Wednesday, July 28, 2010

NEHTA and DoHA are Heading in The Wrong Direction with their PCEHR Plans.

The following article appeared a few days ago.

Labor's e-health plan misses patient safety mark say doctors

Karen Dearne

From: Australian IT

July 21, 2010 6:28PM

DOCTORS say Labor's plan for personally-controlled e-health records is a distraction from the main game of delivering shared, secure electronic medical records that will actually improve patient safety.

Australian Medical Association president Andrew Pesce warns that patient care is "best served" when doctors have access to complete health records.

"Personal e-health records empower and encourage individuals to take responsibility for their own health, but their use may be severely limited in terms of their content, accuracy and the comprehensiveness of information," Dr Pesce said.

"Therefore, medical practitioners need a shared e-health record, in addition to any personal record (held by the patient)."

Launching an election wishlist in Canberra, Dr Pesce said the AMA welcomed the Coalition's commitment to mental health, but was disappointed these programs would be funded by money diverted from e-health and GP infrastructure proposals.

The Liberals say they will scrap the $467 million Budget allocation to personally-controlled e-health records, which Labor has promised to deliver a PCEHR to "every Australian who wants one" by 2012.

More Here:

On spotting this I thought more detail would be on the AMA web site and sure enough we find this.

10. E-health


An e-health system that connects patient information across health care settings, and which can be accessed and contributed to by treating doctors and other health professionals, will improve the safety and quality of medical care in Australia.

The benefits of e-health in making the best use of existing health care services and avoiding errors, duplication and waste are well known. To treating doctors, e-health means being able to access all of the clinically relevant medical information about a patient at the time of diagnosis or treatment.

Australia has made significant progress in developing technical specifications and standards for e-health systems. The time has come to build the overarching infrastructure to make e-health a reality.

Key issues for patients

Health care of the patient is best served when the medical practitioner has access to the full health record.

Personally controlled electronic health records empower and encourage individuals to take responsibility for their own health, but their use may be severely limited for medical practitioners in terms of their content, accuracy, and the comprehensiveness of information.

Therefore, a shared secure electronic medical record, in addition to any personally controlled health record, is needed to improve the safety of patient care.

Key issues for the Government

A commercial approach that relies solely on private investment and private engagement has not served the e-health agenda well. The next Government, with the State and Territory Governments, must drive and fully fund the development and implementation of a shared electronic medical record.

AMA Position

To make e-health a reality, the next Government must fund and build the overarching infrastructure to connect patient information and facilitate access by medical practitioners across the public and private health care sectors so that a summary electronic medical record can finally become a reality.

The medical profession must be a key driver of the design and implementation of the infrastructure to ensure that it works on the ground in medical practices.

A shared electronic medical record that links reliable and relevant medical information across health care settings will help provide treating doctors with the information required to inform clinical decisions.

The next Government must fund and implement a shared electronic medical record that:

  • Contains reliable and relevant medical information about individuals;
  • Aligns with clinical workflows and integrates with existing medical practice software;
  • Is governed by a single national entity; and
  • Is fully funded by Governments and supported by appropriate incentives, education and training.

- End AMA Position.

A few things are clear from this.

First the AMA prefers the direction of provider support and communications and information sharing as the first steps in the development of E-Health in Australia – just as outlined in the National E-Health Strategy.

Second they recognise that for any e-Health initiative to work it must involve clinicians from the outset and integrate into present clinical workflows – or at least not be a distraction and nuisance.

Third they are pretty clear that the leadership and governance of e-Health in Australia is not good enough.

Fourth they have noticed e-Health is both needed and should be properly funded and led.

Sadly what is missing is a recognition that there is no clarity at present as to just what the ‘right’ approach to establishing health information sharing between providers is, let alone how such information can be optimally shared with patients

From this article, and other things that have been reported from the UK, unless our doctors are much more trustworthy and accurate, large scale shared EHRs need a fair bit of work yet.

One in ten electronic medical records contain errors: doctors

One in ten medical records on a new electronic database contain errors which could put patients at risk, doctors have warned.

By Rebecca Smith, Medical Editor

Published: 8:15AM BST 17 Jul 2010

Doctors in Birmingham have found that 10 per cent of the records that have been uploaded so far contained out-of-date information including errors on current medication patients are taking or drugs they are allergic to.

These mistakes could put patients at risk if doctors relied on the information in an emergency and administered a drug they were allergic to or gave them a medicine which interacts with one they are already taking.

The system must be halted as it is not safe, doctors said.

So far around two million electronic patient records have been uploaded to the central database and if the error rate was the same nationwide, which doctors say is not unreasonable to presume, then around 200,000 people could be at risk from inaccurate information stored about them.

GP leaders in Birmingham told Pulse magazine that the organisation running the system, Connecting for Health, knows about the error rate and has not taken action.

Dr Robert Morley, executive secretary of Birmingham Local Medical Committee, which represents local doctors, told Pulse: "The fact that in Birmingham 80,000 patients have had their records uploaded, the majority without their consent, and one in ten have been put at risk from inaccurate data, shows we believe that the uploading of the Summary Care Record has to be stopped immediately because they are not safe."

Lots more here:

The need for a good deal more work and the need to be a bit less dogmatic approach on the part of DoHA and NEHTA would be useful first step to architecting and delivering systems that might actually do the job - i.e. save lives, improve quality of care and make the system just work better!


1 comment:

Dr Ian Colclough said...

Australian Medical Association President Andrew Pesce warns that patient care is "best served" when doctors have access to complete health records.

No one can argue with that. However, we have never had complete health records in the past, we don’t have complete health records today and we won’t have complete health records for a very long time to come.

The fragmentation of the health system, the lack of one collection point for all our health information, the reluctance of health providers to share their records, the dis-aggregation of patient information inside the hospital aggravated by a mix of disconnected paper and electronic storage systems has caused the situation to deteriorate further from what we were prepared to accept and work with a couple of decades or more ago.

Dr Pesce advocates giving medical practitioners a shared e-health record, in addition to any personal record (held by the patient).

That is all well and good provided it is all part of one record; albeit with separate compartments. Separating one from the other creates further fragmentation thus aggravating and perpetuating the overall problem to which Dr Pesce refers - ie. patient care is "best served" when doctors have access to complete health records and the need for “personal e-health records which empower and encourage individuals to take responsibility for their own health”.

The two go hand in glove together and unless we accept that we will not see much progress.