Tuesday, July 10, 2012

I Think The NEHRS / PCEHR Is Becoming Political And That Just Might Be A Good Thing To Get Some Sensible Change.


There were a couple of articles appear in the last day of so on the PCEHR - interestingly reflecting that both the Fairfax Press and News Ltd are increasingly covering progress.
First we have:

Slower than predicted start for personal e-health records

Date July 9, 2012 - 1:38PM
Only 320 people signed up for an electronic health record five days after the Federal Government's much anticipated July 1 e-health launch.
With numbers like this, the Personally Controlled Electronic Health Record project, which aims to streamline patient medical records to facilitate treatment, is unlikely to meet its own target of registering 500,000 users by July 1 next year.
Australians wanting to consolidate their health records including medications, allergies, immunisations, doctor's and hospital notes and prescriptions, can apply online at ehealth.gov.au.
A slow, incomplete start was predicted in May for Australia's most ambitious e-health project to date.
However Paul Madden, deputy secretary and chief information officer of the Department of Health, insisted the slow start was a good thing.
"This is a really complex and complicated system and because it will be living in that very viral system called the internet, which we don't control, we have to take a very measured approach as we implement our system in there," he told IT Pro.
Early problems included constantly busy call-centre lines, the inability to register names that have apostrophes, and Medicare staff unaware that PCEHR registration was available. To register online, applicants are first redirected to the Australia.gov.au site to open an account with no apparent link back to the e-health record registration.
Despite the department undertaking a roadshow to promote e-health records, Madden said that there had been no promotion of the sign-up, hence fewer consumers would be affected by initial teething problems. He said the system could not be tested live until July 1 due to legislative restrictions.
Lots more detail here:
Secondly we have a long article this morning

Auditor-General must audit e-health: Coalition

  • by: Karen Dearne and Fran Foo
  • From: The Australian
  • July 10, 2012 12:00AM
PRESSURE is building for the Auditor-General to examine the cost and performance of parties involved in the Gillard government's personally controlled e-health record program after a dismal launch last week.
Opposition e-health spokesman Andrew Southcott said that given "almost $1 billion of taxpayers' money has been spent or allocated for this in the past two years, it would be prudent for the Australian National Audit Office to examine the PCEHR program".
IT projects were "notorious for costing a lot more than expected and delivering a lot less than expected, and this seems to be in that category".
"I think we've had very poor ministerial oversight of this project," Dr Southcott said. "The infrastructure is not ready, the National Authentication Service for Health, which provides user verification and system security, is not ready, consumers could not register online and the GPs' software is not ready -- I'm told one of the largest GP providers won't have software ready until next February.
"It's time to hear from the Health Minister, Tanya Plibersek, or in her absence the acting minister Mark Butler, to take ownership of the situation because this is unreal."
Two years ago, then health minister Nicola Roxon was "trumpeting a bright, new e-health future" but there's not much to show for it at this stage", Dr Southcott said.
The online registration portal finally launched on Friday night, after an abortive live session on Tuesday afternoon resulted in it being pulled offline.
Lots more here including a comment from your humble blogger.
As pointed out in a comment yesterday, compared with what was promised two years ago we have been rather short changed.
See here:
Now the call from the Opposition for an Audit of what has gone on with the overall E-Health Program seems pretty reasonable to me.
As we can see from the following it also seemed reasonable to the Audit Office in June 2011.

National e-Health Implementation

In the 2009−10 Budget, the Australian Government committed $57 million to e-Health to facilitate the transition of paper-based clinical recordkeeping to electronic means, in support of safer, more efficient and better quality health care. Over the period July 2009 to June 2012, the National e-Health Transition Authority Ltd (NEHTA) is responsible for delivering key components of the National e-Health Strategy, endorsed by Australian Health Ministers in late 2008. Building on the work of NEHTA, the Australian Government announced in the 2010–11 Budget an additional $467 million investment over two years in the key components of an electronic health record system, so that all Australians have access to a personally controlled electronic health record.
An audit would examine DoHA’s leadership, management and coordination of e-Health developments.
----- End Extract.
Here is the link.
For mine - given that this has been a $1.0 Billion program - and such much smaller tasks - such as auditing the GP Super Clinic Program and actually underway - the time has well and truly arrived.
Additionally it seems clear the scope of the Audit needs to cover all Commonwealth funded (or partially Commonwealth funded activities NEHTA etc).
Given the result of the current poll -in less than 24 hours - where over 95% of 24 votes rate value for money low for this program the Audit Task and any required remedial action is becoming urgent.
Both Senator Boyce and Dr Southcott (the Opposition Spokespeople) have now spoken out on the need for an Audit. Time has come!
According to the Medical Observer Dr Southcott has said:
"he would write to the Attorney General to ask that the Australian National Audit Office examine how the government had spent “almost $1 billion” developing the records system."
See here:
http://www.medicalobserver.com.au/news/call-for-secure-messaging-as-coalition-demands-ehealth-audit
A good move I reckon.
David.

9 comments:

Anonymous said...

One of the other interesting things the launch dispels is the mythology that a personal health record and ehealth more broadly is like internet banking. From the Minister down this analogy has been propagated as being the rationale for spending the money that has been spent – it’s like having an internet bank account where you can see and manage your health data just like we are all do with our banking –wow wouldn’t that be great and isn’t it about time the health system and sector caught up with the rest of the economy. Get with the program boys and girls its like having an internet banking account. No.
No it is not like internet banking. If it was, we would be entirely satisfied with the blankness and minimal data provided.
Notwithstanding the relatively black and white nature of banking data, internet banking primarily manages the one to one relationship between a bank and its customer– that is fundamentally not the use case for a personal electronic health record.

Anonymous said...

Is the $1 billion you like to quote accurate? Is that what was spent on the system, or is that what was spent on a range of different things? How much was the contract to build the system again? If not all that was spent on the system, what else was bought, and were those things useful?

Anonymous said...

WHAT DOES THIS MEAN?

PATIENTS WILL SEE MEDICARE RECORDS.

WILL DOCTORS PCEHR VIEW ALSO DISPLAY A PATIENT'S MEDICARE HISTORY WHICH CONTAINS ZERO MEDICAL RELEVANCE?

"The Medicare information view will be available in the August release. Again, we need to provide a specification to the market that allows us to consolidate Medicare information into a view that you can also pull into and display in your clinical software.

"We haven't locked down a timeframe for that, we're looking at December but we're trying to draw that back so there's an earlier release."

http://www.theaustralian.com.au/australian-it/government/nehta-knew-of-pcehr-delays/story-fn4htb9o-1226422820967

Dr David More MB PhD FACHI said...

The Opposition says about a billion and The Australian who has looked carefully says it is a little more on the overall program. At the very least is is $467 + what was in this year's budget that gets the direct cost to at least $700M (ignoring all the staff and resources that were already in place). No matter how you look at it, it is a huge sum.

David

Anonymous said...

Right, but the contract to build the system was about $50M + software, right?

Dr David More MB PhD FACHI said...

And that would be useful without all the other things just how? Staff, continuing operations, testing etc etc.

You can divide the costs down to individual items - like tea and coffee for the staff - if you like - but the overall cost of the program is what matters and that has been pretty large.

David.

B said...

David,

eHealth is, and always will be, political.

IMHO, eHealth is a Wicked Problem, which hasn't yet been solved. There are so many competing stakeholders, many with contradictory objectives. This is what, in part, makes it Wicked.

All these stakeholders are playing politics, which means that that solving the problem probably not even possible, and certainly not possible by implementing a technical solution.

The PCEHR, being a technology solution to this un-solved problem, will fail - just like all other technology solutions to Wicked Problems.


BTW, Lynelle Briggs, when she was the Australian Public Service Commissioner, in 2007, sponsored a paper "Tackling Wicked Problems,
A Public Policy Perspective"

Ironically, Lynelle became the Chief Executive Officer of Medicare Australia in August 2009.

Anonymous said...

Ok so it cost 467 m to build it, but we know it is far from complete. Now it will cost 200 m or more annually to run it and complete it, so a lot depends on getting the guts of it in place, i.e. the real clinical information from clinicians and hospitals. Otherwise we will be paying every year to operate an empty shell until there is something useful to see. And BTW, medicare claim information should be checked by consumers - in my case we have a number of children on our Medicare card, and there are quite a few data entry errors where items have been logged against the wrong family member. Doesn't matter for a claim, but may be significant for a clinical decision, especially if it has been downloaded into a clinical system- where there is little control over correcting it by the consumer who may not even know it has been viewed and downloaded.

Anonymous said...

Paul Madden, deputy secretary and chief information officer of the Department of Health, insisted the slow start was a good thing.

.... otherwise we would have had a disaster of monumental proportions due to our own incompetence and failure to listen to and acknowledge the advice being provided by experts other than DOHA bureaucrats and NEHTA Paul Madden meant to say but didn't else he would have lost his job.