Thursday, January 27, 2011

Some Don’t Miss Comments on the PCEHR Post. These Are The Best Ever!

As I note the commenters on this post are trying to do me out of a job!

Click here and get the real lowdown on how things are working and why the PCEHR project is a disaster waiting to happen.

http://aushealthit.blogspot.com/2011/01/pcehr-seems-to-be-still-lacking-real.html#comments

To those providing the input - thanks and keep it coming!

Enjoy (and quietly cry into your beer)!

David.

8 comments:

Addinall said...

Sorry readers, this has been broken into parts to fits the BLOG entry limit. Apologies David.



I have to take umbrage at the direction evident in the Australian Aging Agenda. viz.
http://www.australianageingagenda.com.au/2012/01/25/article/Telehealth-pilots-showcase-the-NBN/CATJJNSYIS.html

"Telehealth pilots showcase the NBN

By Stephen Easton
Six months after the introduction of new Medicare rebates and incentive payments to encourage the take-up of video consultations in health and aged care, the government now wants to stimulate the use of in-home telehealth technology - but only where it shows off the value of the National Broadband Network."

That astounds me! eHealth is so very important and good, and POSSIBLE, but only where the goodly hand of the NBN has touched. The failing eHealth initiative (only a few BILLION) has now been 'tied' to the acceptance of the NBN (another fifty BILLION or so), so that if one critices ANY of the government ITC practices or principles, one condems the aged and cancer patients to years of dreadful suffering. I am actually quite dismayed that people from the clinical side of this debate, and those in my industry, ITC, can lower the debate concerning better patient out comes to this level of political spin.

ibid.

"Over the weekend, a joint ministerial statement announced a further $20.6 million to fund pilot projects, in areas where the NBN has already been rolled out, which demonstrate how in-home technology can improve aged care, palliative care and cancer care.
Each two-year project will receive roughly $1 million to $3 million, starting from 1 July, to provide in-home telehealth services such as monitoring vital signs remotely, medical consultations and help with general healthy living.
According to the announcement, last July's introduction of Medicare rebates and incentive payments for telehealth has seen more than 7,000 video consultation services provided by over 1,200 clinicians around Australia, mostly to rural and remote areas.
But while the incentive payments encourage residential aged care providers and doctors to buy video consultation equipment, no new Medicare rebates were introduced for consultations between GPs and nursing home residents, depsite longstanding difficulties in getting GPs to attend aged care faciltiies.

For his part in Sunday's joint ministerial annoucement, Minister for Mental Health, Ageing and Social Inclusion Mark Butler said it was older Australians who stood to gain the most from in-home telehealth technologies.
“As we age, health issues tend to be more prevalent and we’re much more likely to require care and support from a wider range of health professionals,” Mr Butler said.
“Expanding telehealth services to older Australians still living in their own homes will help health professionals identify potential health problems earlier, reduce the need for older Australians to travel to receive treatment and increase access to healthcare services and specialists.”"
(cont.)

Addinall said...

Part 2.


Nice in theory. I have worked for the Menzies School of Health Research and also in remote aboriginal communities (providing networks) so I understand that a remote video link can be quite handy at times, although, from experience I noted that most clinicians would rather see the patient for fairly obvious reasons.

This is a question for those of you who are clinicians, help me understand. WHY are we not doing tele-health right now? The technology has been available for at least a decade. All the government is really proposing is a chat over the internet.
Anecdotal, so not really allowed, I telephoned to make an appointment with my MD (and a very fine one he is) and I asked the receptionist if I should send an email describing why I wanted a check-up. "No point, the doctors will never read email" came the reply. Is eHealth so vitally urgent that we need to blunder down a path that seems to have no real purpose or goals in mind, other than a fairly wooly, "helping people and stuff"?

ibid.

"Health Minister Tanya Plibersek said the program brought together two of the government’s key priorities – the NBN, and providing patients with healthcare “when they need it and where they need it”."

BINGO. Can't have one without the other.

ibid.

"“[… Projects] will include having health indicators monitored remotely – for instance, your doctor being able to take your blood pressure online while you are at home – or receiving medical consultations and healthy living support in the home."
Aged Care Association Australia (ACAA) chief executive Rod Young welcomed the announcement and expressed his support for the NBN, which he said would enable new models of care that rely on reliable, high-speed broadband. (note 1 - MA)
“Australians have clearly indicated for many years that they wish to remain independent, in their own homes preferably for all of their lives,” Mr Young said in a statement.
“This desire, if it is to be achieved with an ageing population, declining workforce and diminishing number of voluntary carers, can only be achieved if we support people in their own home with care diagnostics, remote monitoring and telehealth technologies which will support and sustain their independence.
“To provide this level of integrated care and support in seniors own homes, it is essential that fast business grade broadband is accessible and ubiquitous. (Note 2. MA)
"[The] NBN will have the capacity to provide the speed and bandwidth that future service delivery models of care will demand if the wishes of older Australians to stay in their homes and remain independent are to be realised.” (Note 3. MA)
Suri Ramanathan, chair of the Aged Care Industry IT Council (ACIITC) and Rob Hankins, CEO of Aged and Community Services Australia, also welcomed the announcement this week.
Mr Hankins said aged and community care providers were already using various kinds of technology to improve services, but that more could be done “provided the internet has the speed and the capacity”. (Note 4. MA.)
(cont.)

Addinall said...

Part 3.


BINGO. Can't have one without the other.

ibid.

"“[… Projects] will include having health indicators monitored remotely – for instance, your doctor being able to take your blood pressure online while you are at home – or receiving medical consultations and healthy living support in the home."
Aged Care Association Australia (ACAA) chief executive Rod Young welcomed the announcement and expressed his support for the NBN, which he said would enable new models of care that rely on reliable, high-speed broadband. (note 1 - MA)
“Australians have clearly indicated for many years that they wish to remain independent, in their own homes preferably for all of their lives,” Mr Young said in a statement.
“This desire, if it is to be achieved with an ageing population, declining workforce and diminishing number of voluntary carers, can only be achieved if we support people in their own home with care diagnostics, remote monitoring and telehealth technologies which will support and sustain their independence.
“To provide this level of integrated care and support in seniors own homes, it is essential that fast business grade broadband is accessible and ubiquitous. (Note 2. MA)
"[The] NBN will have the capacity to provide the speed and bandwidth that future service delivery models of care will demand if the wishes of older Australians to stay in their homes and remain independent are to be realised.” (Note 3. MA)
Suri Ramanathan, chair of the Aged Care Industry IT Council (ACIITC) and Rob Hankins, CEO of Aged and Community Services Australia, also welcomed the announcement this week.
Mr Hankins said aged and community care providers were already using various kinds of technology to improve services, but that more could be done “provided the internet has the speed and the capacity”. (Note 4. MA.)

OK. Now this is MY area of expertise. What bandwidth, speed or availability do we lack today that is hindering the adoption of eHealth services and techniques? I hint at this at some length in

ehealth.addinall.org

in that, the current bandwidth available is perfectly adequate to monitor a blood pressure (assuming the wireless signal doesn't kill the patient through defibrillator malfunction), have a chat and various other loosely defined 'care'.

People are pitching eHEalth straight out of Star Wars, the great Medical HoloHoax of Australia. I try to explain to people (in the context of the NBN) that eHealth at the very moment, has spent a decade and a BILLION dollars trying to agree on a data format that so far can be transmitted between the patient and the government, however medical doctors have little or no access to this information. As a Doctor of Computer Science, that is not a great patient outcome!

ibid.

"Palliative Care Australia (PCA) has applauded the project too, particularly for its specific focus on older people, cancer patients and those who need palliative care.
“It is great to see such an innovative approach to providing healthcare for these vulnerable people,” said the CEO of PCA, Dr Yvonne Luxford.
“The fact that the pilot has chosen to focus on these groups is evidence of the government’s recognition that our health system is not adequately addressing the needs of older Australians and those requiring palliative care, and that we need to look at new ways of delivering health services.”
Click here for the draft program guidelines for the telehealth pilot program; comments and submissions will be accepted up until 6 February. Final guidelines will be released and applications will be open by March, closing in April."

Dear Dr. More. Please continue exposing this as nonsense.

Regards,
Mark Addinall.

KH said...

In support of Mark Addinall's argument there is a recent article in the SMH:
http://www.smh.com.au/technology/technology-news/patients-log-on-to-stay-out-of-hospital-20120107-1pp7d.html

This describes a trial which was run in Toronto, south of Newcastle during the second half of 2011. As far as I know the NBN has not touched this area, but the trial appears to have been very successful and cost-effective. It involved remote monitoring of the blood pressure, pulse rate, weight and oxygen saturation of a group of elderly people. The bandwidth demands were probably in the order of a few hundred bits per second. If the measurements fell outside the expected range a nurse (or doctor) came online with a video call to discuss with the person what action needed to be taken. This is a bit more bandwidth intensive and requires maybe a megabit per second or so. All very achievable with ADSL. Among other benefits the trial resulted in a decrease in hospitalization for the group of almost 50%, a saving which probably paid for the entire exercise. The technology used was relative cheap and accessinle. With a will and some planning this type of service could be implemented much more widely, with or without the NBN.

Anonymous said...

We don't need the NBN to allow e-Health to take off and we don't need Nehta either. In fact Nehta are the biggest roadblock for e-Health. We have had over 10 years of ham fisted medeling in the e-Health market by government with over a billion $$ spent with no results.

The e-Health community was going fine using the standards process and had the progress we saw before government "intervention" continued we would be miles ahead of where we are now. The large sums of money simply distort the market, encouraging large consulting firms to keep the wheels spinning, while we go backwards. The 12 Billion UK NHS spend encouraged work on HL7 V3 to continue past its use by date, while things that actually work like HL7V2 get ignored by these "genius" managers, because they are not trendy enough.

Inept government spending has inflated a huge e-Health bubble that has to burst soon, About July 1 according to current projections. Meanwhile in the real world slow steady progress occurs under the radar of these high flying Turkeys. It seems that failing gracefully is not in the generic managers "Hollow Men" bible. Its crash or crash through (I am sure with a golden parachute backup plan)

Bruce Farnell said...

I have long held the view that the existing Internet infrastructure in Australia was more than adequate to host improved e-Health service delivery. The problem is in deciding what e-Health actually is and what needs to be done to get the best bang for our buck from an e-Health perspective.

Instead, what we have a politically motivated initiatives which have limited or no relationship to what is actually required and take money and resources away from initiatives which could make a real difference. I continue to be dismayed by the lack of apparent rigour in the processes which have arrived at the current politically motivated initiatives.

A good example of an overlooked opportunity is in the area of pathology results and chronic disease management. What we want are HL7 atomised pathology results to populate the GP clinical databases to allow GPs to manage patients and for this to happen as the default behaviour. What actually happens is that the clinical software vendor interprets the HL7 standards in their own way and pathology providers need to to craft different message types for different recipient systems. Some of them don't bother and still sent PIT formatted files. Although this might make a real difference, it isn't sexy and doesn't require the NBN. What it needs is proper application of standards associated with a government funded compliance/certification process.

As for video conferencing, it is a common-place technology that is oversold and, I believe, under-delivers in terms of improved health outcomes. Yet, it is often trotted out as an exemplar. In reality, it's relatively expensive for the possible benefit it delivers, it's trendy and easy to 'sell' to those in Canberra and it uses lots of Internet bandwidth. Just perfect for the NBN....

Anonymous said...

5 Years ago - Ann Webb, Deputy CEO of the Australian Association of Pathology Practices wrote in her Guest Article on Wed 14 February 2007:

“The AAPP endorses ‘AS4700.2-2004 Implementation of Health Level Seven (HL7) Version 2.3.1 Part 2: Pathology orders and results’. Furthermore member practices currently provide significant volumes of electronic messaging to GPs, Specialists, and hospitals using these standard messages.

The Pathology Practices are not the source of delay in widespread standardisation and would be pleased to move their customers to this mode of messaging now.

The report receiving systems however have to be capable of managing these messages properly. That PIT is provided at all by AAPP member practices is because that is what their customers have asked for.”

http://aushealthit.blogspot.com/2007/02/guest-article-on-secure-pathology.html

David, how far have we progressed?

Dr David More MB PhD FACHI said...

I am sure some domain experts will chime in. I would rather get the current status from the 'horse's mouth'.

David.