Tuesday, July 26, 2011

We Have Some Vendor Fantasy Loose As the PCEHR Infrastructure Provider Decision Apparently Draws Closer.

You can tell a major tender result (the PCEHR Infrastructure Provider Tender) is getting close when the soft marketing opinion pieces and releases start appearing.

First we have:

Shared EHRs: Beyond initial deployment

Over the last few years, the healthcare system — including the federal government, state jurisdictions, media, technology companies and the general public — have jointly placed a major emphasis on eHealth initiatives. While various models and strategies are still being discussed and debated, there is a core principle upon which most in the healthcare industry can agree: That stakeholders along the entire care continuum need readily accessible, patient-centric clinical data that transcends systems and geography.

The ongoing debate around the exact design and priorities of the Personally Controlled Electronic Health Record (PCEHR), which was well articulated by the likes of Medical Software Industry Association, the National E-Health Transition Authority and HealthLink in the previous edition of this very magazine, is a critical step towards finding the golden path — the EHR approach suitable for Australian patients and providers alike.

In this article I will try to look beyond this area of discussion and share some perspective on things to come. This view will encompass what we have seen happening when the rubber hits the road as Shared EHRs projects are deployed, and what becomes of them as they inevitably progress to their second and third release.

So if we close our eyes for a moment and imagine the fully functional PCEHR as described in the concept of operations, we should ask ourselves, “What’s next? Will the PCEHR be sufficient as-is?”

Applying the experience gained from Shared EHR implementation in the US, Canada, Europe and the Middle East, we anticipate several likely next stages of progression.

Lots more here:

http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=744:shared-ehrs-beyond-initial-deployment&catid=16:oz-hit&Itemid=227&utm_source=twitterfeed&utm_medium=twitter

I am pretty sure we need to treat this as a piece of marketing gloss.

I just love this bit - to quote “is a critical step towards finding the golden path — the EHR approach suitable for Australian patients and providers alike.”

This is arrant rubbish as there is no way any clinicians I know want to use an EHR designed for consumers and vice versa. There is just major confusion about what and why the PCEHR is.

The other point to be made is that any experience this company may have with the shared EHR’s is rendered pretty irrelevant by the fact that there is nothing like the PCEHR proposed any-where else I know of. The PCEHR is a one -off!

Second we have this press release from iSoft.

iSOFT Delivers Certified GP Desktop Panel for NEHTA PCEHR Project

Friday, July 22, 2011 - iSOFT

A major milestone in the national e-health strategy to improve the safety and quality of care in Australia has been reached with the delivery of the first NATA Accredited Conformity Assessed GP desktop to NEHTA specifications, by eHealth leader iSOFT.

iSOFT is the first of the six vendors participating in the NEHTA GP Desktop Panel project to achieve third-party conformance assessment for phase I. Independent accredited testing of iSOFT's practiX GP practice software included assessment against Medicare Notice of Connectivity (NOC) requirements for the National Health Identifiers Service, as well as NEHTA specifications for identifiers, discharge summaries and specialist letters.

The National E-Health Transition Authority (NEHTA) managed project for a personally controlled electronic health record (PCEHR), is designed to provide secure access to personal health information. The $466.7 million PCEHR system is part of a wider Commonwealth government effort to deliver a national electronically interoperable health care system.

New research, from a joint Harvard Medical School and University of South Australia study, shows that poorly coordinated care increases the risk of medical error by 100% - 200%(1). Communication between primary care physicians and hospital-based physicians is especially problematic - primary care physicians receive discharge information following hospitalisation only half of the time.

NEHTA and the federal government, hope to address these problems by developing an interoperable eHealth system that improves information flow between primary and secondary care settings.

The NEHTA-conformant practiX GP desktop software will facilitate communication between GPs and hospital-based physicians by supporting the electronic exchange of high priority clinical information such as discharge summaries, specialist letters, referrals, health summaries and medications management.

iSOFT’s ability to deliver the interoperable GP desktop so rapidly, is the result of its Health Information Exchange (HIE) solution, the technology used to enable practiX and competitive applications to participate in the national eHealth agenda.

practiX is an interoperable clinical practice management solution that supports both clinical and administrative processes and facilities coordination across care settings.

(1) C. Y. Lu, E. Roughead. Determinants of patient-reported medication errors: a comparison among seven countries. International Journal of Clinical Practice, 2011; 65 (7): 733 DOI: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2011.02671.x/abstract

The full release is here:

http://www.newsmaker.com.au/news/10308

I just can’t get enough of stuff like this! You should never let the facts get in the way of an exciting press release.

The big facts are:

1. The Certification is for connection to the Health Identifier Service - not the non-existent PCEHR.

2. The NEHTA specifications for all the cited clinical documents are yet to be approved as Standards and some are still draft.

3. Transmission of documents from Hospitals to many different GP systems is well established using HL7 V2.x and a range of connectivity providers.

4. The Standards to be used for the PCEHR program have not been decided or announced as far as I know.

This is clearly a press release for another purpose as far as I can tell and is really not news and not really related to the PCEHR.

David.

1 comment:

Ilan Freedman said...

David,
Thanks for referencing my editorial in Pulse IT. Your comments highlight a few areas which I obviously didn’t get across well enough. I will try to explain things a little better over here.

You wrote: “I am pretty sure we need to treat this as a piece of marketing gloss.”
- You may treat it as you wish, if I wanted “marketing gloss” I would have referenced dbMotion’s experience and expertise much more clearly. My intention, as a newcomer to the Australian Health IT space with heaps of international experience in the Shared EHR space, was purely to contribute to the dialog about Shared EHRs and elevate it beyond the debate around PCEHR.

You wrote (referencing my comment about the debate around PCEHR): “This is arrant rubbish as there is no way any clinicians I know want to use an EHR designed for consumers and vice versa. There is just major confusion about what and why the PCEHR is.”
- I think you took my comment (way) too far, I was simply recognizing the debate in the industry around PCEHR and saying that the dialog and debate between various players is the only way to find a “solution” that serves the various stakeholders and their interests. You are correct in saying that clinicians need solutions designed for clinicians not consumers, but by the same token those saying that the Australian general public won’t tolerate solution that is not patient controlled are right too. May no mistake, it would be nothing short of lovely for “evil vendors” like ourselves if Australian healthcare constituents required the exact same solutions as we deliver in the US, Canada and Europe – but reality is that there are unique aspects in Australia and industry should work together to find solutions that are fit for Australia. To be honest, very few Shared EHRs in the world are completely alike.

You wrote: “The other point to be made is that any experience this company may have with the shared EHR’s is rendered pretty irrelevant by the fact that there is nothing like the PCEHR proposed any-where else I know of. The PCEHR is a one–off”

- 1st of all, as I wrote and the title of the editorial suggests, I was writing about Shared EHRs, not about PCEHR. dbMotion is one of the only (if not the only) pure-play Shared EHR vendors in the industry, with over 15 clients for whom we deliver Shared EHRs (not interface engines or portals or anything else that might be confused with a Shared EHR). It’s all we do and consequently I dare say – we’ve got some pretty good know-how in THAT field. that's the reason I wrote about it. Second, based on the Draft Concept of Operations, the PCEHR is a complex system that among other components has some elements which are typical in Shared EHRs – therefore while it was really not the point of the article – our experience in that field might be relevant for PCEHR, but that is not for me to judge.

I thank you for your comments as they have crystallised elements in the article which were obviously not understood by all readers in the way I hoped for them to be. I welcome any further comments or questions from you or others.