Wednesday, July 03, 2013

A Very Interesting Set Of Comments On The Progress Of Australian E-Health.

The following report appeared a week or so ago.

Long road to successful e-health system

Andrew Birmingham
Over-hyped and over-promised. That’s how Stephen Duckett, Grattan Institute’s health program director, summarised Australia’s two-decade long trek towards a digital healthcare system.
“There has been the promise that the transformation in healthcare caused by digitisation is just around the corner,” he said.
It’s a promise that includes the full integration of different healthcare systems across the private, public and allied health sectors.
Other changes are also expected.
According to recent study by McKinsey and Company, the cost of treating chronic diseases represents 60 per cent of total healthcare spending worldwide. That figure could fall by 20 per cent through technologies such as remote patient monitoring – assuming patients embrace the digital alternatives.
There are plenty to choose from, and plenty more coming. The mobile internet, personal genomics and even 3D printing are expected to impact healthcare, the McKinsey study reports. Also on the radar is an idea known as the Internet of Things. The widespread internet connection of machines and digital devices will make integrated healthcare systems more efficient.
Learning from the past
Are we there yet?
Progress is certainly being made, but the sector’s key stakeholders know too well just how much further we have to travel.
Few think about a utopian destination of integrated healthcare – the task instead has focused on learning from history’s failures and pursuing better collaboration and agreement.
“Most of the implementations of electronic health records (EHR), and to some extent IT generally in healthcare, has been dramatically under-costed and there is a sorry litany of failed implementations and cost overruns right throughout the sector,” Mr Duckett said.
Much more here:
Clearly this is very much a ‘glass half empty’ view of what has gone on from Stephen Duckett.
You can read more from the Grattan Institute and Stephen Duckett here:
It is hard to disagree with the over-hyped and over-promised tag but I would suggest that the root causes of all this are based in Government and its various organs that really don’t understand the fundamental importance of clinicians (as well a leadership and consultative governance) in success.
Those in government really want to be seen to be doing well - but I suspect they simply don’t understand just how to go about doing things in a way that might lead to success.
Interestingly there is at least some feeling that the actual use of clinical messaging and EHRs in General Practice is actually stable despite the efforts of DoHA and NEHTA to make things harder for software providers and the complexity of the ePIP which is being rolled out.
The feelings of some others are rather more pointed.

Let’s not forget what this government has done for primary care

Let’s have a look at some of the big health projects of the past years: Super clinics, Medicare locals and the PCEHR.
Interestingly, there are a few common themes – the absence of a ‘need’ or business case being one of them. But it wasn’t all bad: One of the positive achievements was plain packaging of tobacco products.
…..
PCEHR
Next came the PCEHR. Although we need eHealth solutions, we did not need a national personally controlled eHealth record managed and owned by the Government. There was no business case for this version of shared eHealth records, and clinicians warned the government on many occasions about the risks.
So we got a PCEHR – sort of. It is behind schedule, very expensive and a nightmare for clinicians and practice managers. We all knew it is probably going to fail and it has blown yet another hole in the health budget. Give it some time, say the advocates of the program….
Simon James, editor of Pulse+IT Magazine, wrote in his May 2013 Editorial:
It seems inevitable that only a small number of Australians will have a PCEHR containing any clinician-generated content by the start of July, leading one to wonder whether clinicians – and not contractors with clipboards – may have been the most appropriate people for the government to engage to drive consumer adoption.
Wise words. Engagement of clinicians is required for any health care project. A government that side-tracks important stakeholders sets itself up for failure.
Is it getting better?
After many promises of a budget surplus we’re now in the red. Instead of scrapping wasteful projects, the government keeps spending money on these projects. The National e-Health Transition Authority (NEHTA) recently received $47.2 million and a $10 million federal advertising campaign to promote the PCEHR was launched only last week.
At the same time the government is cutting back on basic health care, including the safety net, self-education of health professionals and Medicare rebates, creating more hip pocket pain for patients.
Let’s hope the coalition will make wiser decisions.
The full blog is here:
It seems clear we have a long way to go to have the majority happy that we have reached a useful, safe and clinically relevant system.
David.

2 comments:

Terry Hannan said...

How often have we heard this story? “Most of the implementations of electronic health records (EHR), and to some extent IT generally in healthcare, has been dramatically under-costed and there is a sorry litany of failed implementations and cost overruns right throughout the sector”.

This whole concept was covered in a 2009 AMIA plenary session by Dr Mark Smith the former director of the Californian Health care Foundation. His presentation was titled, “Health IT: Hope, Hype, and How to Avoid the Road to Hell.” He addressed all and and more issues related to e-Health by Dr Duckett of the Gratten Institute so what are the proposed solutions that these ‘experts’ offer?

 

The need for a clinical focus of e-Health systems ‘based on existing knowledge and experiences of what actually works’ is also emphasised by Dr Smith. He stated, ““I am a General Internist and have an MBA, however I am not and ‘informaticist’ but I use HIT to try and improve health care, its efficiency, reduce costs and enhance its convenience” .

His comments regarding non-clinically designed systems included, ““You may have developed the best designed, expensive, highly functional HIT system however if the “end-users” do not perceive it offers benefits it will not be used!”

So knowing that health care is no longer affordable. We must change what we do. Effective HIT can provide the tools to do so. Therefore we must remove ourselves from

the ‘unscientific, non-data driven personal recommendations’ for care. We also need to move the care delivery system away from the costly and inefficient ‘widgets’ model of care

based on pre-determined ‘appointment system’ involving health care encounters i.e. hospital clinics. Finally care needs to be directed at patient self-management. Give them the HIT tools to manage their health. It has been done. Let us learn the lessons of history.

Bernard Robertson-Dunn said...

Terry Hannan asked :"How often have we heard this story?"

Too many times to count.

It is a fundamental truth of Information System development that if you automate what is already there, you will gain very little value.

If you want to get the most from automating/computerising, you assume that there is a better way of doing things because you have better tools.

You then work out what the better way is and then address the problems arising from implementing new systems.

The Transition part of NEHTA, seems to have been interpreted as "how to transition from the old way of doing things to the same way but with different tools?"

Before the PCEHR, the management of Australian's health information was fragmented and duplicated.

After $1Bn or so spent on the PCEHR, we are now in exactly the same situation. Some new tools have been developed but very few, if any health care workers are using them.

$1Bn has been spent on an IT solution that hasn't solved the fragmentation and duplication problem. Will it? I haven't seen too many commentators who think it will, not real soon now.