Wednesday, April 06, 2011

Observations on the Four Cornered PCEHR Workshop - March, 30 2011.

I have now listened through most of the discussions. The link to the presentations and registration to view the web-casts is here:

Some really clear messages emerge:

1. It is clear there are a lot of different perspectives from the Clinicians, Consumers, Vendors and Government and the work of aligning the often disparate views is not anywhere near done.

2. It is obvious that the obsession with having something working by July 1, 2012 is driving activity in ways that are probably not optimal. The political requirements looks to be distorting what is happening.

3. There is a lot of clinician concern about workflow and access to information impacts. It is not at all clear - even now - just how all this is actually going to work!

4. The Concept of Operations which is to be released very soon (Thursday 7/4/2011 possibly) has a huge number of open items (over 40) with a huge number of use cases still being worked through.

5. There was very clear concern that the governance of the overall program was quite chaotic and that no-one owned the program and was really accountable for delivery.

6. At least some in the room clearly understood just how gargantuan this undertaking actually was and recognised it as a decade long program. The scale of software change and development is really huge. Obtaining co-operation and use will equally take a very long time!

7. No clear benefits or business case was made by the proponents of the PCEHR.

8. The usual issues of privacy, balance of ease of use and access control, what information should be contributed by consumers and who controls just what in an information sense seem quite unresolved.

9. NEHTA made it clear the Wave 1 and 2 sites are experimental and that technology selections for the final national infrastructure for the PCEHR system will depend on the outcomes in these sites. This makes it even more unlikely anything real will be in place by the deadline.

Overall watching was worthwhile, but I am now more convinced than ever the way the PCEHR has been conceived is overly complex and is not deliverable in any real sense in the unreasonable and politically driven deadline.

Just today we had this in 6minutes.

PCEHR pledged for July 2012

Patients will be able to start building their own Personally-Controlled E-Health Record (PCEHR) from July 2012, the head of the Federal health department Jane Halton has announced.


She said a 'concept of operations' document will be released soon to give more details about the $467 million program being overseen by the National E-Health Transition Agency (NEHTA).

NEHTA chief executive Peter Fleming said the 2012 PCEHR rollout would be an ambitious target, and he likened it to US President John F Kennedy pledging to put a man on the moon by the end of the 1960s.

Full article here:

Clearly Peter Fleming has no doubt of the scale of what he is attempting!



Anonymous said...

"Clearly Peter Fleming has no doubt of the scale of what he is attempting!"

I presume by this comment you mean that either Peter Flemming is a bold, courageous leader prepared to go where others fear to tread or he is an ill-informed, dangerous, foolhardy dill who has a very shallow understanding of the health system and all its complexities.

It is unclear to me what you are trying to say with your comment "has no doubt of the scale of what he is attempting".

Anonymous said...

One small step for e-health, one giant leap....of faith?

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

Time will tell, but I give him a snowflakes chance in hell of meeting the expectations NEHTA / DoHA / Minister Roxon are currently spruiking in 15 months!


Anonymous said...

The moon program is a bad example, but is used regularly in this domain. Apollo was metaphorically a single-use application, running in a greenfields environment with basically unlimited budget and talent. The Sydney Olympics was the same formula.

Great results from both programs, but just momentary flashes, not long-lasting edifices

Building e-health systems is much more like getting a new aircraft model built. Incredibly complex, safety critical, long-lived, big budget and regulated like crazy. A380 ran years late, Boeing 787 Dreamliner is still in all sorts of trouble.

I just hope e-health can make a good first test flight in 2012 :-)

Anonymous said...

Points 1, 2.
Aligning disparate views of multiple professional, technical, administrative and political groups cannot be achieved using this approach, and even if it was possible to achieve such alignment it would not last because of the inordinate time required to get a practical working result which glues them all together.

Point 3.
Clinician concerns are totally justified. Disrupting clinician workflow will create multiple widespread ripples of chaos and confusion well beyond the clinician immediately impacted, leading to an increase in adverse events and mishaps. To avoid this eventuality the scope of ehealth projects needs to be tightly contained and well thought through from beginning to end at the outset. By developing on the run (fast tracking) whilst not knowing from the outset exactly how a system is going to work guarantees failed outcomes.

Point 4.
The Concept of Operations for a PCEHR in no way relates to any of the 9 projects as announced. It would be wiser to accept that and step back to take a long hard look at the practicalities, rationale, milestones, benefits and outcomes of each of the 9 projects before descending down multiple deep black bottomless holes.

Point 5.
Chaotic governance combined with lack of clearly defined ownership and accountability guarantees failed outcomes all round.

Point 6 & 7 & 8 are reinforced by our comments above.

Point 9.
It is ludicrous in the extreme to contemplate that the final national infrastructure for the PCEHR being dependent on the outcomes of 9 quite unrelated experiments.

Anonymous said...

DOHA said there were over 90 submissions. It would be enlightening if the other 80 submissions which failed to get up were made public. Perhaps a one paragraph summary of each would be sufficient. It is very difficult to believe that at least some of the other 80 which did not make the short list could have been of lesser substance than some of the 9 chosen ones.

Another interesting thought is that at least 1.8 million dollars was spent preparing submissions at say 20,000 dollars per submission.

Anonymous said...

In the interest of communication, collaboration and transparency in this 500 million dollar exercise it makes good sense to provide a public register of projects proposed and participating parties.

Anonymous said...

Is WA's non-appearance linked to it not signing up to the Health Reforms or would it have been to do with the quality?

WA surely faces challenges that a functional PCEHR would be well placed to mitigate?