Sunday, August 12, 2012

It Is Going From Bad To Worse - Now The NEHRS / PCEHR Is Broken Totally.

I tried to log in to my record a few minutes ago. Here is what happened. Tried 3 times and just no go!
Just to be clear - this all happened after I had been passed from www.australia.gov.au to the front screen of the NEHRS - which you click on to access your record. What you see here is what I saw after I asked to access my record.
This is really pretty sad!
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500: ??title.unexpectedError??

??message.ifProblemsContinueContactSupportWithReference??
A3RR-CPO
2:50 PM Sunday 12-Aug-2012
Version: 7.2.3-27387
-----

500: ??title.unexpectedError??

??message.ifProblemsContinueContactSupportWithReference??
8WQX-CPO
2:51 PM Sunday 12-Aug-2012
Version: 7.2.3-27387
-----

500: ??title.unexpectedError??

??message.ifProblemsContinueContactSupportWithReference??
WGYV-CPO
2:52 PM Sunday 12-Aug-2012
Version: 7.2.3-27387
-----
End extracts.
Clearly these are messages a user is not meant to see. A phone number or e-mail address in the error message might have helped!
I leave it to readers to comment on this sort of nonsense.
Note first comment - worth having in blog - and thanks to commenter:
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Pre-empting any ‘ This was a planned maintenance window’

http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/content/availability

Service availability
HomeService availability
This page identifies scheduled outages to the eHealth record system.


Notification of planned outage
There are no service outages scheduled at this time
---- End Comment
And no one is even monitoring the system (or this blog!)
-----
Later we get:

500: ??title.unexpectedError??

??message.ifProblemsContinueContactSupportWithReference??
C7JC-CPO
David.

40 comments:

Anonymous said...

Pre-empting any ‘ This was a planned maintenance window’

http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/content/availability

Service availability
HomeService availabilityThis page identifies scheduled outages to the eHealth record system.


Notification of planned outage
There are no service outages scheduled at this time

Dr David More MB PhD FACHI said...

Not self healing either it would seem!

500: ??title.unexpectedError??

??message.ifProblemsContinueContactSupportWithReference??

XJ2A-CPO

3:42 PM Sunday 12-Aug-2012

David

Version: 7.2.3-27387

Anonymous said...

Dear DOHA - there is a difference between a staged and slow rollout and a botched rollout. This is a botched rollout. In no other industry would this level of service provision be acceptable.

Have we paid for this yet? I would want my money back if I had. At least the NHS had payment on delivery, and that saved them from a catastrophic national scandal - it was only a big scandal.

It has been clear that DOHA has ignored pretty much every other lesson from the NHS, but I just hope they heeded this one about contracts, and that there is no payment made for this .... well I am searching for an adjective and noun but if I printed it here someone would pipe in and accuse me of negativity!.

Anonymous said...

Spare a thought for Peter Fleming, rumour has it that most of the executives (and key staff), have left or are currently exiting.
Peter I am told, is left with the manager of the architects – apparently an excitable new kid on the block, so should be some interesting errors of judgement and poor discipline coming and the manager of PCEHR, who has proven to be little more than a travelling salesman, not a good executive toolkit by any measure, neither one made a remarkable contribution to the PCEHR. But then perhaps he needs a man with a screwdriver to backup the mouth.
I do hope they can turn things around in the PCEHR and still progress eHealth, however it is not a good start. I wonder if they will use the restructuring approach to cover-up known delays to other eHealth initiatives.
The difference in the NHS and DOHA is the NHS falls under a bureaucracy that knows how to govern.

B said...

Is trust in the system increasing or decreasing?

Are the negative reports in the mainstream media likely to engender trust and confidence in the system by the general population?

Is it important that people trust this system?

Please write a balanced answer and send it to the board of NEHTA.

This is them:
http://www.nehta.gov.au/about-us/nehta-board

They must be so proud of what they have achieved.

B said...

Anonymous said...
Spare a thought for Peter Fleming ....

I'm afraid its a bit late for turning things round. It's like building a house in the wrong place. It doesn't matter what you do to the house it will always be in the wrong place.

In the case of the PCEHR, the whole things has been flawed from the start.

The Deloitte National eHealth strategy was all motherhood and vision. Quote "The first step in defining the E-Health Architecture is to consider the ways in which each of the key stakeholder groups may utilise electronic health information and E-Health
capabilities."

Did they define what is meant by eHealth information. No. They just described how it will be used, not what it is.

The ConOp was all about process, behaviour and technology.

What has been missing is an analysis of eHealth from an information perspective. As soon as you start to centralise and automate information, everything changes. Have these changes been identified? Have they been analysed? No.

Sorry, I'm being negative here. I'll try and be positive.

I'll try again. I'm positive they have stuffed this up right royally.

IMH and positive Opinion, the PCEHR has been built in the wrong place. It has been built in the domain of IT, not health information.

And what is worse, is that it hasn't been built very well either.

Very sad.

Anonymous said...

"Have we paid for this yet? I would want my money back if I had. "

Money back??? Apparently we have just spent another $47m on a two year maintenance contract.

Who pays maintenance on something with this level of basic errors and bad user interface? Payment on delivery is looking really good! We need to take a leaf out of the NHS's book and only accept working systems!

Was there a signed off Acceptance Test? I recall some press release about it being a working system in Singapore? What has gone wrong? It will be interesting to see what an audit shows up here.

The real fear here is that if this system has been "Accepted" then we will see "contract change management 201" at play with good money then being gouged after bad!

The evidence is not looking good and the experience is less than ordinary!

Come on NEHTA and DOHA, get onto this and get it sorted! PLEASE!

Anonymous said...

"Spare a thought for Peter Fleming, rumour has it that most of the executives (and key staff), have left or are currently exiting."

This whole thing needs to be put on the back burner and a new approach looked at that includes all stakeholders. We have a wealth of experience in this country and we need to find a way to use it.

I know I may get flamed for saying this but Peter Fleming is a much wiser man today than he was a year ago, and NEHTA have good staff who want to make a difference. We want to make sure we don't throw the baby out with the bath water.

The real culprit here is the quality and functionality of the system delivered, think about it. If we hadn't paid a load of money for something that obviously has little use or friendliness would we be having this conversation?

Dr David More MB PhD FACHI said...

Peter Fleming joined NEHTA as CEO 23 October, 2008. That is now almost 4 years ago.

Surely enough time for a CEO to sort things out!

David.

Anonymous said...

Jane Halton and her Department are accountable. Minister Plibersek has the authority to do something about this mess. I am sure she has had many knowledgeable people writing to her with plenty of sound advice - hopefully she is talking with some of them and not just asking her Department what she should do.

B said...

Anonymous said...

The real culprit here is the quality and functionality of the system delivered,

No it's not. The system that has been delivered is a solution to a problem that hasn't yet been defined, never mind solved.

Dr David More MB PhD FACHI said...

Time for heads to roll?

David

Anonymous said...

know I may get flamed for saying this but Peter Fleming is a much wiser man today than he was a year ago?

correct me if I am wrong but CEO's are expected to get results, that is why they are paid a nice little sum of money. It would appear that fleming and his little band of merry men have failed to deliver and as such the rules of the game are - Taxi, next please.

And replace all the executives, they all had a hand it in this

Dr David More MB PhD FACHI said...

I am told Mr Fleming is on about $350,000 p.a. Not huge but not trivial!

Surely he can now consider just how well his tenure has worked out after almost 4 years!

David.

Anonymous said...

IMHO
Time for heads to roll? .. Well it won't be those responsible will it?

The wrong problem definition? Probably

Anonymous said...

Does anyone know the headcount in DOHA devoted to ehealth/PCEHR?

Anonymous said...

Anonymous said "Does anyone know the headcount in DOHA devoted to ehealth/PCEHR?"
Before or after 1st July?

Anonymous said...

What was the pre July 2012 headcount at DOHA focussed on e-health and PCEHR? POst July figures also of interest.

Anonymous said...

System looks up at ehealth.gov.au. Resolved presumably. Medicare view seems to be working too.

pilot said...

They should use the mymedicalrecord.com platform. It works is private for me and my family.(not on a government database) My doctor send a fax to my account with my records., I file it. end of story.

Terry Hannan said...

From some of these comments on registering for the PCEHR I am pleased I am not the only "illiterate/incompetent" person trying to get on to this site!

Anonymous said...

Goodness ....My doctor send a fax to my account with my records ..... haven't Fax's almost disappeared?

Keith said...

Seems like a good time to sum up the few known facts and speculate on what COULD be done in ehealth from here.

1. Australians could (more or less) register for a PCEHR from 1 July, but that's pretty much all they could do. I suppose to a politician that's a promise delivered; to anyone else it's another case of weasel words. So far about 5000 people have taken up the offer, and that figure will probably continue to grow at about 1000 per week.

2. The 1 July start was hopelessly unrealistic with the result that what is there is extremely limited, the interface is fairly crude and the system buggy. That's probably OK because there is now the possibility of improving system functioning and reliability before it is expanded significantly.

3. There is talk about the release of provider software later in August, but I believe it will be many months before most GPs are ready to participate. There are many hurdles - HPI-I's and HPI-O's to set up, participation agreements to sign, NASH certificates, software upgrades etc. As far as I can tell, outside the wave sites there has been no effort to engage with the profession or assist in these areas. (The bodies that might have been useful in this - the GP Divisions - have of course been torn down and replaced with Medicare Locals. Some of the GPs that I know have said "Enough!" and refuse to have anything to do with their Medicare Locals.)

Keith said...

(cont) Meanwhile there are several ehealth services which could be introduced and which would actually make a difference:

1. Healthcare Identifiers. The HI service has been in place for more than two years - two largely wasted years. As far as I can tell adoption by medical practices has been minimal because the process is so complex that few have bothered. If applying for an HPI-O and HPI-I was streamlined, and there was some incentive for getting involved more practices would be participating, and they would start downloading IHIs and incorporating them in patient records, pathology requests, prescriptions etc. That would actually be a useful thing and it could have been happening for the last two years. Missed opportunity!

2. Electronic Discharge Summaries. These have received some air-time recently in connection with the PCEHR. Let's be clear - a Discharge Summary is a communication between a hospital (usually) and the providers responsible for the ongoing care of the patient (commonly the GP and possibly a nursing home etc). To make it happen requires not just a standard for eDischarge Summaries, but working SMD, NASH and ELS. Whether a copy goes also to the PCEHR is immaterial, but does no harm. The worst outcome, and possibly the most likely, is that discharge summaries will be sent electronically to the PCEHR and by hard copy to the people who matter.

3. Electronic Referrals/Specialist Reports. These are communications (both ways) between GP and specialist). There would be great value in having these communications take place electronically but it requires document standards, and working SMD, NASH and ELS services. There is some value in a second copy of these going to a PCEHR, but that should not be the primary goal.

4. Electronic transfer of prescriptions/dispense records and medications management in general. These are communications between the precriber and the dispenser (via an exchange). There is huge scope to reduce waste, improve the tracking of drugs dispensed etc. It requires standards including a single exchange standard, a medications repository, CMD, NASH, ELS. As far as I know we still have two incompatible script exchanges and an ETP standard awaiting revision. A report on potential savings identified better medications management as overwhelmingly the largest source of savings, but there seems to be no urgency about implementing anything anytime soon. Again a copy could go to the PCEHR but that is a secondary function and is almost immaterial to the value of the project.

There are others, but that is enough for now. These are all projects/services which have been on NEHTA's books for years and they are all worthwhile with or without a PCEHR.

NK said...

"The HI service has been in place for more than two years - two largely wasted years"

As long as the HI Service is limited by law, it's of no use to anyone. Some extra services are needed to make it work for actual usage.

Note that the pcEHR needed to use it, so acquired special law to get these extra services.

Until these extra services are made available for other uses, the IHI should be understood as "the PCEHR identifier" and that's all it is.

Anonymous said...

"Until these extra services are made available for other uses, the IHI should be understood as "the PCEHR identifier" and that's all it is."

And there in lies a problem for the PCEHR. It i because the IHI is the PCEHR identifier that it is vitally important that the systems supplying clinical information to be stored/indexed by the PCEHR are sure that they have the correct IHI, and to do this they need to be actively using the IHI service in the right way. Someone needs to map out all of the flows and scenarios to make sure that it works from clinical systems to PCEHR. The PCEHR is the first real use of the IHIs, and an important one because the IHI is the primary record identifier.

Dr David More MB PhD FACHI said...

Mr Fleming's remuneration might be a bit more that the $350,000. A number of correspondents have suggested a figure closer to $1.0m.

David.

Anonymous said...

$1.0M in salary? If there's any truth to this, not too sure how Peter Fleming sleeps at night robbing tax payers of this extortionate amount of money while delivering nothing of any substantial value in return.

Then again, if Mr Fleming has no conscience to speak of, then at $1M a year in salary coerced and thieved from Tax Payers, then he probably sleeps very, very comfortably indeed.

NK said...

"Someone needs to map out all of the flows and scenarios to make sure that it works from clinical systems to PCEHR"

This has been done pretty thoroughly through the CCARG etc. For this, the IHI should work safely. The match rates are low because safety is favoured over utility. But if you have a pcEHR, then the match rate is much higher.

But other systems can't use the IHI as their own identifier - like Dr Haikerwal wants - until they get the same access to the IHI as the PCEHR.

Interestingly, the PCEHR will leak IHI information through it's interface - you need enouch information about the person to get their IHI, but given that, the pcEHR leaks one or additional fields that you didn't need to have to match the person (but not enough to be useful to match)

Anonymous said...

Oops. Someone forgot some localisations.

Keith said...

NK said "But other systems can't use the IHI as their own identifier - like Dr Haikerwal wants - until they get the same access to the IHI as the PCEHR."

If this is true Australians have been dudded by their own government (wouldn't be the first time!). Each time a clinical document (referral/report, discharge summary, prescription etc) is sent from one party to another there is the possibility that it will be matched to the wrong patient. An identifier like the IHI has the potential to reduce such matching errors. The PCEHR is a set of repositories, it is NOT A COMMUNICATIONS SYSTEM, and will never replace the communications between health providers. If the use of IHIs is restricted to the PCEHR we are being denied a huge opportunity for improved confidence and accuracy in matching.

Anonymous said...

I was shocked to learn that NEHTA is so corrupt. For an organisation that holds a great division I was very disappointed. Even their Human Resources division - they pay large $$ to recruitment agencies rather than looking at cost reduction strategies for staff recruitment. One would imagine that the millioins of dollars they spend in this area would be better spent on acutal project delivery. I can tell you the relationships are corrupt

NK said...

Keith, the existing matching strategies that are used now will still work. The IHI did have the potential to improve matters a little, but as restricted by legislation, it does not have the services that would deliver that outcome.

Personally I expect that these restrictions will be undone eventually

Anonymous said...

NK,

"but as restricted by legislation, it does not have the services that would deliver that outcome"

what changes do you believe need to occur to improve outcomes? What can't you do as it stands today?

thanks

Keith said...

NK said...

Keith, the existing matching strategies that are used now will still work.

Yes, I guess so, but the present strategies are far from bulletproof. I've seen cases of path reports being returned to the wrong doctor and similar errors which you'd hope wouldn't happen with stronger matching strategies.

NK, thank you for your insightful comments!

NK said...

"the present strategies are far from bulletproof"

true. (though you speak about HPI-I more than IHI, and HPI-I/O is a different kettle of fish I am not addressing)

"what changes do you believe need to occur to improve outcomes?"

Well, if I'm going to use the IHI for matching for my own purposes (not for submitting to the PCEHR, but for sending to a different trading partner), then how does it help me? Given a set of (very) correct demographic details, I can get an IHI. Now what? Can I index safely on the IHI? What if an IHI error is corrected on the master database? Do I have to requery every IHI? Alternatively, can I use the IHI to update my demographics so that I have the most recent information to match on?

No.
- I can't query for demographics
- I can't get a feed of what IHI's have changed
- I can consider the IHI in addition to other matching things such as name, but how do I weight it? How does it help me? You need a perfect match to get an IHI, and if I have a perfect match, I have a perfect match.

No, as currently restricted by law, the IHI doesn't help me match my patients with other systems. Oh
It helps the pcEHR (which gets a feed).

The IHI does have one use - if I have the patient in front of me, and I don't get an IHI, then I can double check their details.
It's not an accident that the existing use exchanges aren't migrating to use the IHI for their own exchanges. It's a bolt on for the pcEHR.

Give us a query, or give us a feed of changes (it only needs to be a list of numbers alone). Then it becomes useful

(btw in the Senate enquiry, DOHA asserted that the HI Service would work, "because the problems of patient matching have long been solved in hospitals" (or something like tha) - but if you don't solve if they way they solve it (feeds, queries, and probabilistic matching) then you can't claim that this is relevant to your solution.

Anonymous said...

David

I hope your sources about Fleming's salary are wrong, because for a government QANGO that level of renumeration is scandalous, setting aside any judgement about the individual concerned.

In the public sector I can only think of university vice-chancellors receiving something close to that, and they run organisations with annual turnovers over a $ billion, some with tens of thousands of employees, and a hugely complex service delivery model. NEHTA aint that level of complexity, scale or import. NEHAT also has nothing like the level of accountability - where performance drives future funding. Its just a standards organisation recently co-opted into project management. $350k makes sense, $1 million is front page of the telegraph.

Dr David More MB PhD FACHI said...

3 Sources have suggested a similar figure.

Last year $2.7M + was paid to the top 13 execs. Up to you to guess who was paid what. All I can suggest is that $350,000 looks a bit low on that basis.

One wonders just why 13 rather than the sum of the top 5 as is usually done. Hiding something?

David.

Anonymous said...

Dear NK
I don't know where you work, but hope that someone is listening - and that they are making the required changes to the HI Service. Otherwise, there will be two white elephant systems - the HI Service and the PCEHR.

NK said...

"hope that someone is listening" - not yet, the noise is not loud enough to make for a change to the law, which is what is required.

And since that part of the PCEHR seems to working reasonably well, the prospects of the HI Service limitations being addressed seem to have receded for now.