Tuesday, September 11, 2012

So We Actually Now Have Some Clinician Authored Information In The NEHRS System. Is This Important or Meaningful And Why Does It Need Special Hardware?

Reports have emerged this week of some progress with the NEHRS.
First we have:

Brisbane GP first to use PCEHR system

7 September, 2012 Paul Smith
More than a billion dollars have been spent to allow Dr Suzanne Williams to press buttons on her keyboard and send a list of diagnoses and medications into the virtual ether.
Last Wednesday the Brisbane GP, became the first GP in the country to upload a clinical document onto the much-vaunted, much-criticised Personally Controlled E-Health Record (PCEHR) system.
It marks the system’s launch into real-world medicine at a time when GP software is being upgraded for doctors to generate the shared health summaries that will form the backbone of the billion-dollar reform.
Dr Williams, who works at the Inala Primary Care clinic in Brisbane, said: “I’m pleased to be part of the whole PCEHR. I suppose I’m less excited about uploading the first health summary than what is going to happen in the future when I’ve done the first 100, the first 200 records, and they are part of bigger system.”
She added: “It is the patients with chronic disease who are likely to gain most — those patients attending multiple doctors, multiple practices.
“I think doctors are going to see the value when they can access the results of tests done in the hospitals, when they can access the full results of investigations.
“It is going to reduce the number of duplicate tests, it’s going to improve care and save money. But it is going to take time to evolve.”
More here:
We also have a report here (among others)

Inala connects to cloud

Kiri Ten Dolle | 3rd September 2012 3:48 PM
AN INALA medical practice is the first in Australia to connect to the eHealth system where patients' records will be stored electronically in a secure online cloud.
Inala Primary Care, on Wirraway Pde, uploaded its first patient record last week marking the start of a major milestone for the nation's healthcare system.
General manager Tracy Johnson said the new online system would increase processing time and eliminate any confusion or doubling up which costs the health system time and money.
"We participated in some pilot work to help generate what the network should look like and trialled the system," Ms Johnson said.
"Majority of our patients have multiple diseases and that's why we were selected to take part.
More here:
You can read a detailed discussion of what has been done here:

Health Industry Exchange releases eHealth conformant GP software and completes the first connection to the national PCEHR System

On 29 August 2012, Dr Suzanne Williams from Inala Primary Care in Brisbane’s west became the first Doctor to upload a clinical document into the national PCEHR System.
Dr Williams used Health Industry Exchange’s Companion application and Best Practice software to create a Shared Health Summary and save it into the patient’s PCEHR record.
Health Industry Exchange CEO, Brett Silvester, demonstrated his confidence in the System by being the first patient in Australia to allow his doctor to share his health summary using the National eHealth Record System.
Mr Silvester was able to view his health summary loaded by the Doctor by logging on to the Consumer Portal.
Much more here:
Browsing around the site I found the following:

Creating, Viewing and Sharing Records

The HIE Companion App is a tool that enables the creation, viewing and sharing of patient’s health information in Shared Health Records.
 Using the HIE Companion App, clinicians can:
  • view a patient’s Shared Health Record during a consultation;
  • review recent patient summaries which may have been contributed by other clinicians;
  • manage the consultation as usual in their PMS; and
  • at the completion of the consultation, upload new or updated health information from the PMS to the patient’s Shared Health Record.
Secure Connectivity to Information Services
The HIE Companion Gateway is a hardware device that works with the HIE Companion App software to securely link GP Practice Management Software (PMS) to external information sources. This enables GPs to provide eHealth services to patients and take advantage of advanced eHealth repository and decision support services. The HIE Companion Gateway is a specialised practice eHealth gateway providing connectivity, information security, access to patient record stores, assembly of clinical data structures and access to national PCEHR services (Personally Controlled Electronic Health Record).  
The full page is here:
What this sounds like to me is a half-baked strung together kludge that is not what has been anticipated - namely seamless access to the NEHRS from the GP PMS. Just what is the hardware doing, how does it work and why is needed? I didn’t see any mention of special hardware from DoHA or NEHTA before this.
This whole project somehow just seems to keep wandering off into some unspecified swamp.
I was also amused to discover that the solution is being supported during thus:

Solution Support

HIE’s Support Team operates during normal business hours, supporting all HIE solutions and systems.
Clearly heavy use is not expected!
David.

20 comments:

Anonymous said...

There is something very smelly going on here - that is all I can say - although others may be able to further illuminate this HIE activity.

Anonymous said...

it's funny that the CIO of the HIE software is the first patient to have a shared health summary using his own software!
More live testing by a vendor! Nothing like real data for testing, and nothing like a bit of free advertising for your business.
Meanwhile, I note that there has been a recent change to the shared health summary conformance requirements for connecting systems. The notification said:
"Please be aware that an updated version of the Shared health Summary Conformance Profile has been released on the Software Developer Resource Centre https://vendors.nehta.gov.au. The amendment relates to additional conformance points to ensure shared health summaries are only uploaded by authorised healthcare providers to align with the PCEHR Act. Please refer to the change log at the back of the document for details of amendments between document versions." I hope that first upload of a health summary aligned with the Act.

Anonymous said...

I agree - all smacks of self promotion and spin to make everyone believe all in the world of NEHRS is rosy. One record uploaded? $500 - 700 Million spent? Hello????

Anonymous said...

NEHTA's "Black Box" finally sees the public light of day.

Courtesy of Health Industry Exchange (please see past and present management identities for the curious), surreptitiously supported by NEHTA with a healthy dose of misused and abused Tax Payers’ dollars, coming to fruition in Australia's very untransparently governed eHealth sector.

The Banana Republic is alive and well in Australia's ehealth sector.

A shame that those in the know fail to recognise what a shameful act and event this truly is for ehealth in this country.

A review of Australia’s ehealth investment by Transparency International would make for some very interesting reading for certain.

(http://www.transparency.org.au/)

Anonymous said...

This is possibly typical NEHTA/DOHA behaviour, pick a winner and give them special treatment and advantage with the idea of disposing of the evil existing players who have the gall to invest their own money in eHealth. The only thing is, DOHA and NEHTA are so far off in the weeds that they will need bucket loads of $$$ to revive this parrot and the economic reality train is fast approaching. Will they pull a rabbit out of the hat or be spattered by the train... I have money on the latter as they have entered a camel in the Melbourne cup and expect to win. Melbourne is not desert yet last time I checked.

Anonymous said...

Remember that scientist that swallowed the H. pylori bacteria himself, causing a peptic ulcer, and then treated it with antibiotics to prove his point? He was a hero! And so is the CEO of HIE - he has caught the fever, and now he has to save himself.

Anonymous said...

I find it amazing how people can contort themselves to make any good news into negative.

It's reasonably common in the sector for the first patient and clinician to be closely affiliated with the software vendor. That doesn't make it testing, it's just basic conservatism - why would you pick someone else to be first. With all the testing in the world there's still a chance of something going wrong.

On HIE, I'm not sure they have been advantaged. They have the same specs and are on the same panel as every other vendor. Sure, their business model is to be first to market because they operate as an add-on product - their market evaporates once the other vendors also offer integration. So they've pushed harder than others in the development process, and they're pretty nimble. But that's not the same thing as being advantaged.

The summary of this story is that the first clinical documents have been loaded, which is a milestone along the journey of the PCEHR. That's good news for anyone involved in eHealth, it doesn't need to be turned into a negative story.

Anonymous said...

Anonymous 9/12/2012 12:11:00 PM said

Surely you really cannot be serious?

Please publish where "Health Industry Exchange" has received its funding from! Let’s see the Balance Sheet and Income Statement of HIE, including the source of funding, and we’ll soon see how legitimate and advantaged they are in comparison with the ehealth sector at large.

You will see that they have been most Advantaged as they are parasitically operating and existing on Tax Payers money, not their own nor investors funds put at risk in expectation of a positive return.

To spin this outright "corruption" as a positive for Australia's ehealth is a naiveté beyond both conscience and comprehension!

Follow the money and you'll soon see how many dirty deeds are being performed rather expensively at Tax Payers’ expense.

Health Industry Exchange “Business Model”, give us a break!

Anonymous said...

Anonymous said...
Is it not true that the market leader has written to all its clients (in confidence) telling them that if they should use these HIE products (NEHTA endorsed and government funded)that their license will be null and void.
Can anyone confirm such a scurrilous allegation?

Anonymous said...

Cannot confirm, but why wouldn't they take such action as any manufacturer of goods will always invalidate their granted licence and any associated warranties when their product is bastardised by a consumer beyond any original recognition or in violation of the rights prominently stipulated in the licence agreement.

And I wouldn’t judge this as a "scurrilous allegation", as if there's any truth to it, it would be more like sound business practice in the face of unethical consumer behaviour taking liberties with their rightly licenced product.

HIE and its bureaucratic backers should be more concerned about public funds corruption and IP Law violations.

Any Attorney General audit will have an interesting time investigating where and how public funds have be channelled to and used by the HIE folks for certain.

Anonymous said...

Is it just me, or does anyone else see a disconnect in this discussion between funding (if any) provided to software vendors to integrate with PCHER, and additional funding (if there will be any in the form of MBS items) provided to providers to use the system...

I don't see why it's such a horrible thing for the government to support software vendors to become compliant and integrated, particularly when most, if not all are supportive of the same for providers...

Anonymous said...

No disconnect.

Difference is the "transparency" around how these funding arrangements are made, justified and most importantly, audited and reported.

MBS items are above board and transparently managed, reported, audited and "policed". If we don’t like them, we can vote for political parties that “promise” to remove them and either legislate or repeal legislation that removes unwanted items and undesirable burdens or expenditures made on the Public purse.

Some funding arrangements to some parties have been none of these, and their funding arrangements have NOT been acquired in a competitive transparent above board process with "Tax Payers" funds.

By definition, this is "corruption"!

Corruption is the abuse of entrusted power for private gain. It hurts everyone who depends on the integrity of people in a position of authority.

(www.transparency.org)

Anonymous said...

Interesting. Boosters for the PCEHR often wonder why there is such negativity in some parts of the e-health community towards the PCEHR, when any investment in e-health should be welcomed.

Setting aside the PCEHR 'thing' itself, one of the common themes throughout this whole process has been the issue of transparency, equity, and fairness. Or the lack of it.

How did the Wave 1 sites get selected? Non-transparently. Non-competitivly.

How did the Wave 2 sites get selected? Sham selection process, with anomalies in outcome all too well know to many, and easily audited if there was a will.

And now it appears we are back to selective, non-transparent funding of private companies - the wave 3 service providers? Creating with tax payer money unnatural monopolies, or destroying the business of other companies less favoured.

Whether you are a lefty (and cry for the lack of good governance and using public funds to create private goods) or a righty (and cry for the rigging of the market) this is not a good look.

I'm sure there are well rehearsed defences, justifications that the means are justified by the ends (but the timetable was artificial remember?). Yet any assessment that is at arms length would find the corruption word creeping in. Corruption can be direct, in that under the table deals are made (maybe not in this case) and corruption can be indirect, in the sense of corruption of process.

Hands up if you think the process of delivering the PCEHR is above board, squeaky clean and fair?

Anonymous said...

" HIE ..they operate as an add-on product - their market evaporates once the other vendors also offer integration."

Goodness - you mean we paid squillions for something that will evaporate? Would it had been better to pay for the longer term solutions from the clinical system vendors?

Interesting to see how many clinical documents are posted from an HIE add on, and how many come directly from clinical systems. Then we can divide the amount invested in the evaporated add-on by the number of clinical documents to see the value for money.

Anonymous said...

"It's reasonably common in the sector for the first patient and clinician to be closely affiliated with the software vendor."

Not in my experience - but please provide other examples?
Reminds me of a radio talkback compere promoting products in which he has a vested interest.
Might have been a much better look to have an independent consumer, not the CEO of the company that has profited from being contracted and paid through the PCEHR Program.

Anonymous said...

Does anyone know the current number of Australian's registered for a PCEHR?

Anonymous said...

"Not in my experience - but please provide other examples?"

So you are saying there are software vendors that would issue a major new release of their product, and the first production usage of that product would be "in the wild" with any arbitrary clinician and patient? I've never seen any software business that would do that, and I've not seen any health software vendors in Australia that would do that. Do you have contrary examples - since it seems to me that your claim is the more outlandish one.

Anonymous said...

Cool - I'm up for a challenge - you find me one other vendor who was being paid to build a system who also became the first 'success story' user of that system, and I'lll find you two health system implementations that started with "any arbitrary clinician and patient", with the production release of a major release of software - because that software had been throughly tested and was safe for use by any patient and any clinician.
Two for one eh?

Anonymous said...

No-one seems overly concerned with transparent or non-transparent 'conflicts of interest' across the health industry, so why would anyone expect the ehealth industry to be any different?

Anonymous said...

"No-one seems overly concerned with transparent or non-transparent 'conflicts of interest' across the health industry ..."

You're kidding right? Maybe because of the sharp practices of big pharma, the need to declare conflicts of interest and manage themactively have become standard practice throughout large swathes of healthcare, from senior governance structures, down to the regulation of research and teaching. Infact I'm not sure any other sector so actively seeks to manage conflicts of interest, because of the consequences that might follow to patient health.

Sorry, you will have to find another rock to hide under. Or are you just a 'troll' baiting the the readership of this blog?