Sunday, July 08, 2012

A First Look - Well We Can Now See What Roughly A Billion Dollars Buys In A Health Record System. It’s Not Much So Far.


I had a frustrating time 2 days ago trying to convince the NEHRS system I was real. Eventually I decided the phone was the go and had a very kind lady spend 15 mins or so to provide me with a password to get started with setting up my personal health record.
Since I am sure not many have do so as yet here is where you wind up and what you will find so far.
There are all the usual disclaimers, warnings and threats to your first born and you get to a sort of record home page.
The layout is traditional - with demographics at the top and then this menu down the left had side.

Health Record Overview

Clinical Documents
Shared Health Summary
Personal
Personal Health Notes
Personal Health Summary
Advance Care Directive Custodian
Your Personal Details
Emergency Contact Details
Medicare Records
Medicare Services Overview
Restricted Settings
Medicare Information Preferences
Notification Settings
Manage Access to this Record
Manage Document Access
Restricted Settings
Audit Log
----- End Extract.
In the real system each of these are links to their own pages.
The record is powered by Orion’s Concerto software using Oracle as the Single Sign On and Security Manager.
Initial Impressions:
1. Clean open screens with lots of explanations meaning there is a lot of navigation (not all that quick) to move around.
2. The log on with a combination of ID, Password and Random Security Question (1 of 5) is slow and annoying but I guess necessary.
3. There is essentially no content of any sort - except what you type in and an non-user friendly audit trail. There were no Medicare records I could see also.
4. Just how records will be managed over time (a potential lifetime indeed) with all that entails is not hinted at here.
5. That this is a consumer and not professional system is emphasised throughout with all the disclaimers about clinicians not needed to read some parts and other parts being fully available.
6. The lack of a condensed consumer information summary screen seems to be a big omission.
7. Flicking between Australia.gov.au and the record is slow any annoying.
8. Right now the term PC-LES for Largely Empty Shell is spot on!
 The bottom line is that right now it is impossible to see where the money has gone. What we have is a pretty clunky web-based system of a design that was common close to a decade ago. The complexity of what is on offer is very low and right now the system is about as user friendly as a piranha. There is really no point much to using this right now.
Until there is wide-spread co-operation from the profession in the provision of Shared Health Summaries and Event summaries (and the provision of effective, slick and very quick Business to Business (B2B) links between the system and practitioners) this system is a remarkably expensive aide-memoir. Right now a MS Word file on my home computer looks like a pretty good and cheaper option.
If that is to ever really to be adopted and used it will rely on dramatic improvements in usability and information content. I am really not sure I can see that happening any time soon. Time will tell.
David.

19 comments:

Anonymous said...

I like the yellow colour on the sidebar.

Anonymous said...

I am annoyed by all the Unnecessary Capital Letters. Makes it look either American or old fashioned, or both. Seriously, from a consumer perspective, I have created my eHealth record, I have entered my emergency contact details -- now what? What was the point of rolling out this empty system? Especially given that all the experts were telling them they were launching too soon, I wonder why they didnt wait until at least some doctors, etc were able to join up and give the system some meaning? I honestly feel like closing mine down again until I can do something with it.

Keith said...

Anonymous (7/08/2012 06:57:00 PM) said...
... "I have created my eHealth record, I have entered my emergency contact details -- now what? What was the point of rolling out this empty system? Especially given that all the experts were telling them they were launching too soon, I wonder why they didnt wait until at least some doctors, etc were able to join up and give the system some meaning? I honestly feel like closing mine down again until I can do something with it."

Give it a few weeks at least before pulling the plug. According to the announcements MBS and PBS data should be added to your record within a couple of days. After that it could be a long wait unless you are in the area of one of the wave sites. Judging by the amount of money that has been thrown at them every effort will be made to get these areas operating quickly, possibly with pre-release software and authentication. As I've written in another comment, the number of GPs registered (outside the wave sites) is likely to be quite small at least until early next year, simply because it will take time to roll out new software and to distribute the PKI tokens for digital signatures and authentication.

Anonymous said...

because the minister said. That's what she promised, and that's what she gets. Since when as the fact that it doesn't make sense mattered to ministers?

Anonymous said...

What’s all this complaining about? Job well done if I’m not mistaken. So it was roughly a day or a week or so late, depending on how you’re counting, and with the challenge and complexity of the task put to them, NEHTA and DOHA are to be sure to be giving themselves big pats on the backs for pulling this gargantuan task off with only a few grammatical hitches and a piece of negligible and surplus to requirements NASH service missing. But no one will notice, be harmed or disadvantaged as a result. The NASH is a mere technical non-event that is meaningless as evidenced by the ability to go-live with the PCEHR and meet the budget targeted milestone in its absence.

We believe the delivery of healthcare services should be transformed.
So tonight, I am announcing $467 million to modernise our health system by providing a personally controlled electronic health record for every Australian who wants one.

This will mean patients and their doctors will have their health records at their fingertips — improving patient safety and health care delivery.


(Budget Speech, Hon Wayne Swan, May 2010)

Of course, to be ever so watered down by the department of health and ageing straight after the budget speech in their department’s budget papers:

An individual’s personally controlled electronic health record will not replace or hold all the information contained in doctors’ and other health providers’ records. The personally controlled electronic health record system will provide a summary view of an individual’s health information, and access to key clinical data such as demographic information, conditions, treatments, medications, test results, allergies and alerts. Australians will be able to choose whether or not to have a personally controlled electronic health record, and if patients choose, they can specify information that can be viewed and by whom. Commencing in 2012-13, individuals will be able to "register" for a personally controlled electronic health record online.
(Budget Papers, DOHA, May 2010)

So please stop all the continuous and unbridled bleating going on here on this site and give some well deserved credit to those fearless and frank ehealth warriors where it is well and truly due. The time for complaining was in May 2010, the time for cheering and commendations of the highest order for our ehealth leaders is well and truly now. Nothing but bouquets to be delivered and shared at the next Senates Estimates hearings for both DOHA and NEHTA leadership, you watch.

Get over it.

Dr David More MB PhD FACHI said...

Anon said:

"So please stop all the continuous and unbridled bleating going on here on this site and give some well deserved credit to those fearless and frank ehealth warriors where it is well and truly due. The time for complaining was in May 2010, the time for cheering and commendations of the highest order for our ehealth leaders is well and truly now. Nothing but bouquets to be delivered and shared at the next Senates Estimates hearings for both DOHA and NEHTA leadership, you watch."

Just what are you smoking and who is paying you to suggest that setting up a web registration screen for an empty system is progress?

None of us here agree as far as I know.

David.

Anonymous said...

OK bouquets and flowers for DOHA and NEHTA. But spare thought for Dept of Human Services (Medicare). They have worked hard to provide a large chunk of what you see so far - the link from health.gov.au through the the identity check, the PKI/authentication service (while we wait for the NASH), the HI Service backing up provider registration and consumer identification, the lovely patient ladies at the call centre, the data entry from the forms, and soon - as you say - the medicare claims data and PBS claims data, and the organ donor status and childhood immunisations - just so there will be something to see in each record. And they have provided the much needed experience and advice to DOHA and NEHTA, because guess what, they have done this all before. They probably deserve the biggest bouquet at this point in time. The quiet achiever.

Anonymous said...

Just what are you smoking and who is paying you to suggest that setting up a web registration screen for an empty system is progress?

Self-evident is it not? The tax payer of course, to the tune of $467M since May 2010! And still counting more and more.

Just Google "DOHA PCEHR" and you'll see who's really making great state “sponsored” progress around here.

Tasmanian Sheep said...

Hang on a minute. My understanding is that what we have right now is *supposed* to be a shell that will be a method to access information that is held within other "integrated" systems. There will be a small subset of information held "inside" the PCEHR itself, and that will be populated from other systems and provided by the patient themselves. As of right now all we can reasonably expect to see is this last aspect.

We would all of been crying blue murder if nothing had been delivered for July 1st, so let's not now turn around and cry "shame" instead!?!

This is surely a first step in a longer journey? Right now I expect that people responsible for all those "conformant systems" will be hard at it, testing interfaces and bringing their systems into the PCEHR world.

We all know that the really hard stuff is the systems integration behind the scenes. We have to assume that all that is there ready and waiting for a "conformant system" to come along. The first of which I guess is Medicare?

As soon as we get some real clinical data in there we'll be able to work out whether the Orion system is any good or not... until then, well they've delivered what they said they'd deliver, credit to them.

Don't forget, we all want this to work, right?

Dr David More MB PhD FACHI said...

All these laudatory comments show just how easily the goal posts can get moved. When the PCEHR was announced the Summary, Medicare Data and all sorts of other stuff was meant to be working at launch.

Then about a year ago it was realised they had 'bitten off way more than they could chew' and the expectation management kicked in.

The plan was that the $467M was to buy a great deal more than was delivered.

Remember right now not a single GP can directly access the PCEHR System - and no one is going to use the portal - too slow and inflexible!

David.

Dr David More MB PhD FACHI said...

For the Record:

Go here to see what we were promised in 2010.

http://aushealthit.blogspot.com.au/2012/05/its-time-to-check-what-we-were-promised.html

David.

Anonymous said...

While we wait for the shell to be filled, you can actually already see your Medicare data on medicare's portal. With the exception of the PBS claim data - but here is a handy little phone app that you can use to list your medications, including those that are not claimed through PBS..

Anonymous said...

Yes, we're not getting completely what was promised at the outset. No, people probably haven't learnt from their mistakes. Yes, we'll probably get there eventually. No, no one will be held to account.

As someone said before: Get over it!

As of right now I reckon they've done a lot better than most people expected, especially given some of the conversations on this blog.

For sure, there was a little bit of noise around July 1st, and a few people throwing grenades. For my 2c worth, hats off to the people who had to take that Concept of Operations document, make sense of it, and implement something (anything) that works and keeps the government people happy.

It may well be a "web registration to an empty system", soon medicare information will be there (yes, it will replicate what we already have, but I'd be willing to bet that extending the medicare / PBS systems to include all the other information in GP/Hospital land is a non-starter), and it will eventually be extended to provide access to all that stuff.

Dr David More MB PhD FACHI said...

I find it amazing that not only do we have progressively reduced system scope (make a registration web-site) and deadlines but now we find that this is now being called a 'glorious victory' by some.

Getting a simple web-site up for $500 million is a genuine farce - especially as another few hundred million are now being spent to continue the 'progress'.

Clinician involvement has hardly even begun and won't for ages, if at all. Remember most of the Medical bodies are not at all happy with what has and is being done.

Declaring PCEHR victory for creating a web site is premature and frankly nonsense. Until we see improved patient outcomes that can be fairly attributed to the PCEHR I will remain deeply skeptical and concerned about the waste of public money.

And no - I have no intention of 'getting over it'. This whole saga is a model of how not to undertake Health IT projects.

David.

Anonymous said...

Maintain the rage David, these drones obviously have absolutely no idea of what value for money is about. To believe that congratulations are due for delivering what has been delivered to date for $450M is not only sad, but if not so serious, laughable!

Anonymous said...

David, tut, tut, how can you say .... Clinician involvement has hardly even begun and won't for ages, if at all. Remember most of the Medical bodies are not at all happy with what has and is being done.

Surely you've heard of Dr Haikerwal's hail and hearty Clinical Leads. They've been out and about engaging with clinicians, attending meetings and conferences, and generally appearing knowledgeable and helpful now for almost 2 years showing us all the way forward and telling us how wonderful IT will be.

Do you have a problem with that?

Anonymous said...

Hey aren't they the ones in the truck with "pathology, images, etc" promised in large writing on the side? Perhaps that is where the clinical data is it's in the truck.

Anonymous said...

Great, they got web registration working! Portals, too many to name, have been doing this since the late 1990s. If this had been done in 3 months at a quarter of the price I would be the first to say "Job Well Done".
Any objective IT manager would laugh at a price of $108m and a time-frame of 12 months for delivery of this empty system. Did it really take the equivalent of 1080 staff on $100k pa to deliver?

Any objective clinician would laugh at this being lauded as some sort of victory for e-health.

This remains, a document management system, with little or no clinical domain capability at a price that is embarrassing for most IT professionals.

I think everyone is glad to have something there, yes it is a move in the right direction. I am just gobsmacked and annoyed at the cost of what has been put up.

Anonymous said...

Anonymous said "This remains, a document management system, with little or no clinical domain capability at a price that is embarrassing for most IT professionals.

I think everyone is glad to have something there, yes it is a move in the right direction. I am just gobsmacked and annoyed at the cost of what has been put up."

Too true by half - except I'm more gobsmacked and annoyed at the cost of what HAS NOT been put up, including NASH. And the timeframe for any of it to BE put up?????? Maybe that project plan is in the truck along with the pathology and the images!!