Posted: June 16th, 2015

Topic: understanding Health Information

Introduction

A Health Information System (HIS) is defined as the collection, analysis and the use of health data for the purpose of making decisions within the health sector (The University of Queensland, 2015). It is an essential tool for planning, designing and setting priorities through research, monitoring and evaluation. It needs to be timely, reliable, accurate and transparent throughout the process for purposes of developing policies that will be used in the healthcare department. The analysis below will therefore discuss the various aspects involved in the healthcare system of Australia (The University of Queensland, 2015). This paper reports on the actions of the Australian HIS using HIS rapid assessment tool (see attachment 1). By using documented references available through the websites the occurrence and effectiveness of 33 criteria structured under 6 modules are confirmed and proof is presented about their adequacy, functional status and sustainability.

 

Discussion

HIS resources

Coordination, Planning and Policies

• There is the presence of a functional national cross scrotal HIS committee in Australia that is adequate and sustainable. The country has the National Health Information and Performance Principal Committee (NHIPPC) that is responsible in reporting to the Australian Health Ministers’ Advisory Council (AHMAC), and through this body to the Standing Council on Health (SCoH). The NHIPPC has the responsibility of advising the AHMAC towards the strategies that they can adopt through their work processes, and in ensuring that collaboration has been established and implemented between the States, Australian Government and the existing territories. The body is also responsible in giving advice concerning the technical aspects of the national performance indicator specifications. The Secretariat of the body adds the data development project to the agendas scheduled for the meetings being held on a regular basis by the National Health Information Standards and Statistics Committee NHISSC (WHO, 2008).
• There is a written national HIS policy that is operational and functioning. The review further indicates the written policy to being adequate and sustainable (University of Queensland, 2009).
• There is a related legislation that is available, adequate and sustainable in being used to measure the vital statistics. The vital statistics in this case are resources that are very valuable for the government for their implementation or assessment of the on-going economic and social development programs (Who, 2013).
• There is a HIS related legislation in reference to the preview which is functioning, adequate and sustainable. The legislation is important in this case as it is used in regulating the HIS as a way of properly managing the ethical issues that concerns the aspects of data collection and dissemination (AIHW, 2014).
• Australia has the National Notifiable Disease Surveillance System (NNDSS) that was established in 1990 and is responsible in coordinating the communicable disease or the disease groups. Each of the states or territory has their own legislation that outlines the diseases to be reported, the bodies that the notifications are sent to, and the circumstances under which they should be reported (Department of Health, 2015). The preview indicates the presence of the HIS related legislation which is functioning, adequate and sustainable, and whose main function is to measure the Notifiable Disease Reporting (Department of Health, 2015).

Financial and Human Resources

• The human resources in Australia are specifically assigned to the HIS, but the financial and administrative irregularities in the areas of their remuneration and benefits have been created, and they are responsible in questioning the adequacy and sustainability of the whole system. A number of measures have been taken to address these issues, and they include the improvement of the efficiency in the system, employment of the more qualified staff, and the improvement of the oversight and increase of different governance and transparency aspects (The University of Queensland, 2009).
• The report on the Australian Bureau of Statistics (2013) is a clear example that indicates the existence of a clear line of responsibility towards the management of the existing Australian human resources which is properly functioning and adequate. The system however faces a number of constraints towards the effective management of their human resources since the decision making has been removed from the front line service delivery and has turned out to be more centralized. There are many layers that exist between those at the front line and the ones who hold the authority on decision making in the cases, where the system does not function properly even when it is sustainable. The organizational structure is meant to be reformed for purposes of giving more responsibility and authority to the periphery, and this is meant to have both the training and oversight over decisions being increased in the process (National Health and Hospitals Reform Commission, 2008).
• There is a well-functioning and sustainable budget line within the health department that has been allocated for the HIS activities. The system in place however has inadequacies in terms of their financial management like the irregularity on their payroll system, problems on the financial data management, and security of application, incorrect salary calculations and miscalculations of the employee leave entitlements among other factors. The reformation of the system therefore requires professionals who are well qualified in order to increase governance and transparency in the system that will be focused on attaining solutions for the existing problems (The Department of Health, 2013).

 

Infrastructure

• The hardware resources provided by the Australian government for use by the HIS are not adequate enough, and this is a factor that affects their performance, functionality and sustainability (The University of Queensland, 2011). It is therefore recommended to have solutions to the problem that will include the improvement of their efficiency, governance and other transparency aspects.
• The HIS system is supplied with the necessary software. This is indicated in the case where Australia has a projected cost of implementation in the National Broadband Network (NBN) being 42 billion; but on their submission to the NBN Senate Select Committee, Australian medical software company and the Soft (2009), the estimated cost of savings for the integrated health records was between $8 to $10 billion annually, and it emphasized on the importance of the broadband for the realization of the full E-health system (WHO, 2013). The software is however functioning even though it is deemed to be inadequate. The high costs of software and hardware exists, along with the maintenance costs, poor coordination and duplication in the E-health which forms part of the major issues that are meant to be addressed. Their quality, efficiency and safety are poor compared to other industries, and therefore measures have been put in place to solve them which includes the increase of the information access and sharing, investment on computer system and tools, and the health system for increasing adoption and using high priority system that will increase their effectiveness through different coordination and oversight (The University of Queensland, 2011).
• The networking infrastructure for health information system as an integrated information communication technology (ICT) is widely adopted by the Australian HIS workplace environment (The University of Queensland, 2011). The HIS work stream focuses on implementing the basic building blocks of infrastructure that are required to enable effective electronic information sharing across the health sector. The current state however produces high expenditure on the system and security threats, and a further poor availability in the broadband and mobile networks with high maintenance costs forms part of the challenges facing the system which is functioning presently with presence of adequacy and sustainability problems (The University of Queensland, 2011).

 

Indicators

• The HIS of Australia has identified its core national indicators to measure health determinants, system and status. In February 2008, the Australian Health Ministers’ Conference, the Australian Institute of Health and Welfare (AIHW) placed a request to develop a set of performance indicators that will support the agreement which will replace the 2003 to 2008 Australian Health Care Agreements (WHO, 2013). A Minimum Data Set (MDS) therefore exists, and is used in determining the types of data that are collected, and the set of indicators in Australia are functionally adequate and sustainable (Aihw, 2015).
• The national core indicators exist, and they are adequate and sustainable. The discussion in the question above indicates the existence of a national core indicator that measures the health system inputs and outputs which are functioning well (Aihw, 2008).
• The earlier discussion has clearly indicated the way national core indicators measure the health outcomes and status, as well as their performance, adequacy and sustainability (Aihw, 2008). An example in this case is the Australia which has an agreed group that measures the routinely collected mental health services that includes the clinician and consumer rated measures in children, adolescents and adults.
• The national strategy for collection of health indicators is present, adequate, and sustainable and functions well (Aihw, 2015). The national Performance Framework is an aspect that has been agreed by the government and includes 42 indicators for the three domains that provide broad perspective on the Australian health and system performance (WHO, 2008).

 

Data source

Population-based

• The Census Dictionary has been developed and the practice is conducted regularly. The population census is present, functions well and is held regularly therefore being adequate and sustainable. The Australia’s seventeenth national Census of Population and Housing will in this case be held in August 2016 to review the various issues of the sector (ABS, 2012).
• There is a Civil Registration for all births and deaths in Australia which is functional, sustainable and adequate (Familysearch, 2015). The Civil Registration has been created by the government, and it includes births, marriages and deaths; data that is commonly referred to be vital records as they entail the critical events through the livelihoods of their citizens. The data forms an excellent source of information as it provides all the required details that will be needed for any national planning processes (Familysearch, 2015).
• The Australian government regularly undertakes an adequate, functional and sustainable survey based on the population of the country. The survey is one of the largest and important one in the country as it covers the population and household data which is important for planning processes (Familysearch, 2015) (ABS 2013).

 

Institution-based

• The individual health records are maintained for recording the provided ongoing services for the users, and they are adequate, e and functions well. The collection of the individual health records which specifies each of their healthcare details are important as they are collected during the service delivery, and therefore they exist in all the health service delivery points, in addition to the E-Health and electronic health records which have been created and maintained for health service consumers (Queensland Health, 2015).
• The system provides an appropriate health service records from the health service users which is well functioning. The privacy act of Australia provides the requirements for handling sensitive information of individuals that concerns their health issues (Mater, 2015). The requirements govern the information collection, storage and maintenance, use and disclosure along with access of the information by the individuals with information on how they are managed by the institution (Mater, 2015).
• The requirements for keeping or destroying records of the administrative business are carried out by many of the Australian Government agencies using the set rules from the Administrative Functions Disposal Authority (AFDA) (National Archives of Australia, 2015). The functional purpose in this case includes the aspects of finance, human resources, publication management and procurement. The records are present, but do not function adequately through the health sector in Australia (National Archives of Australia, 2015).

DATA MANAGEMENT

Data storage, management and transmission

• There well-functioning is written procedure for data storage which includes security and destruction. The policy that has been put in place expounds on the storage conditions for the paper records, and they are designed to be protected from the unauthorized access, theft and other forms of damage that might result from fire, natural disasters, mould and water (Western Australia Department of Health, n.d.). The Western Australia forms an example that describes the procedures for such storage and disposal due to the structures and policies that have been put in place for such processes (Western Australia Department of Health, n.d.).

 

• There is no existence of a functioning centralized database or data warehouse that is meant for combining all the health data collections. This is an issue since it is important for the storage of data to always be carried out, and needs to be addressed by the Australian government for purposes of improving the efficiency, effectiveness and safety (The Australian Stroke Coalition, 2012).
• There exists Australian HIS which is well defined with mechanisms that are locally appropriate for transmission of data. The mechanisms however faces the challenge of sustainability and being inadequate, and therefore recommendations for proper networking and provision of hardware can be applied as being part of the solution to the problem (Western Australia Department of Health, n.d.).

Information products

• The effectiveness of transforming data into information is an important aspect for proper functioning of the HIS. The staffs working in these areas are trained to acquire the required skills, and the data is regularly analysed with information being extracted and displayed for users. The skills in the Australian HIS is therefore sufficient for transforming data into information, even though they face a number of challenges such as the cost, availability, inadequacy and sustainability processes (Western Australia Department of Health, n.d.).
• The skills of the staff are important in transforming data into information that leads to the use and interpretation for decision making. The use of advanced technology has been adopted at different levels of the data collection in the healthcare system of Australia, and therefore the government had designed the E-health record system which can carefully manage different stages that in the long-term will assist the healthcare professionals in accessing information quickly concerning the health of the individuals(Australian Health Ministers’ Conference, 2008). The implementation of the Australian E-Health has been successful for its purpose in addressing the local needs of the healthcare system, and therefore different aspects that faces their effective implementation remains to be the challenge facing the government (Australian Health Ministers’ Conference, 2008).
• There exist the functional tools and procedures that are used in assessing the quality of data, even though they are not enough compatable to the required levels. The quality of data involves the use of standard definitions along with the other characteristics like timeliness, appropriate methods of collection, data security and confidentiality of the information with their accessibility and required adjustments (WHO, 2008). The WHO has been able to come up with standards of data elements with the stated minimum data sets that ought to be attained in the system.
• The National health data dictionary along with the National Minimum Data Sets (NMDS) have been put in place and are available on different websites of the Australian HIS as a way of providing definitions and a set of the national health data standards which will be available and used through the health data collections (AIHW, 2010).

Dissemination and use

Demand, Analysis, Policy and Advocacy

• The information for policy and advocacy is fully functional, adequate and sustainable, and is used by the decision makers as they rely on the data collected from the healthcare system into designing the required policies and advocacy procedures that will be put in place (Better Health Channel, 2011).

Planning, Priority Setting and Resource Allocation, Implementation and Action

• A functional, adequate and sustainable annual report is issued by the Department of Health, and the process has been ongoing since 1997 (Australia Government, 2015).

 

• The data in Australia is frequently used by the policy makers for planning, priority setting or resource allocation. . The National Health Information Agreement (NHIA) is responsible in governing the structures and processes that the commonwealth, Territory health and the State use in improving and maintaining the national health information (AIHW, 2013).
• The Clinicians evidently use the information to plan and prioritize settings. The meetings that are held regularly by the National Lead Clinicians Group are directed at making use of the available information which has proven to be adequate and sustainable (The Sax Institute, 2012).
• The data is available in such a way that it has enabled data to be readily available for all individuals and parties interested in accessing the information (Abs, 2006).

Conclusion

The health information system in Australia has been seen to be an essential factor that helps in the decision making processes concerning the aspects of healthcare, and therefore is widely used through all areas of the health services. The standard tools have been developed to help in designing the quality, timeliness, completeness, accuracy and dissemination of the information that needs verification. The tool has been seen to comprise of six hubs which are divided into smaller criteria to allow thorough assessment of the system; therefore gaps are identified in the process and the necessary improvements carried out. The system in Australia is therefore encouraging since many of the criteria are met, but improvements have to be carried out on the aspects such as the financial management and payroll maintenance among the other issues that will be centered on improving the healthcare sector. The government is recommended to adopt mechanisms that will improve their efficiency and enable easier accessibility of the information for effective healthcare services.

References

 

Australian Bureau of Statistics,. (2006). DATA AND COMPUTERS. Retrieved from http://www.abs.gov.au/ausstats/[email protected]/0/6083B0D8AE258A86CA2571FE007D69E9?opendocument

Australian Bureau of Statistics,. (2012). Census of Population and Housing. Retrieved

from http://www.abs.gov.au/ausstats/[email protected]/Lookup/2007.0main+features32016

Australian Health Ministers’ Conference,. (2008). National E-Health Strategy. Retrieved from http://www.ahmac.gov.au/cms_documents/National%20E-Health%20Strategy.pdf

Australian Institute of Health and Welfare,. (2008). A set of performance indicators across the health and aged care system. Retrieved from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442471955

Australian Institute Of Health and Welfare,. (2010). National health data dictionary. Retrieved from http://www.aihw.gov.au/publication-detail/?id=6442468385

Australian Institute Of Health and Welfare,. (2013). National Health Information Standards and Statistics Committee (NHISSC). Retrieved from http://www.aihw.gov.au/nhissc/

Australian Institute of Health and Welfare,. (2015). Health indicators. Retrieved from http://www.aihw.gov.au/health-indicators/

Australian Institute of Health and Welfare,. (2014). Australia’s health system (AIHW). Retrieved from au/australias-health/2014/health-system/”>http://www.aihw.gov.au/australias-health/2014/health-system/

Better Health Channel,. (2011). Ottawa Charter for Health Promotion. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ottawa_Charter_for_Health_Promotion?open

Familysearch,. (2015). Australia Civil Registration. Retrieved from https://familysearch.org/learn/wiki/en/Australia_Civil_Registration-_Vital_Records

Queensland Health,. (2015). Health records and personal information. Retrieved from http://www.health.qld.gov.au/system-governance/records-privacy/health-personal/default.asp

The Australian Stroke Coalition,. (2012). Australian Safety and Quality Goals for Health Care. Retrieved from http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/National-Goals-consultation-Submission-75-Australian-Stroke-Coalition-17-Feb-2012.pdf

The Department of Health,. (2013). Health system capacity and quality. Retrieved from http://www.health.gov.au/internet/budget/publishing.nsf/Content/2013-2014_Health_PBS_sup2/$File/2013-14_DoHA_PBS_2.10_Outcome_10.pdf

The Department of Health,. (2015). Australian national notifiable diseases and case definitions. Retrieved from http://www.health.gov.au/casedefinitions

The University of Queensland,. (2009). Improving the quality and use of health information systems: essential strategic issues. Retrieved from http://www.uq.edu.au/hishub/docs/WP05/HISHUB-WP5-Full-12-WEB12Oct12.pdf

The University of Queensland,. (2009). Summary: Issues and challenges for health information systems in the Pacific. Retrieved from http://www.uq.edu.au/hishub/docs/WP07/WP07_Summary_WEB_15%2004%2013.pdf

The University of Queensland,. (2011). Understanding the role of technology in health information systems. Retrieved from http://www.uq.edu.au/hishub/docs/WP_17.pdf

The University of Queensland,. (2015). Defining HIS – HMN Framework – Health Information Systems Knowledge Hub – The University of Queensland, Australia. Retrieved from http://www.uq.edu.au/hishub/definition-of-health-information-systems

Western Australia Department of Health,. (n.d.). Information Storage and Disposal Policy. Retrieved from http://www.health.wa.gov.au/CircularsNew/attachments/719.pdf

Who,. (2008). Framework and Standards for Country health information systems. Retrieved from http://www.who.int/healthmetrics/documents/hmn_framework200803.pdf

Who,. (2013). Strengthening civil registration and vital statistics for births, deaths and causes of death. Retrieved from http://www.uq.edu.au/hishub/docs/Resource%20Kit/CRVS_ResourceKIt_active_content.pdf

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTACHMENT A – HIS RAPID ASSESSMENT TOOL

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
HIS RESOURCES
Coordination, Planning and Policies
1	Is there a national cross scrotal HIS committee?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/WorkArea/DownloadA sset.aspx?id=60129546543
2	Is there a written national HIS policy?	Yes	Yes	Yes	Yes	http://www.uq.edu.au/hishub/docs/WP05/HISHUB- WP5-Full-12-WEB12Oct12.pdf

 

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
3	Is there HIS related legislation to measure Vital Statistics?	Yes	Yes	Yes	Yes	http://www.uq.edu.au/hishub/docs/Resource%20Kit /CRVS_ResourceKIt_active_content.pdf
4	Is there HIS related legislation to measure Service Delivery?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/australias-health/2014/health-system/
5	Is there HIS related legislation to measure Notifiable Disease Reporting?	Yes	Yes	Yes	Yes	http://www.health.gov.au/casedefinitions
Financial and Human Resources
6	Are there human resources uniquely identified as HIS?	Yes	Yes	No	No	http://www.uq.edu.au/hishub/docs/WP07/WP07_Summary_WEB_15%2004%2013.pdf
7	Are there clear lines of responsibility for HIS?	Yes	Yes	Yes	Yes	http://www.health.gov.au/internet/nhhrc/publishing .nsf/content/16f7a93d8f578db4ca2574d7001830e9/ $file/options%20for%20reform%20of%20commonw ealth%20state%20governance%20responsibilities%2 0for%20the%20australian%20health%20system%20(j %20dwyer%20k%20eagar).pdf

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
8	Is there an allocated budget line within the MOH for HIS activities?	Yes	Yes	Yes	Yes	http://www.health.gov.au/internet/budget/publishin g.nsf/Content/2013- 2014_Health_PBS_sup2/$File/2013- 14_DoHA_PBS_2.10_Outcome_10.pdf
Infrastructure
9	Is there sufficient hardware available for HIS use?	Yes	Yes	No	Yes	http://www.uq.edu.au/hishub/docs/WP_17.pdf
10	Is there sufficient software available for HIS use?	Yes	Yes	No	Yes	http://www.uq.edu.au/hishub/docs/WP_17.pdf
11	Is there sufficient networking infrastructure to support HIS use?	Yes	Yes	No	Yes	http://www.uq.edu.au/hishub/docs/WP_17.pdf
INDICATORS
12	Are there national core indicators to measure health determinants?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/health-indicators/ http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442471955

 

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
13	Are there national core indicators to measure health system inputs and outputs?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442471955
14	Are there national core indicators to measure health outcomes and status?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442471955
15	Is there a national strategy for collection of health indicators?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442471955
DATA SOURCES
Population Based
16	Is there a complete population census undertaken at least every	Yes	Yes	Yes	Yes	http://www.abs.gov.au/ausstats/[email protected]/Lo

 

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
	10 years?					okup/2007.0main+features32016
17	Is there a Civil Registration process in place for all births and deaths?	Yes	Yes	Yes	Yes	https://familysearch.org/learn/wiki/en/Australia_Civil_Registration-_Vital_Records
18	Are periodic surveys undertaken to capture information for key health issues?	Yes	Yes	Yes	Yes	https://familysearch.org/learn/wiki/en/Australia_Civil_Registration-_Vital_Records
Institution Based
19	Are individual health records maintained for recording the ongoing treatment of patients?	Yes	Yes	Yes	Yes	http://www.health.qld.gov.au/system-governance/records-privacy/health-personal/default.asp
20	Are there appropriate health service records collected?	Yes	Yes	Yes	Yes	http://www.mater.org.au/home/privacy

 

 

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
21	Are there appropriate resource records collected, including finance and human resources?	Yes	Yes	Yes	Yes	http://www.naa.gov.au/records- management/publications/
DATA MANAGEMENT
Data Storage, Management and Transmission
22	Are there written procedures for data storage, including security and destruction?	Yes	Yes	Yes	Yes	http://www.health.wa.gov.au/CircularsNew/att achments/719.pdf
23	Is there a centralised database or data warehouse that combines all health data collections?	No	No	No	No	http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/National-Goals-consultation-Submission-75-Australian-Stroke-Coalition-17-Feb-2012.pdf
24	Are there defined, locally appropriate mechanisms in place for data transmission?	Yes	Yes	Yes	Yes	http://www.health.wa.gov.au/CircularsNew/attachm ents/719.pdf
INFORMATION PRODUCTS
25	Are staff appropriately skilled to transform data into information at national level?	Yes	Yes	Yes	Yes	http://www.health.wa.gov.au/CircularsNew/attachm ents/719.pdf

 

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
26	Are staff appropriately skilled to transform data into information at divisional/provincial/local level?	Yes	Yes	Yes	Yes	http://www.ahmac.gov.au/cms_documents/National %20E-Health%20Strategy.pdf
27	Are there tools and procedures available to assess the quality of data?	Yes	Yes	Yes	Yes	http://www.wpro.who.int/publications/docs/Impro ving_Data_Quality.pdf
28	Is there a set of national health data standards and definitions that are used across all health data collections?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/publication- detail/?id=6442468385
DISSEMINATION AND USE
Demand, Analysis, Policy and Advocacy
29	Are managers and clinicians using information for policy and advocacy?	Yes	Yes	Yes	Yes	http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ottawa_Charter_for_Health_Promotion?open
Planning, Priority Setting and Resource Allocation, Implementation and Action
30	Is an annual health report submitted to Parliament each	Yes	Yes	Yes	Yes	http://australia.gov.au/topics/government-and- parliament

 

 

 

 

 

Number	Criteria for Success	Present*	Functioning*	Adequate*	Sustainable*	Comments/Evidence
	year?
31	Are health managers using information for planning, priority setting or resource allocation and action?	Yes	Yes	Yes	Yes	http://www.aihw.gov.au/nhissc/
32	Are clinicians using information for planning, priority setting or resource allocation and action?	Yes	Yes	Yes	Yes	https://www.saxinstitute.org.au/wp-content/uploads/01_Priority-setting-methods-to-inform-prioritisation.pdf
33	Is data readily available to internal and external users, e.g. on the internet or intranet?	Yes	Yes	Yes	Yes	http://www.abs.gov.au/ausstats/[email protected]/0/6083B0D8AE258A86CA2571FE007D69E9?opendocument