Sunday, August 12, 2012

The NEHRS Seems To Have Made It To The Sunday Press. Not A Good Sign For The Future.

The following appeared earlier today. Indeed on Page 3 to maximise exposure.

Patients reject eHealth

Date August 12, 2012

Tim Barlass

Only 5029 people have joined the federal government's controversial $466 million eHealth system since it was launched on July 1.
Figures obtained from the Department of Health and Ageing show that each individual to take up the personally controlled electronic health record system has so far cost the government $92,662.
Patients can volunteer to join the system, which stores all their health information, including test results and prescriptions, in a national database. It is the first time patients will be able to access their medical details.
The Coalition's eHealth spokesman, Andrew Southcott, compared the slow adoption to the government's problems with the Building the Education Revolution program and pink batts installation.
''The government's own target and benchmark was 500,000 sign-ups in the first year,'' he said.
''At the current rate, if they maintain this pace they will get approximately 60,000 so well short of the 500,000 and they are anticipating 6.8 million within four years.
''The low take-up shows that doctors and patients don't see it as being of much value at this point in time. This is the government that brought us school halls [BER refurbishment] and pink batts and lost control of our borders.''
Dr Southcott said the Health Minister, Tanya Plibersek, was avoiding talking about the scheme.
''The government doesn't want to be associated with another disaster,'' he said. ''They championed it before the last election but they don't really seem to have a lot of enthusiasm for it now.''
More here with reactions from the Health Minister, DoHA, the AMA.
It seems to me that what we are seeing here is a very deliberate strategy from DoHA to keep the population unaware of the existence of the NEHRS since it simply is not ready yet.
Surely if there was something that was real, useful and working actually in existence the Government would be keen to let us all know with an advertising campaign and all the bells and whistles that go with that?
Additionally it seems to be a ‘State Secret’ as to when we will actually see something potentially useful emerge from out of the fog.  With the need to sort out NASH, GP and Hospital Software as well as the necessary links, Patient and Provider Education, Patient Safety and Compliance Issues and the Health Identifier Service (at the very least) there is a fair  bit to be done.
It also seems to me that now it is clear the Program has not met its initial public objectives this is the time for a NEHRS Program reset and review followed by publication of a realistic Program Plan that actually has some prospect of delivery. Of course this review should also include options of a fundamental change in approach and direction. To just commit to ‘pressing on’ with no serious option analysis would be pretty sad.
Anyway, an open and frank review of what is being done is really needed. It would be a pity if more good money is thrown after bad with the lack a full review. An unconsidered and blinkered consideration of what has happened so far will help no one. We need to be aware not making a sensible set of mid-course corrections (and having the whole thing fall over)  may lead to damage to e-Health as an idea that could take a decade to repair. That would be the worst of all possible outcomes.
David.

14 comments:

Anonymous said...

I have just viewed my eHealth record. When I select Medicare Services, my eHealth record says (for organ donor status):
"Australian Organ Donor Register - AODR
No organ donations registered."
Yet, if I log in to Medicare, it tells me I have registered as an organ donor.
Which system is correct?
Or why doesn't my eHealth record say "organ donation data is not available at this time".

B said...

Anonymous said...

Which system is correct?
Or why doesn't my eHealth record say "organ donation data is not available at this time".


Who is responsible for sorting out such data discrepancies?

Who do you alert when you find data problems?

Who fixes them?

As this is a personally controlled health record, maybe it is the patient?

Suppose the patient is incapacitated? After all, the time at which the health record is likely to be most useful is when the patient is least capable of taking such responsibility.

IMHO, these are just some of the information related issues that have not even been identified, let alone addressed in the whole eHealth strategy.

Pat D said...

Unintended consequences abound in even the best run projects; my bet is on the PCEHR being a star performer in this regard. The 'P' factor is a fatal flaw and the consequences of human error will keep on giving grief until the adults in Canberra see the light.

Anonymous said...

If all the registered organ donors suddenly become not-donors because of the NEHRS, then this is not a beneficial system.
If you are not meant to look here to see if a patient is an organ donor, then why have the information here at all.
And if it is only meant for consumers to check their own status, then you just simply have to get it right.
People (doctors and consumers) will lose trust in the system and will not use it.

Anonymous said...

David, you said "It seems to me that what we are seeing here is a very deliberate strategy from DoHA to keep the population unaware of the existence of the NEHRS since it simply is not ready yet."

Yes, the NEHRS is not ready yet. This is demonstrated by the soft launch and lack of content. The next release of the software (due sometime real soon now) should see some of this addressed. But the vendors are just starting to get the needed certification. Then the GPs and hospitals will need to upgrade their systems. This will start happening soonish, at least at some sites. The NEHRS may start being useful by the end of the year. Expecting anything else is premature.

The commonwealth is able to claim that they delivered what was promised. It is just that it is not useful yet. DoHA and the Minister are correct to keep it low key until it is useful.

Dr David More MB PhD FACHI said...

No. They did not deliver what was promised. All they did was give a pathetic log on to a useless system.

See here to see what was promised:

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

David.

Anonymous said...

David, in that press release there was no mention of having everything delivered by July 1st, it was talking about funding over two years for the project.
They seem to have promised a fully functioning system but didn't give a timeframe - probably deliberately.
I could be reading that wrong though...

Dr David More MB PhD FACHI said...

I read it to say that the 2 years funding announced will deliver what is described - which clearly did not happen.

Remember this was all meant to be evaluated for clinical outcomes - having been delivered - before there was to be any more funding. That is also still not done.

The bottom line is that they had absurd ambitions and expectations which they did not meet - as I warned from the get-go!

David.

B said...

The September 2011 ConOp says:

The Government has invested $467 million in the first release of the PCEHR System. The first release delivers the core functionality required to establish a PCEHR System that can grow over time. The first release will ensure that all individuals seeking care in the Australian healthcare system have the option
to register for a PCEHR from July 2012.


They have delivered a system that allows individuals to register for a PCEHR. It has faults and issues but they have delivered what they said they would deliver.

However, I have three issues.

1. The way they have delivered the system does not build trust - it seems to destroy it.

2. They have not made public a plan that shows how the system is supposed to "grow over time"

3. I don't think the system they have described will do what they want it to do.

Dr David More MB PhD FACHI said...

May 2010 Press Release - They said:
Personally Controlled Electronic Health Records for All Australians
Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.
11 May 2010
Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.
The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia.
The national e-Health records system will be a key building block of the National Health and Hospitals Network.
This funding will establish a secure system of personally controlled electronic health records that will provide:

Summaries of patients’ health information – including medications and immunisations and medical test results;
Secure access for patients and health care providers to their e-Health records via the internet regardless of their physical location;
Rigorous governance and oversight to maintain privacy; and
Health care providers with the national standards, planning and core national infrastructure required to use the national e-Health records system.


I do not see that as having been delivered.

David.

NK said...

These things are still being worked on. Did they give specific dates for these? (Heaven help us if they did)

My worry is that, having shoved an ill-prepared system over the line in order to meet the political imperative driven dates, they will not be able to repair the damage because "the system is already live and can't be changed"

Dr David More MB PhD FACHI said...

Yes:

"The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia."

They said it would take a little over 2 years.

David.

B said...

David,

There are many quotes that we can point to that are casual with the truth. Most use the word "will" but do not include "when".

As we have said before, this system is driven by politics. However, reality has a habit of catching up with those who think that politics is the only game.

Anonymous said...

You would have to wonder if NEHTA retains the level of expertise to deliver. I wonder that with the current skill set they would win an ICT contract of any significance.
I would be interested in the level of subject matter experts in place to support SMD, NASH, HI, PCEHR etc, does anyone now the current state of play in there?
If they are after adoption of their solutions, they had better be able to provide a lot of support. If they are unable to support the products then should NEHTA be, ear marked as a high risk or clinically unsafe??