Wednesday, August 11, 2010

A Few Comments on the ABC Health Report Monday August 9, 2010 on E-Health.

The basics:

Links to the show with audio and a full transcript are found here:

http://www.abc.net.au/rn/healthreport/

The contents of the show was described as follows.

E-health

listen | download (10.9MB)

Daniel Keogh investigates the future of Australia's pursuit of electronic health records; a venture that has already taken a considerable amount of time and money with little to show for it.

Among the major contributors were:

Ms Sally Crossing – Frustrated Patient

Dr Mukesh Haikerwal - NEHTA

Dr Terry Hannan – Formerly President of the Australian College of Health Informatics

Ms Lisa Pettigrew – CSC Health Practice

Ms Carol Bennett – Consumer Health Forum

Dr Ashish Jha - Associate Professor of Health Policy and Management, Harvard School of Public Health

My first comment is that this was a good effort and really needs a listen!

If I had to summarise my feelings about the 23 minute or so discussion I would have to say that I found the discussion a little naive and insular from the Australian speakers and maybe a slightly pessimistic view from the American ‘expert’.

As with so much we seem to see and read in e-Health these days there was a lack of clarity about just what it was that was being spoken about and just how applicable it is to the larger Australian community. An EMR system that works well in Kenya or the NT may just not be the right fit for metropolitan Sydney or Melbourne for example.

There was a lot that was good among what was said like the recognition that the days of paper records should be over and that younger clinicians were amazed at the lack of automation in the health sector.

Sadly what was missing was any clarity, again, around just what the path from where we are now to what the desired end state might be. It is really extremely simplistic to keep saying e-health and electronic health records are good and not really putting together a clear picture of what is a sensible path forward – as we were actually given by the National E-Health Strategy.

I remain very concerned that we have not had any real explanation of just what NEHTA / DoHA are cooking up in the backroom with various consultants who may, or may not, have some vested interests in the outcomes of the consultation. Until we see what is suggested and the strength of the option analysis and business case provided how can we even begin to form a view? All this is a multi-year billion dollar endeavour that should not be being undertaken without proper public and technical scrutiny!

On the basis of overseas experience creating a half baked summary record of questionable provenance, completeness and quality for which there is no real benefits case for is probably the wrong way to be going until we have got the basics of EMRs and Secure Messaging in place.

I am also still of the view the Health Information Exchange route as being followed in the US - as provided by people like Axolotl and others - needs to be looked at very closely in terms of cost, benefits and practicality before we lock ourselves into any specific directional approach. To go to a large scale Shared EHR without careful review of alternatives could be very, very stupid.

I also was a trifle surprised to have an American expert comment on how hard and difficult all this is – and it is – without pointing out there are some exceptional examples of success in the US. (Think Kaiser Permanente’s Health Connect and the Systems at Partners in Boston and at Intermountain Health.)

The bottom line is that this is important and needs leadership, transparency, expertise, appropriate funding and serious long term political commitment. I leave it as an exercise for the reader to work out how many of those we have in place!

David.

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