Monday, July 26, 2021

The digital Estonian

Greetings from the ANU where Ms Kersti Eesmaa, the Estonian Ambassador is giving an entertaining talk on how her country became the most digital. This includes e-voting, e-tax, e-health and just about e-verything. They have backed up the country's records in Luxembourg and are considering Canberra. The ambassador complemented Australia's online services but suggested it was tie for one national ID  At qesttion time I asked about e-residency and the ambassador asked when I would drop in to get my card.

Thursday, July 15, 2021

Provide Online Informed Consent for COVID-19 Vaccination

The ABS reports that only 73% of Australians would get a COVID-19 vaccination. Of the others, 52% were worried about side-effects and 15% effectiveness. In response, I suggest that Australia's National Cabinet approve the use of online informed consent using multimedia in multiple languages, to streamline COVID-19 vaccination, using any of the vaccines approved for use in Australia for any adult of any age.

The Australian Technical Advisory Group on Immunisation (ATAGI) has advised

"... AstraZeneca vaccine can be used in adults aged under 60 years where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits".


"Noting the current constrained supply of the Pfizer vaccine, ATAGI also recommends adults under the age of 60 who do not have immediate access to the Pfizer vaccine should consider the benefits and risks of earlier protection through the AstraZeneca vaccine. "

However, that advice has been implemented in a way which makes it very difficult for anyone who does not have a GP with supplies of AstraZeneca, from being vaccinated. 

The Australian Government provides a document "Weighing up the potential benefits against risk of harm from COVID-19 Vaccine AstraZeneca" to assist with informed consent. But, this is intended for doctors to help explain to patients. As a result those who don't have a GP to explain it to them cannot give informed consent and so cannot be vaccinated at mass vaccination center. 

I suggest National Cabinet decide that a standard audio-visual package in multiple languages be prepared. This would be added to online booking systems, allowing any adult to give informed consent to an AstraZeneca vaccination online. Any adult should be able to walk into any vaccination center at the booked time, show ID and be vaccinated immediately, without the need to speak to anyone, or fill in any paperwork.

Individuals would still have to option to visit their doctor to discuss vaccination. However, I suggest our leaders now need to ask every Australian to accept that the risk, in the interests of their family and the community to get vaccinated now.

Saturday, July 03, 2021

Make Getting a Vaccination Should be as Easy as Ordering a Pizza

It is more than a year since the beginning of the COVID-19 pandemic emergency in Australia. Federal and state governments have spent billions of dollars on health measures, but are still unable to field an easy to use online vaccination booking system. I suggest modelling this on the ease of use, and sophistication, of a pizza ordering system. Some years ago I ordered a pizza online for collection. The system took my details and presented pizza options. It then listed the nearest places I could collect it. What was impressive was the system then asked my means of transport and estimated when I should leave to get there just in time. I left at the time suggested, and as I walked through the door of the pizza parlor, my order popped on an electronic display indicating it was ready. I picked it up and was out the door in under a minute. It should be possible to do something similar for vaccinations.

A responsive online vaccination booking system would instill confidence in the public and increase the efficiency and safety of the vaccination process. Removing long queues at vaccination centers will decrease staffing to manage the crowd and also reduce the risk of spread of infection. All of the information the patient needs should be able to collected online and them arrive with a QR code ready to be scanned and jabbed.

An efficient online vaccination system could prevent tens of thousands of deaths, by speeding up vaccination and preventing mass breakouts of COVID-19. This could also decrease the risk of mental illness and death, due to the suffering brought about by lock-downs and unemployment, particularly of younger people. This places such systems in the category of "safety critical", requiring a higher level of care in design, testing and deployment by computer professionals.

Improved ACT Health COVID-19 Vaccination Booking System

To make an online booking at ACT Government COVID-19 vaccination clinics, clients are required to use the MyDHR system. Previously when I tried to register I found the process confusing and was not able to register. When I tried today, I found the process had improved and I was able to register, but it appears it is still not possible to use this system to book a vaccination online. This differs from private vaccinations clinics, where the patient is shown dates and times they can select from, online, as soon as they are registered in the system. 

Medicare Number Format

A problem still exists with the way the patient has to enter the Medicare number on the ACT Government system. This differs from the format used by Federal Government and private providers. It will only be a problem the first time the patient registers with the system. For someone who will regularly attend a clinic for medical treatments, that is not a major problem. But for an emergency vaccination campaign, where each patient will attend only two or three times, difficulties in initially registering are more significant. 


The ACT Government page on vaccinations has a link for patients to register. However, that link doesn't take the patient to the registration screen, but to the login screen. The patient is then asked for their user ID and password they have not yet been issued with, which is confusing. There is a link for registering, but patients are may be confused at this point and never see the link.

MyDHR One Time Security Code,
ACT Health, 3 July 2021
Once the link is found, registering is not too complex. The patient is asked to enter a code sent by email or SMS. This is described as a "one time security code". If this process only applies during signup it is not clear how this authenticates the person, as neither the email address or telephone number have been separately authenticated (unless perhaps this information is obtained from Medicare). 

Secure Username?

MyDHR Choose User name,
ACT Health, 3 July 2021
After entering the security code (which arrived promptly by SMS), I was asked to create a user name. Confusingly, the instructions were to "think of one that is secure and easy to remember". It is not clear why the user name has to be "secure", as there is a separate password to be entered. The instruction to make the user name secure contradicts the one to have it easy to remember. Also the indication that this username
can never be changed would add to the stress for the patient. Also it is a flaw in the security of the system to have a code which must be secure and cannot be regularly changed.

MyDHR Main Screen

MyDHR Main Screen,
ACT Health, 3 July 2021

After choosing a username and password, I was presented with a reasonably easy to read main screen. However, the first item listed was not booking a COVID-19 Vaccination, but checking eligibility. I suggest this be changed, s the purpose of the exercise is to book a vaccination

MyDHR Vaccine Eligibility,
ACT Health, 3 July 2021
After answering a short list of questions about eligibility, I expected to be told I was eligible. However, instead the message was that if I was eligible, I would be contacted withing 24 hours to let me know when an appointment was available.  This is not a good systems design, as first of all the patient has to wait 24 hours, for no good reason. Secondly, a patient who hears nothing doesn't know if they have been placed in a lower priority category, or missed the message. Thirdly, it is not clear to the patient how they actually book a vaccination.

No Medical Records on System

The ACT Government system is intended to provide a comprehensive system for patients of ACT Health, not just vaccinations. So I looked to see what records were recorded. There was not record of my ever being a patient, although I had spent a night in the ICU and received numerous tests. It may be my treatment was too long ago to be worth loading into the new system, but patients will not feel reassured about receiving further treatment, if there is no record of their previous treatment.

Confusing Email

After registering, I received an email with the subject line "Please check your MyDHR account". However, the body of the message said "... you have new information in MyChart.". But what is MyChart? There was no signature block to indicate this message was from the ACT Government, and no contact details to reassure the patient this was a genuine message and help the patient seek further information (the message had a "no reply" address).