Sunday, November 18, 2012

This NEHRS Will Get Unmanageable Over A Pretty Short Time I Reckon. It Will Also Become Increasingly Hard To Use.

Just how messy and unwieldy the NEHRS is going to become is illustrated by the following.
Here is part of the side-bar to access your record (note links don't work)
If you click on one of these links (and you are actually logged in and have access) you will get the following for each link.
----- Begin Document
DAVID G MORE DoB xx Feb 1949 (63 years) Sex Male IHI xxxxx 6011 8114 24xx

6 May 2012 00:00+1000 Pharmaceutical Benefits Report

START OF DOCUMENT

Pharmaceutical Benefit Items

Generic Name
ALLOPURINOL
Brand
PROGOUT 300
Prescribed
Sat May 05 00:00:00 EST 2012
Supplied
Sun May 06 00:00:00 EST 2012
Form and Strength
TABLET 300MG
Quantity
60
Repeat Number
2


Administrative Observations

Age when record was created        63


Document details
----- End Document.
This is just a 5-6 month display. In a few years even on just a few medicines one will be able to accumulate a heck of a large number of records. Also it needs to be remembered that each pathology test will have a similar record - assuming they make it to the record which in my case very few did.
Once you add the various shared summary record and the other planned documents (referrals and so on) it becomes clear just how unwieldy this will all become.
This whole document based approach may need a careful re-think. It makes much more sense to re-design the way information is presented - both for clinician and consumer - to make it acceptably useful.
My belief is that the root cause of the looming issue of just too many documents that are not properly organised is due to design overreach. We should have had a minimal shared EHR to start with and then move on incrementally. Sadly this is not what has happened.
The mess we have now reveals that NEHTA’s and DoHA’s job is by no means done despite claims to the contrary.
Additionally on the last two occasions I have logged on the performance of the system has been glacial.
I wonder why that might be?
David.

8 comments:

Anonymous said...

Did you also visit the Medicare Services Overview? This shows a summary of that same information, so for most people there is no need at all to click through into those individual Medicare documents.

Dr David More MB PhD FACHI said...

I know there is a summary - but it will also suffer the same problem. It is just too clumsy in my view.

My records are also grossly incomplete!

David.

Anonymous said...

There is also a date based filter at the top which looks like an eye.

Earl Hose said...

When the Nerds Go Marching In will brighten your spirits, David.
They created the most sophisticated email fundraising program ever. The digital team, under Rospars leadership, took their data-driven strategy to a new level. Any time you received an email from the Obama campaign, it had been tested on 18 smaller groups and the response rates had been gauged. The campaign thought all the letters had a good chance of succeeding, but the worst-performing letters did only 15 to 20 percent of what the best-performing emails could deliver. So, if a good performer could do $2.5 million, a poor performer might only net $500,000. The genius of the campaign was that it learned to stop sending poor performers.
A team like that could knock the NEHR into shape.
On email, some may be thinking about the security of their own, after the revelations from the Petraeus saga. For example, I've only just picked up that Gmail has a pop-up that lists the IPs that accessed your account. It's interesting to watch what happens when you read your Gmail using an iPad on 3G.
On a related matter, Evernote sent round notice of changes to their Terms of Service, with emphasis on their privacy settings. That's where I read about, for the first time, tracking pixels or web bugs.
All of that has little to do with NEHR, but with so much new technology, the people who will drive acceptance of NEHR will need ongoing reassurance and somewhere to have their questions addressed. Perhaps Ms Halton is the person to ask?
--
Trevor

Anonymous said...

Obviously nobody has worked in a records management background in at NEHTA i.e. structure, context, navigation, user friendliness. They seem to have forgotten the basics.

To Earl's point, if you use email as a secure form of communication or ever have need to have a rethink, me thinks.

Encrypt, Encrypt, Encrypt

Anonymous said...

"Additionally on the last two occasions I have logged on the performance of the system has been glacial.
I wonder why that might be?"

IMHO...

Because they paid as much attention to the performance testing of the system as they did to:

Realistic use cases based on real domain knowledge;
Testing properly and removing defects before delivering;
Interface Useability;
Storing clinical information not just copying admin documents;
Identification of and consultation with stakeholders;

and nowhere near as much attention as they paid to:

RAH RAH RAH, mission accomplished, and Job Done! marketing spin;
Fleecing the Australian taxpayer;
Gouging for maintenance of a system with few users and little useful content;
Creaming off money for a job well spun;

What a terrible system, I wonder what the Million Dollar A Day Men think of this?

Anonymous said...

On performance of the system, I suspect you're saying that it was slow to log on, but once you were logged on it went same as ever?

Dr David More MB PhD FACHI said...

It is always slow to log in. The performance while logged on was also awful - wirly 'please wait' symbols all over the place!

David.