Tuesday, July 02, 2013

The Australian Medical Association Is Still Not Happy With The NEHRS / PCEHR.

This appeared a little while ago.

Overcoming e-health roadblocks

Steve Hambleton  - President of AMA.
There is widespread support among the medical profession for electronic health initiatives that will make it easier to provide quality health care, especially in situations and locations where services are scarce or hard to access. But there are hurdles to overcome.
Most doctors support an e-health environment that provides the profession with reliable, key clinical information that can enhance their decision-making about the health care their patients require.
While doctors appreciate the potential benefits of e-health, it is difficult for private medical practices to establish a clear cost benefit, particularly general practices that will incur the greatest costs but derive the least direct benefit.
Participation in the Personally Controlled Electronic Health Record (PCEHR) has been made unnecessarily complex and difficult. For example, the PCEHR legislation and its participation requirements are complex and introduce new and significant obligations on medical practices.
There are substantial penalties for non-compliance with the complex legal requirements. Medical practices will have to devote substantial administrative and information technology resources to meet these new requirements.
In respect of secure messaging, which allows secure point-to-point transfer of patient information, there is also a level of complexity that will require most medical practices to buy in expert IT advice to install and configure SMD technology correctly.
The practical clinical value of the PCEHR has been compromised by its design. While the PCEHR could empower and encourage individuals to take responsibility for their own health, its usefulness for medical practitioners is limited by the accessibility, content and accuracy, and the comprehensiveness of the information it contains.
Health care of the patient is best served when the doctor has access to the most basic information that is critical to patient care – medications, allergies, hospital discharge summaries, and pathology and diagnostic imaging results. This is what the e-health agenda should be delivering.
More here:
Dr Hambleton then goes on to point out issues with Standards setting, clinical input and so it goes on.
Clearly the AMA is just fed up with the way all this is being done. Their attitude I would suggest is nothing to do with Luddite clinicians but much more to do with paternalistic ‘we know best’ out of touch bureaucrats who inhabit the halls of NEHTA and DoHA.
It is hard not to believe this program is doomed to be an expensive white elephant without dramatic, radical and clinically led change.


Anonymous said...

Expecting GPs to use systems that can support better models of care doesn't seem unreasonable - the real problem lies elsewhere.

If the vendors of comms and clinical software for GPs weren't pursuing myopic customer lock-in strategies - based on proprietary, arcane and incompatible standards for interoperability - then GPs wouldn't need experts to configure their systems.

It is unfortunate that NeHTA standards like secure messaging are needed to address this market failure, however, when it comes to a choice between corporate profits and public benefits, the public is the loser.

Health IT is one of the last major holdouts for outdated, winner takes all, business models - feeding on the inability of governments to break the vendor monopolies and cabals. And the hypocritical moral posturing of the vendors would be funny, if it didn't result in real human suffering.

Capitalism preying on misery - not a good look...

Anonymous said...

"- the real problem lies elsewhere."

And only here where you state this are you correct!

True, the real problem is elsewhere, and it lays squarely at the foot of the government and its self-serving bureaucracy, certainly not the vendors. Blaming GP Desktop Vendors is tantamount to putting the blame on the flees for the dog with rabies and its undesirable behaviour!

If there’s a market failure anywhere here, it’s the governments insertion and intervention within the healthcare sector (“Terminal Decline”, Khadra, M., 2010).

Unfortunately, you seem to possess a severe case of "The Anti-Capitalist Mentality" (http://mises.org/etexts/anticap.pdf), where the government and its bureaucracy cause, prey and profit on the misery it manifests, and all at taxpayers’ expense.

Don’t worry, the AMA and Pharmacy Guild are also well cozied up to the Government teat, solidly in bed with the bureaucrats against ALL public interest and despite ALL ensuing misery. Not a good look, agreed…

I encourage you to keep looking elsewhere but certainly not in the direction and drawing the conclusions you're expressing here -- as misguided as you no doubt will one day come to realise with enough honest research and reflection.

Anonymous said...

In Pulse IT (http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1486:pcehr-promise-yet-to-be-fulfilled&catid=16:australian-ehealth&Itemid=327 ) Steve Hambleton makes the following point:
“In a perfect world implementation support activities should have been coordinated so that as a patient registers for the PCEHR, their medical practice is also ready to provide them with PCEHR services, such as preparing and loading their shared health summary and viewing event summaries from other providers. A patient who has been convinced to register for a PCEHR should not be confused and disappointed by discovering their medical practice is not ready to participate. Unfortunately at this point it is difficult to know where patients are being registered and where practices are already providing PCEHR services, and to what extent the two align.”
It just seems silly that DOHA’s measure for success was to register 500,000 confused and disappointed consumers. Perhaps it would have been better to target one area first – perhaps aged care, with a better measure of ‘success.’ Or to just register consumers when the system was ready and their practice was participating?

Bernard Robertson-Dunn said...

Market failure is often used as a justification for government intervention.

However, there is an expectation or assumption that government action is better than market action.

Unfortunately, in the case of large scale information systems, each is as bad as the other.

IMHO, the biggest failure of the government was not recognising that these large projects usually go wrong and at least attempting to do things differently.

And simply letting the market try and develop a national health infrastructure and associated systems is just as naive.

I think the government has failed to draw a clear distinction between infrastructure and system. The PCEHR is far more than infrastructure, it is a proprietary, centralised, integrated system with a huge amount of user oriented functionality.

It's like the government building roads and then saying you can only use government provided public transport. Sounds a lot like the railways - and look how successful and profitable they are. I live in Sydney and my nearest railway station is 12km away.

Anonymous said...

@Anonymous 7/03/2013 12:21:00 PM

Of course - how dare our government intervene in the healthcare sector, they only pay for the vast majority of it...

And unbridled capitalism must lead to a better health system - I mean look at the US...

Other major industry sectors, like banking and transport, figured out how to connect up systems decades ago - and the consumer benefits today with interoperable and connected capabilities. Healthcare is still in the dark ages - and has amply proven it will stay there without some form of regulation or inducement.

I would proposed that most vendors don't want regulation or standardisation, mainly because history has proven that there's far too much money to be made from chaos and anarchy in Healthcare IT.

It seems that one thing we will agree on is that the unions, I mean the AMA and the Pharmacy Guild, do not act in the public's interests.

Finally, I hope you're not a doctor, as your diagnosis of my case of "Anti-Capitalist Mentality" is made on little evidence. Even a brilliant economist like von Mise would recognise that markets need regulation…

Anonymous said...

Bernard makes a good point. As the OP I was commenting on the article's reference to the complexity and cost of standards compliance in the secure messaging area. I was arguing that when the market could be seen to have failed in providing connected health systems then the government has a role to play in ensuring suitable standards are established (and by extension other requisite national infrastructure).

The problem is then how do you fund national e-health infrastructure within the political context - because it's basically too ephemeral. You can't put a big sign up like governments do when they are building new highways. So what happens then is someone in the bureaucracy comes up with something marketable like a PCEHR - irrespective of what it can deliver.

However, it also must be noted that basically none of the vendors were interested in NeHTA standards like secure messaging prior to something like the PCEHR - they basically saw the standards as having the potential to erode the significant barriers to entry they had put around their little proprietary walled gardens.

It's always about the money...

Bernard Robertson-Dunn said...

It's always about the money...

... and the politics.

I don't believe that the Australian government has sinister or ulterior motives. Most federal (I'm not so sure about state) politicians and senior public servants genuinely want to improve things and make a difference.

Unfortunately, most people with the drive and ambition to make minister or secretary, have little self doubt, so they don't like to hear contrary opinions, or evidence that they have made bad decisions.

They also want things to happen quickly so they can get the credit.

I saw the Human Services Access Card project fail, up real close and personal, at the highest levels. I see so many similarities, it's not funny. The only difference I can see is that the Access Card failed after only(??) $200million or so was spent and nothing got built.

The lesson I get from these projects is that governments don't learn.

Andrew McIntyre said...

Some of the negative comments above show an appalling lack of understanding of the medical industry and medical software industry in particular. I suspect the writer in in a position of influence in the public service as the attitude mirrors the clumsy attempts to “help” that we have seen. In the mid to late 90s we saw enormous innovation and advancement of eHealth with any help from government. Things that are useful to clinicians succeed and we saw the invention of PIT and later use of HL7v2 by pathology companies and this has been a great success story. Subsequent to this we have gone backwards with the help of a few billion $ of tax payers money.
To suggest that some public servant can dream up a “better” model of care is quite amusing as the PCEHR has demonstrated. It solves nothing for busy clinicians and simply adds an enormous burden of administrative overheads, legal risk, and time penalties for no proven or obvious benefit.
The attempt to pin the blame for lack of interoperability on messaging providers demonstrates a profound lack of understanding. If Ms Roxon herself, on a fast motorcycle, moved messages around on a USB stick they would often still fail to work because of a lack of standards compliance. The messaging vendors have long been threatened with being put out of business by public servants, which has been almost amusing given the level of understanding they have of the actual landscape. What we have needed is regulation of standards compliance by government, not ham fisted attempts to write software, a task which government is notoriously bad at. What on earth is wrong with messaging vendors competing to provide the best, fastest, lightest weight software to not only move messages but plaster over the cracks in interoperability? A fully functioning free SMD messaging system would result in chaos as issues of compliance and addressing would cause widespread failures, some with serious consequences. This is a failure to attack the compliance issues at a governance level is the messaging problem and not some evil plan to fleece customers by small dedicated companies, who often have far more knowledge and technical capability than the large consulting groups so worshiped by ignorant, well funded, public servants who are trying to “help”. We need the government to cut their losses and simply regulate for quality with existing standards. The IT companies can work on delivering self funded software that their customers want to buy. We have evidence of failure of government intervention, not a need for it!