Thursday, December 02, 2010

How Did We Go Getting Answers From the E-Health Summit? You Be The Judge.

A couple of weeks ago I published a blog asking the questions I had hoped the Summit might answer.

The full post is here:

Here is what I wrote then (in italics) and how close I feel we got to clear answers in plan type

The key questions I want to see addressed are:

1. Just what exactly is meant by a Personally Controlled Electronic Health Record (PCEHR)?

I really did not get the feeling there was clarity among the speakers on this.

2. Exactly how is the PCEHR intended to operate?

We saw a five minute concept video.

There is a link to the video here:

This is well worth a look as it is the most detailed information available so far on just what is presently envisaged. The presentation is about 1 minute in (and is also available from the 11 am Tuesday link found here:

I have to say what is shown here on this link seems a bit more evolved but very similar to the DoHA effort.

3. What is the literature evidence that supports the adoption of this - rather than a more conventional - approach to the progressive implementation of e-Health?

None was offered that I saw.

4. Where has a PCEHR similar to the proposal been successfully implemented?

The concept of consumer control of an EHR which clinicians are to use is not really implemented anywhere I am aware of.

5. Where is the information to be held in the PCEHR to be sourced from and how will the quality of the information be assured? Will providers be paid for providing information?

The information is intended to be sourced from securely connected operational systems and the PCEHR will provide a presentation service and the security / authentication etc. Just why health professionals would provide information was not made clear.

6. What support is the Government planning for provider EHRs and Secure Clinical Messaging?

It was not clear if any further support - beyond standards setting and NEHTA’s assistance - was contemplated

7. What will be the medico-legal status of information held in PCEHRs and what will be the consequences if clinicians mistakenly act on erroneous information? Will they be indemnified?

This was not really addressed as far as I can tell.

8. What is the evidence base that supports the other Government e-Health proposals (teleconsultation and the like) as the optimal expenditure of the available funds?

It was not clear that this area has been addressed by DoHA.

9. How do the PCERH and the other proposals fit with the National E-Health Strategy which has been endorsed by Health Ministers and has yet to be implemented?

This is not at all clear and was not really explained in what I heard.

10. When are the issues of absent leadership and failing governance in the e-Health domain going to be addressed?

The Health Minister indicated that DoHA would be driving the PCEHR project. NEHTA is to be a delivery manager of private sector contracts in a range of areas to support the as yet fully defined initiative.

The separate e-Health managing entity suggested by the National E-Health Strategy and the AMA is yet to be agreed.

The full speech from the Health Minister is now available on the web and is worth a browse for the details (which sadly it does not seem to provide).

See here:

You can read Senator Conroy’s speech here:

There is some fun analysis of what he said here:

Conroy's NBN health hustle

Rob Burgess

Published 7:35 AM, 2 Dec 2010

Stephen Conroy is Australia's greatest hustler. And the NBN is a giant hustle that the newly dubbed 'Minister Assisting the Prime Minister on Digital Productivity' knows will utterly snooker the opposition at the next election.

Senator Conroy was out pulling his usual trick in Melbourne yesterday, singing the praises of the NBN at the 'e-health Conference 2010: Revolutionising Australia’s Health Care'.

The trick works like this – tell the punters about the amazing health services the NBN will make possible, but studiously avoid the two main criticisms levelled at the NBN by Shadow Communications Minister Malcolm Turnbull and his pool-room buddies:

1) Aren't these services mostly possible using existing technology?

2) Can't the market mostly provide the infrastructure to deliver these services?

Beyond the public eye, Conroy has good answers to both (and I will address them in a separate article), but his speech to the conference yesterday, as usual, did not include them.

More here:

All in all as a commenter said on a recent blog this was really a conference that was organised for the ‘wrong’ audience.

What is contained in the discussion paper which is to be delivered early in the new year now becomes crucial to see if this is a real project or folly!



Jane Kennedy said...

In the video linked to above, it says that with a PCEHR, I can decide "if" I have an electronic record. Does this mean that I can decide to only have paper notes recorded about my care? Will this mean that I receive a worse quality of care than someone who has decided to have an electronic record (as we keep getting told that an electronic record = better care)? Will it send the wrong message to the clinician providing me care if I decide not to have an electronic record? If my GP already has electronic records about me (which he does) does this mean he will have to get rid of them if I decide I don't want an electronic record? What happens if I change my mind and want to have an electronic record later? Will my old information on paper be copied to it?

I suppose all these questions (and more) will be answered. I had hoped this conference would have answered more of them than it did.

Did some of the discussions that took place not on the webcast cover these?

Keith Heale said...

Jane Kennedy, according to the model described in the video, the PCEHR is essentially a set of links to information held in a range of "repositories" of various types. Most of these already exist, or will exist, as part of other systems. You can opt in or out of the PCEHR, but that won't affect how your local GP records your visits, nor will it affect your records in hospitals, pharmacies etc that you have dealings with. The PCEHR, as described, attempts to bring together information from a wide variety of sources and make it available wherever and whenever needed. This is great for accessibility, but poses significant security and privacy challenges. It is also at least ten times more difficult than other health IT projects that have been attempted in Australia, and general deployment and development to the scope that is hinted at will take a decade or more. The probability of being able to opt into any meaningful PCEHR in 2012 is negligible.

Jane Kennedy said...

Thank you Keith! How about the quality of my care diminishing if I elect NOT to have a PCEHR?