This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Sunday, September 22, 2013
I Am Suffering Considerable Cognitive Dissonance Reading About Australian E-Health These Days. What Do We Really Need To Happen?
A couple of interesting articles appeared last week.
MEDICAL experts and industry players have urged Tony Abbott to rectify the national e-health record system's "significant mistakes and missed opportunities" and ensure transparency is a key plank in its delivery.
In the lead-up to the election, Mr Abbott vowed to overhaul the cumbersome personally controlled e-health record (PCEHR) program, calling for a review.
Details on who will conduct the review and its parameters are still scant as Mr Abbott only yesterday announced his frontbench, to be sworn in tomorrow.
Peter Dutton has been appointed health minister, as expected, while Nationals NSW senator Fiona Nash is assistant health minister.
Andrew Southcott, previously opposition parliamentary secretary for primary healthcare and the Coalition's e-health spokesman, missed the cut.
About 650,000 people have registered for an e-health record but only 0.6 per cent or 4000-odd shared health summaries exist. These records are created by a patient's GP and contain diagnoses, allergies and medications.
Mr Dutton, a vocal critic of the PCEHR, has described Labor's implementation of the PCEHR as a $1 billion disappointment.
"With nearly $1 billion spent on the program, it has failed to deliver anywhere near what the Labor government promised," he said last month. "The e-health program has been shown to be more about politics than about policy and more about spin than about outcomes for patients."
Pharmacy Guild national president Kos Sclavos said it supported the concept of an audit "because there have been some significant mistakes and missed opportunities".
Mr Sclavos said the Guild would make a detailed submission to the e-health review. It will be centred on three elements: patient issues, pharmacy issues and system issues. "Community pharmacies provide a range of professional services that focus on screening and risk assessment as well as the monitoring of chronic conditions.
"To date, the information collected cannot be uploaded to the PCEHR. This is a gap that must be addressed," he said.
Mr Sclavos said the Coalition's review could result in changes to the PCEHR and the role of community pharmacy. He said his members "need a clear path on the future of the system and at present there are many unknowns".
Australian Medical Association president Steve Hambleton said "We're not happy with the uptake or the process of the PCEHR ... Everyone agrees that e-health has great potential to improve patient healthcare with increased instances of sharing key information about patients but we need to find out why we haven't got there."
More transparency was vital in order to gauge the true situation with the PCEHR.
Dr Hambleton said the system was too cumbersome for doctors and could lead to errors.
AUSTRALIA'S billion-dollar e-health system is in danger of becoming an expensive white elephant with doctors refusing to use it.
A key clinical adviser to the government who quit in frustration last month has described the system as "shambolic".
And the medical software industry says the body running the system, the National E-Health Transition Authority, lacks the skills to do the job and warns patient safety could be at risk.
Dr Mukesh Haikerwal who resigned in frustration from work on the e-health record says he's uploaded 150 patient records on to the system but "no-one can read it".
Patients who want a hospital or specialist to see their e-health record have to take their own ipad to the consultation to show the record because hospitals and specialists don't have the software to read it.
Fifteen months after e-health was launched - 888,825 Australians have signed up for an e-health record but by last month doctors had loaded only 5427 health summaries on to the system.
Only hospitals in the ACT and South Australia can currently access the record, although more are scheduled to come on board next month.
Some of the medication records loaded on to the record by the government are wrong and Dr Haikerwal says this could have grave consequences for patients who could be misdiagnosed.
The AMA says doctors or hospitals trying to use the records have less than a 0.5 per cent chance of finding anything clinically relevant.
Last month, four of the clinicians advising the government quit in frustration.
The mounting problems with the system come as it emerged that the cost of Britain's failed e-health system has reached 10 billion pounds.
However, a spokeswoman for the Department of Health said it was wrong to compare Australia's e-health record with Britain's which managed the entire stay for every patient seen or admitted to hospital all the way to their billing system.
Health Minister Peter Dutton who was sworn in on Wednesday has pledged to undertake a "comprehensive assessment" of Australia's e-health record.
DR MUKESH Haikerwal remains an advocate for the government’s personally controlled e-health records (PCEHR) system despite serious concerns about the accuracy of clinical records and the system’s useability.
Dr Haikerwal, who recently quit his post as NEHTA’s chief clinical lead, told MO the system was still “some time off” being a reliable, useful and widely accessible resource for doctors, and there remained much to be gained from the work already completed.
“We all know there are issues with the program and project that need to be fixed up but the positive side is that there is something to be worked from and built on,” he said.
“There is stuff out there now that exists because of the work that has been done over the years. It just has to be in a format that is useful for clinicians.”
His comments followed News Limited reports that quoted him labelling the PCEHR as a “shambolic” system containing potentially incorrect patient medication histories.
He told MO that in at least one case a patient had been given the medication record of another patient sharing the same name.
A GP could conceivably see someone with a PCEHR that said they were taking something like olanzapine (Zyprexa) and say, ‘oh, you have schizophrenia, are you taking these tablets?’ Dr Haikerwal said.
If they did not have schizophrenia then the GP may unnecessarily upset them or give them a medication they don’t need, which is not a good thing, he added.
Dr Haikerwal said there was much work to be done to support and reassure doctors to get them to embrace the PCEHR.
Technology heads in the healthcare sector continue to back the federal government’s controversial and slow moving national e-health record program, saying it has a future despite lacking the critical mass it needs to succeed.
As of July 31, 612,391 Australians had registered for an e-health record, according to a recent National E-Health Transition Authority (NEHTA) report. A further 4500 organisations had registered in the personally controlled e-health record (PCEHR) system and 4585 shared health summaries had been uploaded as of 22 May.
Meanwhile, industry has called for the Abbott government to fix the troubled system. Before he was elected on September 7, Tony Abbott vowed he would seek a review of the struggling e-health program.
Mal Thatcher, CIO at Mater Hospital, said the scheme has not yet reached the critical mass it needs to succeed and is lacking the right policy framework for broad adoption.
“That includes the need for strong ongoing engagement with the entire health ecosystem whether by NEHTA or the current system operator in DoHA. Unfortunately, in my experience at least, engagement has not been nearly effective enough.”
Thatcher also said access to and use of the PCEHR has to be “symbiotic” with clinical practice and electronic medical record systems to convince clinicians that it’s worthwhile. He added that clinicians need to trust the quality and currency of the data and industry needs to articulate a tipping point for adoption.
Bill Vargas, CIO at the Sydney Children’s Hospitals Network, told CIO clincians' time is fairly precious given their heavy workload, so they have to convinced that using these systems will give them benefits as well as for the patient.
Vargas believed that more than half the population and health organisations have to be using the national system for it to reach critical mass.
“This will ensure that information gives a holistic picture of a person’s health record and makes it useful for the ongoing care of the patient.”
Despite some doctors baulking at the system or indicating they will not take part, Vargas believes consumers will drive uptake as they will request that their doctor is connected and contributes to their e-health record.
“In discussion with consumers, in particular parents of young children, they have an expectation that this will occur in the future or else they will seek doctors who are connected to e-health,” said Vargas.
Vargas said the benefits of sharing appropriate and concise clinical information between treating clinicians for the benefit of the patient should “no longer be an argument.”
“The potential reduction in clinician incidents by having information about current medications, allergies, diagnostic results or medical conditions would be a great benefit to the patient and the health system,” said Vargas.
When taken as a whole it seems to me a few things emerge pretty clearly - other than some of the headlines not quite reflecting what the articles are saying.
First there does not seem to be a single commentator who is of the belief that the status quo is even alright - let alone ideal.
Second there is a pretty strong view that without major changes in the system and a great deal of work to reshape the NEHRS / PCEHR to be both valuable to / and supportive of clinicians getting their work done it will fail.
Third there seems to be a view that adoption will be driven by consumers. I suspect this is not correct as in its present incarnation the system does not do what patients most value (appointment making, repeat scripts, secure messaging to their doctor etc.)
Fourth there is a pretty clear recognition that the way the Program has been led and delivered has been ill-conceived and not clinician friendly.
What is missing is any real clarity as to what should and needs to be done to address the problems as they have been articulated.
I have my own ideas (which I have rabbited on endlessly about) - but would be very interested to hear just what people believe should be the actual outcomes of the promised review of the whole effort.
Over to you. I look forward to some new ideas on the way forward that can snatch victory from the jaws of defeat!