Sunday, July 14, 2013

What Is The Biggest Issue With E-Health At Present? I Don’t Think It Is What You Think.

This week we have the most recent Health Information Society of Australia (HISA) annual conference in Adelaide. (15-18th July, 2013)
You can download the program here:
I thought I would have a browse to see what was being featured.
Reading through there was lots of emphasis in Digital Health and following patient journeys in areas such as oncology and mental health.
What seemed to be missing  was some sense of how the overall e-Health initiative was going and any serious retrospective review of what has gone on to date and what real outcomes have been achieved that make measurable differences to cost, quality and actual clinical outcomes for the health system.
I guess my point is that what is going on is not being strategically co-ordinated and more importantly we do not seem to be measuring the things that matter - i.e. the impact technology is having on the overall health system and what benefits are flowing overall - and not just at a particular institution with a particular narrow expertise.
Astonishingly it seems everyone speaking at the conference is so convinced everything is just fine and dandy that titles suggesting we have all the basics in place with e-Health and now need to elaborate, complexify and move forward. A search of the program reveals one hit for PCEHR and one for ‘record system’ do clearly that is seen and being done and dusted.
I would suggest that what we are seeing is a evidence based fantasy at the macro and outcome level. We have not measured and reported anything meaningful regarding the NEHRS / PCEHR for example other than the numbers enrolled - rather than the levels of actual use and actual clinical impact and even simple usage stats are unavailable.
This says it all:

GP input to PCEHRs remains miniscule

9 July, 2013 Paul Smith
The number of shared health summaries created by GPs for the personally controlled electronic health records  system is little more than 1100 — about 0.3% of nearly 400,000 patients who have been recruited to the billion-dollar scheme.
Health summaries are meant to be the backbone of the PCEHR and will list patients' current diagnoses, medications, allergies and immunisation histories.
However, there have been ongoing concerns about the workload the scheme will generate for GPs.
Doubts have also been raised over whether the profession will agree to take on the task of managing the summaries, which are designed to help streamline care with other health providers, such as hospitals and specialists.
The number of shared health summaries was obtained by Australian Doctor in May.
The Department of Health and Ageing did not respond when asked to provide an updated figure.
More here:
All this just goes back to a theme I have mentioned a few times on this blog - being that what we need is to do the absolute basics well, show those basics are actually working to deliver the benefits expected and then - in an incremental evidence based way - move forward measuring what we do for the population as a whole.
Reading as I do about what is going on overseas I am getting a distinct sense that the e-Health world is dividing into the excited spruikers who a technology focussed and sure all is well and the much more realistic and pragmatic who are realising that benefits delivery will be very hard and that issues of useability, complexity and safety in actual use in the hands of ordinary clinicians.
What is happening in the universities, research labs and the facilities lucky enough to have great leadership and motivation is fine - but diffusion into the real world is a much more challenging issue. We are a long way from that I believe.
I hope people have a great time in Adelaide and give a moment or twos thought to the bigger and much less clear picture.


Anonymous said...

Hi David,

I believe that keeping a weather eye on GP use of the PCEHR is the only feasible way of seeing whether it really has any meaningful value. I believe we should all be looking at how many GP summaries are uploaded to it and how often it is accessed. The number of PCEHR enrollees is somewhat meaningless. How often it is used in a clinical setting is what really counts.

Trevor3130 said...

Vic Govt is wrangling with paramedics over staffing issues. ED staff get drawn in due to bed-block in public hospitals.
Perhaps there is a session at this, or a future, HISA on "How PCEHR and digitisation have improved the efficiency of patient management in the ED".

Anonymous said...

"...we should all be looking at how many GP summaries are uploaded to it and how often it is accessed.."
Agree - other useful measures would be how many hospital discharge summaries are uploaded and how often they are accessed.
A few good news stories would be good - perhaps an aged care home patient who is admistted to ED and the ED is able to see what their current medications are. Surely there is a need for this, as it was one of the cohorts.

Bernard Robertson-Dunn said...

IMHO, the only meaningful measures are:

1. Improved health outcomes at the same total cost

2. The same health outcomes at reduced total cost

3. Some combination of 1 and 2.

If health outcome is not part of a measure, then that measure is either political or management speak.

Anonymous said...

B.R-D: Please illustrate or enumerate measurable "Health Outcomes" in SMART form?

Also feel free to demonstrate the related correlation, or even better causation of eHealth on these "Health Outcomes"!

Bernard Robertson-Dunn said...

Anon said:

"B.R-D: Please illustrate or enumerate measurable "Health Outcomes" in SMART form?"

You must be able to find some examples of health outcomes that have been set for the eHealth strategy and/or the PCEHR. After all, the government is spending many millions on these projects and must be expecting something of value from them.

Or is the government spending these millions without knowing what impact it will have on the delivery of health care for Australians?

Or are you suggesting that it cannot be done? In which case, I'll ask the previous question again.

Anonymous said...

DoHA cannot demonstrate performance measures, including SMART, and thinks it doesn't need to bother:
Additional Estimates 2011-2012, 15 February 2012
Question: E12-194
OUTCOME 10: Health System Capacity and Quality
Written Question on Notice
Senator Boyce asked:
NEHTA's strategy documents are consistently missing any published SMART (Specific, Measurable, Achievable, Relevant, Time-bound) Metrics to aid with the performance
management and accountability of this COAG tax payer funded non-profit private corporation. How can DOHA demonstrate that the performance management of NEHTA is
being conducted competently and how can DOHA demonstrate that NEHTA is being held accountable for its spending of tax payers money to achieve promised outcomes in the absence of such SMART Metrics?
The Council of Australian Governments (COAG) funds and mandates how the National
E-Health Transition Authority (NEHTA) develops and progresses eHealth funded activities.
NEHTA is a not-for-profit company limited by guarantee. Its members are the Australian Government and the eight state and territory governments. NEHTA is governed by a Board of Directors comprising of the chief executives of the health agencies from all jurisdictions,
three independent directors and an independent Chair.
NEHTA’s Strategic Plan describes the COAG funded milestones achieved to date, the work
planned to progress the key eHealth foundations and initiatives for the remaining period of NEHTA’s current COAG funding. The Strategic Plan is publicly available on the NEHTA
website at
Progress of NEHTA’s work program is monitored through the Standing Council on Health (SCoH) and the Australian Health Ministers’ Advisory Council (AHMAC).

Anonymous said...

”Progress of NEHTA’s work program is monitored through the Standing Council on Health (SCoH) and the Australian Health Ministers’ Advisory Council (AHMAC).”

Surely Senator Boyce did not accept and tolerate this response to her question on notice?

No surprise that a key word conspicuously absent from the response from DOHA/NEHTA is that all important term ”Accountability”!

A very interesting point explaining this phenomenon is the supposed ”Standing Council on Health (SCoH)”, the “Australian Health Ministers’ Advisory Council (AHMAC)” and the ”NEHTA Board” are almost ENTIRELY staffed by the SAME CAST of CHARACTERS from the political and bureaucratic fronts! An understandable and completely explainable failure of ”Governance”.

Check it out for yourself if this justifiably beggars belief:

Now it’s easy to see why no SMART metrics are defined and targeted, and why neither DOHA nor NEHTA are held to account for their waste of taxpayers’ funds. While obviously a purposely designed and engineered vacuum of accountability, it is very easy to see how getting away with taxpayer rorting is facilitated when you are your own judge, jury, executioner and most importantly, perpetrators!

Senator Boyce, please feel free to follow-up on this ruse of a response to your question on notice and inquire further as to exactly:

”How can DOHA demonstrate that the performance management of NEHTA is being conducted competently and how can DOHA demonstrate that NEHTA is being held accountable for its spending of taxpayers’ money to achieve promised outcomes in the absence of such SMART Metrics, and given the obvious incestuous composition of the proposed Governing committees (COAG, SCoH & AHMAC) and that of NEHTA’s Board?”

I only hope Senator Boyce has not been captured by the DOHA and NEHTA bureaucracy as the Hon Ms. Plibersek so obviously has as betrayed by her speech at this week’s HISA conference. At least one elected “representative” of Australia’s Taxpayers needs to keep these B#%$ds honest!

Anonymous said...

Actually, Senator Boyce is owed a debt of gratitude for her dogged attempts to bring accountability in the e-health space. One only has to look at her efforts through the tedious Senate estimates process. She is obviously well briefed as she asks detailed questions about very specific policy and technical concerns, and the Health department studiously ignores them until they are long overdue. Then it provides very brief responses that do not in anyway address the issues raised. It's an art the Health bureaucrats - and their NEHTA cronies - have honed to perfection.

Anonymous said...

Granted, Senator Boyce's efforts are to be commended and gratitude is expressly given!

Unfortunately, despite her valorous efforts, with the artful evasiveness, obfuscation and deception of the Health Bureaucrats, ”Accountability” of either DOHA or NEHTA is still absent in the extreme.

"That Is The Biggest Issue With E-Health (In Australia) At Present!"

Anonymous said...

In a word. Credibility. Relevance. Oh thats two. Relevance can be probably judged via a measure of meaningful use. Credibility by a ratio of the aggregate expense, cost, inconvenience and pain associated with its use and some form of net outcome or contribution to health outcomes. (Many of which were never measured and only loosely described in fluffy paragraphs in strategy documents).
White elephant, pink batt. Dead parrot also come to mind.

Anonymous said...

Based on recent involvement with NEHTA, you have seen nothing yet! This will all look like a reasonable effort. Some have a strategy, some stand on the sidelines making up strategies, restructures and anything else to feel important, all the while just making more of a mess for those of us who need to develop and implement e-health.

Anonymous said...

7/20/2013 05:42:00 PM the inference being NeHTA is in am unfathomable mess OR NeHTA is making progress and we have seen nothing yet.