Wednesday, March 09, 2011

The Current Operational Plans For The PCEHR Fail The Sanity Test Badly and Shows That NEHTA and DoHA Reside in Some Alternate Universe!

(Note - click on images to enlarge)

As part of a Vendor Briefing NEHTA have provided some slides related to how they see the PCEHR working.

You can access the various files from this link:

In the view of the Operating Model we see in the top image the plan appears to be that an individual will access a Personally Controlled EHR (PCEHR) having registered and asked to do so.

This service will be via a portal. The security and authentication for individuals is not yet clear to me.

Interestingly the individual or their representatives will be in control of who can access their PCEHR and decides who else might.

In the bottom half of the we have the provider with their electronic record. For some reason the picture seems to be suggesting that the clinician will register for access to each individual PCEHR and then only be able to see what the patient deems to be appropriate. It is not clear why the clinician would bother to either access or update the individual’s PCEHR.

On the second slide we have a patient having a consultation with a clinician, reviewing the content of the summary record and authorising that to be uploaded to the PCEHR - presumably after the clinician has registered for access.

Unless there is a substantial fee attached to doing all this - the chance of this happening in our fee for items of service environment are two. Buckley’s and None with None being the most likely.

I really have not - especially with the experience of HealthELink behind us - seen thing near such a stupid plan.

Back to the drawing board guys - this dog simply will not hunt!



Anonymous said...

So please present a model that will work that will also satisfy the privacy oversight to which the process is subject to (for political reasons)

You must find it easy....

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

It is easy. You get over the politics and do what patient safety and care quality requires and take the steps that all the evidence supports.

See the National E-Health Strategy for some very good first steps!

Announcing a flawed strategy is no reason for just going on with it until it falls in a heap. My view is that the PCEHR is just a rubbish idea in its current form.


Bruce Farnell said...

As it stands I cannot see how PCEHR could ever be populated with meaningful information. If a provider needs to be specifically identified before they can contribute to the shared record then the chance of all of the 'ducks lining up' at the time of consultation is going to be quite low. Also, as the PCEHR record is likely to be very incomplete the clinician is unlikely to waste time with it - even if they did have permission to access it.

Wouldn't it be better if the PCEHR authorisation model could distinguish between adding to the record vs accessing the record. Then any GP could add a progress note (for example) without having to be pre-registered to access the PCEHR record (unless they specified that they would not add to the record from that consultation). Existing clinical software could be modified to perform this function in the background without having to amend existing clinician workflows. You would end up with a much richer shared record in this manner.

This still doesn't solve the key problem of the health summary and who does it. However, if the shared record was more comprehensive it might encourage clinicians to seek approval to access it.

What do others think?

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


Sorry I disagree. You need to stop trying to work out how to fix a totally politically and bureaucratically driven lump of nonsense and start from a blank sheet of paper to design a national e-Health environment / system that is evidence based and might actually help.

This proposal is as far away from that as one can imagine!


Bruce Farnell said...

David - you are right. Nothing is going to save this puppy.