Tuesday, October 02, 2012

I Think We Need To Work Out Just What We Mean By E-Health. The Confusion Is A Major Distraction.

This blog post has been triggered as a result of a discussion with a colleague and the NEHRS / PCEHR.
The comments that triggered my thinking is this:
Me: “Glad your glass is 1/2 full. Same as the likelihood of the EU getting its debt under control in my view - but there you go!
If you can provide one bit of evidence that the approach planned with the PCEHR will actually work I will consider a switch...10,000 users in 3 months etc. does not reflect a great future to me.
 Right now a billion dollars and a lot of people praying. But, as they say, 'Hope is not a strategy'.
Correspondent: “I can only agree about the state of the land – don't misunderstand - it’s just that I don't tend to think PCEHR when I talk e-health – PCEHR is just not part of the operational e-health mix.
I was just saying that e-health (in its full and traditional and broad reading) is now a growing part of the health system discussion – which is for the good. Problem is that PCEHR has made everyone stop looking at what is happening in e–health and instead just focus on it. But you know that!”
I wonder if we should more often simply  talk about 'true' e-health whilst also still holding those delivering PCEHR to account for what they have said they were going to do?”
This is why I think being clear we are talking about? We need to do a little better than talking about ‘real’ or ‘true’ e-Health in one breath and then suggest the NEHRS is not really part of the greater concept.
The reason it that any real progress requires at least some level of political understanding and consent, and if we are loose with terminology the political class may not be able to properly understand those things that are worthy of support and those that should not be supported of funded.
It is also important, to me and many others, that distinction is drawn between those thinking the NEHRS is a conceptually and operationally flawed program and drawing from this some idea that these people are somehow opposed to e-Health. This is of course arrant nonsense.
To me a useful way of distinguishing between ‘good’ and ‘bad’ e-Health is probably to assess the evidence for whatever the proposed initiative is. On this sort of basis electronic records, standards, secure messaging, coding, information exchange, analytics and so on are on the good side and politically driven, industry distorting, mega programs are probably bad.
Essentially I want to see those things that are likely to really improve clinical care be supported and those things that are extravagant, wasteful and evidence of benefit free curtailed. To me the NEHRS is a sideshow that is distracting from the main game.
We want the politicians to support and fund the good - so we need to be clear what we are on about.
What do others think?


Anonymous said...

"electronic records, standards, secure messaging, coding, information exchange, analytics "

A good starting point David, perhaps we might add some patient/provider level areas to the list.

Privacy/consent/access is one from the patient's perspective with the power to make a large difference to the quality of care. Decision support is another from the industry stakeholder perspective.

I am sure that there has been some good work done in all of the above areas over the past several years. I think our challenge is clearly for politicians not to throw the baby out with the bathwater here.

IMHO any funding in this area from government needs to be at more reasonable/directed/outcome goal oriented levels and accepted within the industry, provider/patient and standards bodies. If we ever fund anything at the slush fund size of the PCEHR elephant again we will get what we deserve, inappropriate use of public money by large cumbersome multinational consultants.

Time for a sea change, DOHA needs to be listening to the health industry bodies plus supporting local smaller, more cost effective and inclusive efforts for the ways forward. Incremental, agile, cooperative and inclusive will get us there and will assist/grow/benefit the local health economy in the process. Big bang exclusive certainly hasn't.

I wonder what MSIA, Standards Australia and the provider/patient advocacy bodies are up to at the moment?

Geoffrey Sayer said...

Standardising the foundation pieces (HIs, SMD, terminology, NASH) are a good idea. Then if people want a PCEHR as a byproduct of that then that is consumer choice coming into play.

The problem is we haven't got the foundation pieces sorted yet, despite many of them being work in progress for a number of years.

We also have spent alot of tax payers money on the national infrastructure, change and adoption etc when the the foundation pieces are still wanting. I know people will say PIP will help and I don't disagree but these financial drivers have in the past been hit and miss. I expect this one will be better than the last one but unless we truely get the foundation pieces right with established standards and supported CCA processes we will continue to take interim measures while we establish what the foundation pieces ultimately are (e.g. NASH, ELS, ETP).