Friday, November 29, 2013

HISA Offers Views Gathered From A Pretty Large Survey. The Recommendations Are Very Self- Serving And Fail To Grasp The Main Problems in My View.

Here is the link:
Short Extract.
The Recommendations are:
Section 14.0

Recommendations

Involvement, Expectations, Consultation and Use
Recommendation 1:
That the PCEHR Review recommends the immediate, comprehensive and extensive integration of health information/informatics professionals into  current and future PCEHR and related infrastructure design, build and implementation and, importantly, health provider infrastructure’s implementation of the PCEHR, and its linkage with other EMRs and fund management IT.
Barriers, Usability and Future Work Required
Recommendation 2:
The PCEHR Review recommends the high and immediate prioritisation of the engagement of health and health information professional associations and colleges in the change management process required to ensure adoption of the  PCEHR and  enable its vital contribution to health reform success.
Key Drivers and Incentives
Recommendation 3:
The PCEHR Review Panel consider  engaging HISA and HIMAA to undertake a  comprehensive qualitative analysis of the 4590 individual free text responses  contributed by the 673 respondents
This analysis should be done over the course of the next 1-2 weeks to provide valuable data to inform  the Panel’s final report, or post-report to inform report implementation Strategies to Improve Adoption in Three Categories
Category One –Simplify Registration Processes & Improve Training & Support Approaches
Recommendation 4:
The PCEHR Review recommends the convening and resourcing of a handpicked  working group to simplify all aspects of the PCEHR registration processes for both HIMAA and HISA: Experts in e-health, health informatics and health information management HISA-HIMAA PCEHR Inquiry Submission providers and the public.
This working group need to have regard for a balance between the need for controls and accountability, but also need to clearly recognise that the current processes are acting as severe impediments to the whole system and arrangements. This work needs to be completed by early February 2014.
Recommendation 5:
The PCEHR Review recommends that, in parallel with recommendation 4, the implementation of phase II of the recent workforce productivity, change and adoption work with AML Alliance on EHealth Support Officers’ competencies and skills be progressed.
This work, which includes the proposed Competency  Framework Toolbox, needs to be completed by late February 2014 so the E Health  Support Officers are better equipped to support primary care providers to embrace the PCEHR , particularly  as more registrations are completed through the simplified  registration processes.
Category Two –Medication Management through Engaging the Pharmacy Guild plus Radiology & Pathology
Recommendation 6:
The PCEHR Review recommends the development of a strategy to achieve the holistic and seamless sharing of pathology and radiology information in the PCEHR.
This strategy must be practically designed, with the support of the  Pharmacy Guild andthe respective pathology and radiology professional bodies, such thata richer functionality of the PCEHR can be more readily achieved.
Category Three Proper Participation by Hospitals with Discharge Summaries Universally Implemented
Recommendation 7:
The PCEHR Review recommends the consideration by COAG ,through AHMAC of how to fast-track  universal hospital participation in the PCEHR .
The initial focus needs to be upon the implementation of universally available electronic discharge summaries in all jurisdictions by mid-2016. This particular functionality should provide a clear purpose and focus for the universal engagement of the hospital sector throughout Australia.
Recommendation 8:
The PCEHR Review recommends harnessing the currently convened multijurisdictional CIO group as the vehicle for development of a practical and collaborative model for designing a national roll out scheme for the PCEHR and associated infrastructure for enabling universal hospital participation.
Private Sector Involvement and Standards
Recommendation 9:
The PCEHR Review recommends vesting authority for the development and maintenance of technical and professional standards and associated engagement and change management strategies in the professional bodies concerned, rather than in the private sector or in government bureaucracy.
Government, however, should play a central role in auspicing, funding and supporting this authority and the infrastructure required for the PCEHR (terminology, identifiers, secure messaging).
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HISA and HIMAA commend this submission to the PCEHR Review Panel, and wish it well in its deliberations. Our two organisations would welcome further involvement in the review process, either within the Panel’s current terms of reference or beyond.
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Really they just seem to want more paid work and fail to see what an awful project this actually is. They simply assume the PCEHR is a wonderful and glorious thing and should roll on forever.
Where are the recommendations as to what is needed to be reviewed and properly fixed in the PCEHR, what is wrong with the status quo etc. Just adding extra functions to a flop is hardly a plan.
What nonsense!
David.

13 comments:

Anonymous said...

The quality of academic eHealth is not high. Wheel reinvention is the rule, they appear to ignore existing standards and start everything from scratch, which is not going to fly in the real world. HIC conferences are very frustrating events because of this.

Dr Ian Colclough said...

The Recommendations are disappointing. They miss the point about the root cause of the underlying problems with the PCEHR project and in so doing they convey the impression that the PCEHR - as you say David “is a wonderful and glorious thing”.

Putting the HISA/HIMAA Recommendations to one side and after perusing the Submission it appears there is a gold mine of potentially valuable ‘information’ concealed in the Report which may never see the light of day.

673 Respondents is a significant survey base.

4,590 individual free text responses (averaging 7 per respondent) are probably where a great deal of TRUTH lies; no doubt reflecting a considerable degree of frustration, anger and disillusionment among the apparently diverse respondent population.

Undertaking a quantitative analysis of the free text responses to produce a summary report could therefore be useful. However, what would no doubt be more useful would be to publish the responses under their respective questionnaire categories in their raw form.

This should not be too onerous a task and certainly less costly and time consuming than doing the analysis as recommended. The naked truth is often more revealing; regardless of from which side of the fence it originates.

Eric Browne said...

I agree with your assessment David. I consider it an embarrassment for the members who responded to the survey in good faith. I've been a member of HISA for about 14 years. This is the first time I've been ashamed by their contribution to the e-health agenda in Australia. Very self-serving.

I applaud HISA and HIMAA for conducting the survey. I don't applaud them for the submission. There isn't even a cursory analysis of the 1600 volunteered examples of blockages to using the PCEHR supplied by over 70% of respondents. There's not even a coarse classification of them.

Bernard Robertson-Dunn said...

David,

I also agree with your assessment. I'm particularly gobsmacked by this:

"The PCEHR Review Panel consider engaging HISA and HIMAA to undertake a comprehensive qualitative analysis of the 4590 individual free text responses contributed by the 673 respondents."

Crowd-sourcing (which is what this is) may be OK at guessing the number of beans in a jar, but it is of no use whatsoever when it comes to developing creative and innovative solutions to complex problems. This takes competence and leadership.

As I've said before, and will continue to say, the problems with the PCEHR are in the fundamentals, not the details of specific functionalities. It doesn't matter what you do to a house to improve it if it has been built in the wrong place.

And I have exactly the same criticism of the RACGP who wants the system's developers to work on consolidating existing PCEHR functionality.

Anonymous said...

So who were the authors of this funding request? Should say a lot once we find that out.

Anonymous said...

At least they are open and honest about it.

Anonymous said...

I'm very disappointed in both the recommendations and the summary of issues HISA/HIMMA have presented. As a member of HISA, I had expected a much more impartial, informed and objective representation of views, rather than a self serving political positioning piece.
Shame on them.

Anonymous said...

HISA/HIMMA are being more obsequious than self-serving which is their only rational response to not "bite the hand that feeds them"!

While the power and money are concentrated in so few bureaucratic hands within Australia's healthcare system, expecting anything other than these self-affirming and self-serving responses is irrational.

Biggest reason, I suspect why the large majority of feedback and commentary on this BLOG is Anonymous!

To do anything otherwise is to be ostracized.

Dr David More MB PhD FACHI said...

That may well turn out to be a very stupid approach - Let's see how this plays out.

David

Anonymous said...

In all the submissions the issue of "TRUST" has not been the main focus of the responses. It is in some but not all, and not covered in detail.

If Consumers, GPs, other Health Professionals etc. do not have TRUST in the system, they simply will not use the it.

If the Government is involved you already have a TRUST issue.

TRUST is the main factor, PRIVACY, LEGAL OBLIGATIONS, ACCESS, DATA OWNERSHIP are the other key factors (linked to TRUST)that must be addressed.

Standards, design, meaningful use etc. are important, but without TRUST they are superfluous..

Who is truly addressing the TRUST factor?

Anonymous said...

11/29/2013 10:53:00 AM Anonymous said... the quality of academic eHealth is not high. Wheel reinvention is the rule, .....

Academe is driven by undertaking research in the drive for publications which underpins the pursuit of funding grants to sustain the squirrel in the cage - Academe.

That is not to denigrate Academe. It has an important role to play in eHealth. But the eHealth Academics are not:
- commercially pragmatic
- risk averse
- experienced in running a business

They live in a different atmospheric bubble from those eHealth practitioners who have to survive in the real world battling the vagaries of the bureaucrats who try to help but know nothing about the business of ehealth or the broader health industry.

Bernard Robertson-Dunn said...

Anonymous said...

In all the submissions the issue of "TRUST" has not been the main focus of the responses. It is in some but not all, and not covered in detail.

That's because trust, or lack of it, is a consequence, or property, of the system. Many bad decisions have led to this lack of trust and much of the focus has been on these decisions rather than trust itself.

Any half decent Information (not ICT) System architect would have taken trust as a major driver for the system and factored in how it should be achieved during the design and implementation stages. I haven't seen any evidence of artefacts produced by an IS architect, never mind ones that discuss trust.

And to answer the question "Who is truly addressing the TRUST factor?" - nobody has. And that's the problem. The PCEHR has been implemented as an ICT system, not an information system. (Sorry, I'm repeating myself).

Who should have addressed the trust factor? Those who developed the business case.

Oh dear!! There was no business case. Therein lies yet another early decision that's now causing trouble.

Dr David More MB PhD FACHI said...

Can I just say the trust was pretty heavily featured in my submission among a good number of others.

David.