Tuesday, August 03, 2010

A Business Case For Personally Controlled Electronic Health Records - How Does That Work?

The following appeared earlier today.

Labor considers alternatives to government-funded e-health scheme

THE Labor government was considering alternatives to a government-funded e-health record system during public consultations on the controversial Healthcare Identifiers Bill over the past year.

CSC was paid $1.7 million to plan and cost the "personally controlled e-health record" program unveiled in the May budget, in a three-month project over Christmas.

While consumer, privacy and industry representatives spent their break poring over the draft legislation, the government was investigating National Health and Hospital Reform Commission recommendations on a more commercial approach.

A Health spokeswoman has confirmed CSC's brief was to develop a business case for the personal e-health record initiative announced in the budget.

E-health observers hoping for $1.6 billion over four years to fund the rollout of the agreed national e-health strategy were surprised when the government instead said $466.7m would be spent to provide a personal e-health record "to every Australian who wants one" by June 2012.

CSC is also a prime contractor with the government-owned National E-Health Transition Authority, and worked on "a comprehensive information security framework" for the Medicare-built HI service from early 2008.

More fun stuff here:

http://www.theaustralian.com.au/australian-it/labor-considers-alternatives-to/story-e6frgakx-1225900239811

As no one has a clue what is actually being talked about here – other than DoHA and CSC and none are actually talking let’s make an informed guess.

For the sake of argument, let’s assume the personally controlled e-health record (PCEHR) is a longitudinal summary EHR similar to what NEHTA describes as an Individual EHR (IEHR) that has access to the information contained in it controlled by the person who is the subject of the record and who has chosen to have one of these established for themselves.

The NEHTA concept for the IEHR is very similar to the older HealthConnect Shared EHR project’s approach.

Each individual has:

1. An Identifier Set of Information (Name, Age, Sex, Address, IHI etc)

2. A Shared Health Profile:

* Allergies, Alerts, Adverse Reactions

* Current Meds / Ceased Meds

* Problems and Diagnosis

* Procedure History

* Limited Family and Social History from Individual

* Lifestyle

* Immunisations

* Implanted Devices

* Screening Results

* Key Physiological measurements

3. Event Summaries – including possibly Discharge Summaries, Test Results, Care Plans and so on.

4. A Supported Self Managed Care Record. (I think this is a traditional user contributed Personal EHR)

This is found here:

http://www.gpv.org.au/files/downloadable_files/About%20Us/Partnerships/20090619_prs_NeHTA%20and%20eHealth%20Reform.pdf

Slide 21 and in many other NEHTA presentations.

The models that are similar to this – without the personally controlled aspect – are HealtheLink in NSW and the Shared Care Record in the UK.

Now a business case typically has two main aspects (cost and benefits) and some extra areas (context, management, risk management, project control and so on).

To derive the cost side you need to define just what is intended and then cost the various technical, staff and labour impacts to work out a start up and continuing cost budget. Note the key is to know exactly what you want before you can cost it.

Equally to derive benefits you need a clear idea of what is planned and just what its impact will be on workflows, quality, safety, efficiency and so on.

The efforts at a Shared Care Record in the UK have had a difficult time:

See here:

http://aushealthit.blogspot.com/2010/07/now-here-is-issue-or-two-nehta-and-doha.html

and here:

http://aushealthit.blogspot.com/2010/04/problems-with-nhs-shared-record-any.html

and most critically here where only very limited benefits were able to be identified.

http://aushealthit.blogspot.com/2010/06/if-ever-there-was-some-research-to.html

As far as Healthelink is concerned the evaluation did not seem very positive and was very constrained – no costs to be mentioned for example.

See here:

http://aushealthit.blogspot.com/2008/12/nsw-healthelink-evaluation-devil-is-in.html

and there has been no extension of the initial pilots in 18 months as far as one can tell – so not a raving success.

The bottom line of all this is that I do not believe an evidence based business case for the proposed PCEHR can be mounted without either some enormous fudges and assumptions that may not really stand close scrutiny or a totally novel and really interestingly innovative approach I have yet to see described.

The only way we can know the truth is for this Business Case – which we now know exists – to be released publicly. To go to an election and not level with all of us about just what is proposed is an outrage I believe. The politics are obvious here. If the business case is credible then those wanting e-Health progress need to support the Government – if it is not then the risk of wasting half a billion dollars seems pretty high.

For the e-Health community not have the information on which we can make an informed decision before the election is unacceptable.

David.

3 comments:

Anonymous said...

David, I couldn't agree more.

Why the clandestine efforts to hide this business case? Clearly there is some plan being executed with tax payers money.

The disturbing thing is that a bunch of incompetents have control of our money and are not being transparent with how they are using it.

Whilst eHealth is hardly front page news, I smell the whiff of yet another expensive disaster.

Terry Hannan said...

David's dissertations are very important interrogations of 'what in the name of hell is going on'. As a clinical informatician I have major concerns of the "business case" models. As Professor Warner Slack (Harvard Center for Clinical Computing) states, 'medicine is not a business. Our business is clinical medicine'. Any mention of HealthConnect should send shivers down yoru spine. The biggest cost drivers in health care relate to Clinical Decision Making. Tis is where the focus of e-health reform must be. Finally which of the 25+ EMR models is the Federal Government going to use?

Anonymous said...

I would have thought that the business cases should be crystal clear to Nehta after 5 years of spending $160,000 a day. If they had no business case then why were taxpayers spending this sort of money?

The fact that we are seeing yet another one done in a secretive fashion simply confirms the generally held view in the eHealth community that Nehta are hopeless and dangerous and the sooner we see the back of them the better.

The are moving in ever decreasing circles towards the drain hole. The last thing we need at the moment is anything that resembles a plug.