Tuesday, November 30, 2010

An Apparent Conceptual Overview of the PCEHR. Lunch Report from E-Health Summit

The e-Health Conference has now heard from many speakers including the Federal Minister for Health. (See link below for program and list).

It is fair to say that most of what has been said would come as no surprise to readers here.

My key observations are:

1. Most speakers were not at all clear just what was being talked about in any precise sense - with most equating the PCEHR with a bit of a cross between a Shared Summary EHR and a Personal Health Record.

2. Both the AMA and the Consumer Health Forum really get how complex this will be.

3. Everyone recognised that Mid 2012 as a date with the PCEHR would be available to be signed up to was a pretty huge ask!

4. A lot of the early discussion felt like it was suggesting the PCEHR was basically an 'aide memoir' for patients!

5. The linkage between what was described and the intended benefits was tenuous at best to me.

As far as the Ministers / DoHA view is concerned the following seems to be what they are talking about with respect to the PCEHR - derived from a 5 minute animated conceptual model shown about 11am.

1. There will be a central infrastructure that will be have an indexing service (to locate relevant records using the Health Identifier Service)

2. There will also be a central authentication / permission service that will decide what information is to be accessed.

3. There seemed to be the core concept of a centrally held summary record that was to be augmented by information acquired from remote clinical systems (referrals, discharge summaries, results etc.). It is this central Summary that Professor Coiera pointed out was pretty problematic yesterday.

The Minister made it pretty clear that DoHA was into standards setting, governance and piloting and the delivery of ‘linkages’ not actual systems (however that is to play out)

4. It is not totally clear just what information flow are patient / consumer controlled and what flows are healthcare provider controlled.

5. There is an underpinning assumption that all providers will make information they hold available for indexing and access and use. This assumption strikes me as extremely problematic.

6. Overall what seems to be under discussion is a model very similar to the US Health Information Exchange Model - available commercially and view the US DHHS Connect program (and based on the IHE methodologies to some degree)

The Minister repeatedly referred to the PCEHR as a shared effort between private and public sector but it is not at all clear what incentives / rewards are available for involvement. There was a lot of discussion about governance but just how the private sector (which includes GPs) are to be involved is still being evolved it seems.

All in all an interesting morning where 1-2% more clarity may have emerged. The session on Denmark and its approach at around 4:30pm looks interesting as does the summary of the day which follows.

Go to the webcasts tab to watch from here:


It worked pretty well this morning.


1 comment:

Achilles said...

I notice that the discussion immediately equates e-health with PCEHR. No dicussion as to whether this is the best way to proceed. No thought about picking th low-hanging fruit? No mention of doing first the sort of things that Prof Coiera mentions - e-discharge summaries, e-prescribing, even e-mail? No thought of working from the middle out? Just let's talk about this ill-defined idea that won't work until well after all of these other things (and many more) are in place.