Sunday, January 01, 2012

There Are Some Pretty Smart People Out There Who Think The PCEHR is a Crock!

This popped up a few days ago.

PCEHR launch to the moon

2011-December-21 | 12:56 By: Filed in:
During the Health Informatics Conference in Brisbane in August 2011, the CEO of Australia’s National E-health Transition Authority, Peter Fleming, likened building the  national system of Personally Controlled Electronic Health Records (PCEHR) to putting a man on the moon. Well let’s examine where we are at the end of 2011, with 6 months to go to the launch date.
At first glance there is one notable similarity between building a national PCEHR system and putting a man on the moon. They both have a daring, pioneering spirit typical of young nations – a “Great, grand idea. Bugger the cost” mentality. We have seen it with Australia’s Snowy Mountains Scheme and more recently in Australia with the National Broadband Network.
In the case of the PCEHR, I suspect this is where the similarity ends.
Firstly, we still have no detailed design of the system, although we do have some notion of who will be building the rocket and what some of the components will probably be. We certainly don’t have any detailed specifications; we don’t know where the journey will take us, nor how we will know when we are there. We don’t know how long the journey will take; nor how much it will cost.
Secondly, we seem to be fixated on meeting the launch date, despite reservations in many quarters about various technical, policy and operational matters. In fact, beyond the launch, we have no understanding of the operational matters at all. None whatsoever! Six months to launch date!
Long before the North American Space Agency (NASA) launched the Columbia space ship on its historical, Apollo 11 journey in 1969, they had very detailed designs, very detailed costs, had spent years testing and retesting components and had spent years testing and retesting processes and procedures. NASA certainly did not merely focus on the launch, but on all the operational details of how the space ship needed to get to the moon, achieve a successful landing, perform a range of tasks on the lunar surface, and return the astronauts safely back to earth. The rocket launch itself, was but one small step for mankind, albeit one large step for man.
Read the sad conclusion of the blog here:
What can one say? Eric has said it all and just adds to the reasons this PCEHR program needs to be closely reviewed and rethought.
Thanks Eric (quoted with permission)


EA said...

Ian Gust (medical virologist) tells the story of how Fairfield Infectious Diseases Hospital met the huge challenge of HIV diagnosis in the mid 80s. They needed to get a new laboratory fitted out. They were given an empty animal house. They started the re-fit with Gust and the builder walking through the shell and marking positions for new electrical power-points. Gust said "Here" and the builder punched holes in the lining with his screwdriver. (That's my memory of the yarn, it may not be correct in every detail.)
The point is, a new project has to begin somewhere. A complex project must begin at the right place, if it is to be successful.
It's my opinion that the EHR should have begun with Identity Management. It would have been difficult, it would been painful, it would have required continual attention to new technologies and shifts in notions of privacy, but the EHR will fail to deliver where it matters most until Govt gets onto Identity Management.
Yes, all politicians quietly walk away from IM, but, in the end, we all want there to be no stuff-ups when it comes to correctly identifying our own children.
Ms Roxon, as A-G, could do the right thing, but not while they are shifting the Privacy goalposts.

Anonymous said...

But they did start with Identity Management! We call it the HI Service, and it is shiny and good...but if you want to correctly identify your own children, may I suggest a tattoo?

Anonymous said...

The HI Service is a joke, if you already know everything about a patient and what the HI service has matches exactly then it will work, but is only as good as Medicares underlying data, which is a concern.

In the real world we need a matching service, which does certainly raise privacy concerns, but despite that, is whats needed. Perhaps the big centralised government controlled model is the problem??

EA said...

The HI story, as a subset of Identity Management, would be a fine case study in itself. For instance, were the big names (Microsoft, IBM, Google) ever interested in the contract? If they were, did they walk away, or were they pushed? If they did walk away, then why? What is the current role of KPMG in brokering IM as the extension of HI?
We'll never know, of course, because the blameworthy have locked themselves away from public scrutiny behind commercial-in-confidence.
If anything is revealed, it will be only because a forlorn whistle-blower breaks cover.
The ethical way for business to be conducted at that high level is for the Govt to require robust declarations of conflicts of interest.

Sarah said...

EA was probably fishing here. So I might as well provide the catch!

The large Identity Management (IM) companies (Oracle, Sun) and the consulting companies that put in their products were interested in providing a full national IM solution for the entire Australian health sector, but were not invited.

NEHTA only asked Medicare Australia to specify a solution because NEHTA’s understanding of IM and its importance was immature. Medicare Australia (which does not exist in its own right any more as it has become part of the Department of Human Services) did not produce IM solutions as a core business service.

The NASH was initially devised as a way of bringing basic IM principles into the HI Service. The provision of PKI certificates, either server based or on a smart card, is a by product of IM. But since proper IM was never implemented the implementation of the NASH has been difficult as it is really hard to understand what the NASH is about. It only makes sense as a sub product of a larger IM solution; otherwise it doesn’t match business practice in the health sector.

Anonymous said...

Sarah has provided only part of the picture – For a fuller one undertake a social network analysis of the contractors involved in NASH and Identity Management within NEHTA and understand their prior vendor/technology experiences, relationships and behaviours. Patterns and commonalities emerge – eg. with Queensland Health, Queensland Transport etc and a long history of contractor nepotism, systematic program failure and project non-delivery. All at the expense of others.