Wednesday, March 02, 2011

What Is All This About Portugal Being A Model for E-Health? It Is just Nonsense with No Offence To Portugal Intended!

The following appeared a couple of days ago.

Portuguese model for e-health rollout: e-health records on a national scale

THE federal Health Department is looking to Portugal for direction in its e-health rollout, deputy secretary Rosemary Huxtable says.

"A number of countries are engaged in developing e-health records on a national scale," she told a Senate estimates hearing.

"In fact, I've recently had discussions with representatives of the government of Portugal, which is doing very similar work.

"Certainly the Scandinavian countries are well advanced in that regard, and France has been doing work in that area. Of course, large private insurers in the US like Kaiser Permanente have systems serving greater populations than ours."

Queensland Liberal senator Sue Boyce had queried whether there was a PCEHR (personally controlled electronic health record) system running anywhere in the world.

A Health statement to PCEHR contract bidders in January said there was "no single solution in place that meets all of the specifications. But every single component has been implemented successfully somewhere".

Ms Huxtable said Australia had been alive to international experience, and the risks and benefits of various approaches.

"Our design is very much a combination of top-down in terms of standards setting and the foundations, but also bottom-up where information is drawn in a live sense from existing systems into the e-health record," she said.

"Rather than having a single national repository, it's a process of aggregating information and using indexing technology (so medical providers) can view health summaries.

"I certainly took out of my discussions with the Portuguese that they were doing something quite similar and had come to it via a similar route."

More here:

http://www.theaustralian.com.au/australian-it/portuguese-model-for-e-health-rollout-e-health-records-on-a-national-scale/story-e6frgakx-1226013719205

Now I had not heard of Portugal (one of those economically crippled PIIGS some may recall) as being a major force or leader in e-Health.

As luck would have it I came upon a brand new review on e-Health in the EU.

European Countries on their Journey Towards National eHealth Infrastructures

Thursday, 24 February 2011

Since the publication of the European Commission's (EC) eHealth Action Plan in 2004, eHealth has gained significant momentum across Europe. "European countries on their journey towards national eHealth infrastructures - evidence of progress and recommendations for cooperative actions" is the title of a just released overview and synthesis report on eHealth in Europe. In addition, more than 30 individual reports detailing policy actions and deployment of eHealth applications in Member States and other European countries are available there as well.

The summary report traces European countries' progress along the goals set out in the eHealth Action Plan. It focuses on the core applications of EHR-like/patient summary and ePrescription systems. It also analyses governance, structural and legal issues as well as policy lifecycle aspects.

Study results show that in virtually all European countries surveyed, political as well as stakeholder interest in eHealth policies, and the planning and implementation of national or regional infrastructures has strengthened considerably. This concerns not so much the number of new priority objectives identified, infrastructure elements tackled or pilots run, but rather the overall level of awareness, activities and concrete undertakings. EC as well as Member State initiated activities and co-operations like epSOS or the eHealth Governance Initiative have both significantly contributed to this state of affairs and are witness thereof.

As PÄ“teris Zilgalvis, Head of the EC's ICT for Health Unit commented, "Europe is experiencing a strong political momentum to advance eHealth solutions for the benefit of both its citizens and health systems. The recommendations for further actions submitted in this study are based on a thorough analysis of eHealth strategies and implementation activities in European countries as well as the results of a validation workshop in September 2010 in Brussels ... now the challenge is to cooperatively address the issues identified."

empirica Communication and Technology Research, with more than 20 years of experience in research on eHealth and telemedicine topics, coordinated the study. The Finnish partner institute THL (National Institute for Health and Welfare), legal specialists from the law firm Time.lex and Professor Denis Protti (University of Victoria, Canada), contributed domain expertise. The study's communication efforts and final validation workshop were supported by the communication agency EMC Consulting Group.

A host of experts as well as reviewers from the i2010 Subgroup on eHealth contributed their intimate knowledge of the eHealth situation in their respective countries and validated the content of the country reports. This comprehensive collection of country information constitutes a unique resource and important database of up to date evidence on eHealth progress across Europe, which updates and complements the results of the earlier eHealth ERA study of 2007.

Download European countries on their journey towards national eHealth infrastructures - evidence of progress and recommendations for cooperative actions (.pdf, 1.060 KB).

Download from eHealthNews.eu Portal's mirror: European countries on their journey towards national eHealth infrastructures - evidence of progress and recommendations for cooperative actions (.pdf, 1.060 KB).

The release is here:

http://www.ehealthnews.eu/publications/latest/2494--european-countries-on-their-journey-towards-national-ehealth-infrastructures

A download of the document was fascinating to read.

Page 14 (of 58) tells us Portugal is mentioned.

On Page 29 we read:

Amongst the forerunners in designing a legal framework adapted to the use of eHealth are Denmark, England, Estonia, Finland, France, Norway, Scotland, Slovak Republic and Sweden. Almost all countries which do not (yet) have specific regulations with regards to one or more fields of eHealth, such as Austria, Cyprus, Latvia, Malta or Portugal, do have some regulation on health data, if only through the transposition of article 8 of the EU Data Protection Directive.29

On Page 37 we read:

Other countries such as Portugal have local implementations of ePrescription software in hospitals or pharmacies, but currently no electronic transfer of prescriptions from GPs to pharmacies is implemented.

On Page 46 we find:

Patient eCards are often based on or equivalent to multipurpose eCards for eGovernment services - including healthcare. In Finland for example, when providing citizens with a personal identity code, the Population Register Centre creates also an electronic identity for them (FINEID). The electronic client identifier is used for electronic user identification in secure online transactions. It is a dataset consisting of a series of numbers and a check character that helps identify Finnish citizens. In Portugal, an eCard for patients was deployed, that integrates previously issued cards in the field of personal identity card, taxpayer‟s card, social security card, voter‟s card and health system card. Their eID is a smartcard that provides visual identity authentication, with increased security, and elec-tronic identity authentication based on biometrics (photo and finger print) and electronic signature features.

And that seems to be it according to the Adobe Acrobat search.

There is also a 2007 review that is found here:

http://www.ehealth-era.org/database/documents/ERA_Reports/Portugal_eHealth-ERA_country_report_final_01-06-2007.pdf

A classic from this report is here (Page 15)

“Means available to the general public for expressing their opinions on eHealth policies and plans

There are no particular means for the general public for expressing their opinions about eHealth policies in Portugal.”

From my review it is clear Portugal is going down a different e-Health path basic on an eCard (rather like an Access Card +) and that it is way behind Scandinavia, Holland and a range of other sites.

There is nothing unique or special I can see that is specifically relevant to Australia, other than they seem to have some administrative Health Portals.

Ms Huxtable seems to have been making it up as she went along when speaking with the Australian Portugal is in an average to poor e-Health place right now!

Senator Boyce is right. There is nothing remotely like the PCEHR being done anywhere and certainly not in Portugal!

David.

Ps. A small factoid - Kaiser Permanente serves about ½ of the number of people in OZ! Of course their e-Health sadly makes Australia look just a little behind the game having integrated hospital, ambulatory care and patient access systems that are fully implemented and very well used.

See here:

http://en.wikipedia.org/wiki/Kaiser_Permanente

D.

12 comments:

Anonymous said...

The number of people who speak Portuguese in Australia is very small so to point to Portugal as the model is a very sensible choice David.

You are going to have to borrow Yes Minister from the video shop to really understand eHealth in Australia!! We learnt that it's about "Change Management" for the billions spent, "well done", is the only appropriate comment in the Yes Minister tradition.

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

I have the full set of DVD's in my collection for regular review!

David.

Anonymous said...

Ms Huxtable said Australia had been alive to international experience, and the risks and benefits of various approaches. "Our design is very much a combination of top-down in terms of standards setting and the foundations, but also bottom-up where information is drawn in a live sense from existing systems into the e-health record," she said.

Surely no-one has a problem with that - do they?

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

Assuming she knows how she is going to persuade the holders of that information to give it to the Government and how she will protect it and make sure it is accurate and current.

Information on that is pretty thin right now!

David.

Anonymous said...

Well Ms Huxtable also said "Rather than having a single national repository, it's a process of aggregating information and using indexing technology (so medical providers) can view health summaries.

In other words she is saying there will be no single national repository.

Therefore the issue you raise of "persuade the holders of that information to give it to the Government" is no longer relevant.

It seems to me she sees the health summary will be an aggregation of information collected from multiple disparate sources using some form of 'indexing technology' where the information once collected will be made available for viewing by busy medical providers after that information has been aggregated and collated in real-time as and when needed from multiple disparate repositories which are managed and controlled by a number of third parties not associated with Government and where the information so collated will be available for viewing as required but where the summary record will not be written to because it won't be stored in any single repository.

Have I got that correct?

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

I should have said 'share' rather than 'give' but otherwise no.

The PCEHR concept enforces a bizarre separation between 'person controlled' information sourced from where ever and provider clinical information from clinicians.

Clinicians hold the information on the patients they care for in their own systems and this information is for their use and my not be easily understood by the patient - indeed may confuse / terrify the patient.

For this information to be passed to even a range of repositories raises all sorts of very complex issues about trust, information currency, reliability etc etc. Also the incentive to do this is pretty low if making this information available is going to lead to all sorts of queries, explanations etc.

There is a huge amount of work needed to sort out just how to, and what to, share patient information (with other clinicians and patients) that DoHA / NEHTA seem to have no clue about as far as I can tell.

It is a great deal harder than simplistically saying just share a 'patient summary'!

David.

Anonymous said...

It is far more interesting that large private insurers in the US like Kaiser Permanente have systems serving greater populations than ours and countries like Sweden have already implemented similar patient health solutions. Should we not be turning to these leaders as opposed to Portugal?

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

Obviously!

However it has taken a decade in both places (or so) and we have lots of time to do it again but no time to get it right and do it properly (same with funding - doing it properly is not cheap!)

David.

Anonymous said...

Just who is going to write the patient summaries? As David has pointed out many times, producing a patient summary is a not insignificant task. Just ask the Hospitals battling to get clinical staff to write meaningful discharge summaries.

"aggregation of information collected from multiple disparate sources using some form of 'indexing technology'" is most certainly not a summary, and is probably a very dangerous form of clinical information since there is no way of knowing what clinical information has not been indexed.

Anonymous said...

So why not start with an application that is quite precise and which impacts us all (service providers, carers and patients-consumers?

If we can get that right first it should become the basis for getting all the infrastructure (communications, messaging, coding, terminology, security, privacy, authentication, interoperability) into place.

If this is done embracing an open systems, standards compliant approach then surely we will have the core infrastructure we need to build upon and extend the ubiquitous reach of ehealth in other application domains.

Wasn't that the reasoning underlying the development of MediConnect in 2003 (eight years ago) when the MediConnect website was launched on 14 April 2003 at www.mediconnect.gov.au ?

Anonymous said...

8 years ago!!!!! What was MediConnect? Where is it today? Thanks to Medicare Australia we can read all about it here - MediConnect was:

http://www.medicareaustralia.gov.au/provider/patients/mediconnect.jsp

"Eligible Tasmanians and Victorians were able to control their individual records and participate in MediConnect. Registration was voluntary and once registered, consumers could access a copy of their MediConnect medication record from their doctor, pharmacy or Medicare Australia. They could also add information to it by either writing/calling Medicare Australia or visiting a Medicare office."

"Plans are well underway to begin implementation of HealthConnect in Australian states and territories-starting in Tasmania , South Australia and the Northern Territory in 2005."
Last updated: 19 March, 2010

Oh!

Anonymous said...

DOHA also proudly reminds us about MediConnect here:

http://www.health.gov.au/internet/hconnect/publishing.nsf/content/mediconnect-1lp

“The MediConnect program (formerly the Better Medication Management System) was initiated to provide a medication management system that could be used Australia-wide to ensure quality and safety for consuumers in the area of medication usage. The system was intended to help reduce adverse events with the use of medicines.”

and

“It was a secure national electronic system to help improve quality and safety in the way we managed our medicines.”

and

“The MediConnect Program became incorporated with the HealthConnect program in Minister Abbott's announcement of 10 March 2004.”

Oh !!