Monday, May 30, 2011

Consultation NEHTA Style - Long Lists of Participants But Not Many Answers!

Last week, just a day or so before submissions on the PCEHR were due, we had two consultation reports released. These were sent to stakeholders and today CHIK has received permission to make them available.

Two documents were made available to those groups consulted last week - but were not made available publicly.

As mentioned they are now accessible and have been made available from CHIK servers.

1. The PCEHR Consultation Report January 2011 to April 2011

http://www.chik.com.au/files/NEHTA/PCEHR_ConsultationJan_April2011.pdf

2. Questions and Responses - from the roundtables held during March.

http://www.chik.com.au/files/NEHTA/PCEHR_Q&A.pdf

I was lucky enough to be sent copies late last week, and have has some time to browse them.

Sadly, in usual NEHTA style, we have many issues raised but very, very few issues actually resolved.

Typical of the sort of responses is the following.

NEHTA PCEHR Q&A page 8

Q - How can we be confident that the information in a PCEHR is correct and accurate at the time?

A - This is a challenging issue. The accuracy and reliability of information in any health record must be taken into account, in the context of other sources of information, including directly from the patient. However, this is largely dependent on the quality of information provided by healthcare organisations. Experience with shared records in Australia and globally indicate that the quality may be not be high initially, but improves rapidly with the introduction of the system due to its exposure and “peer-review”. The concept of having a nominated provider to manage the information going into the Shared Health Summary will help to ensure that information is up to date and relevant and to highlight important information needed for the ongoing care of the patient.

All one can conclude is that the whole PCEHR idea is just a very early work in progress.

Working out how the quality of information held in a shared record can be fit for purpose is quite fundamental and to be this vague at this point, is really quite alarming!

Enjoy browsing, if only to the frustrated regarding just how little is actually sorted out!

David.

13 comments:

Anonymous said...

Imagine this appearing in the mail from your bank.

Q - How can you be confident that the information in your bank statement is correct and accurate at the time?

A - This is a challenging issue. The accuracy and reliability of information in any financial record must be taken into account, in the context of other sources of information, including directly from the customer. However, this is largely dependent on the quality of information provided by non-bank organisations. Experience with on-line banking records in Australia and globally indicate that the quality may be not be high initially, but improves rapidly with the introduction of the system due to its exposure and “peer-review”. The concept of having a nominated accountant to manage the information going into the online bank account will help to ensure that information is up to date and relevant and to highlight important information needed for the ongoing management of your money.

Anonymous said...

bank statement is a wrong analogy - and a dumb one. A better analogy would be a credit report. And we know about those.

Anonymous said...

Not so dumb. Your bank account offers you access to your online credit card account, which contains entries from multiple third parties. The statement you get each month is a summary view of all transactions submitted by third parties to the bank repository. We would not accept our summary financial record (the credit card statement) to be governed in the way being proposed for our health summary record. Wy should we accept a lower standard for information upon which our life might depend?

Anonymous said...

How pathetic - one resounding issue that was raised at the event I attended was the lack of any governance model for the PCEHR. A simple question was asked - who is accountable for operating the system once it goes live - who is (for example) accountable for the security of the system, or the safe and appropriate use of the data it contains?

There was no answer at the event. Not DOHA, not NEHTA, not the high-paid sycophant advisors. There is no governance model - it's being worked out.

This fundamental flaw turned in the report into a banal comment: "There needs to be education on the governance model"

What an utter waste in an exercise of phony consultation.

Anonymous said...

Until a competent professional Occupational Psychologist is set loose on the upper echelons of NEHTA we will wallow around in this pig-swill forever and a day.

Tim said...

What a pathetic beat up - all NEHTA are suggesting is that the content of the PCEHR will only be as good as the people who take charge of its content (the healthcare provider and the patient). It's hardly cause for alarm, in fact - it's common sense, and comparing it to a bank statement is ridiculous, a bank statement is driven by pure objectivity, while a medical diagnosis by a professional and especially by a patient is generally subjective.

I'm all for criticism where criticism is due (that's why I read this blog!) - but this and many other recent posts smell of News Limited beat uppery and tall poppy negativity.

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

Hello Tim,

I have to disagree. Data quality in clinical records - especially when they are to be shared with other clinicians - is vital. The UK NHS recognised this and has spent very large sums of money fixing (partly) the data quality in their shared records.

To not have a plan beyond just hoping it will fix itself is not good enough!

David.

Anonymous said...

Yes, allergy to penicillin is such a subjective thing.

Anonymous said...

> The statement you get each month is a summary
> view of all transactions

yes. accounts, transactions. If they don't account for their transaction, they don't get paid. Does your combined health record work the same way? That if things don't go in, the real world event doesn't happen?

Also, it's not a *summary*, it's a list. We could easily build an ehr which is a list of transactions. (medicare already have the information. but they don't - and won't - share it, because the uses it has are not good for patients)

What is not present in a bank account transaction list is any concept of assessment of value or meaning. Which is why a comparison between an EHR and a credit report is more meaningful.


submitted by third parties to the bank repository. We would not accept our summary financial record (the credit card statement) to be governed in the way being proposed for our health summary record.

Anonymous said...

So if an entry in my PCEHR is not clear and this leads to a poor treatment outcome at a 3rd party provider.

Who do I take legal recourse against?

Napolean

Anonymous said...

I don't think suing Napolean will be much use.

Anonymous said...

Napolean asks: Who do I take legal recourse against?
Let me see: As long as you are not yet dead, you could sue the Government for having the wrong concept of operations; and the government could sue nehta because it didn't design it properly, and nehta could sue the national infrastucture people because they built it wrong or operated it wrong, or you could sue the source of the PCEHR entry (Is it possible to sue a conformant respository?) Or probably you should sue the person who is personally controlling it (is that like suing yourself?), or you could just sue the lot of them and that should make you FEEL BETTER. After all, it's all about you feeling better, isn't it?

Anonymous said...

Boom Boom

Clone Napolean put him in charge of NEHTA and then we may be onto something.

It is a lost cause, NEHTA don't want to say and the Govt don't want to hear.

Having been to some of the presentations, I feel like saying ....'Excuse me I can't see the screen, there appears to be a large elephant standing in our way'

Would be the end of my current career, but it would almost be worth it.

Napolean