Tuesday, April 17, 2012

NEHTA Gets Carried Away With Spin And Looses It Utterly It Seems. They Are In Fantasy Mode On What They Have Achieved.

A day or so ago NEHTA published a February 10 dated submission on the Australian Safety and Quality Goals For Healthcare.
The consultation period is now closed. Here is the request for submissions. Apparently a report went to Health Ministers in late March, 2012

Australian Safety and Quality Goals for Health Care

Consultation period has commenced

The Australian Commission on Safety and Quality in Health Care has prepared a draft set of Australian Safety and Quality Goals for Health Care and is currently seeking comment on these via a consultation discussion paper.
The purpose of the Australian Safety and Quality Goals for Health Care is to describe high priority areas that should be the basis of coordinated national action to improve the safety and quality of care and achieve better outcomes for patients and a more effective and efficient health system.
You are invited to make a submission on one, or all, of the draft Goals, or any other aspect of the consultation paper.
A copy of the consultation paper is available to download here. (PDF 275 KB)
Submissions, marked ‘Australian Safety and Quality Goals for Health Care’, can be made by post or email, or by using an online survey.
Post: GPO Box 5480, Sydney NSW 2001
Email: goals@safetyandquality.gov.au
All submissions should be received by close of business on Friday 10 February 2012 to be considered in the consultation process.
All submissions will be published on the Commission’s website, including the names and/or organisations making the submission. The Commission will consider requests to withhold part or all of the contents of any submission made.
Copies of this paper can be obtained from the Australian Commission on Safety and Health Care. Contact details are:
Phone: (02) 9126 3600
Here is the link to the page and further information.
More information on the broader initiatives is here:
The Australian Commission on Safety and Quality in Health Care (ACSQHC) is a government agency which was established by the Commonwealth, with the support of State and Territory governments.
We lead and coordinate national improvements in safety and quality in health care across Australia.
Here is the link:
I thought the NEHTA submission might make for some interesting reading.
You can find it here:
Sadly I have to say what I found was what could be safely described as a ‘puff piece’.
On page 1 we read:
“The Personally Controlled Electronic Health Record (PCEHR) System is the next step in using eHealth to enhance the healthcare system. The PCEHR System enables the secure sharing of health information between an individual’s healthcare providers, while enabling the individual to access their own health information held in their PCEHR and control who else can access it.
The PCEHR will build on the range of eHealth products and services already developed by NEHTA, including the Healthcare Identifier Service, Secure Messaging, the National Authentication Service for Health (NASH), eReferrals, ePrescriptions, specialist letters and discharge summaries.”
I am sure it will come as a surprise to many to know NEHTA has all these products and services out there. They have written a few documents and have had Medicare put in place an IHI service which is still awaiting significant use after almost 2 years. The rest is just hopeful spin as far as I can tell.
On Page 2 we read:
“NEHTA is charged with delivering the Australian Government’s eHealth solutions that will underpin the secure electronic exchange of relevant clinical information across the health sector. The agenda for eHealth is moving beyond a singular focus on the delivery of information communications technology (ICT) solutions to focus on ensuring the safe, effective use of these tools in the real world of healthcare.”
One asks just solution NEHTA has delivered? I can’t see much as yet after almost six years.
If anything is being delivered it is by Accenture and its partners and the local health software industry. How long is it since we knew NASH was needed?
Page 3 contains even more fun:
“For Australians who choose to have one, the information in a PCEHR will be able to be accessed by themselves, their selected carers, and their authorised healthcare providers. With this information available to them, healthcare providers and consumers themselves will be able to make better decisions about the consumer’s health and treatment. Consumers will also be able to contribute their own information and add to the recorded information stored in their individual PCEHR via Consumer Entered Notes.
The PCEHR is not a duplicate or replacement for local clinical records; it will complement local records by allowing access to key information from other providers. As the PCEHR becomes more widely available consumers will be able to access their own health information anytime they need it, from anywhere in Australia and overseas where connection to the internet is possible.
Based on an in-depth review of international eHealth studies, shared electronic health records , such as the PCEHR have the potential to contribute to improvements in healthcare quality and safety through enhanced access to and use of best practice guidelines, reducing errors (e.g. medication prescribing errors) and enhanced public health planning outcomes. They can also generate efficiencies by reducing duplication of effort, facilitating timely access of information to chosen providers and generating wider indirect effects e.g. timely discharge results in better information to the General Practitioner (GP) resulting in less repeated admission to hospital. Together, these have the potential to result in a healthier population, reduced demand on both primary and acute care, and saved lives.”
I really wonder just where the evidence is for all that. Not in this document and given the architecture of the NEHRS is unique in the world as far as I know they are just making it up!
On page 8 we read the following:
“Strong clinical leadership in the development of the PCEHR and on-the-ground support throughout its implementation will ground this reality of personal control in better and patient centred health delivery.
NEHTA's Stakeholder Reference Groups comprise a range of organisations representative of Australia’s healthcare sector. These organisations join jurisdictional representatives to provide their input to NEHTA’s work program and importantly provide information back to their members.”
This is really just not true. The PCEHR concept was dreamed up by some IT people in NEHTA / DoHA and just dropped on the unsuspecting clinicians. It is the worst of all possible shared record types as far as clinician needs are concerned.
We also read the following:
“Potential enhancements to the PCEHR
The PCEHR will be available for registration from 1 July 2012. However, provider capability and uptake will develop over time, as evidenced in other local and international eHealth implementation projects of this nature. The National E-Health Strategy proposed that the PCEHR System rollout be undertaken via an incremental approach, with the capabilities of the system being expanded over a four-year implementation period.”
Given the National E-Health Strategy is a 2008 document that framed a totally different implementation approach this statement is just insulting to the authors of that strategy. It has been funded and ignored and now 4 years later suddenly another 4 years is needed.
This document is spin city gone mad. The benefits are grossly overplayed, adoption is not really encouraged and the one system for the docs and one for the patients is just rubbish no matter how you look at it. Worse still this mad intervention has sucked the life out of some practical, sensible initiatives which were underway.
Pretty sad.


B said...


re: “NEHTA is charged with delivering the Australian Government’s eHealth solutions ..."

I think this just about sums it all up. NEHTA is implementing an IT solution. Unfortunately they are doing this without understanding what the problem is.

The fact that there is so much angst and disagreement between NEHTA and doctors, the AMA and others who understand the problem, or at least parts of the problem, would strongly indicate that the solution does not match the problem.

NEHAT thinks the problem is all about sharing health information electronically. It isn't. The real problem is how to better deliver health care capabilities to those professionals who need such capabilities.

Patients don't give a toss about personally controlled e-health records, they just want to have their health problems fixed.

The government is heading towards spending over $1billion (including costs such as set-up and implementation costs) without improving anyone's health in the slightest.

There are better ways of improving health care delivery, the way NEHTA is implementing the e-health "solution" is not one of them.

B said...


Here's an interesting news item

Law firms see big money in healthcare breach cases

Cybercriminals are not the only ones looking to make money from health data breaches.

In California, where a unique state law provides for damages of $1,000 per person per violation of the Confidentiality of Medical Information Act of 1981 (CMIA), plaintiff law firms are lining up to file privacy data breach class-action lawsuits against hospitals, medical service providers and health insurers that, if successful, could easily yield payouts in the multiple millions

If NEHTA and DoHA are so convinced they are doing the right thing, how about they commit to paying damages and penalties to those people who have their health information misused because of deficiencies in their PECHR/NEHR system?

If they truly believe that their systems will be up to it, then there is little risk in them doing so.

If there are legal reasons why this cannot be done, how about key personnel agree to resign at no cost to the government if the system does not live up to expectations?

That would require agreeing on success factors - but they should have been done in the business case.

It's called putting your money where your mouth is.

Geoffrey Sayer said...

Sadly if government activity or system does you harm you have to take legal action against them. Government really don't seem to put warranty on their activities or their systems. Everyone else who works in Health does but they don't. In the case of harm, the affected person uses the significantly lesser amount of their own money against the government who has the tax payers' seemingly unlimited amounts of money to use in any legal case. Maybe I am being a bit simplistic... maybe this situation is diffrent.

B said...


That's why I am suggesting the government agrees to pick up the liability in the cases where it does go wrong. They could appoint a mediator who would independently assess damages and the government could agree to accept its responsibilities without a one-sided fight.

The fact that this is highly unlikely would suggest that they know it is unrealistic to expect the system to work to expectations.

The only reasonable conclusion is that the government wants patients to control their e-health record, correct any mistakes in it, and wear any risk if anything goes wrong.

That's not a deal I feel comfortable signing up to.