Tuesday, March 15, 2011

Is There Any Chance the PCEHR Dog Will Hunt? I Think Not. It is Fundamentally Flawed.

Key Point:

Does it make any sense for the Government to be operating a Patient Controlled EHR System in parallel and alongside provider managed patient EHRs with the associated risks of inaccuracy, confusion and lack of currency?

Now read on:


I thought it would be useful to go back to the official source on the PCEHR.

NEHTA Home - eHealth Implementation - What is a PCEHR?

What is a PCEHR?

A Personally Controlled Electronic Health Record (PCEHR) is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view.

Information in a PCEHR will be able to be accessed by you and your authorised healthcare providers. With this information available to them, healthcare providers will be able to make better decisions about your health and treatment advice. Over time you will be able to contribute to your own information and add to the recorded information stored in your PCEHR.

The PCEHR will not hold all the information held in your doctor's records but will complement it by highlighting key information. In the future, as the PCEHR becomes more widely available, you will be able to access your own health information anytime you need it and from anywhere in Australia.

----- End Extract.

Here is the link to the page (Accessed March 14, 2011)


If you read closely you can extract the following points:

1. The PCEHR is “is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view.”

2. The information in the PCEHR is accessible by the patient - and with permission their clinical provider.

3. The record will gradually also become a Personal Health Record (PHR) as the patient will be adding information.

4. The PCEHR does not replace but is in addition to information held in an EHR by the responsible clinicians.

In summary the PCEHR is an additional EHR controlled by the patient which will contain information that the patient my decide to disclose to their carers - or not.

What is needed for this form of Electronic Patient Records to be successful and valuable?

The list I would suggest includes:

1. A compelling reason for use by Clinicians.

It is hard to see this being the case since Clinicians already have their records. Only if there is unique information that the patient highlights as being important is the record even likely to be accessed.

An alternative might be to provide a fee for use to the clinician to compensate for the time and professional effort involved but this does not seem to be on any agenda I have seen.

Expecting clinicians to use and update the PCEHRs for no charge will be about as successful as having lawyers stop charging for their ‘billable hours’!

2. Demonstrable and proven clinical benefit of the approaches adopted.

International experience does not provide much evidence that running parallel systems (clinician and patient controlled systems) will add much value or be widely used.

3. Essentially zero interference with present work practices unless there is a reward associated with any negative impact.

It is difficult to imagine how this can be achieved with parallel systems. The clinician has no reason to trust an external system as opposed to their own records.

Overall the PCEHR looks likely to be an expensive, time wasting, nuisance for the vast majority of clinicians. The chances of significant adoption without major re-design and major financial incentives seems remote.

Yes I know all the arguments about involving patients in their care, co-ordinating care delivery and so on but this macro architecture does not get there I believe.

The ideal of IT system design over the last 20+ years has always been to try for a single ‘source of truth’ for any data element as it is this that makes sure only current and as accurate as possible information is that presented to the user. The NEHTA approach guarantees there are multiple sources which may lack both currency and accuracy. How idiotic is that? Take it from me the CBA does not have multiple sources of information regarding your bank balance - one is plenty!



Anonymous said...

I read the NEHTA Document PCEHR System DRAFT Concept of Operations Vs 0.9.30 - 2010 1126 very very carefully all 103 pages of it. I concluded the claims made throughout the document to justify a PCEHR are extreme fantasy. I also concluded that because the document is bulky and of many pages it will be used to justify the expenditure of enormous sums of money by people who believe NEHTA must know what it is talking about because it says it has been given the seal of approval by its Expert Reference Groups. There is nothing you or any other experienced intelligent health informatics experts can do about that.

As you say the PCEHR is fundamentally flawed. But, will the dog hunt you ask? Oh yes, 'that' dog has been hunting like a good truffle dog is trained to do - sniff, sniff, sniff for the money. It has found the truffles and dug them up - pure gold is the expression they use to describe truffles in France.

Anonymous said...

"Take it from me the CBA does not have multiple sources of information regarding your bank balance - one is plenty"
Yes but, if I have lots of accounts with a number of different financial institutions, then as a consumer, I might like to have a PCFR - that is a personally controlled finance record. And I can choose if I want to have the details from each of the banks I deal with there and I can control who can see each of those records. And for example if I become incapacitated or die, then my power of attorney or executor can see the whole lot - wouldn't that be something!

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

I said one source for each data element. How it is managed from there is up to you.

NEHTA is setting up one source you can use and one your doc can use. Dangerous duplication in my view!


Anonymous said...

Health Net discloses loss of data to 1.9 million customers.


Of course nehta would ensure it could never happen here

Anonymous said...

More importantly the health-net article said" The data center is managed for HealthNet by IBM".

Anonymous said...

IBM also manage the Medicare operations, have won the NASH project and are responsible for the Queensland Health payroll system debacle.

Go figure!

Anonymous said...

I'm not sure blaming IBM is the whole story. QH has a history of screwing up implementations - and it was actually corptech who "owned" the payroll roll out from a Government point of view.