Monday, July 16, 2012

The PCEHR Is Still Not Fixed!

Logged on at 6:15pm Monday July 16.

Still get this while wanting to see Medicare Services Overview.


Error Details

An error has occurred processing your request.


Hardly what is expected of a 1/2 billion dollar National E-Health System.

What a farce! It just was not ready.


Update 10:30pm 17/07/2012

Guess what? Still not fixed!



Anonymous said...

I'm not sure I follow. A large government program. Huge amounts of money. And it's not ready on time.

Just what were you expecting?

Dr David More MB PhD FACHI said...

Better than this?


Anonymous said...

Give me a hundred million and I could have had this built on time on budget ages ago - and I believe anyone with a business head on their shoulders could have done it! This is a farce, and will rival Pink Batts and School Halls for incompetence. The concept is great, but government cannot deliver these types of programmes!

Anonymous said...

Interesting how easy it all is... if you don't understand the problems. What the commenters on this blog appear not to grasp is that this is not primarily a technology problem. It's a social project, a social problem. Any bunch of morons could go and built a half-decent health records server - oh wait, they did - but all that was built came very much second to the social challenges, and these have not even begun to be solved.

All these contributers who think it's easy: what would you have done about that?

Anonymous said...

David, your robot-check it getting ever harder to pass. I fear I will have to depend on software to pass it soon.

Anonymous said...

...well, the PCEHR may have been designed by NEHTA but the software has actually been built by private sector vendors and will be fed from Clinical Documents produced by commercial Practice Management Systems.

Whether any of these systems are capable of generating atomised, coded, clinical data that will facilitate any kind of interoperability remains to be seen. Many vendors may just continue to cite the lack of a business model for doing this and the PCEHR will just be a vast repository of un-structured data.

Cris Kerr said...

Dear Anon 7/16/2012 08:22:00 PM

I believe govt can deliver this type of programme... if they pause now to develop an honourable overarching long-term mission and meaningful purpose, succinctly detailed primary and secondary objectives (where all objectives are in the best long-term public health interests of all Australians), and guidelines that are adequate to guide governance within those parameters for all prioritized projects and activities.

After that, they could then comprehensively scope all work completed to date to see if it is 'fit-for-purpose', and can either tick off and continue, or review and correct... or discard.

Having said that... noting what has been announced and has occurred to-date, I don't hold any hope that any of that will happen.

To say that govt can't do this is not correct.

The problem begins with a 'vision' in the absence of an honourable, succinct overarching 'mission'. That's followed by a strategic plan that is not comprehensive, is vague or non-transparent and omits meaningful, measurable targets and outcomes associated with the mission, etc, etc.

Everything that comes after that follows the same course and so is pretty much doomed from the word 'go' to falter.

If the strategic plan has quality, all work after that will be clearly directed and all activity will be pro-active.

If it is not, all work after that will eventually succumb to a highly reactive environment where the goal posts keep changing and everyone runs frantically playing catch-up with unproductive or work-around activities.

The only difference between govt and business capacity to deliver is... that business must be succinct and specific about what it wants to achieve and why and how it's going to do it.

Effective planning empowers every person to work pro-actively and productively toward the same goals within the same guidelines and parameters, in the knowledge their outcomes will be routinely monitored and measured against known goal posts (not a big deal - no surprises - everything you needed to do was known and detailed before you started).

Anonymous said...

I totally concur with annon7/16/2012 10:51:00 PM. Those that comment purely as those ehealth is a technology issue lessens the value of their opinion. It also degrades the value of this blog/ website and its readership as being a powerful critique of the state of affairs of ehealth in this country. Technology is important and addressing the technology issues are important but please don’t default the commentary to it being the only thing. This along with shrill negativism lessens the value of this blog and all of us.

Dr David More MB PhD FACHI said...

I agree to an extent but not totally. Cris has the right idea where the necessary processes are cited.

My view is that you need to get the clinical and other outcome objectives sorted and then work down from there to design appropriate technology to deliver - taking into account all the socio-technical barriers that are in the way.

However, at the end of the day the technology needs to be 'fit for purpose'. The evidence that the NEHRS is, is not in yet by a long stretch.


Anonymous said...

@Cris - if your thoughts were followed, I agree entirely that Government would be able to deliver a major project. It is just that we continually fail to see them follow your sage advise, and then we end up with this debacle and a huge waste of money - again. I agree that it is not just about the technology - there is much else involved, but as David notes, the technology must work in the first place - and again, we see little evidence of this being the case - and again at a huge cost - just where has all this money gone? (that is rhetorical!)

Anonymous said... screen, you know that the data isn't available, and you're getting a timeout. That's the only complaint you have about the system?

Dr David More MB PhD FACHI said...

Hardly..if you want to know what else is wrong besides being ill-conceived, clinically useless (for the foreseeable future), user hostile, not what was promised 2 years ago and vastly too expensive for what it is read more of the blog!


Anonymous said...

ANNON 7/17/2012 10:50:00 AM while we are largely talking about nuances in our respective arguments – you have also largely illustrated part of the point in my earlier post of 10:06. The cause of this “debacle and huge waste of money” is largely due to the social or people stuff playing out (power, money, and vested interest/ lack of leadership and sense of service or working towards a common good).
Yes the technology must work. But largely technology has come along in leaps and bounds and is no longer the barrier to undertaking such initiatives that it once was. I think that when one says that the technology doesn’t work (in this instance), one is actually referring to the implementation of technology within this problem space – hence what we have ended up with is the artefact of the social/people stuff playing out.
I think what disappoints many is that you have had some very smart people (in NEHTA) working on the technology /architecting their way to the solution – they themselves have suffered the hubris of thinking believing this was /is sufficient – and we are yet to see any humility/honesty from anyone who has taken the money or lead this gravy train. I am not holding my breath for that – as it would require some personal honesty that by definition is beyond those who have taken everyone else for a ride.

Pat D said...

Anon's last post is to be supported. PCEHR is all about delivering the interoperability of content from (different) systems. This is not a technology problem - it is a PEOPLE problem. Health participants are very chauvanistic about "their" data. This is unique to the health sector and long since eliminated in all the other sectors that are so far ahead in industry wide use of ICT, and hence, data interoperability

B said...

Anonymous said...

"Interesting how easy it all is... if you don't understand the problems. What the commenters on this blog appear not to grasp is that this is not primarily a technology problem. It's a social project, a social problem.

I suggest you haven't been reading this blog very carefully.

NEHTA and others not understanding the problem is exactly what most commenters have been saying.

That said, I totally agree with you.

Anonymous said...

"This is unique to the health sector and long since eliminated in all the other sectors that are so far ahead in industry wide use of ICT, and hence, data interoperability"

So, is there a single portal where I can see all my banking details? Yeah right. Where's anything else that works like a collated eHealth records system?

"NEHTA and others not understanding the problem is exactly what most commenters have been saying" - oh yes, all along. And so they also propose a solution - just give the money to industry. We'll solve it. (Oh yes, we will too. If your goal is to waste money, we'll waste it ever so effectively for you)

Anonymous said...

It's more than a social problem. If we had a good technology solution then its a social problem. What we have is a people trying to solve it as a social problem without a technology solution that works and then you have a mess. We are in a mess because the underlying technology solution needed time to mature, but its been "solved" as a social problem when the technology won't work no matter how many minsterials are issued!

Anonymous said...

Anon 7/17/2012 02:42:00 PM not sure you got the point of the commentary above. The technology to solve these issues is largely available and there. That an individual solution IE the current PCEHR etc doesn’t work from a technology point of view is because of all the other things like people, politics, power etc have got in the way.

Cris Kerr said...

The problem is that the system was never designed to evolve into a system that collected quality data for meaningful purpose, i.e.; data that can be analysed to find the most effective and fastest path to improved health... to effect a continuous cycle of improvement in population health outcomes that not only results in measurable improvements in population health, but also improves the economic sustainability of our public health system.

This is very, very important, because public health economic projections are forcing govts to review how long they can continue to afford free and subsidized public health services.

The cheap, quick, and nasty path forward for govts is to devolve public health to private health in ever increasing chunks.

This is the easiest path for decision-makers because it devolves responsibility for everything that happens after that to others.

This has occurred elsewhere in the world with highly questionable consequences, such as people having to mortgage or sell their homes to pay for operations, whether the operation was successful or not.

It begins with govts tweaking policies and making minor changes, services and benefits being reduced, patients paying more and more for their care, and more use of private healthcare and private health insurance, and sometimes even systems that fail and have to be rescued by the private sector.

It's a gradual conditioning process that occurs over many years so that consumers don't notice until everything is turned over to the 'market'.

I'll bet no-one remembers how long ago the word 'public' was removed from the Dept of (public) Health and Aging.

Who was on the panel of the National Health and Hospital Reform Commission whose report was the basis for many of the changes we are seeing? When I saw the report and realised ehealth wasn't even mentioned I raised it. It was added as an addendum.

Who will be wanting to sell products to doctors or perhaps even marketing directly to consumers via the ehealth system and its plan to faciliate other 'portals' and 'applications'?

Austrailans need to open their eyes about what is happening, who is doing what and why... such as the Strategic Review of National Health and Medical Research currently underway where, until I raised it, no-one had even considered that a de-identified national ehealth database might be of value in assessing the actual health outcomes of patients and of great interest to researchers in their pursuit of improving health outcomes for all Australians.

This is the size of the risk we Australians are taking by not implementing effective reforms now, by not getting everyone to think about what we really want in our futures, by not implementing effective long-term plans that ensure we do things better and better as time progresses, in the nation's best interest and for all our health futures, and especially for our children's health futures.

Anonymous said...

Poor Mr Madden - someone has to stand up and start defending the indefensible. I guess he is earning the big bucks too! so has no sympathy from me.

Anonymous said...

The technical ability to do this is NOT worked out by any means and Nehta are the least likely people to get it right with a best guess "Tiger team" methodology of working out what to build and how to make it work. Its an open technical problem that is not solved. This is not the way to solve it and there is enormous pressure to "Just make it work" even thought many parts of it are just wrong and should be discarded. There are technical and social issues, and the social ones are insoluble until we have a good technical solution. In fact convincing people to support a fatally flawed technical solution will prevent good solutions, some of which are already known, from being supported when this falls in a heap.

Anonymous said...

If this is a social problem, and not a technology problem, then how come the governments measure of success is getting a piece of technology up and running by a particular date? To truly measure social success might involve listening to people and how they like the system that they have paid so much for.

Anonymous said...

Cris raises some interesting and very relevant points.

Basically, most western governments can no longer afford to provide public universal healthcare as we have known it.

This includes Australia.

There is a growing political agenda to devolve, hand over and subsequently abandon many aspects of the health care system to either – the free market or the individual health consumer (IE you are on your own buddy). Look at what is occurring in the UK re trusts.

One of the ways to see the emergence of the PCEHR is to see it as a tool within this context – then much of what does not make sense does.

Government can say it has done something while simultaneously cutting loose from its historic obligations – all the while using the language of the conservative right in terms of individual personal control and choice.

YES Folks that is what is happening!!!! Progressive abandonment of the provision of health services – you are on your own!

Amazing what a bottle of Scotch does – helps you make sense of it when otherwise you would go spare.

Dr David More MB PhD FACHI said...

Just tried again and still not fixed - same error message after 30 seconds or so. (11:15am Jul 18)

Also edited my allergies - with some difficulty. The screen is so spread out you really have to scroll all over the place to find edit and save buttons. Edit is at top and save right at bottom of screen. Doh!