Tuesday, May 28, 2013

This Article Makes An Important Point That Is Just Being Skated Over By Government and DoHA.

This article appeared a little while ago.

eHealth measures missing the point

Opinion: When will the PCEHR lead to patient outcomes?

One of the great challenges for eHealth is to convince governments, healthcare organisations, practitioners and the general public that it is worth the investment.
This involves first of all working out whether anyone is actually using the technology, then determining what they are using it for and finally trying to judge whether this use has any positive outcome.
These evaluations are all aspects of what is called “meaningful use” and apply to any technology, not just technology in healthcare.
When governments sell investment in technology to the public, they couch the benefits in terms of the positive outcomes of meaningful use, yet they measure the success of the deployment in terms of the more basic measures, specifically how many people are using the technology.
Use in this context can mean a download or registration. It doesn’t mean that they actually ever did anything further with the software or technology.
The use of download numbers or registrations can be useful if you are considering the deployment of the NBN for example, as it is very likely that people who connect to the NBN will actually use it.
When it comes to measuring the success in deployment of something like the PCEHR, it is very much less useful other than to serve as a distraction from the real issues of the success or failure of the investment.
In the case of the PCEHR, the Government is struggling to even get the registration numbers it had originally set out to achieve. It is falling short of its target of 500,000 registrants by June 2013 by a considerable margin. As of the end of April it had signed up only 109,000 people.
Lots more here:
There was a good comment following up from a regular contributor here on the blog:
Bernard Robertson-Dunn
Two points:
First: benefits are different from value. A technology solution may have lots of benefits but if nobody wants these benefits (i.e. they do not value them) then implementing it is probably not worth the cost. I think what the article is actually saying is that the indications are that very few people - patients or health professionals - see value in the PCeHR.
Second: IMHO, the value that might come from implementing technology such as the PCeHR should have been established before it was implemented. Otherwise you end up in the situation where a lot of money gets spent but no value accrues from that expenditure.
So we are now in the ludicrous situation where a technology has been implemented and nobody knows if has been worth it. There is no value assessment of any problem being solved, just a great big bill and a meaningless statistic of the number registered users. Trying to justify a technology spend after the event is a little naive.
So, I am agreeing with the thrust of the article but from the persepective of the value that comes from solving a problem, not from that of the costs and benefits of a technology solution. In the case of the PCeHR, no problem has been clearly identified and agreed amongst all the stakeholders, never mind the value of solving it.
The phrase White Elephant comes to mind.
----- End Comment.
Being a simple soul I have a different perspective. Part 1 is that it is clear the number of registered users really does not matter - what matters is the actual usage - in anger - (by which I mean for a purpose that the system was intended - if anyone is clear what that is?).
Part 2 is that usage statistics can easily be generated from the PCEHR to identify how many people are actually using the system - but I suspect hell will freeze over before they are made public.
The $ cost per real user would be a great statistic to have! Maybe some questions along these lines at Senate Estimates this week?


Tom Bowden said...

I think that Health leadership in both NZ and Australia need to measure the success of what is being invested in - and urgently.

It is simply not good enough for large centrally funded projects to continue chewing up cash and not be critically examined or compared.

I am personally involved in two major New Zealand initiatives, each of which have competing approaches, contrasting paradigms - which in itself is good.

However there is no process of objective measurement to determine the value of the approaches and let the competing players finetune their offerings and help decision makers decide which approach to opt for.

In Australia, David Glance accurately pinpoints the need to measure usage of the PCEHR system - not how many people have been (notionally) registered.

This should be the bureaucrats'/health leaders/ administrators' key role - provide useful information to inform the market and steer the ship.

Or am I under some massive illusion?

Kind regards to all,

Tom B

Paul Fitzgerald said...

@ Tom, as Sir Humphrey would say, "courageous decision, Minister!"
I agree entirely with your comments. Why is it that a company director can go to jail for this sort of negligence, but these people continue to spend vast amounts of money with no governance or accountability.

Keith said...

Yes, Tom, you're being utterly delusional. It's very important that government projects have no quantifiable goals and no significant measurements of outcomes. This is important to ensure the "success" of the project,because if there are no goals and no measurements the project can never be said to have failed. The project champions, be they senior bureaucrats or politicians can point to the amount of money spent on ehealth (or whatever) and declare what a great job they are doing. Been going on for years.

Anonymous said...

Sounds like the corporate strategy & modus operandi of The National E-Health Trasition Authority (NEHTA).

Would welcome the slightest evidence if they beg to differ.