Sunday, July 15, 2012

It Really Looks Like The Right and Left Hands Of E-Health Have Not Co-Ordinated The Story. They Have No Explicit Plan And Are All Over The Place.

The following very long piece appeared in the Saturday Health Section of the Australian yesterday.

Sideshow obstructs e-health traffic

THERE is a truck trundling across Australia that should be pulled over and its owners charged with false and misleading advertising.
It's the Model Healthcare Community Roadshow, and it claims the Gillard government's $1 billion personally controlled e-health record guarantees "your health e-info travels with you".
Although that is indeed the aim of modern electronic health systems, the PCEHR is a repository containing a static, point-in-time medical summary uploaded by your GP, and possibly a few "event summaries" from other practitioners.
It's unclear how a hospital will upload a discharge summary after surgery or a visit to an emergency department, just as it's uncertain how specialists will contribute their summaries.
That's so as each person's record is supposed to be "curated" by a single, nominated provider, usually their GP.
It's also unclear how long it will take to update individual records. It's certainly not in real time.
Doctors have made very plain their concern they will be unable to rely on the PCEHR as accurate, up-to-date and complete.
The last point is certainly tricky as it's impossible to ascertain that every healthcare provider you encounter has the capacity or the will to contribute to your record. It's a voluntary system for providers as well as patients.
Take, for example, an emergency admission following a sudden collapse. You're fortunate enough to land in a hospital with good internal e-health systems and a specialist who is already communicating electronically with their colleagues and local doctors through secure messaging systems.
How will the PCEHR help in this situation? It won't.
When you arrive in emergency the receiving doctors will be able to access only a brief health summary from your most recent GP visit, perhaps six months or a year ago.
What about the "X-rays, pathology, scans" proudly emblazoned on the truck's side, implying they too can be uploaded to your record? They can't.
Efforts to provide access to diagnostic imaging through the PCEHR are yet to begin. Work on creating the technical standards and processes for handling diagnostic images, reports and requests is scheduled to start sometime next year.
Worse, it appears the initial versions will provide images in the PDF format only. That's better than nothing but unlikely to please medical professionals already exploring new worlds of computer-assisted technologies as well as those doing 3-D modelling of surgery plans for patients.
And what about pathology? Again the best doctors can expect is a summary of test results, in static form. That means doctors won't be able to dynamically monitor variations.
Instead, they will need to open each result separately, perhaps print out the report, and then work out the changes and trends themselves, much as they do at present.
Pathologists warn that the summary nature of PCEHR information poses particular challenges, as pathology results need to be interpreted in the context of other test results, both normal and abnormal, with a normal result just as important as an abnormal one.
Any omission of results from the record may inadvertently lead to wrong conclusions and wrong diagnoses, thereby compromising patient care.
Lots more here:
The second half of the article then goes on to explain how systems which are in-place, proven and working are being harmed and replaced by the push from a presently worse than useless system ‘from the Government’.
One colleague had the following reaction.
“It's a pretty powerful and very provocative article. I'm sure it will be widely circulated electronically in addition to all the hard copy readers. It could have the effect of dramatically slowing down the e-Health momentum OR it could act as a real wake-up call to the Minister to exercise real leadership and employ some common sense thinking about how best to fix the PCEHR fiasco.”
My feeling is that no one is taking any account of the harm the PCEHR Program is doing to our current e-Health providers and worse that the messaging about e-Health is now hopelessly confused. We have the wandering truck promising the earth while down on Planet Earth it is well known this is all going to take years to make any difference - and the Minister and other senior people are all saying just that.
Again we have an excessive simplification of a debate which is not all that simple. Simply saying ‘e-Health’ is good and opposing ‘e-Health’ is bad misses the point that there is good evidence based e-health and what is going on with the PCEHR which is the extravagant opposite in every sense. I strongly support the former and oppose the latter - despite what you might read elsewhere.
What is missing in all this is the Government actually levelling with stakeholders and providing a real plan of what is foreshadowed over the next few years and the business case and evidence to support that plan.
Dream on David I guess.


Anonymous said...

Perhaps a good way to get the ball rolling with the PCEHR is to start with putting hospital discharge summaries into it. Most health services/states have or almost have capability to load up electronic discharge summaries. And most GPs and specialists have wanted to have easy access to discharge summaries for many years. This would get GPs and specialists involved early. And the issues with having GPs take time to do shared health summaries can be handled later.

Any other ideas for low hanging fruit for the PCEHR, so it is not an empty shell? Perhaps a smart phone app to allow consumers to document current medications, and populate this to the PCEHR? I know I would love to do that for my elderly mum through my own phone.
Perhaps NEHTA & DOHA are already thinking along these lines?

EA said...

The National Health Performance Authority released its' Strategic Plan the other day, and it's is up for public comment.
On of the first jobs for the NHPA, perhaps, is to guide selection of private hospital beds that may be contracted to the public system to ease the back-log. To do that, they'll need pretty good data to make comparisons that will stand up in court.
Patricia Faulkner is Chair of NHPA. She boasts "Ms Faulkner has held prominent health and social policy roles through her career including time as secretary for the Department of Human Services, Victoria where she was instrumental in establishing the National e-Health Transition Authority."

Anonymous said...

"Perhaps a good way to get the ball rolling with the PCEHR is to start with putting hospital discharge summaries into it. "

Good idea - and that, as well as much other 'low hanging fruit' was the in the business case approved by COAG for national information exchange - and then side-stepped, ignored, forgotten by the PCEHR team.

We HAVE a reasonable national plan, signed off by all the states at COAG - and it was ignored in a confusion of marketing spin generated by certain consulting houses in cahoots with NEHTA and DOHA leadership.

My recollection is that the sets of individuals involved in the COAG plan and the PCEHR plan were largely independent.

So I guess the just knew better than the folks that created the COAG plan. Clever them.

Anonymous said...

We HAVE a reasonable national plan, signed off by all the states at COAG - and it was ignored in a confusion of marketing spin generated by certain consulting houses in cahoots with NEHTA and DOHA leadership.

And nothing will change for that is the way the big consulting firms and large vendors work together and they share share the loot once mined. The Minister is beholden to her Department - the bureuacrtas lead her to the consultants and vendors of their choosing.

It would be a rare thing for a Health Minister to kick back and take control of the agenda. Defense Minister Smith had the courage and strength of his convictions to do so on a point of principle. Health Minister Plibersek may just be biding her time. We have to hope so.

Anonymous said...

On messaging systems we read .... NEHTA wants to replace these working methods (HealthLink, Pro Medicus, Medical-Objects and Argus Health Systems) with its own messaging system.

On interoperability we read .... commercial firms have made enormous strides in e-prescribing, and two script exchange hubs are operating. Efforts to achieve interoperability would quickly pay dividends in real-time patient medication information.

It seems as though NEHTA’s unspoken mission is to put roadblocks in the way of these and other private sector initiatives while it attempts to coral other software vendors into developing separate Application Program Interfaces into its PCEHR system. This might make a lot of sense to NEHTA but not to anyone else. In other words, instead of working with the private sector it is working against it.

Not unexpectedly the first sign of the private sector kicking back is the recent announcement that the messaging vendor systems have agreed to collaborate with each other to protect their turf – and so they should. Perhaps the messaging vendors could convince the two script exchanges to do the same.

Andrew McIntyre said...

If I really thought NEHTA were capable of providing good reliable messaging and would maintain it I would just use it and do fun stuff with it. What annoys me is that they keep saying they want to replace messaging vendors when its quite clear they have no idea whats involved in supporting clinical messaging and even SMD is backward focused with store and forward messaging as its focus.

Its a bit of a joke that they want to replace messaging vendors given their current ability to deliver the goods. They would not last a week in the marketplace. Please stop talking about it and just do it, or stop suggesting to our customers that we are about to be replaced as you have no idea how far from doing that you really are!

Cris Kerr said...

Dear EA of 6.40pm at

I opened and scanned the NHPA Strategic Plan page and this is what I saw... Our Key Deliverable - The Authority will prepare quarterly reports on matters relating to the performance of local hospital networks, public and private hospitals, primary health care organisations and other bodies that provide health care services.

It seems the 'performance authority's' role is to collect and publish submitted data and related statistical measures, with an option to publish an analysis on data collected.

The authority does not appear to be responsible for meaningful purpose/use of any data collected, eg; no charter to improve the long-term health outcomes of all Australians.

It was only a quick look but there were no high level strategic objectives or associated measurable targets. Instead there was a list of day-to-day operational activities presented as objectives.