Sunday, June 16, 2013

Isn’t It Interesting Just How Widely Different Medical Commentary Is On The NEHRS / PCEHR.

I found it amusing to see just how different the commentary on the PCEHR in the social media is. Here are two examples that appeared in the last week or so.
First we have a tale of frustration and time wasting:

Tillyard Drive Medical Practice

Friday June 15, 2013
A few months ago I thought that our system was finally ready to use the #PCEHR. This was after at least 18 months' worth of countless forms, calls, faxes and e-mails. We were the eight out of 88 Canberra GP clinics to get to this stage. Lo and behold it would appear that we were not there yet. We were now told we had to fill out a form to link us with a Contracted Service Provider which in our case turned out to be Healthlink. A month later this was done and we had the nice Tech from Healthlink log into our system (yet another stranger allowed in behind our security barriers) and after nearly an hour he managed to set up the secure certificates - AFAIK we are the first GP clinic in Canberra to get this far. Everything should work now? Not. It would appear that our business HPI-O is supposed to be linked to each individual doctor's HP-I but off course it is not. We are now required to fill in a form for each doctor to get this done (a form that looks nearly identical to the multiple previous ones we filled out). In addition we are told we have to log into Medicare' secure HPOS website to link and publish our details in the Health Provider Directory. Now to do this the RO or the OMO for the organisation needs to use his PKI certificate/Dongle to log in. All the doctors and the practice manager has one of these but we have never felt the need to use them so they have been in a drawer. So today our Practice manager tries to log into HPOS - it turns out that none of our PKIs can be used as they are more than a year old and incompatible with Windows seven or eight machines. So guess what - we have to fill out a multi-page application out for each user again - last time it took nearly two months to get a response.
More of the saga here:
Secondly we have a post of enthusiasm and optimism with great faith that after 8 years NEHTA is about to deliver and a slight recognition it has taken way too long.
Shared publicly  -  Jun 12, 2013
David Guest
Trust me I'm a ... data manager
‘Grete long cures note in folio/ shorter common cures that come or send in half side or quarto/ note visiting cuers in a manuell" Thus wrote Dr Barker in early 17 century England advising his colleagues on the way to record medical treatments. It was early days in Western medical data management and the routine recording of a patient's clinical details was a long way off.
Things changed little for centuries. The doctor's diary was, like Samuel Pepys', a personal record of his life. While it contained some clinical details, it was for private thoughts and memoirs and was not written with the patient in mind. The physician's day book was more financial than clinical record and Dr Finlay's Case Book was produced primarily for the edification of the audience. Dr Joseph Bell, Conan Doyle's inspiration for Sherlock Holmes, would have had little need for documentation. A brilliant mind and shrewd observation seemed to make both history taking and medical records superfluous.
By the early twentieth century science and medicine had changed. Early diagnostic testing added to the volume and complexity of the data that needed to be managed. More people were involved in an individual's care. In 1906 Dr Henry Plummer of the Mayo Clinic sparked a revolution in medical data management. The "unit record" contained all the patient's data in one folder that accompanied the patient around the Clinic.
Despite computerisation changing both the world and medicine in the last 40 years, medical records have been surprisingly resistant to its advances. The vast majority of Australian hospitals still use paper records for patient management. The business case for computerisation in general practice has been much stronger. Over the course of ten years from the early nineties, electronic health records progressed from printing scripts, producing health summaries and generating letters to note taking, pathology and radiology processing and finally document handling. By the early 2000s many practices were completely "digital".
Form follows function, but function does not follow form. Cheap, near instantaneous communication has been a reality since the late nineties. Education, banking and the business supply chain have readily embraced it. It continues to make significant inroads into retail. Ten years ago it seemed inevitable that the medical IT marketplace would develop solutions for rapid seamless secure communication.
It didn't happen. Clusters of proprietary medical data transport systems developed in pockets around the country but the coverage was patchy at best. There was no incentive for competing companies to interoperate and many medical practitioners after dabbling in electronic communication returned to the lingua franca that paper provides.
In 2005 the government established he National Electronic Health Transition Authority to break the impasse. To the outsider the pace of change has been glacial. This is probably inevitable given the foundation work needed for developing the legal framework, medical IT standards and specifications, and for developing the authentication infrastructure for the Australian populace. These were major undertakings but made no change to a GP's day to day medical practice.
Lots more here:
I will leave it to others to comment on how they see all this (glass half full or empty etc.)  but I would point out that there is still a long way to go, no matter how you look at it, before we will see the hoped for benefits and improved clinical outcomes.
Is this the triumph of experience over hope or hope over experience? You be the judge..
David.

1 comment:

Terry Hannan said...

Maybe Ms Jane Halton and Ms Huxtable should read these commentaries following their inputs into the Senate Estimates Committees. I am sure they will have an "answer/response" that is non negotiable. If people read these dissertations WHERE ARE THE PATIENT CARE FUNCTIONALITIES of this system? ............. I could ramble on......... is not the primary aim of eHealth to IMPROVE CARE.