Tuesday, February 15, 2011

What Is Currently Being Said About What the PCEHR Actually Is? It is Fantastic is the Real Sense of That Word!

I thought it would be useful to provide a summary of what PCEHR Tenderers are being told about what the PCEHR is and what it is intended to do.

This is directly from the Infrastructure Partner Tender released today.

2 PCEHR PROGRAM DESCRIPTION

2.1 Release 1 Outcomes

2.1.1 In executing its responsibilities under the Contract for the provision of Services specified in this RFT pack, the National Infrastructure Partner will work towards an outcome that aligns with the Government’s commitment to eHealth, as defined by the Minister for Health and Ageing on 11 May 2010:

Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.

The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia. The national e-Health records system will be a key building block of the National Health and Hospitals Network.

This funding will establish a secure system of personally controlled electronic health records that will provide:

· Summaries of patients’ health information – including medications and immunisations and medical test results;

· Secure access for patients and health care providers to their e-Health records via the internet regardless of their physical location;

· Rigorous Governance and oversight to maintain privacy; and

· Health care providers with the national standards, planning and core national infrastructure required to use the national e-Health records system.

A personally controlled electronic heath record will have two key elements:

· a health summary view including conditions, medications, allergies, and vaccinations; and

· an indexed summary of specific healthcare events.

Implementation of personally controlled electronic health records

Personally controlled electronic health records will build on the foundation laid by the introduction of the Individual Health Care Identifiers later this year. Under this, every Australian will be given a 16-digit electronic health number, which will only store a patient’s name, address and date-of-birth. No clinical information will be stored on the number, which is separate to an electronic health record.

Implementation will initially target key groups in the community likely to receive the most immediate benefit, including those suffering from chronic and complex conditions, older Australians, Indigenous Australians and mothers and newborn children.

This investment includes funding for the first two years of the individual electronic health record business case developed in consultation with all states and territories and the National Electronic Health Transition Authority (NEHTA).

Subject to progress in rolling out the core e-Health infrastructure, the Government may consider future investments, as necessary, to expand on the range of functions delivered under an electronic health record system.

Reforms to take health system into 21st century

A national e-Health records system was identified as a national priority by the National Health and Hospitals Reform Commission and the draft National Primary Health Care Strategy. It was also supported by the National Preventative Health Strategy.

The Government’s reform plans in primary, acute, aged and community care also require a modern e-Health infrastructure. It is a key foundation stone in building a health system for the 21st century.

A personally controlled electronic health record will not be mandatory to receive health care. For those Australians who do choose to opt in, they will be able to register online to establish a personally controlled e-Health record from 2012-13.

2.1.2 The following table specifies the key outcomes and capabilities to be delivered for Release 1 of the PCEHR Program.

Table 1: Key Outcomes and Capabilities for Release 1 of PCEHR Program

Outcome Area

PCEHR Core Infrastructure

Capability

Consumer Portal

Provider Portal

Indexing and Search Service

Outcome Area

Strengthen Consumer Participation

An appropriate system and interface for accessing Personal Health Records is finalised and ready for implementation.

Capability

Portal for Consumers to access their own health information, manage who has visibility of their PCEHR and view an access audit trail.

Outcome Area

Better Assessment and Treatment Selection

Capability

Pathology report summary information available via PCEHR indexed GP summaries.

Radiology report summary information available via PCEHR indexed GP summaries.

Outcome Area

Safer Medication Management

Capability

Pharmaceutical Benefits Scheme information indexed by PCEHR.

Prescription provider information (e.g. GP Prescriptions) indexed by PCEHR Program.

Outcome Area

Improved Continuity of Care

Capability

Discharge summaries electronically sent from participating hospitals to GPs.

Discharge summary indexed by PCEHR Program.

Referrals from GP to Specialists.

Referral indexed by PCEHR Program.

Outcome Area

Enhanced Coordination of Care

Capability

PCEHR populated with initial static health summary view using readily available information (e.g. Medical Benefits Scheme and immunisation).

PCEHR information is available for download to local GP system upon request.

Outcome Area

Health System Intelligence

Capability

Reporting and evaluation framework.

----- End Extract (Note I have left out the level of requirement for each area as most of it is mandatory)

It seems to me that this set of capabilities are utterly ‘pie in the sky’. Given the tender does not close till March 22, 2011 and evaluation has to take a couple of months, to have 12 months to deliver this range of capabilities is just not realistic.

Of course just how all those in GP land, all the pathology and radiology services and all the hospitalsare going to be lined up to record electronically and provide the required information to populate the PCEHR is an utterly unanswerable and clearly impractical question which is not based on any reality.

I feel this is all part of an enormous and very expensive hoax on the public at large!

David.

11 comments:

Anonymous said...

"a very expensive hoax" - well, sort of, but more closely resembling a very expensive public sector experiment that has gone totally off-the-rails to mimic a humongous hoax to the point that it is now so big, so costly and so unbelievably impossible to comprehend that something so important and so badly needed could possibly be so far beyond the point of salvation that anyone contemplating pulling the plug on it would have to ask why do so - there must be some good in there somewhere - but where?

Anonymous said...

Tuesday, February 15, 2011 11:22:00 PM pretty well sums up the whole NEHTA DOHA PCEHR IHI story.

Extracting four vitally important words from 2.1.1 above the most important thing that led to this pathetic state of affairs has been the complete lack of -

"Rigorous Governance and oversight".

Anonymous said...

Given all of the above, and information in previous blog postings, does anyone know what is actually happening at the Divisions who are supposed to piloting the PCEHR with GP's?

They were recruiting staff to market and promote the PCEHR to GP's and I assume that IT staff from somewhere (?) are actually setting up the technical infrastructure (?) for GP's to use a PCEHR with other service providers.

So does anyone know what progress is being made at this level in order to inform subsequent PCEHR implementation stages?

:-(

Anonymous said...

Well, as reported in The Australian on Feb 11 “each site received $4.83m in grant funding on February 2”. So the money bucket is well primed for ……. !

Does that answer your question?

Anonymous said...

It's all a bit cart before the horse.

They have thrown heaps of money at the divisions to run around clicking "upgrade" and read the software change log at the Monday staff meeting...something practices are quite cable of doing themselves, having had 10-20 years practice. From the end users perspective...HI and even PCEHR will take all of 15 minutes for a doctor/practice staff member to get their head around. Most dealt with HIC/Medicare Online without too much trouble and neither HI or PCEHR approach this level of end user complexity.

This whole "change and adoption" tender is even framed in the terms divisions have been repeatedly saying for months now...if this isn't a setup job designed keep public money in the hands of impotent and inefficient public servants, I don't know what is.

Unfortunately the software vendors think the whole thing stinks and without them upgrading their software, divisions will be sitting around doing Sweet F All, which is in line with what they currently do.

Anonymous said...

Seriously.

How can this be delivered by 30 June 2012.

Anonymous said...

30 June 2012 is not the delivery date - you have missed the point entirely. You probably need to get a job in the public sector for a while to better understand that.

30 June 2012 is the political drop-dead date for the purposes of getting funding immediately in order to fit with artificial politically determined dates that give a sense of urgency that politicians will respond to.

Once the money has been allocated the pressure is off and we then focus on redefining the timelines and drop-dead dates to fit with the next lot of important dates relating to the election cycle.

Once we are through that hurdle we then adjust again to fit our own long term job survival expediencies.

I hope this helps you understand. The date has nothing to do with delivery of anything of relevance!

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

Thank you. I feel I understand the rules much better now.

Yes Minister has nothing on this!

David.

Anonymous said...

You're welcome. It took me many years of working in the public sector on Health IT projects as far back as HealthConnect and subsequently with HealthSmart and NEHTA to thoroughly understand what I found so hard to believe for so many years.

No-one ever said as much, it's just that the way they would talk about political cycles and Ministerial imperatives, how hard it is to get big funding support, and why it must be 'urgent' to get attention and Ministerial support that I finally understood what they were all thinking but not saying.

And let's face it they, we, all know that the PCEHR will cost a lot of money to develop and implement, and there are many small steps that need to be taken along the way, but to try to sell the small steps and get funding support for them is a no-win situation all round, not big enough, not national enough etc.

So we have to sell the end-state goal, which is a decade away, as the immediate 12-18 month goal, and we have to bag whatever money we can get before they have time to take a breath and think about how unrealistic that is. When they believe, they will pay - that is our motto.

Anonymous said...

Yep - that reminds me of the mining industry's marketing campaign fighting the new 'super-tax' just prior to the federal election. The politicians rolled over and backed down and look at BHPs announcement yesterday - incredible profits - extraordinary profits. The politicians believed and they paid. And if Labor had lost the election the Liberals would have cancelled the super tax altogether. In the end the taxpayer pays regardless of whether its super taxes, PCEHR issues or something else. It's our money they take, use, waste or give away. Kerry Packer was right when he said "the government isn't spending it so well that we should be donating extra" - you don't use wisely what you get already?

Keith Heale said...

Anonymous (February 17, 2011 6:04:00 AM) has one explanation for the 1 July 2012 date; I can suggest another. None of the press releases or utterances by the PM or Minister for Health actually mention anything WORKING by that date. They merely say that, as from 1 July 2012 people will be able to REGISTER for a PCEHR. Mostly they don't even say "register ONLINE", although this is specified in a 2010 press release which said that people will be able to register online by 2012-2013. My guess is that the registration process will be working by July 2012 even if nothing else is, and even if the registration process is a pile of forms in Medicare offices.