Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Monday, April 06, 2009

Health IT Components of Garling Report Response from NSW Health – Looks Pretty Pathetic.

To start a little background.

New body to assess if hospitals measure up

  • Louise Hall and Alexandra Smith
  • March 30, 2009

HOSPITALS and their departments will be assessed on performance measures such as infection rates and distance a patient has to travel for treatment in an overhaul of the NSW health system's public reporting.

Today the Health Minister, John Della Bosca, will announce an independent bureau to collect, analyse and report on the safety and quality of patient care in public hospitals.

Peter Garling recommended setting up an independent bureau after his special commission of inquiry into the health system. The Government will release its response to his report today.

"The information collected is to be directed to how well the patient has been treated, not to process-driven, often politically driven, data which may make administrators more comfortable, but not the patients," Mr Garling's report says. The $5.8 million Bureau of Health Information is one of the "four pillars of reform" he recommended.

In his wide-ranging critique of a public health system "on the brink of collapse", Mr Garling said an independent bureau would identify, develop and publish patient care measurements at arm's length to the Government.

This would include a patient's ability to gain access to hospital services and other community and home-based health services, as well as how quickly a patient could access services and how far they needed to travel from home to receive care. Clinical performance including the outcome and quality of treatment would also be published as well as the costs of care.

Mr Della Bosca said the bureau would make hospital data more transparent and enable information analysis at a local level, which had been urged by many doctors and nurses consulted during the process.

More here:

http://www.smh.com.au/national/new-body-to-assess-if-hospitals-measure-up-20090329-9fm1.html

Health IT improvement was a major focus of the Garling Report Review of NSW Health. Somehow it seems however to have slipped through the cracks to quite a dramatic degree.

The response document mentions technology only 9 times

Let’s consider each of the recommendations and response comments in order.

The first (general) mention is on page 15.

“Prioritising of the information communications technology program rollout will support clinicians in providing safer care for patients, assist in removing red tape on recruitment and enable better management of equipment and other assets.”

Just what priority is not made clear and one really wonders how it is that safer patient care is dealt with in the same sentence as removing recruitment red tape and improving asset management?

Now to the relevant specific recommendations.

Page 16

Recommendation 2.

In order to improve the availability of interpreting services in public hospitals for non-English speaking patients, each Area Health Service must investigate the sufficiency of, and ensure the adequacy of, the hands free communication equipment available in each hospital to maximise the opportunities for the use of the telephone interpreter service.

Response. – Supported as Stage 1 – Immediate Action.

NSW Health will investigate current equipment and technology options and consider requirements in specific locations (e.g. a dedicated interpreting services line in emergency departments) to ensure access.

Blog Comment:

Not actually supported – just will investigate what might be done. Not very convincing. Easy to commence an investigation that goes nowhere.

Page 32

Recommendation 50

NSW Health should cooperate with and support the National E-Health Transition Authority including in particular developing appropriate policies to and platforms which govern the manner of and the circumstances sufficient to permit general practitioners, specialists, allied health professionals and community health clinicians, who are located outside the hospital, to gain access to relevant parts of, and information from, the electronic medical record generated within NSWpublic hospitals.

Response – Supported – Immediate Action.

The NSW Government has supported the introduction of centralised electronic health records and is pursuing the development of these in conjunction with the e-health strategy being considered by the Council of Australian Governments.

Blog Comment:

Of course it is supported because it the response totally avoids NSW Health actually having to do anything! No actual mention of improving access to information for GPs etc.

Page 33

Recommendation 51

Within 4 years NSW Health should complete the current information technology program including the following stages:

Timing

Stage 1: 12 months

Infrastructure

Stage 2: 18 months

Electronic medical record

Patient Administration System

Stage 3: 24 months

Human Resources Information System

Business information strategy

Medical imaging

Intensive care

Hospital pharmacy system

Stage 4: 36 months

Community health system redevelopment

Automated rostering

Clinical Documentation

Medication management

Stage 5: 48 months

State-wide roll out of the electronic health

Record

Response - Supported with modification and a different slower timeframe.

Commissioner Garling acknowledged that ...NSW Health has embarked upon one of the largest IT projects in the country (p7, 1.48). NSW Health will prioritise implementation of the Information Communications Technology (ICT) program within the Health capital program with a new rostering system, planning for a community health system and improved infrastructure progressing during 2009/10 to better support patient care. The program has already started and NSW Health will continue to prioritise work with commencement of the entire program staged over the next five years.

NSW has piloted the use of an electronic health record but the timing of implementation depends on national action and funding. NSW Health will be funding its contribution to the National E-Health Transition Authority to enable it to continue its existing work program towards the establishment of a national e-health records service.

Blog Comment:

What this actually says is “we plan to ignore Commissioner Garling on this as we like our own much slower and less expensive plan. We also plan to do nothing on shared EHRs that we have conducted an inconclusive pilot on until someone stumps up some extra funds”

Page 34

Recommendation 58

In order to ensure compliance with the NSW Health policy on the mandatory provision of discharge summaries to a general practitioner the GP Liaison Officer in each hospital is to institute a regular process of checking and auditing:

(a) the provision of a discharge summary;

(b) the accuracy of and the sufficiency of the discharge summary; and

(c) where appropriate, the legibility and readability of the

discharge summary.

Response – Supported Immediate Action

Statewide introduction of the electronic medical record commenced in January 2009 and will improve information sharing between NSW hospitals and general practitioners. In the interim, auditing on discharge summaries will be included on the internal audit program in each Area Health Service.

Blog Comment:

This might come as news to many! I wonder how many people presently have these records? Interesting that the response does not seem to answer the question at all as best I can read it. Just what does an internal auditor know about the quality of discharge summaries. Obfuscation alert with this one!

Page 48

Recommendation 113

Within 18 months, every public hospital in NSW ought be fitted with a digital radiological imaging system, such as PACS, or a compatible system thereto, which will enable the electronic transmission of medical images to remote locations for use in clinical treatment, reading and interpretation.

Response – Supported sort of and to go more slowly.

Consistent with the Information Communications Technology Program, NSW Health will action within 26 months rather than 18 months.

Blog Comment:

Again it seems NSW likes their slower implementation time-frames. Forgetting that there is public outrage about the degradation of their public health system the bureaucrats sail on unperturbed.

Page 52

Recommendation 129

Within 24 months, NSW Health should establish a central State-wide equipment asset register recording details of fixed assets with an acquisition value greater than $10,000 and attractive assets greater than $1,000. Details recorded in the register should, as a minimum, include:

(a) the purchase price;

(b) the date of acquisition;

(c) the estimated life expectancy (usability) or contract expiry date;

(d) the half-life usability assessment date; and

(e) the location of the asset.

Response – Supported – Stage 3 – Within 18 months.

NSW Health will establish a more comprehensive registration and reporting system for assets and include leased equipment. NSW Health has already introduced the Health Asset Management and Maintenance System (HealthAMMS) in three Area Health Services, which is an enabling technology tool specifically to assist health services in the effective management and maintenance of their facilities and biomedical equipment. A strategy has also been completed for the rollout the HealthAMMS application to other Area Health Services

Blog Comment:

Typical we want to count the widgets but not assist patient care and safety.

In summary, given the strong emphasis Commissioner Garling and many submissions made about the need to get the Health IT in the system up to scratch this is really a non-response. Sadly this is exactly as expected! The only good thing I can see in the information management area is the Bureau of Health Information proposal – but, unsupported by rich operational clinical systems this is not likely to make the different that the Commissioner desired.

David.

2 comments:

Anonymous said...

It was clear from the beginning the Garling Report's references to anything to do with IT would get the 'flick-off' treatment. So we shouldn't be surprised.

Anonymous said...

The one outstanding gem of analysis in the Garling Report was the sensible review of the question What is a safe occupancy rate? in Volume 3 p993, IMHO. But in general, the report did not show much analysis nor deep understanding of acute hospital care complexities. And the response was of course underwhelming, and tragically, as expected. But this time of darkness will pass, as all things do...