Sunday, September 18, 2011

The Health Minister is Playing A Very Risky Game With the PCEHR. She Needs To Change Tack or She Will Fail!


On Friday we had an intervention in the PCEHR conversation by the Health Minister.

Pulling E-Health Together, Not Tearing it Apart

Article by Minister for Health and Ageing Nicola Roxon and published on 6 Minutes.
16 September 2011
The following article by Minister for Health and Ageing Nicola Roxon was published on 6 Minutes.
This week we took eHealth to the Federal Parliament, demonstrating to politicians how records will make a real difference to patient care in the hospitals, GP surgeries and pharmacies in their electorates.
The same demonstration will soon travel to different parts of the country, helping clinicians, consumers and others in the health system understand how connecting the patient journey will make a real difference.
What we were able to show to politicians is that this is not a technology system – it is a health system. It will improve care for patients, reduce medication errors and avoid unnecessary tests.
The display also demonstrates how eHealth is real, and no longer a vague plan for the future. We now have over a million healthcare identifiers downloaded to be used, lead implementation sites underway, secure messaging being used and patient consultations being undertaken through videoconferencing.
And from next July, Australians will be able to register for an eHealth record.
Yesterday we released the finalised plans for the service which will be built by our infrastructure partners. These were released following long and detailed consultation with clinicians, health consumers and ICT industry professionals across the country.
Now that we’re getting on with the job, it is important that people who want eHealth to be delivered get behind the program. I am buoyed by the enthusiasm that there is for eHealth across the spectrum of professional groups and the community.
Over the past decade of inaction it was easy for everyone to agree – because since nothing was being done, no decisions had to be made.
But now that the Gillard Government is actually getting on with the job – it creates the environment in which differing interest groups want to get their hands on the steering wheel. That’s obviously impossible.
For instance, we’ve seen the AMA saying we’re not listening to doctors. This couldn’t be further from the truth. They should try telling that to the College of GPs that has endorsed the plan, the leaders of the program include former Presidents of the AMA and RACGP, and the over 50 clinical leads that are closely engaged in the program.
The truth is that while the AMA haven’t won every single discussion about how the records will work, we agree on most of the design of the system. We’ll never be able to agree on every single detail because the Government has to take all the right advice and make decisions that are in the overall interest of the community and patients, not one professional group.
What the AMA needs to consider is whether they will be a partner to deliver eHealth, or whether they will act in opposition and miss this once in a generation opportunity.
By working for the collective good, everyone can help us deliver a solution to benefit patients and clinicians. The alternative option is to try and tear apart consensus on this program and leave a legacy of mountains of paper in hospitals and GP surgeries – unconnected and stuck in a luddite time warp.
It would be a waste to miss this opportunity to transform our health system.
For our part, we will continue to push ahead with this program in a way that engages our hard working clinicians, but unapologetically also making sure that this is a system that has patients at its heart.
The press release is found here:
The original publication in 6minutes.com.au is found here:
There was a report of the intervention here:

Minister urges AMA not to reject PCEHR

Health minister Nicola Roxon has rejected AMA claims that the government has failed to listen to doctors in the design and implementation of the PCEHR.
In an opinion article in today’s 6minutes, the minister says compromise is essential in a project that involves so many different groups, and she urges the AMA to come on board as a partner rather than “tear apart consensus” and leave medical records in a Luddite time warp.
.....
The Rural Doctors Association of Australia also said it supported the PCEHR program but was disappointed that no special rebate will be paid to doctors.
“Many rural doctors are already working long hours and struggle to keep their practices economically viable. Given this, they may be reluctant to participate in the PCEHR system without appropriate incentives for the time they will have to spend creating and updating the electronic records,” said RDAA president Dr Nola Maxfield.
This article is found here:
Miss Roxon was presumably reacting to this release from the AMA.

Medical advice missing from e-health records plan

AMA President, Dr Steve Hambleton, said today that the AMA was disappointed that the Government has failed to heed medical advice in finalising its Concept of Operations for the personally controlled electronic health record (PCEHR).
Dr Hambleton said the proposals could ‘de-medicalise’ electronic patient health information.
“Little has changed from the draft plan despite the sound advice provided by many medical groups, including the AMA, about what should be included on a patient’s health record.
“The Government has caved in to minority consumer groups.
“Under the proposed arrangements, people will be able to alter their health record without consultation with their doctor.
“Patients could entirely remove from their record clinical documents that they had previously considered worth sharing with healthcare providers.
“This is a very dangerous precedent that could undermine all the potential benefits of an electronic health record.”
Dr Hambleton said that the AMA would prefer the system to be opt-out, not opt-in.
“The opt-in system has resulted in incredibly complex rules for patients to give their doctors access to their PCEHR,” Dr Hambleton said.
“And there are still concerns around medico-legal liability associated with the electronic health record.
“The AMA is a huge supporter of e-health and the benefits it can bring to the health system, but we cannot support aspects of the system that do not improve on what we have now and which potentially create risks to patient health.
“We will have a system that doctors and other health practitioners are keen to embrace but won’t be able to because their patients haven't yet given them access to their records.
“Australia has the opportunity to be a world leader in electronic health but it won’t happen with the very complex health record announced today,” Dr Hambleton said.
The release is here:
We have also had the Rural Doctors Association of Australia react.

Patient controlled e-health records: Better support needed to ensure rural uptake

The Rural Doctors Association of Australia (RDAA) has warned that rural practices will need adequate support to ensure the success of a Patient Controlled Electronic Health Records (PCEHR) system in the bush.
RDAA was responding to comments made this week by the Federal Health Minister, Nicola Roxon, that at this stage no special rebate will be paid to doctors to cover their time in creating health summaries for PCEHRs.
RDAA wrote to the Minister earlier this month advising that, without such a rebate, many rural practices will find it difficult to meet the challenges associated with implementing a PCEHR system.
“RDAA supports the PCEHR as a means of making important patient information available to doctors working in different locations and with different systems” acting RDAA President, Dr Nola Maxfield, said.
“This is particularly relevant for rural patients who are most likely to be transferred away from their local community in the event of a medical emergency or serious illness.
“However, we have a number of concerns about the likely uptake of the PCEHR system in rural and remote areas.
“Many rural doctors are already working long hours and struggle to keep their practices economically viable. Given this, they may be reluctant to participate in the PCEHR system without appropriate incentives for the time they will have to spend creating and updating the electronic records.
Full release is here:
In the presence of this response I find two sections from the Minister very worrying:
First:
“For instance, we’ve seen the AMA saying we’re not listening to doctors. This couldn’t be further from the truth. They should try telling that to the College of GPs that has endorsed the plan, the leaders of the program include former Presidents of the AMA and RACGP, and the over 50 clinical leads that are closely engaged in the program.
The truth is that while the AMA haven’t won every single discussion about how the records will work, we agree on most of the design of the system. We’ll never be able to agree on every single detail because the Government has to take all the right advice and make decisions that are in the overall interest of the community and patients, not one professional group.”
The Minister is assuming here she can undertake the implementation of the PCEHR without at least tacit support from the AMA and the RDAA. She clearly does not have that support at present and she surely can’t imagine she is on a winner without such support. What is happening here is she is trying to ‘verbal’ the AMA etc. to support a plan they know is flawed. That is a looser of an approach if I have ever seen one!
“What the AMA needs to consider is whether they will be a partner to deliver eHealth, or whether they will act in opposition and miss this once in a generation opportunity.
By working for the collective good, everyone can help us deliver a solution to benefit patients and clinicians. The alternative option is to try and tear apart consensus on this program and leave a legacy of mountains of paper in hospitals and GP surgeries – unconnected and stuck in a luddite time warp.
It would be a waste to miss this opportunity to transform our health system.
For our part, we will continue to push ahead with this program in a way that engages our hard working clinicians, but unapologetically also making sure that this is a system that has patients at its heart.”
What the Minister should be considering here is that the PCEHR she has been advised to try and implement is by no means the best approach to this mythical ‘e-health’ she is conceptualising at a remarkably simplistic level.
I am perfectly sure both the AMA and the RDAA would be thrilled to work with Government in implementing a practical workable e-Health Strategy and but sadly the present ConOps is just not it!
The bottom line is that the RACGP thinks the PCEHR needs some work according to their most recent release:
See here:
 “Dr Bennett pointed out however, that some aspects of the plan still needed to be worked out.
“As highlighted in previous College submissions, we would have preferred to have a default option of the patient’s usual GP being the nominated healthcare provider. However, the College acknowledges that in some very remote areas without full-time general practice services, this role is best filled by a healthcare provider other than a GP.
The RACGP is also concerned that the current plan doesn’t offer any incentives for GPs and urges the Government to consider how this additional effort will be acknowledged.
“We would like to see amendments to the Medicare Benefits Schedule to recognise the additional workload GPs will undertake in consultations initiating and maintaining the patient’s shared health summary and other elements of the PCEHR,” Dr Bennett said.”
Full release here:
- and the AMA and the RDAA are pretty convinced it is not a goer in its present form.
Sorry Minister you have a lemon here of the same sort as a number of other Labor plans.
I hope your advisers are brave enough to tell you that without medical profession support this will be a huge unused white elephant!
David.

3 comments:

Anonymous said...

"eHealth fiasco has a deep and wasteful history"

Here as of Sep. 2011 you have the Canadian story: http://www.therecord.com/opinion/columns/article/587794--ehealth-fiasco-has-a-deep-and-wasteful-history

Tea leaves are saying 2013 will see this same story in Australia in the lead up to the next C'th election (if they go full term) and the PCEHR will have had enough elapsed time to be proven to be the wasteful "White Elephant" that it is.

There will be no official announcement as such, just the PCEHR deposited into the same wasteful bin the Health Connect legacy is festering in.

Then the big four can ramp up their forecasts for another windfall of a decade long e-health gravy train, with DOHA and COAG spending lots and getting precious little as a result.

BCG 2004 report will be republished in 2014, and they can just change the publication date to save costs and time.

And the e-health merry-go-round can start again with its fallacious platitudes, bureaucratic conceit and empty political promises by the health ministers puppeteered by their bureaucratic mandarins.

David, be sure to link to this post (http://aushealthit.blogspot.com/2007/07/previous-boston-consulting-group-report.html) when you publish your 2014 commentary once the Tea leaves have proven to be all so shamelessly and tragically prophetic.

Anonymous said...

It's a perfect example of doing the same thing over and over again and expecting a different result.

Anonymous said...

The Minister is technically correct to say that "secure messaging being used", but then it has been operating for many many years thanks to the secure messaging providers. There is still, however, a long way to go before secure messaging can be used to link the eHealth system together.

First thing missing is NASH which has been due to be delivered for 3 or 4 years. Maybe 2011 will be its year of delivery. Next is ELS, which is bogged down in Standards Australia. Next, the HI Service is supposed to provide some sort of lookup of ELS endpoints, but there is confusion about its use with that of the Human Services Directory. Finally, interconnect arrangements between the secure messaging providers need to be in place.

There are recruiting and registration processes in place for practices involved in the wave sites, so that these will have HPI-Os and appropriate certificates when SMD arrives in their town.

And this is only one of the essential building blocks where we keep having to hurry up and wait.