Friday, December 03, 2010

Finally the Department of Health Releases a Description of the PCEHR. Does It Make Sense?

The 6 page document can be downloaded from here.

http://moreassoc.com.au/downloads/DoHA%20Fact%20Sheet%20No%201.pdf

The file is a .pdf and about 2.5 megs.

It seems to be the basic idea of all this is that their PCEHR will have a basic record for the absolute clinical basics and pull everything else in from current systems. It is very much like the US Health Information Exchange approach as best I can tell.

A grand vision that will take ages to implement! Note it will be easy to have people register to have something that won’t deliver for years into the future!

David.

7 comments:

Jane Kennedy said...

"Will there be a national repository of medical records? No, the PCEHR will operate in a distributed system.

Individual health records will be stored in national, state or privately operated databases."

Maybe I'm being stupid here. Don't these two sentences immediately contradict each other?

Keith Heale said...

Jane,
For a document that is meant to through light on the subject of the PCEHR, it's poorly drafted. I believe the situation will be that only some demographic data, your Individual Health Identifier (IHI) and a set of links to other servers will be held in a national darabase specifically set up for the PCEHR. It may also include a very basic summary health record containing things like allergies. Everything else will be in databases belonging to hospital networks, state health departments, private clinics or whatever. These will comprise the bulk of clinical information in a person's PCEHR and will be accessed through the links (indexes) in the central PCEHR system. This is the sense in which the PCEHR will operate in a distributed system. The databases holding the actual data which together make up an individual's PCEHR may be national (eg Dept of Veterans Affairs), or state or private. Does that make sense? If we are really lucky by July 2012 you will be able to apply for a PCEHR and you will get a record on a server with your name and address and IHI in it. The indexes to the various databases around the country will likely not appear for some years.

Keith Heale said...

"For a document that is meant to through light.."
Did I write that? Clearly it should read "For a document that is meant to throw light.."

"People who live in glass houses shouldn't stow thrones"..or something like that!

The final sentence in my previous post (about the indexes or links not appearing for some years) is a reflection on the fact that it is going to be really difficult both technically (because of the diversity of systems and the fact that many of those systems, and their network connections, are not designed for handling external queries) and politically (because of the many questions regarding ownership of information, privacy, and other legalities).

Jane Kennedy said...

Keith - thank you - that makes a lot of sense. I mean that in the way that I understand what you are saying, not that it is a really good idea! What happens if the private database is not available? This is a tangent, but my understanding of network connectivity in Australia is that the majority is provided via ADSL - that is ASYNCHRONOUS, with (for example) 20mb download and 1mb upload. So, I'm guessing, there is a dependency for this model to work well of NBM to be deployed and every provider system connected to be using a NBM DSL connection?

If there's one thing that is certain - it's that nothing is certain. The article in today's Australian tells me that: http://www.theaustralian.com.au/australian-it/leak-of-draft-e-health-document-raises-privacy-concerns/story-e6frgakx-1225966635891

This again seems to contradict the minister's assurances. I'm guessing that there is a disconnect between the Minister and her direct advisers, those leading NEHTA, and the people working for them at NEHTA (who appear to be the people making the actual decisions).

Do we know who these people are and what qualifies them to make these decisions without discussing with us? David?

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

Jane,

They are neither competent or qualified to do this unaided in my very humble opinion, but I would say that wouldn't I?

The evidence in front of us all suggests I am rather close to the mark however!

David

Jane Kennedy said...

David,

So who are they? Do we know them? Who would be your perfect team?

Jane

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

Jane,

The perfect team does not exist, but some smart experienced people who are prepared to really look hard at what has gone on in the rest of the world before coming up with what you see in today's blog would be a good start!

David.