Sunday, August 04, 2013

It Looks Like A Refresh Of The National E-Health Strategy Will Come Soon. We Sure Need It. - Article Draft.

Over the last few months I have been hearing that a range of stakeholders have and are being consulted as to their views on what will be the best way forward for e-Health in Australia, recognising that we need e-Health to work well as a part of the larger response to addressing the rising cost of healthcare in the context of the ageing society.
In thinking about any strategic change in direction the first thing to do is to assess just where we are now. As I see it now we have reasonable basic use of Electronic Health Records and practice management systems  among GPs, rising but much less use among specialists, rising levels of the use of private secure clinical messaging service use and gradual improvement in the levels of private and public hospital automation. Adoption of actual use of the Government’s Personally Controlled Electronic Record (PCEHR) is still very low with less than three per cent  registered for the service and many less than that actually using the service.
Despite claims to the contrary no review or evaluation has yet been conducted so, other than the odd anecdote, no one has any idea as to how useful the PCEHR will turn out to be. Interestingly there also seems to be an emerging level of resistance among GPs to the use of the PCEHR based system.
This presentation found on the web and written by a Geraldton GP Dr Edwin Kruys summarises some of the key perceived issues with use of the system.
Issues covered include information ownership, the real purpose of the PCEHR and so on.
Most especially there is a lot of concern regarding this paragraph in the PCEHR Participation Agreement with many not clear just why such broad and ongoing permission is provided.
“7.3 You grant us a perpetual, irrevocable, royalty-free and licence-fee free, worldwide, non-exclusive licence (including a right to sub-license) to use, reproduce, copy, modify, adapt, publish and communicate (including to other healthcare provider organisations and to organisations that store health information) material you have uploaded to the PCEHR system for the purposes of the PCEHR system.”
The full document can be downloaded from here:
As well as concern about the PCEHR and just where it is heading there is also rising concern regarding the way Standards Australia is managing the process of developing Standards in the e-Health domain. This most especially revolves around the way volunteers working on the relevant committees are being treated and the excessive non-technically qualified input and pressure being applied by DoHA bureaucrats.  
The common thread in all this is that the views of clinicians and professionals are being treated with less importance and respect that the reasonably ought to be and that this is having long lasting implications for how effective e-Health can be in the future.
As they say I believe it would be fair to describe the progress in e-Health under Labour as being something of a curate’s egg - good in parts.
As to the future it is my belief that what is needed are a few major initiatives.
These include most importantly a major revamp of the leadership and governance of e-Health nation- wide.
Additionally we need to re-orientation of the focus of e-Health so it is clear that the major objective of e-Health is the support of clinicians to assist them in delivery and co-ordination of quality and safe care for their patients. Within this it seems it would also be useful to reshape the PCEHR to become a patient resource to assist patient engagement with their health problems and to improve the communication between patients and their clinicians.
Improving clinician support will involve taking steps to improve the useability of systems, the support of clinician workflow and the breadth of information and decision support.
Lastly - at the highest level - we need to work to improve the direct information flows between all the actors of the health system to assist co-ordination and safety. What is needed here is to properly join up practices, hospitals, laboratories, community care and so on to optimise the content and quality of these flows.
There is a lot of detail that sits under each of these steps and what I am hoping is that the Strategic Refresh will, in general, agree with the directions I am suggesting and hopefully provide some rich detail of the steps needed.
In summary, in my view,  the present PCEHR initiative is not a clinician friendly plan and it is not at all popular with both clinicians or patients. Improvements are more than possible and could preserve the value of most of the investment made so far and actually get better clinician and patient engagement and use.

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Comments welcome!
David.

13 comments:

Anonymous said...

Edwin makes some key points about moving this issue forward. It does not need to be so expensive, there are some useful tools available for creating the environment for useful sharing of clinical information , with technical protection of sensitive data and implementation of role based access controls. Also the government needs to underwrite the indemnity for practitioners engaging in the process

Anonymous said...

How about ceasing the ongoing madness and waste around "IT Magical Thinking" for a start!

http://content.healthaffairs.org/content/27/5/w383.full

We don't need another eHealth Strategy as we really have never had one in the first place, especially over the past 10 years.

What's needed is a true "Health Reform Strategy" and any enabling eHealth will effectively follow suit accordingly.

Any semblance of a new government post September 7th will be timely in providing the opportunity to do so, and allow the drowning of the NEHTA puppy in the process.

Anonymous said...

The article you reference sums up the problems well. The idea that you can transform healthcare by introducing government mandated systems that are not based on the system actually aiding workflow is naive.

Systems and standards have been developed around things that work and are accepted by users and not imposed on them. This is one area that a free market does much better than government. Governments role is mandating compliance with standards when safety is at sake and not inventing standards and systems. Clearly they are not very good at developing systems, there is plenty of evidence for that. It appears that DOHA think they can control healthcare with software, but they cannot, especially given the current offerings.

Anonymous said...

It's all a joke and the continued waffle and spin is giving rise to some band-aid fixes for gaping wounds.

There are no retro fixes for the PCEHR. Anyone that understands databases knows that to retro-fix means re-write. In essence start again.

It is important to note that the PCEHR is a tool to review historical information about a patient. It is not designed to be providing real time data.

If we are to truly have a PCEHR, hand it over to private enterprise with the support and consultation of stakeholders, supported by a government mandate and some funding for the provider of the service and let them wear the cost of operation, mistakes etc.

Simple Q&A - Would IBM. CSC, Oracle, Accenture, Microsoft (tried and got out), Google (tried and got out),Deloitte, PwC build and maintain a PCEHR system?

I doubt it as it would have an adverse impact on the bottom line.

So let the government pay it is an easier route for revenue.

Anonymous said...

No doubt those will vesting interests and egos to defend will say don't throw the baby out with the bathwater, but all I can see is water. Can anyone see anything alive in this muddy pool? We desperately need budget savings and the PCEHR should enter the headlights at some point. Lets hope they get the shot off.

Saul Kamen said...

David,
How about some more balanced reporting in your blog.

In relation to IP, you quote paragraph 7.3 of the Participation Agreement but fail to mention that the next paragraph, 7.4 grants those same rights to the original owners of the IP, ie the health providers.
"7.4 We grant you a perpetual, irrevocable, royalty-free and
licence-fee free, worldwide, non-exclusive licence
(including a right to sub-license) to use, reproduce, copy,
modify, adapt, publish and communicate material you
have accessed via or downloaded from the PCEHR system
for:
(a) the purpose of providing healthcare; and
(b) other purposes of the PCEHR system."

Dr David More MB PhD FACHI said...

"How about some more balanced reporting in your blog."

My report is reporting what the docs don't like - having to give all these rights to the Government forever. No right to withdraw etc etc.

Take it from me - they simply don't like that and the rights are hardly reciprocal as the Government has all the records and you only have a few.

The agreement should be much more limited in my view as well.

David.

Anonymous said...

Simple Q&A - Would IBM. CSC, 8/05/2013 08:26:00 AM said Oracle, Accenture, Microsoft (tried and got out), Google (tried and got out),Deloitte, PwC build and maintain a PCEHR system?

They wouldn't unless they received mucho dollars from Government to do so.

Why not invite Telstra into the game? They have a presence everywhere - that could be a good starting point even if they know absolutely nothing about health.

Anonymous said...

Good point about Telstra and them knowing nothing about health, as they would only join the club of all the parties listed in an earlier post.

They obviously also nothing about health, look at all their failures and the rubbish that has been served up as a PCEHR.

Bernard Robertson-Dunn said...

Saul Kamen said...


In relation to IP, you quote paragraph 7.3 of the Participation Agreement but fail to mention that the next paragraph, 7.4 grants those same rights to the original owners of the IP, ie the health providers.
"7.4 We grant you a perpetual, irrevocable, royalty-free and
licence-fee free, worldwide, non-exclusive licence
(including a right to sub-license) to use, reproduce, copy,
modify, adapt, publish and communicate material you
have accessed via or downloaded from the PCEHR system
for:
(a) the purpose of providing healthcare; and
(b) other purposes of the PCEHR system."


It would seem that those who own the original IP grant the government a licence to do just about anything it wants to (apart from re4strict its use) with that information, including to sub-licence it to anyone else who can access the PCEHR.

In other words, the owners of the IP rights give away all those rights by putting their material into the PCEHR.

para 7.4 does not grant rights back to the IP owners, it grants a licence to anyone else using the PCEHR - i.e. it makes things even worse.

Anonymous said...

Mmmm perhaps 8/05/2013 12:47:00 PM needs to think again if telstra's media announcement is anything to go by http://www.telstra.com.au/abouttelstra/media-centre/announcements/telstra-invests-in-electronic-health-record-specialists-ip-health.xml
Telstra invests in electronic health record specialists IP Health
Media Release 02 August 2013

Anonymous said...

I think the point about Telstra is simple, just because you acquire something does not mean your knowledge increases about an industry segment.

Perfect point in example CSC and iSoft, enough said.

Anonymous said...

"CSC and iSoft"

What is your point exactly?

Please, pray tell and say more!