. Its Convolutional Neural Network was ‘trained’ with a large data collection of dermoscopic images and corresponding diagnoses. Through growing experience and its own autonomous rules, it then distinguishes between benign and malignant lesions. “Moleanalyzer pro features the possibility to manually evaluate lesions according to acknowledged checklists and optionally contains an innovative algorithm based on AI, allowing a risk-of-malignancy evaluation,” Niemela said. “In the last few years, the new algorithm has been trained with a large number of dermoscopic images. FotoFinder Systems has an international network of partners who contribute to the training of the algorithm with their pictures of histologically proven lesions.” The analysis then determines a risk assessment score of both melanocytic and non-melanocytic skin lesions, allowing physicians to verify their diagnoses. FotoFinder Systems is working towards making this AI score available for doctors on mobile devices. “When this technology becomes available for mobile devices, rural physicians, for example, who practice far away from clinics or specialist centers can use the Moleanalyzer pro's deep learning algorithm on their mobile phones to get a second opinion on their diagnosis of skin lesions,” Niemela said. The application also allows physicians to request a second opinion from skin cancer experts. “The AI represents a ‘silent virtual colleague’ that delivers a virtual opinion simply, uncomplicatedly and at any time. But together with the human experience delivered by the optional second opinion service, the tool helps to increase diagnostic accuracy.” [Read more: New bid to map AI’s impact in radiology | New AI imaging solution to accelerate critical patient diagnoses] According to Niemela, a man-against-machine study involving 58 dermatologists from 17 nations found that whereas the experts correctly identified 86.6 of malignant skin tumours, Moleanalyzer pro successfully detected 95 per cent. In addition, the technology identified 82.5 per cent of benign naevi correctly, while the experts identified 71.3 per cent as benign. However, Niemela said the technology was not expected to replace specialists. “As fascinating as AI is, it cannot take the place of human experience in the matter of skin cancer. AI will increasingly find its way into dermatology and mole examinations by supporting physicians, not by replacing them,” Niemela said. “Doctors need to combine total body mapping with video documentation of single moles and AI-based evaluation. The combination of these three elements are the pillars of early skin cancer detection. Only a physician with profound knowledge and experience can map this complex process. “In addition, patients do not want to do away with doctors under any circumstances and want to combine high-tech solutions with specialist competence.” And the future potential for AI in skin cancer detection is huge. “The aim of AI is to bundle global knowledge and consistent diagnostic standards – independent of the practice location – all over the world. The combination of human experience and AI can contribute to a drastic improvement in diagnostic accuracy in early skin cancer detection, with the potential for almost 100 per cent accuracy,” Niemela added.

SA Health is expected to scrap and reconstruct its troubled electronic patient records system following an independent review of the program. The EPAS Independent Review found that the beleaguered Enterprise Patient Administration System (EPAS) failed as it “contrasts with other successful EMR implementations in Australia”. This conclusion was reached after an expert panel assessed the software solution supplied by Allscripts, its configuration and management by SA Health, and the implementation and governance of the program. The report identified that SA Health chose to implement the system without the assistance of “expert organisations including the Allscripts vendor” resulting in the billing module not being fit-for-purpose. In addition, it found that EPAS has a flawed governance model with “accountability for outcomes poorly understood and managed” and a lack of current governance arrangements empowering clinicians to be key decision-makers. It also found the governance model doesn’t enable the implementation of the system to be tracked, measured or managed, amongst other determinations. “The Review Panel concludes that all three factors have contributed to EPAS not meeting user expectations,” the report stated. The South Australian Government commenced implementation of EPAS in 2011, which it expected to deliver by 2014 at a cost of $421.5 million. But, by 2018, it claimed that 78 per cent of the funds for the original scope “had been expended.” Following public debate and change of government in March 2018, the rollout of EPAS was paused to commission an independent review to inform decisions on the most appropriate way forward, which resulted in the EPAS Independent Review. “The review finds that the EPAS program has been a failure and should be discontinued and replaced. The review has determined that the EPAS program should not continue as planned,” the South Australian Government said in response to the review. “The review recommends that SA Health completely overhaul the program, reconfigure the underlying information technology and commence a roll out at two exemplar sites before a final decision is made on whether to continue to use the Allscripts suite of products.” [Read more: SA Health launches taskforce after claims of lost and delayed pathology results caused by new IT system | Xenophon calls for SA’s EPAS to be paused and investigated, while new RAH suffers a power outage mid-surgeries] The EPAS Independent Review also made 36 recommendations for a proposed way forward. “Every effort should be made to optimise the underlying elements of the EPAS program,” it stated. This includes improvements to Sunrise EMR (Electronic Medical Record), an integrated suite of clinical and financial solutions that is also used by hospitals and health systems in the US, UK, Canada and Singapore, and Allscripts PAS (Patient Administration System) implementation – terms that will replace EPAS. Allscripts ANZ General Manager Todd Haebich said the company welcomes the independent review into EPAS. ‘We look forward to working more closely with SA Health to fulfil what it has set to out achieve – the establishment of a state-wide electronic medical record,” he said in a statement. Other recommendations include the creation of an SA Health Digital Strategy with a Digital Health Board and “significant governance reforms” that put control into the hands of clinicians. “The Government will transition from the EPAS project to a new electronic medical record project, which will utilise two Allscript software programs, a patient administration program and an electronic medical record program,” the South Australian Government said. “Deployment to the exemplar sites will be the focus of immediate action for Government, with deployment to take place during 2019.”

Earlier this week, the Ministry of Health (MOH) in Singapore made an announcement that confidential information regarding 14,200 individuals diagnosed with HIV up to January 2013, and 2,400 of their contacts, has been illegally disclosed online and is in the possession of an unauthorised person. This was yet another serious case of data breach in the healthcare system following the SingHealth cyberattack which happened in June to July last year with 1.5 million patient records being illegally accessed. A Committee of Inquiry (COI) was quickly formed and its findings were published earlier this month. For the case of the HIV data leak, MOH was alerted by the police on 22 January and the Ministry made a police report on 23 January. On 24 January, MOH ascertained that the information matched the HIV Registry’s records up to January 2013.From 24 to 25 January, MOH worked with the relevant parties to disable access to the information. The records were those of 5,400 Singaporeans diagnosed with HIV up to January 2013 and 8,800 foreigners (including work and visit pass applicants/ holders) diagnosed with HIV up to December 2011. The information included their name, identification number, contact details (phone number and address), HIV test results and related medical information. The name, identification number, phone number and address of 2,400 individuals identified through contact tracing up to May 2007 were also included. Background The confidential information is in the illegal possession of Mikhy K Farrera Brochez, a male US citizen who was residing in Singapore, on an employment pass, between January 2008 and June 2016. Brochez was remanded in prison in June 2016. He was convicted of numerous fraud and drug-related offences in March 2017, and sentenced to 28 months’ imprisonment. The fraud offences were in relation to Brochez lying about his HIV status to the Ministry of Manpower, in order to obtain and maintain his employment pass, furnishing false information to Police officers during a criminal investigation, and using forged degree certificates in job applications. Upon completing his sentence, Brochez was deported from Singapore. He currently remains outside Singapore. Brochez was a partner of Ler Teck Siang, a male Singaporean doctor. As the Head of MOH’s National Public Health Unit (NPHU) from March 2012 to May 2013, Ler had authority to access information in the HIV Registry as required for his work. Ler resigned in January 2014. He was charged in Court in June 2016 for offences under the Penal Code and the Official Secrets Act (OSA). In September 2018, Ler was convicted of abetting Brochez to commit cheating, and also of providing false information to the Police and MOH. He was sentenced to 24 months’ imprisonment. Ler has appealed, and his appeal is scheduled to be heard in March 2019. In addition, Ler has been charged under the OSA for failing to take reasonable care of confidential information regarding HIV-positive patients. Ler’s charge under the OSA is pending before the Courts. According to an article by The Straits Times, it is understood that Ler no longer has a certificate to practise medicine in Singapore and no longer has access to the confidential information of patients in the National Electronic Health Records (NEHR), which includes all public-sector patients. Timeline of events leading up to the leak May 2016 - MOH had lodged a police report after receiving information that Brochez was in possession of confidential information that appeared to be from the HIV Registry. Their properties were searched, and all relevant material found were seized and secured by the Police. May 2018 - After Brochez had been deported from Singapore, MOH received information that Brochez still had part of the records he had in 2016. The information did not appear to have been disclosed in any public manner. MOH lodged a police report, and contacted the affected individuals to notify them. 22 January 2019 - MOH was notified that more information from the HIV Registry could still be in the illegal possession of Brochez. On this occasion, he had disclosed the information online. What could have happened This incident is believed to have arisen from the mishandling of information by Ler, who is suspected of not having complied with the policies and guidelines on the handling of confidential information. Additional safeguards in disease registries Since 2016, additional safeguards against mishandling of information by authorised staff have been put in place. For example, a two-person approval process to download and decrypt Registry information was implemented in September 2016, to ensure that the information cannot be accessed by a single person. A workstation specifically configured and locked down to prevent unauthorised information removal was designated for processing of sensitive information from the HIV Registry. The use of unauthorised portable storage devices on official computers was disabled in MOH in 2017, as part of a government-wide policy.