Tuesday, September 10, 2013

NEHTA Reports On e-Health Progress. Shows Oz E-Health Is In Disarray And That DoHA Is Just Being Obstructive and Childish!

This appeared a few days ago.

NEHTA eHealth Scorecard

Created on Thursday, 05 September 2013
This scorecard shows progress in adoption of national eHealth programs across sectors. Uptake is shown for the PCEHR system, secure messaging, electronic prescriptions and dispense ratios, healthcare identifiers and the national authentication service for health. This scorecard does not present a complete picture of uptake of eHealth, as it is limited by the data available to NEHTA.
This scorecard shows progress in adoption of national eHealth programs across sectors. Uptake is shown for the PCEHR system, secure messaging, electronic prescriptions and dispense ratios, healthcare identifiers and the national authentication service for health. This scorecard does not present a complete picture of uptake of eHealth, as it is limited by the data available to NEHTA.
Most notably, the widespread implementation of electronic medical records in hospitals is not shown, nor is the volume of messages sent between hospitals and general practice, which have been some of the most substantial eHealth programs within States and Territories.
The release is found here:
Before discussing a few points that are made in the report I have to say there is one astonishing sentence found in the release. This is:
“This scorecard does not present a complete picture of uptake of eHealth, as it is limited by the data available to NEHTA.”
What on earth is this telling us. As I read it, it is saying we don’t actually know what is actually going on in the e-Health space. Surely if anyone is meant to know and to be reporting what is going on it should be NEHTA. Just what are they being paid for if it is not this as at least part of their role. This all goes back to the increasingly clear fact that NEHTA really is not being governed and led appropriately to meet Australia’s e-Health future.
As far as the contents we have the following.
Page 2.
“Meaningful use data is not yet available to NEHTA in relation to the PCEHR System, though a change request has been progressed through DOHA to expand the data available to NEHTA to allow this reporting to occur. It is expected that the next scorecard will contain more detailed information on use of the PCEHR System. In the meantime, we can report that 4,585 shared health summaries have been uploaded to the PCEHR System as at 31st July, an increase of 230% since 23rd May 2013. More detail about documents uploaded to the PCEHR System by providers can be found in figure 5 on page 5. In addition, figure 8 on page 5 illustrates that ePrescription volumes continue to rise significantly.
There has been no change in the rating of benefit realised. Data that would permit evaluation of the extent to which benefits have been realised is not currently available to NEHTA, though qualitative case studies are indicative of early improvements associated with use of the PCHER System and other eHealth solutions. “
So we have no real idea how much the PCEHR system is actually being used and if DoHA knows - as System Operator - it does not know!
By the way has anyone ever seen a definition of what NEHTA and DoHA think is ‘Meaningful Use’. This is well defined in the US - where the term came from - but in Australia I have seen nothing. Let us all know if you have.
Page 3 seems to be saying that Community Pharmacy has a long way to go at present.
Page 5 shows us that provider usage is still less than 5% of the possible providers.
Page 6 shows us how the paid push has ramped up the numbers of people who have registered for a PCEHR.
Page 7. On the consumer view.
“Meaningful use by consumers appears to remain at a low level, and detailed data is not yet available to NEHTA. The number of consumer portal accesses lags the total number of registrations, indicating that not all consumers are interacting with the PCEHR System after they have registered. By comparison, the frequency of accessing via the mobile gateway, which has been accessed 81,733 times since 12 May 2013, is very high relative to the number of CeHR apps that have been downloaded. This would seem to indicate that the mobile channel is capable of driving relatively high engagement. Lastly, 30,700 documents have been uploaded by consumers; see figure 14 on page 9 for more detail. “
Overall it is just a shocking report as it reveals two amazing things.
1. NEHTA and DoHA are simply not working together closely - why else would we have the comments above about not having information.
2. No one has worked out just what Health Outcomes (which is surely the purpose of the PCEHR) are to be measured.
This is just a mess!
David.

4 comments:

Anonymous said...

Don’t know whether to laugh or cry …

1. No mention of how many providers are registered in the HI Service (and visible in the HPD)
2. Overall proportion of providers registered in the PCEHR is woeful
3. 695 discharge summaries in the PCEHR!
4. Less than 200 providers a week uploading documents
5. About 500 providers a week looking at the PECHR (out of more than 250,000 nationally)
6. PES data (number 8) has nothing to do with the PCEHR program!
7. Cumulative accesses to the PCEHR by consumers = number of registered consumers; therefore, everyone has used it once, presumably when registering!

Best of all is this, from NEHTA’s scorecard website:

“Most notably, the widespread implementation of electronic medical records in hospitals is not shown, nor is the volume of messages sent between hospitals and general practice, which have been some of the most substantial eHealth programs within States and Territories.”

Neither of these two activities have anything to do with NEHTA or the PCEHR program!

Anonymous said...

Health Minister Peter Dutton's minders closely monitored comments on this blog prior to the election. Now they are in power they may be too overwhelmed with other stuff to have time for this blog.

Even so, the consistent messages from years gone by remain the same. The problem will be political. Not much different from what to do about Kevin Rudd - leave him alone to continue doing what he has always done and let the cancer keep spreading.

NEHTA is no different - it has gone beyond the point of no return but it will continue as such if no-one does anything about it. Catch 22. Tragic in the extreme.

Bernard Robertson-Dunn said...

I agree about the problem being political. Potential solutions are also political and so are the risks.

re the PCEHR/NEHTA, at the moment Health Minister (elect?) Peter Dutton has no risk and he need do nothing.

He has said that the PCEHR has been a waste of money - that's no big deal for him and he can't do much about money already spent. What he hasn't said is that he thinks the PCEHR could be a source of trouble - somebody dieing or getting the wrong treatment. If he had, then if something does happen he can be accused of doing nothing, when he should have done something. And in politics, doing something can usually be a defence, even if it is useless.

His risk will greatly start to increase as soon as he says something about the PCEHR/NEHTA - he can then be accused of doing or saying the wrong thing.

IMHO, he has two realistic options.

1. starve PCEHR of funds, let it slowly fall into disuse, claim it was a failure by the past government and terminate it. NEHTA will also probably fade away, because the skilled resources it needs will not want to work for an organisation going nowhere.

2. announce a review, see what happens and make a decision later. They can do this even if they know now exactly what they are going to do with it.

Unless there is a compelling political reason to do something (community outcry, a minister's personal ideological objective or managing future risk are the usual ones), doing nothing is often the preferable option.

However, in this case, my money is on a review. It's political risk management which should buy at least a year. If the minister makes an early announcement that the review will start in July next year (two years after the PCEHR went live and after a suitable amount of time to see how the uptake has gone) that could be stretched out to 18 months.

That also allows the minister to combine option 2 with part of option 1 - starve the PCEHR of funds. The result of that strategy is that he doesn't have to come up with a large amount of money to do something else (the Libs are trying to cut costs) and he is minimising his political risk.

All this is pure speculation. I have no inside or other knowledge whatsoever. However, it is an extrapolation of the current situation of missed opportunities.

When it comes to predictions the most frequently accurate one is "What happens today will happen tomorrow". In the case of eHealth - nothing.

Bernard Robertson-Dunn said...

A follow-up on governments choosing to do nothing, even when they say they want to do something:

Sale of Medibank Private faces delay
http://www.smh.com.au/business/sale-of-medibank-private-faces-delay-20130911-2tkpo.html

Quotes:

The Coalition's plans to expedite the multibillion-dollar sale of health insurance giant Medibank Private have been dealt a blow, with expectations a sale is up to two years away.

Sources say the long-mooted sale won't happen until late 2014, if not 2015, due to the complexity of the task. But others suggest the Coalition won't leave it to the tail end of its first term, because it won't want members thinking of the sale at the ballot box.

...

Legislation enabling the sale of Medibank was enacted by the Howard government but never repealed by Labor despite it opposing a sale.