Tuesday, December 07, 2010

It is Now Clear The PCEHR Is Nothing But a PR Exercise and a Hoax on An Ill-Informed Public.

It seems the Government is trying to use confusion and deceit to have us believe that the PCEHR (The Personally Controlled Electronic Health Record) is the answer to a large swag of our Health System ills.

To put it simply this is just bunkum.

I have written enough on this topic to possibly bore some but there are a few things that need to be made crystal clear.

First the proposal for the PCEHR we see from NEHTA just ignores the fact that there is an e-Health system in place in Australia which is providing desktop support for many clinicians and which is facilitating - albeit somewhat imperfectly - secure clinical communications between the various health system participants.

The view offered in the diagram just simply ignores that NEHTA has had a goal since its inception of improving the quality and range of those clinical communications. All this seems to have been just tossed out the window in a misguided attempt to respond to a totally impractical and unachievable political hoax or con.

The diagram I am chatting about is found here if you missed it.

http://aushealthit.blogspot.com/2010/12/it-isnt-only-wikileaks-that-can-cause.html

Consider that as a result of what NEHTA and DoHA are doing we now have a totally undignified ‘grab for cash’ from a granting agency that really is not providing realistic guidance as to what it is seeking. This is highlighted in this report.

$55m funding spurs progress on e-health personal records

A $55 MILLION pot for e-health projects is creating a scramble among health, consumer and industry groups for a stake in the new landscape.

Health Minister Nicola Roxon is seeking a "second wave" of alliances, offering innovative programs based on the personally controlled e-health record rollout.

"We want demonstrations that cover patients, GPs and other health providers, pharmacies, hospitals and aged-care facilities," Ms Roxon said.

The non-profit Integrating the Healthcare Enterprise, a global standards-based working group that solves real-world problems, said the funding could deliver a "fully functional" personal health record system for Australians by the end of 2012.

More here:

http://www.theaustralian.com.au/australian-it/m-funding-spurs-progress-on-e-health-personal-records/story-e6frgakx-1225966629876

This sort of ‘grab for cash’ reminds me of the legendary pink bats program where skills and capacities were promised and not actually delivered. Indeed some died because of it.

Delivering a properly planned, operational, evaluated and sustainable Health Information Exchange is just not possible in 18 months (it needs more like 4-5 years).

What NEHTA is planning to deliver is nothing more or less than an empty, portal based, political fix for a Government either to stubborn or too ignorant to gather good advice, gather good information from the rest of the work and lay out a systematic and well considered plan to meet the goals we all seek.

The risk of ignoring what needs to be done (NEHTA’s original mandate) while spending on this new fantasy is that we get nowhere with either project and waste a vast amount of money in the process.

On a related topic I was considering the example given at the Summit for the utility of the PCEHR discussing a middle aged chronically diseased woman who spent summer in Melbourne, a few months in Sydney with the grandchildren and the winter in Brisbane with her sister. She has 3 GPs - one for each port of call. The PCEHR was going to be a total wonder for her. Not actually so.

Each GP will have a practice management system and when the index service, using the IHI comes calling, it finds 3 different sets of records and results etc. Which is the most valid, most current and most reliable - who knows? The lack of a capitation system in Australia - linked with the use often of multiple GPs (one for the depression and one for the rest etc) means confusion and accidental discovery of information will abound. There are a zillion use cases like this which is why the secrecy and non-disclosure of what is planned needs to cease - or we will all suffer.

The support of clinicians and the place of the PCEHR (if any) needs a serious rethink or it will be a major cause of Labor losing the next election as it is seen to have grossly over-promised and failed to deliver.

As currently proposed the PCEHR is a hoax and a ‘dead man swinging’. It was always ill conceived and based on little more than a political slogan, as developed it is poorly designed, it will not engage clinicians and is highly likely to be rejected by consumers when they see how thin the actual offering is.

David.

10 comments:

Anonymous said...

Dr David More MB, PhD, FACHI wrote:

"ignores the fact that there is an e-Health system in place in Australia which is providing desktop support for many clinicians and which is facilitating - albeit somewhat imperfectly - secure clinical communications between the various health system participants"

I think most informed observers would argue that the current situation is actually one of very little interoperability and a few "walled gardens" of communication capability between limited sets of providers.

For those old enough to remember, the current eHealth communications situation in Australia could probably be likened to all the commercial "networks" available in the '80s, such as CompuServe, Genie and then AOL and MSN - everything was fine as long as everything you wanted, and everyone you wanted to communicate with, was within your own "walled garden". This is the situation that occurs when these things are left exclusively to commercial interests - there was no sensible business driver to be interoperable.

It took the bad old Internet, with its government mandated base standards and services (like DNS), before real progress was made and the commercial vendors in this space, with their "lock in" mentality, were seen to be what they were - inhibitors to progress.

That aside, it would be good to see some constructive debate around what might be considered as viable options regarding how the "finds 3 different sets of records and results" and associated validity issues might be addressed.

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

Anon,

You have made my point for me. We should fix the issues you raise with the present environment before setting out on another journey with a very vague destination!

Re the other point. I look forward to clever ideas!

David.

Anonymous said...

The reason that interoperabilty is limited is mostly due to compliance issues with the content. Messaging providers get around these quality issues in a variety of ways to allow it to actually happen. SMD will not work unless the HL7 compliance issues are fixed and NEHTA have totally ignored the critical compliance issues we have today. They lack an understanding of the real issues which is a major concern. They have no real understanding of HL7v2 which is the backbone of our eHeath system today and is likely to be an important part in 20 years time. Issues such as business rules around orders and results have been well understood and supported by HL7v2 for many years and yet they continue to employ business analysists to try and document and develop the business rules from scratch which is silly. By ignoring what works they reduce the chance of success to zero. They are doomed to repeating the mistakes of history.

Anonymous said...

I'm not sure they understand HL7V3 either - they seem hell bent on defining their own messages rather than using anyone elses.

Anonymous said...

When it comes to HL7v3, that is probably a good thing...

Anonymous said...

So the summary position is:

1. They don't have a clue about the stuff that works ie HL7v2

2. They support the "new" stuff (HL7V3/CDA) but don't understand it well enough to realise its problems and pitfalls

That explains a lot

Hercules said...

I think there is an overwhelming belief inside NEHTA that they "... need to DO standards ...", which has been interpreted as a "... need to DEFINE standards ...", as opposed to a "... need to sit down and work out what's been done around the world and our country before, and use it, build upon it and generally make progress.".

If you look at other countries, US, Canada, UK, Sweden, Denmark, Norway etc, in addition to our own Australian experience, there's a heck of a lot that could be done before we need to start defining "new" standards for Australia.

There is an argument that the unique way we do things in Australia means that we need to define some unique mechanisms for communicating (e.g. ETP) - and I would argue that we should be spending some time working out if that is WHAT we really should be doing, as opposed to coming up with unique solutions to a flawed business model.

I think we run a real risk of defining a bunch of Australian-specific approaches which are sufficiently inflexible that as healthcare-reform takes place (which it will), we are constrained by the technological approach taken.

Anonymous said...

"I think we run a real risk of defining a bunch of Australian-specific approaches which are sufficiently inflexible that as healthcare-reform takes place (which it will), we are constrained by the technological approach taken."

What most people seem not to understand is that health-reform is occurring at a pace that is leaving DoHA and NeHTA well behind. And that a lot of that reform is technologically driven but is occurring to meet the needs of the providers and patients at the clinical interface. Even the "define some unique mechanisms for communicating" is occuring.

Although standards are neccessary it is the change in workflows that is occuring and ability to deal with the myriad of needs in a flexible manner that is the harder ask and that could be hindered by inflexible standards.

NeHTA needs to have learnt by now that they can't drive the change - they should be facilitating it!

Hercules said...

A very good point - and I think reinforcing what I said? Health Reform is, will and will continue to happen.

We need to define WHAT ehealth will do to support that, and how to facilitate health reform.

John Johnston said...

The good thing I see in the PCEHR WAVE2 initiatives is that it encourages collaboration between parties with a common focus on a better patient result. I have seen examples of effective collaboration in a range of settings but when the chips are down, the collaborative spirit can be overtaken by self interest. I am hoping that the PCEHR initiatives will be different and that DoHA sponsored teamwork will accelerate the progression towards a better result. eHealth advancement in Australia will always be a shared activity between governments and private enterprise and when there are opportunities to get involved we should take them. As far as the standards debate is concerned it is clear that HL7 v2 is doing a job in its window of capability but implementation experience suggests that decision support, sharing of clinical records, and care planning will be better served with HL7 V3. That is our belief and the experience also tells us that, irrespective of decisions about how it will be implemented, there will be a continuing evolution of the standard. It is implementation experience that exposes strengths of the standard and identifies the weaknesses that require "work-arounds" in the short term and the "fixes" that are required in the medium term. The HL7 orchard can bear much more interesting fruit if the HL7 V2 purists are happy to pick it, taste it, and digest it.