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Australia's new e-health platform crashes as people rush to opt-out

zdnet.com

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Re: Australia's new e-health platform crashes as people rush to opt-out

#71

Post by pimmen »

vertex-four wrote: post #62
pimmen wrote: post #38

Earlier quoted context omitted.

But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. The risk of that happening to you is actually significantly higher than dying from a lot of pretty common illnesses.

Unless I’m unconscious, I can give my doctor permission to access my medical history from where it’s kept under my control, and give them a quick run-down in the meantime if necessary. I feel that I should have a right to choose between the risk of death when both myself and my emergency contact are unable to provide medical information to a doctor, and the risk of my medical history becoming publicly available - or…

And it would be much simpler if all you had to do was give them that authorization and they could retrieve your medical records in an instant, in the correct format for them to work quickly.

If they have to order your medical journal from a completely separate jurisdiction, in a completely different format, and then import it that would take longer. If you require specialist care which is not available in your area this is an issue that comes up again and again.

Not saying a centralized system would fix all the problems, or be perfect, but if it improves 1% of cases that's potentially thousands of people saved every year. That's a huge return for a very minor improvement.

Re: Australia's new e-health platform crashes as people rush to opt-out

#72

Post by gruez »

Avamander wrote: post #69
gruez wrote: post #68

Earlier quoted context omitted.

>If that database contained everyone's medical data it will not fit on anything that anyone non-state/non-corporate actor can aquire source? that might be the case if you're including all the high resolution imagery, but I'd imagine all the text records can't be that big. >and if you have state actor or corporate level of budget one could easily scale stealing paper medical records that would either require an operat…

> as someone is going to notice eventually That's going to be true with the database theft too. > All you'd have to do is have a small team of experienced hackers hack it from a the safety of a country with no extradition treaty I'm not so sure that's won't raise any red flags anywhere (foreign IP and possibly a lot of data being transferred). Imo it should, but we can't really know? I agree with rest of what you sai…

>That's going to be true with the database theft too.

at that point, all the data is already gone. whereas with burgling doctors offices, they've been noticed within a few dozen break-ins.

>I'm not so sure that's won't raise any red flags anywhere (foreign IP and possibly a lot of data being transferred). Imo it should, but we can't really know?

that depends on how the system is accessed. if it's some webapp on some government intranet running off some random computer (that's also used for other stuff), then it's pretty easy to hide your tracks by compromising one of those machines. even if they have egress alerts (doubt it) it'd be pretty trivial to go for the high value to size ratio files first (text files), and exfiltrate over a long period of time.

Re: Australia's new e-health platform crashes as people rush to opt-out

#73

Post by jbob2000 »

michaelt wrote: post #61
pimmen wrote: post #38

Earlier quoted context omitted.

But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. The risk of that happening to you is actually significantly higher than dying from a lot of pretty common illnesses.

But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. Don't you think I'm in a better position to make that decision than a central government bureaucrat, given that I have my medical records and an incentive to protect my own privacy, and he has neither?

It's not good public policy for millions of people to make individual decisions about this. It's expensive for the healthcare system when there are a million different ways for it to access your data; some people bring in papers, some papers are on the other side of the country, some people have a USB stick, oh granny lost hers in a fire here's a photocopy from 10 years ago. It's just much more effective to manage these things at scale.

You have incentive to product your privacy, but you don't have the means. Are you going to bolt a fire-proof safe to your basement floor and keep a backup in a storage unit? Are you going to store them on a disconnected harddrive and create backups every 3-6-12 months? Can we expect every Australian to do this? Can we expect everyone to want to spend hundreds of dollars to make this happen?

Re: Australia's new e-health platform crashes as people rush to opt-out

#74

Post by pimmen »

michaelt wrote: post #61
pimmen wrote: post #38

Earlier quoted context omitted.

But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. The risk of that happening to you is actually significantly higher than dying from a lot of pretty common illnesses.

But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. Don't you think I'm in a better position to make that decision than a central government bureaucrat, given that I have my medical records and an incentive to protect my own privacy, and he has neither?

I'm not saying I like the Australian take on this but I do think a central database for medical records has the potential to prevent medical treatment mistakes by a couple percent. That's thousands of people saved. At that point, I think it's something we really should discuss as a society because it would have a profound effect on the economy and public health. I don't think the idea is fundamentally flawed, I think that just like the justice system incentivzes people with a monopoly on violence to protect you we can legislate in a way that public health servants would be incentivized to look after your interests.

Re: Australia's new e-health platform crashes as people rush to opt-out

#75

Post by Insanity »

Tharkun wrote: post #54
TheSpiceIsLife wrote: post #2

The Australian government is paying doctors to upload patient records to a centralised government controlled database. The Australia government is incentivising doctors to sell client data to the government . What part of this is ok in any sense?

AFAIK the same thing has happened in Belgium. There are several databases, allegedly controller by hospital networks, which you can access using government ID. There's supposedly an opt-in clause, but I've certainly never opted in and all my x-rays are on the interwebz. Must be nice to be a 21st century government, where you can access any data on anyone in your country.

That is the case indeed. However the ehealth-ehub system (which I assume you are talking about) is not automatically in-sync with the data the hospitals have about you. When it is necessary to receive the data, the system will poll the hospital for the required data.

Then we have "NexuzHealth" in Belgium, which is an app you can install that shows you which data the hospital has about you. It's a network of 20+ hospitals but you can only view your data if you are actually a patient at these hospitals, and the goal was to provide the _patients_ with the same information doctors can see about you. Something you would normally not know about.

Source: I work in one of these hospitals (software engineer) but not directly related to the app nor the ehealth system, so this is my (limited) understanding of how it works from being around the people actually implementing this.

Re: Australia's new e-health platform crashes as people rush to opt-out

#76

Post by TheBeardKing »

I get that there's benefit to a centralized health database if you're in a country with socialized medicine, but if dealing with private doctors, why not let the market provide this capability? My primary GP uses one version [1], and I get that there would be several competing others until some convergence happens. But at least with these private providers, if one fails or falls out of trust, patients and doctors can move to another - your data isn't permanently locked with an untrustworthy government.

[1] https://healow.com/

Re: Australia's new e-health platform crashes as people rush to opt-out

#77

Post by vertex-four »

pimmen wrote: post #74
michaelt wrote: post #61

Earlier quoted context omitted.

But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. Don't you think I'm in a better position to make that decision than a central government bureaucrat, given that I have my medical records and an incentive to protect my own privacy, and he has neither?

I'm not saying I like the Australian take on this but I do think a central database for medical records has the potential to prevent medical treatment mistakes by a couple percent. That's thousands of people saved. At that point, I think it's something we really should discuss as a society because it would have a profound effect on the economy and public health. I don't think the idea is fundamentally flawed, I think…

Sure, and I’m participating in that discussion right now - for me, it has a high risk of seriously negatively affecting me. There’s other bits of law that I oppose for similar reasons - there’s an opportunity to do a bit better/be a bit more efficient, but at the obvious cost of seriously harming people. I think that many people don’t recognise the downsides to centralised databases vs more efficient records transfer systems etc.

Re: Australia's new e-health platform crashes as people rush to opt-out

#78

Post by TheSpiceIsLife »

Avamander wrote: post #57
TheSpiceIsLife wrote: post #42

Earlier quoted context omitted.

I believe you’ve misunderstood the concept of single point of attack . This means single point of attsck for everyone with an ehealth record . With paper records, or in-house digital records, a hacker / thief, or malicious government, or what have you, has to compromise many systems. The same applies to your paper record comment.

> I believe you’ve misunderstood the concept of single point of attack. Single point in who's perspective though, OP worded it more like (s)he cares about his/her data not everyone else's (e.g. "I visit another doctor when on holiday - they don't have my records"). But yes, you are right about it being in general a higher risk endeavour. The question now is though, when other commenters here describe how their life a…

> which do you think is going to be much harder to breach, your local doctor's office or a central database that's guarded by armed guards and experts?

Who’s going to break in to a doctors office, then scan and upload your medical records? I don’t think thieves in Australia would even bother with doctors offices because no drugs or cash.

Rather, it seems certain that this database will be breached and the data sold on the black market, and / or some future government using it outside its intended scope.

Re: Australia's new e-health platform crashes as people rush to opt-out

#79

Post by Spooky23 »

Avamander wrote: post #60
Spooky23 wrote: post #45

Earlier quoted context omitted.

Paper records have a better scope. It isn’t economically justifiable to steal paper. Electronic records are easier to steal and cheap to sell, mine or otherwise utilize.

> Electronic records are easier to steal How are they easier to steal? I would really like to know.

It’s easy to bypass whatever security mechanisms are in place by a hospital, physicians office, insurance company, subrogation contractor, pharmacy, billing contractor, branch office of a sprawling health network. The sheer volume scope of custodians is big, and every one of them is a risk, some more than others.

Even without a breach, custodians are able to monetize “anonymized” data to third parties, who can often reconstruct it.

In olden times, all of our records were in a paper folder. Breaches were more often related to office staff losing said folder. Incidents where a bunch of guys with a truck stole shelves of folders were rare if they ever happened.

IMO, with the exception of inpatient orders, prescriptions and referral automation, most of the impact of EMR has been a net negative to the patient. The fact that all of my providers don't trust the system and ask me the same 5-15 questions every time I see them belies that.

Re: Australia's new e-health platform crashes as people rush to opt-out

#80

Post by TheSpiceIsLife »

pimmen wrote: post #35
jopsen wrote: post #15

Earlier quoted context omitted.

Even if there is a risk of this. It might be a risk worth taking. Edit: I don't know the specifics, but I sometimes wonder what good stats on more health records could do for future treatments.

I agree. In the US, the equivalence of a packed Boeing 747 of people die every day because of medical mistakes. It's the third leading cause of death. If you could reduce that number by 1% through this policy, that would mean thousands of people saved every year. In my opinion, the risk-reward analysis is clearly in favor of a centralized system.

That’s actually a Grady point. Thanks for raising it.
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