Dr Clarke said the program was a guise to mask the creation of an ID regime in the health sector, following past failed attempts to introduce national identity cards.
"If the personally controlled e-health record falls over and the smokescreen disappears, the bureaucrats won't care," Dr Clarke told The Australian.
"Because they will have achieved their goal of a centralised patient identification regime and everything behind it, such as the individual healthcare identifiers, will continue.
"IHIs are an enabling mechanism for linkage between agencies, allowing the creation of virtually centralised national databases."
An IHI was assigned to everyone on the Medicare database last year to support the program, but the system is not yet operational.
Health Minister Nicola Roxon said last week that an Accenture-led consortium would build the IT infrastructure by July next year at a cost of $77m.
But Dr Clarke said the system showed that the key objectives were administration, cost control, insurance and research rather than clinical care.
"From a consumer's perspective, this is awful," he said. "They're not designing the system to help patients and doctors, they're designing it to suit bureaucratic needs."
A spokesman for Ms Roxon said Dr Clarke's claims were "silly -- at best ill-informed, at worst intentionally misleading". He said: "We are not building a national patient database.
"E-health records are being developed for the ultimate benefit of patients, and not for the conspiracy theory reasons claimed."
Dr Clarke said the concept showed that the "vast majority of infrastructure is about the back-office systems" in the health and human services departments.
"Their intention firstly is to achieve linkage -- and I don't mean interoperability -- among large numbers of databases around the country," he said.
"They plan to consolidate some into centralised components; obviously not a single physically central database, because that would be impossible, there's too much data."
The foundation maintained this was "completely the wrong approach", he said.
"It's so damn big and so damn complex -- you don't need to link everything together because it's only in particular circumstances that particular islands need to talk to one another," Dr Clarke said. "You should focus on interoperability among those islands."
The failure of the Health Department, the National E-Health Transition Authority and Medicare to involve consumer representatives in the program's design supported the view they were not interested in outside input.
And Dr Clarke was uneasy about the selection of the team delivering Singapore's $140m national patient records program.
"Singapore has a very nice centralised operation that strongly believes in national identity schemes and stultification of the populace," he said.
Meanwhile, the building of the national PCEHR IT infrastructure involves the creation of a national data repository to host summary records, along with an indexing service to locate and present matching records held by agencies as well as local private and public databases.
The privacy foundation's health committee chairwoman, Juanita Fernando, says it will be a centralised database of information under one management.
Dr Fernando has drawn together the initial proposed linkages facilitated by the IHIs.
"I don't think people are aware of just how much information the government now holds about them and the ways this data may be linked," she said.
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Autor(en)/Author(s): Karen Dearne
Quelle/Source: Australian IT, 23.08.2011
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