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.

'It's not a push of a button', says PCEHR lead

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:

PCEHR still too difficult: GP

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.

A second opinion on the progress of e-health

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.
See here:
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.


Pat G said...

I attended a two day seminar years ago at a Sydney Airport hotel. Afterwards I told many peopel that I must be as thick as a plank as I could not understand the model nor how it would work. Privately I decided that PC stood for a politically correct solution, that is, one desiged to be clever but otherwise useless. Seems I was understating the obvious. Records are about effective data capture systems. The rules are: accurate, timely and useful. Who then should collect data? Clinical providers and NOT patients. Do you think all the other large record/database operators; insurance, retailers, banks and so forth would allow the public to control the organisation's data quality and colleteral. Of course not. PCEHR breaks every data capture rule book and as such is a dud.

Anonymous said...

Pat G hits the nail on the head!

Look at every other area of commerce in our society, including the "Government". There is the "Institutional" side of information and operations, and the "Consumer" side of information and operations with well defined boundaries and interfaces between these two spheres and very different needs and utility of information within those spheres. Look at your own personal relationship with any institution you directly engage with that has "YOUR" information within their organisation.

The PCEHR is conceived, designed and implemented in "No Mans Land" and forever will it languish there while consuming vast amounts of taxpayers funds that are wasted.

If Dr Chris Mitchell and Dr Mukesh Haikerwal are so confident and enamoured with the idea and utility of these Shared Electronic Healthcare Record systems within their own sphere of expertise amongst their peers, then why don't they put THEIR Money where THEIR mouth is and invest, or cultivate Venture Capitalists and RISK THEIR Funds to fund and fuel their PCEHR Wet Dream.

If it succeeds and they make a squillion in creating value and benefitting their customers of clinicians and patients, then GOOD ON THEM, but odds are they will lose their investment and see it part their hands to enter the failed ehealth ventures and experiments such as Google Health, HealthVault, NHS CfH and Canada Infoway.

Stop ripping off Taxpayers and put your own well-healed resources at risk pursuing YOUR ehealth Wet Dream and pay for your own 5-star hotels and 6-course dinners at YOUR expense!

Anonymous said...


Amazing what you think is forgotten and then the dim memory comes flooding back

I also recall attending a DOHA hosted meeting at a Darlinghusrt hotel long before the PCEHR was more than a wet dream; probably 2005 or so. DoHA had consultants try and present the options to a room of ICT people. Most of the presentations and strategies were literarily laughed out of court. The embarrassment was almost palpable. One earnest chap tried to explain a model that today we would call the cloud. He was sort of right; just that at the time it all seemed to be preposterous. He was right about one thing: the data would being with and remain the property of the clinical service provider. Therefore any solution would require outside access to these individual ‘balloons’ of patient data using a robust search process based on a tight patient ID regime.

Like everything else in health the boffins simply refuse to look at what works, and why it works, in other industry sectors. Had they studied the global data capture and database expert systems and solutions they would never had gone down this silly path.

One other gripe, from memory

At the airport event we were broken down on the second day into groups of ten or so with a facilitator. We then went through a series of issues, around the table, so that the facilitator could present our teams contribution at the end of the day summary session. Our village idiot was a female staffer from the minister’s office. Every single comment, suggestion, observation and option I contributed DID NOT make into her summary presentation. I stood up and made this point to the room in the Q and A session and received a giggling silence. Her answer was that I seemed NOT to be a health expert; rather a mere industry interloper. Sigh

There is nothing worse than pseudo intellectuals who refuse to heed the words from those that know what works and what won’t work

Feels better to get that off my chest!

Anonymous said...

Anonymous said (above)
Pat G hits the nail on the head
This person says that two doctors, Mitchell and Haikerwel should ante up and invest, et al. I think there is a much simpler and more powerful way for them to walk the talk. Publish the statisticts on how many patients they have on their books, or that they know of professionally, who are regularly using PCEHR input and output tools and have saved content to files and to what level of practical clinical benefit this is this delivering to them (the doctors), and then to them (their patienst, other service providers and then onto NeHTA/DoHA and other governing cohorts.

What real data have they accumalated during their advocacy roles as champions of the PCEHR?