Sunday, January 29, 2012

What Does The Next Year or So Hold For E-Health in Australia? It Might Be Quite A Ride!

(The follow is a draft article for a magazine I do a column for - comments welcome)
I first have to point out that this short article is being written in late January and while, as we slipped off into the ‘silly season’ last year, we might have been forgiven for thinking the e-Health path for 2012 has been clearly marked, it seems, somehow that six short weeks have changed everything.
To go back to 2011 we had all watched the announcement of the Personally Controlled Electronic Health Record (PCEHR) by the then Health Minister, Nicola Roxon, the announcement of contractors and the selection of some pilot implementation (Wave) sites around the country. Funds has been allocated, a Concept of Operations document, explaining at a high level, what was planned had been released and, after some perfunctory consultation some enabling legislation had been introduced into Parliament.
We were assured that behind the scenes there was frenetic activity and that when we arrived at July, 1 2012 we would all be able to register at a web portal for our very own PCEHR, if we wanted one, and having your own PCEHR would be transformative for your patient care, the delivery of that care and the way the whole Health System worked.
Sceptics were pretty quiet by and large and there was also a sense that while it all looked very rushed the alternative of total inactivity was  obviously less desirable. This sense was doubtless heightened by the money that was on offer to those involved to get involved and make it happen.
I think was can pretty accurately date the moment when all the external gloss and smoothness started to erode and real concerns began to emerge about just how practical and realistic what was being proposed actually was.
I suggest the date was when this report was released by the Federal Parliamentary Library. The report was RESEARCH PAPER NO. 3, 2011–12 17 November 2011. The e health revolution—easier said than done. Author: Dr Rhonda Jolly.  In the broadest terms the report pointed out that there were more than a few issues that needed work and that the present plans might be a little over optimistic.
The report can be downloaded from this link:
With the introduction of the Bills to enable the PCEHR the next shoe fell and the Senate Community Affairs Committee decided on an enquiry into the legislation and a range of related matters. Submissions closed in mid-January, 2012 and to date over 40 submissions have been published on the Senate web site. Without in any way pre-empting the Committee’s findings it would have to be fair to day a good number of concerns and issues get a pretty substantial airing in these written submissions and it is hard to see how the whole program can continue unchanged at this point.
The enquiry will oral take evidence in early February, 2012 and a report is due by the 29th February - a date that it is hard to see will actually be met given the complexity of the matters raised in the submissions.
All of a sudden we now have all sorts of uncertainty about the timing of delivery of the PCEHR, the continuation for funding for National E-Health Transition Authority (NEHTA) and the PCEHR program and a host of other questions which have now been thrown up in the air.
The haste to meet the July 1, 2012 political deadline has had the effect of causing some ‘innovative’ approaches being adopted to specification development by NEHTA (the so-called Tiger Team process) and in the last week of January, 2012 it was announced that work on most of the pilot sites was being suspended for six to eight weeks while some erroneously issued specifications were corrected and re-issued to the affected technical teams. The impact on the time lines and budget are unknown at the time of writing.
With all this going on it would be fair to say the crystal ball was becoming pretty cloudy, but it has now become really opaque with the replacement of Nicola Roxon by Tanya Plibersek as Federal Health Minister as a result of a Cabinet reshuffle late last year.
From any sensible perspective it has to be concluded that the future for E-Health in Australia has become very uncertain for at least the next 2-3 months.
It is more than possible the new Health Minister will want to call a ‘pause’ and come to grips with just what is happening, what is doable and what the next steps should be. It is also possible the Senate Enquiry will make a series of important recommendations that change the landscape.
I do not recall a time when the forward direction of e-Health in Australia has been so unclear and indeed - on the basis of the submissions to the Senate Enquiry - so contested.
There is no doubt we need to make serious progress in the e-Health domain but it also seems that - on the basis of issues seen a many international programs - that progress is by no means as easy as it might seem at first glance!
I would suggest you drop back to the column in three months’ time to find out how all these possible options have actually played out and what the impact will be on your health service and those who are working there.


KH said...

David, it is tempting, when writing about eHealth, to concentrate on the PCEHR to the exclusion of all else. This is a great pity, because it is in other areas of eHealth that useful progress is possible and should be encouraged.
* Health identifiers have a role quite apart from the PCEHR and could begin to have some benefits during 2012 (two years after the launch of the HI service!).
* The lack of Secure Messaging is the greatest barrier to many simple eHealth services (electronic specialist referrals and reports, discharge summaries etc), so we should keep beating that drum. Who knows, 2012 might be the year that some progress is finally made in harmonizing the dozen or so incompatible messaging systems.
* We should also expect to see the authentication service (NASH) during 2012, and this is an important enabler for many useful services.
* It might also be worth speculating on the future of e-prescribing which at present is caught in two "pre-standard" incompatible implementations. While this situation prevails we won't see most of the potential benefits of e-prescribing.

I guess there is enough material for many columns, but my main point is that we shouldn't allow the ehealth agenda should to be hijacked by one project.

Dr David More MB PhD FACHI said...

Hi KH,

If ever there was a 'trust but verify' situation this is it! We can hope - but as they say 'hope is not a strategy'! Remember it is NEHTA who is making such a mess of the PCEHR that is meant to be sorting these other matters out as well.

There might be some progress on these fronts - and it would be a very good thing - but the oxygen is being sucked out totally by the ill-conceived PCEHR nonsense.

Pity that.


Andrew McIntyre said...

It all about the quality of the content, and not the messaging that needs to be fixed. This is a message I have been trying to deliver for a long time. The issue with messaging is the lack of quality and reliability of the HL7 produced from various systems, combined with the poor ability of systems to reliably consume quality content.

If the content was "fixed" wrt quality and systems could reliably consume standards compliant content and we had a national system of reliable location specific provider and practice identifiers and a national PKI infrastructure then getting interoperable messaging would be easy. Currently its impossible because all of those requirements are not in place. Interoperable messaging will result from standards compliant messages and software and national infrastructure that works. We have none of those so don't expect interoperable messaging on anything other than demonstration projects.

KH said...

Dr David More wrote: "..There might be some progress on these fronts - and it would be a very good thing - but the oxygen is being sucked out totally by the ill-conceived PCEHR nonsense."
I agree entirely, that's why I believe it's important to keep reminding people that "PCEHR doesn't equal EHealth".

Andrew McIntyre wrote: "It all about the quality of the content, and not the messaging that needs to be fixed.."
I'm sure that looking at the big picture you are correct. What I see is office staff scanning hundreds of specialists' letters per week because they can't be sent electronically - a scene which is repeated in thousands of general practices around the country at a cost of many millions of dollars per year, and it's been going on for years. It's a very depressing situation.