Medicare Australia has reached an agreement with e-health vendors surrounding a legal blackhole in developer agreements signed for use of individual healthcare identifiers, with hopes a revised license to be released in the coming week will encourage wider use of the identifiers in clinical software.
The negotiations, which were sparked last year, accompany ongoing testing of the identifier system among consumers by lead e-health agency, the National E-Health Transition Authority (NEHTA), more than eight months after legislation for use of the identifiers passed Parliament, and the numbers assigned to 23 million Australians and healthcare providers.
Sources told Computerworld Australia that the legal blackhole was identified as impossible to comply with by both Medicare, the current managing agent for the identifier system, and NEHTA.
Under the current contract, the developer would be held liable for any mistakes made by Medicare or the healthcare provider - however unlikely - involving the use of a patient’s healthcare identifier after implementation of the clinical software.
The issue was first raised by the Medical Software Industry Association (MSIA) in April last year, but it is believed an agreement on a draft revision of the contract was only reached on Monday this week. Wider industry are yet to acknowledge the new licence.
A spokesperson for Medicare confirmed the agreement had been revised and would be available on the agency’s website once fully complete.
NEHTA’s head of clinical leadership and engagement, Mukesh Haikerwal - who has been known to use strong words about the original agreement himself - said Medicare was “pulling out all stops” to improve the contract.
“I think there’s been an understanding which is being addressed that the original contract was difficult to comply with and many would say untenable; I think they used stronger words than that,” he said.
“They’re in the negotiation phase and I would hope that that process is done in good faith and I would hope that that’s done with mutual respect and an understanding of the end goal and I suppose the needs and difficulties of the component players.”
MSIA president, Geoffrey Sayer, welcomed Monday’s milestone in the negotiations.
“Commonsense is prevailing,” he said. “We’ve just been persistent in asking for what you would argue is fair and reasonable that if you make a mistake, you’re the one who has to be liable.
“You can’t ask somebody to accept liability, even for the extremely unlikely event. No insurer is going to insure you to take liability for someone else’s action.”
The MSIA expects the revised contract to build confidence in Medicare’s operations among e-health vendors, with up to 200 developers expected to come on board as a result. In June last year, it was revealed only three vendors had signed up for testing of the identifier in NEHTA’s contained environment as a result of discrepancies in the contract.
Legislation for the Federal Government’s identifier initiative, a precursor to the personally controlled electronic health record (PCEHR) to be rolled out by July next year, was rushed through Parliament in the dying hours of the sitting calendar in June last year, ahead of official number assignments to Australians and registered healthcare providers on 1 July 2010.
Original intentions were to have the identifier compatible with Medicare’s Health Professionals Online Services (HPOS) web portal by October last year and vendor support in clinical software during the first quarter of 2011.
However, the system has been hit by numerous setbacks, including lack of support from vendors, and continued testing of minute aspects, such as registration and continued maintenance of individual identifiers, by NEHTA through Christmas and into January of 2011.
Recent clinical assessments have also recommended the identifier not be used as a single source of identifying a patient during the initial stages of healthcare, a fact confirmed by the Department of Health and Ageing during Senate estimates last week. Haikerwal also confirmed that was the case, but said the identifier could be solely used once the patient had been verified.
“The purpose of the health identifier is different to the use of the Medicare card or passport to identify who you are - you wouldn’t throw your passport into the Murray [river] because I’ve now got my IHI,” he said.
Though the MSIA has traditionally been critical of various steps of implementation in the identifier and other e-health initiatives, Sayer said decisions to delay the identifier’s use in production environments was reasonable in order to ensure utmost safety.
“We just wanted to make sure that the range of risks were identified and quantified and subsequently reduced," he said. "A licensing or access agreement to the health identifier materials needs to operate around the quality that all parties are trying to achieve.
“We as an industry have been looking for the end-to-end quality from the generation of the numbers to the actual use of the number sin the real world, so we’ve been pushing to ensure that the total risk assessment has been done from end to end, that the right checks and balance are in place as well.”
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