A "very strange model" allows all Queensland Health clinicians to edit the medical data of all patients in public hospitals that have the integrated electronic medical record installed, a leading health law expert says.
Queensland University of Technology innovation law professor Matthew Rimmer said it appeared the $600 million electronic medical record project had a “whole host of issues”.
Dr Rimmer, who specialises in intellectual property and public health, questioned why clinicians working in any of the state's digital hospitals could view any patient's record and edit all aspects, including medication prescriptions.
“That seems a terrible approach, surely one would want to engage in data minimisation,” he said.
An Australian Medical Association Queensland letter to Queensland Health director-general Michael Walsh, dated September 2018 and seen by Brisbane Times, warned that clinicians were seriously concerned about the statewide access.
"Clinicians are concerned that write access to medication charts outside their immediate hospital can result in adverse events," the letter reads.
"For example, a doctor from Princess Alexandra Hospital had prescribed heparin on a patient in Mackay ICU who was also on other blood thinning agents, resulting in the patient bleeding and coming to harm."
The letter says the Mackay Hospital's medication safety committee had been "inundated with incidents" due to difficulties prescribing medications such as insulin and heparin, a blood thinner, through the integrated electronic medical record (ieMR), and other medications have gone missing from the system.
In one instance a clinician calling the ieMR helpline because oxytocin "went missing from the system" was told to prescribe an alternative drug, when there was none available.
"System wide 'upgrades' have also resulted in alerts to all ieMR sites about patient safety risks on the medication module and an order to revert to using paper with little notice," the AMAQ letter says.
The letter cites an alert issued on April 11, 2018, which warned of urgent patient risk.
'It has a lack of proper oversight'
The state’s ieMR project began in 2011, when a contract was signed with US medical technology giant Cerner to purchase its Millennium software “off the shelf” and modify it as it was installed in each public hospital.
A Brisbane Timesinvestigation has revealed serious safety risks in the software, with clinicians, health bodies and independent consultants repeatedly voicing concerns to the government.
Blood samples have been left in the wrong test tubes, test results have gone missing in the software, and patient data has been added to the wrong patient records in the years since the program was installed.
State Opposition Leader Deb Frecklington said the LNP believed the integrated electronic medical record program should be halted until issues were resolved.
But Health Minister Steven Miles said the LNP needed to explain why a 2014 report commissioned during the Campbell Newman government that held serious warnings about the project was not heeded.
In 2014, an independent consultant report said the software could cause problems for Queensland Health similar to the 2011 payroll debacle, when thousands of hospital staff went without pay for months after a new IT system went live, triggering a commission of inquiry.
A Queensland Health general manager requested that the 2014 ieMR report be modified to remove those warnings.
Dr Rimmer said the December 2018 Auditor-General’s report - cited by Queensland Health as the roadmap for the future of the program and described by Mr Miles at the time of its release as a “big tick” for the ieMR project - raised “huge issues”.
“The current approach seems very flawed, and it’s providing very wide access,” he said.
“It has a lack of proper oversight, it seems insufficient that they’re merely relying upon disciplinary measures for individual staff for such a system in place.
“There’s a real failure there to understand what adverse impacts could take place.”
The Auditor-General's report found the ieMR was generally improving patient health and hospital performance but had issues particularly in its future costs and highlighted concerns about the wide access and "weaknesses" in password controls.
Staff who left the organisation might still be able to access data using their logins for several months, and the Auditor-General found dormant accounts "could be exploited by internal users".
Hospitals were "expected to monitor access logs" but that process "relies heavily on co-operation from staff assigned the responsibility", the Auditor-General found.
Citing international electronic medical record failures such as in Singapore, where the HIV status of more than 14,000 people was leaked online in January after its national electronic medical record was hacked, Dr Rimmer said he wondered about the legal and ethical implications of the ieMR project for Queensland Health.
Any clinician can edit any patient's record
To date the ieMR is installed in nine Queensland hospitals, with Ipswich Hospital the latest to go live in December 2018.
Dr Rimmer said the ieMR project appeared to be experiencing similar issues to other big government digital technology programs, such as the federal 2016 “census fail”, the Centrelink “robo-debt” scandal and the controversial My Health Record.
The federal government’s My Health Record sparked serious concerns after it was revealed every Australian would have to opt out if they didn’t want all their sensitive medical data stored in an online record.
The integrated electronic medical record project is specifically designed to allow all clinicians at all public hospitals both read and write access to patient records, allowing clinicians to log in remotely and edit records.
It also connects directly to My Health Record and allows clinicians to see a patients’ medical records and upload test and imaging results and discharge summaries to the national database.
Any patient who enters a Queensland public hospital with the ieMR installed will have a record automatically created for them.
A Queensland Health spokesperson said only authorised Queensland Health staff could access a patient’s electronic medical record.
“Medical information is protected by strict legislation and built-in security measures to prevent unauthorised access,” the spokesperson said.
Dr Rimmer said on both a state and federal level there needed to be a serious reconsideration of how patient confidentiality and health privacy were handled.
“There seem to be huge gaps between the aspirations to have seamless bureaucratic IT systems and the very ugly reality of what’s taking place,” Dr Rimmer said.
A Queensland Health spokesman said the integrated electronic medical record had improved patient safety and hospital efficiency.
“The recent Queensland Audit Office report into digital hospitals, released just last month, confirmed the digital hospital program is improving healthcare and patient outcomes,” the spokesperson said.
“Patient safety has markedly improved since the integrated electronic medical records was first rolled out.
“It has reduced the average length of stay, unplanned readmissions, and the number of serious falls and pressure injuries.”
Minister often 'lack technological expertise'
By 2025 the department wants 27 hospitals to have the ieMR installed and fully operational, by which time the project is predicted to cost $1.2 billion.
Dr Rimmer said a “political problem” with the implementation of such whole-of-government digital health IT projects was the minister in charge often lacked technological experience.
“Often it’s passed from one minister to the next; we’ve had a sequence of people serving a couple of terms as health ministers in Queensland for a while,” he said.
Mr Miles is the latest minister to oversee the integrated electronic medical record project after taking over from Cameron Dick in 2017.
Previous health ministers overseeing the digital transformation of Queensland Health were Stephen Robertson, Paul Lucas and Geoff Wilson under the ALP Bligh government, followed by Lawrence Springborg under the LNP Campbell Newman government.
Ms Frecklington said the rollout of the ieMR should be halted until issues were resolved.
“We’ve seen a $256 million cost blowout and clinicians’ concerns have been ignored by the Labor Health Minister,” Ms Frecklington said.
“This has all the hallmarks of Labor’s health payroll debacle except worse – patient safety is at risk.”
Mr Miles said the LNP needed to explain why the 2014 report was buried.
“Since coming to government Labor has made changes to the LNP’s program to address some of the concerns I understand are in this secret LNP report,” he said.
“A more recent report, the Queensland Audit Office (QAO) report released in December 2018, confirmed the digital hospital program is improving healthcare and patient outcomes.
“The report found the digital program contributed to a significant increase in early identification of deteriorating patients, a decrease in emergency patient readmissions, staff can access clinical information faster and patient records are more legible.”
Mr Miles said Queensland Health was “continuously looking for ways to improve the system”, which included regular consultation with staff and stakeholders.
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