Tuesday, July 30, 2013
The Light Is Starting To Dawn That The NEHRS PCEHR Is Based On A Fundamentally Flawed Concept. Pity It Has Taken So Long.
In the last few months there have been a couple of very interesting contributions to the PCEHR debate.
We have had articles like the following appear from people who should really know.
23 July, 2013 Paul Smith and Jo Hartley
The Federal Government's much critcised patient controlled electronic health records scheme is still a long way off benefitting GPs, according to the clinical lead of National E-health Transition Authority.
In an exclusive video interview with 6minutes Dr Mukesh Haikerwal, a Melbourne GP, reveals the extensive amount of work involved in uploading shared patient health summaries and event summaries which are the backbone of the $1 billion scheme.
Check out the full video below to hear more of what he has to say:
The full article is found here - the video is short and worth a watch:
and articles like this:
23rd Jul 2013
A SPIKE in personally controlled e-health record (PCEHR) registrations almost brought the federal government to its target of 500,000 sign-ups by the end of June, but GPs insist the system is still not useful or accessible enough to lure them.
Dr Peter Hopkins, a GP in NSW’s Hunter region, said using the PCEHR was still too complex and the benefits not apparent enough.
“To actually get a patient enrolled and hooked up in the system, it’s a difficulty which I haven’t even attempted.
“We are all waiting for the better understanding and leverage of this,” he said.
“But the time and effort it takes and explaining it to the patient and justifying it, it adds to the workload so much that it’s just not being done.”
The health department confirmed it passed the half million milestone last Wednesday, just over two weeks after the target date.
The same day, Health Minister Tanya Plibersek upped the incentive for patients to sign up by saying pathology and diagnostic imaging results could be uploaded to e-health records following an $8 million federal government investment.
Much more of the perceived problems are found here:
Of course we have the defence leap out as well, from those on the inside and presumably of the payroll, such as this article on the ABC site.
By John Casey
Wide criticism of the government's e-health system is premature, but more needs to be done in "meeting the gap" faced by regional and rural areas.
Dr Chris Mitchell, Head of Adoption, Benefits and Change at the National E-Health Transition Authority, says it is "really important that we prioritise rural Australia" for the roll out of ehealth initiatives and infrastructure such as the National Broadband Network which drives it.
"I think rural Australia misses out in a whole lot of areas - in terms of a whole lot of infrastructure - and I think Australia should do more to be meeting that gap for our rural communities," Dr Mitchell explained.
"I think it is really important that we prioritise rural Australia for the roll out of these sorts of technologies if we are going to be taking advantage of them and meet the health needs of our rural communities.
"I think all of us want to work in a better connected health system," Dr Mitchell added.
The National E-Health Transition Authority (NEHTA) has been the subject of rasping criticism, particularly from doctors.
Lots more here:
Additionally, in recent times a new blog has appeared which makes many cogent criticisms of the PCEHR program and how engagement with GPs has, and is, being handled.
There is a lot of very interesting material to be found on this blog.
So what is the problem. If pushed I would suggest there are three principle problems that lie at the root of the concerns.
The first is that the PCEHR does not know what it is and who is its intended user / customer. As presently architected the PCEHR is neither ideally suited for use by either a technically and clinically aware professional or their patient. It is a compromise that is neither fish nor fowl and so is in any way ideal for anyone. It simply addresses no one’s needs properly.
The second is that the present system really does not provide the things - such as easy access to your doctor, repeat prescription requests, appointment making and so on surveys all over the world say patients value. The PCEHR simply does not facilitate this sort of interaction.
The third is that separates the patient record the clinician uses in their day-to-day work and the record the patient holds with an imposition of issues on both parties such as currency, timeliness, completeness and so on.
All this, of course, ignores the issues of workflow impact, system slowness and clumsiness, security and liability issues that many have raised.
It is clear what needs to be done. First, with real consultation with a broad range of working clinicians there need to be major changes to the PCEHR’s architecture to restore clinician centrality and to ensure the system works optimally for them.
Second with broad consultation approaches to patient access and use need to be developed and implemented.
Third the leadership and governance of the whole e-Health effort needs to be drastically overhauled and made accountable and realistic regarding what can be achieved and what will make a difference - preferably based on real evidence and not hunch.
These three steps would save the salvageable from what presently could reasonably be argued to be an unsatisfactory system for both patients and their doctors.
Posted by Dr David More MB PhD FACHI at Tuesday, July 30, 2013