Monday, November 29, 2010

It Seems Some Serious Thinkers Are Pretty Concerned about the Current NEHTA / DoHA Strategy and Direction.

The following Commentary appeared in the Medical Journal of Australia today.

For Debate

Do we need a national electronic summary care record?

Enrico Coiera

eMJA Rapid Online Publication


  • Electronic referrals and discharge summaries can improve the quality and timeliness of clinical communication.
  • The electronic summary care record (SCR) extends the concept of digital health summaries to create a perpetually updated and centrally stored summary of care, extracting key data from local systems after each encounter.
  • The only major SCR evaluation to date, in England, found that rates of usage were low, and any impact on care was difficult to quantify.
  • The SCR is seen by some as a first step to building a national distributed shared electronic health record (SEHR). However, the SCR may be a problematic diversion, creating a need for centralised databases, while the SEHR can function by sharing locally stored records, letters and discharge summaries.
  • Uncertainty about the quality and provenance of SCR data raises concerns about patient safety, as key data may be absent and old data may persist, partly because of a lack of ownership of the summary.
  • A national e-health strategy should emphasise the true stepping stones to a distributed and shared electronic record, including encouraging the uptake and meaningful use of electronic clinical records, clinical messaging, electronic discharge summaries and letters, and services such as decision support and e-prescribing, all of which have good evidence to support them.

The full article is available (free) here:

It is well worth a click through to read the full article.

There is also coverage here:

Electronic summary care record a waste of GP time: expert

29th Nov 2010

Andrew Bracey

A SENIOR e-health expert has questioned Australia’s push to develop an electronic summary care record (SCR), saying it lacks evidence and will create more work for GPs.

In an article published today in the MJA online, Professor Enrico Coiera, director of the Centre for Health Informatics at the University of NSW, called on authorities to instead focus on developing technology to better share existing health records nationally.

“Right now, we should keep our eye on the main game, which is to develop a way of sharing our existing health records nationally and connect up the different silos of clinical data,” Professor Coiera wrote.

“Making clinical data ‘liquid’ enough to move across the system is our primary challenge. We need to ensure that every clinical service has its own electronic records, and that these records are meaningfully used.”

Professor Coiera said there remained little evidence supporting the worth of an SCR, saying its purpose and impact on clinical care remained unknown.

Full article here:

Additional coverage is here:

E-health records "unjustified"

By Gemma Collins

Nicola Roxon’s plans for a $467 million personally-controlled e-health record (PCEHR) system are “simply unjustified” and could cause major problems for Australia’s healthcare, a health IT expert has warned.

Professor Enrico Coiera, Director of the Centre for Health Informatics at the University of NSW, makes the scathing attack in the MJA (online 29 Nov) as he says that the negative response to the UK’s summary care record (SCR) should make Australia “pause and think again” before rolling out a similar system.

The government’s PCEHR systems are due to be rolled out by July 2012 but Professor Coiera says the national record system in England has only been used in 4% of GP consultations in England and has generated additional workload for doctors.

More here:

What Professor Coiera is saying here overall is that the direction of the 2008 National E-Health Strategy is a far preferable way to proceed than the silliness and wooliness of the NEHTA IEHR / DoHA PCEHR proposals. Both these proposals lack the evidence base to justify the proposed investment and these funds would be conclusively better spent on the projects mentioned in point six of the abstract.

The issues raised by Prof. Coiera are very serious and have not been properly addressed to date. Until they are there are much better things to do with the e-Health dollar!

Nice to have some heavyweight support for what I have been saying for a good while now! Maybe the Summit tomorrow could give some thought as to whether the present plan from the Federal Government is actually the right one?



Anonymous said...

Hi David,

Just so it's clear from the outset of the discussion, the PCEHR and the SCR that I believe Prof Coiera is referring to are different things, as Govt envisage them.

Tom Bowden said...

Wow, shot below the waterline! It is going to be an interesting conference.

I firmly believe that PCEHR is the correct direction of travel, however, like Enrico, I think that we need to focus on assembling the building blocks and we will get a lot of value from doing that. If we focus effort on building a PCEHR without the rest of the ecosystem to support it, it is likely that we will be failing to learn from the lessons of history and alas therefore, doomed to repeat them.

Anonymous said...

A centralised SCR database is most definitely a piece of infrastructure that NEHTA wishes to introduce as part of the PCEHR. Another piece is a national clinical record index.

Don't believe me, look at the tender NEHTA recently released for a panel of GP desktop systems.

Dr David More MB, PhD, FACHI said...

And see the blog just posted - where the same concept was in focus.