Monday, July 29, 2013

Another Very Helpful PCEHR Presentation From Dr Edwin Kruys


This presentation makes it clear just what problems many of the proposed users of the PCEHR see with the system.



Looks like DoHA and NEHTA have a lot of work to do.

Mandatory viewing.

David.

6 comments:

K said...

Several questions
- what is the Australia wide alternative available for <$10M/year? (And does Dr Kruys have any relationship with it?)
- Who does own the patient's data? the clinician? Why does he think that the patients will yield control to the clinician? (other than because he is one?)
- Does anyone know what the government intends to do with the data? Are people opposed to secondary use of de-identified data for population health studies?

Dr David More MB PhD FACHI said...

Answers:

1. Extensia Shared Record - Used and funded by his Medicare Local. No commercial relationship.

2. The law says Doc owns his record but, if asked, has to give patient a summary.

3. No - and de-identification may not actually work. Many suspect it is part of a set of data-bases that DoHA intends to mine internally.

David.


Andrew McIntyre said...

I think the "Holy Grail" of a shared record is wrong and what we need is data in standards based formats that is easily and quickly shared on demand. Combine this with a "break the glass" access ability by eg A&E departments and we would have a good eHealth system that respects privacy and is less vulnerable as there is no single point of attack.

This is what should have been the focus for the last 10 years ie the ability to reliably share data in standards based formats. I am not quite sure what we have been doing for the last 10 years, but the outcome has been nothing of significance, despite billions spent. This trial has confirmed the finding of the NHS trial which also had the same outcome. Now its time to practice some evidence based government.

Bernard Robertson-Dunn said...

IMHO, that presentation fails on slide 1.

A patient's health record is part of a complex information system, with many relationships and types of relationships with other information systems.

A national health record system is even more complex in that the number and type of relationships increases.

To consider that a PCeHR has "customers" is to misunderstand, at the most fundamental level why a health record should exist.

Also IMHO, this misunderstanding is only matched by NEHTA/DoHA's apparent view that the PCeHR is an IT system.

Many information systems fail because of invalid assumptions and bad early decisions. I see many of both in this whole sorry saga.

Dr David More MB PhD FACHI said...

Bernard,

The only way an opt in system gets used is by using bribery or by treating the interests of the user / customer as important.

DoHA / NEHTA have mastered the first but are clueless about the second. The analogy is perfect IMVHO.

David.

Bernard Robertson-Dunn said...

David,

IMHO, the only way an opt in system will get used is if it

a) delivers significant value to at least some of the stakeholders by solving some problem they have

and

b) does not create major problems of its own.

The evidence so far suggests that a) is minimal and b) is unknown.