Sunday, November 10, 2013

How Should We Respond To The PCEHR Enquiry Terms Of Reference? Some Interesting Questions Posed. What Have They Missed?

I thought it might be useful to have a look at the Terms of Reference in detail and make a few comments.
Here they are.

Review Terms of Reference

The panel will conduct a Review into the personally controlled electronic health record system dealing with implementation, uptake and including, but not limited to the following:
  • The gaps between the expectations of users and what has been delivered
  • The level of consultation with end users during the development phase
  • The level of use of the PCEHR by health care professions in clinical settings
  • Barriers to increasing usage in clinical settings
  • Key clinician and patient usability issues
  • Work that is still required including new functions that improve the value proposition for clinicians and patients
  • Drivers and incentives to increase usage for both industry and health care professionals
  • The applicability and potential integration of comparable private sector products
  • The future role of the private sector in providing solutions
  • The policy settings required to generate private sector solutions
The Panel will make findings and recommendations to the Minister.
-----
Now one by one with a few comments:
  • The gaps between the expectations of users and what has been delivered
International experience has made it pretty clear that what consumers want from systems like this are things like access to e-mail the doctor, ability to request repeat prescriptions and appointments and access results. Most of this the PCEHR cannot do and at present it does none. Ease of use is also important - not good on this front as well - as well as slow.
For clinicians the needs are for usability, no workflow issues, integrity and no medico-legal issues or liability as well as sufficient useful information to make access worthwhile.
This would only score 2/10 at best.
  • The level of consultation with end users during the development phase
Essentially there was none until very late and this did not actually create a useable system at the time of launch
This would only score 1/10 at best.
  • The level of use of the PCEHR by health care professions in clinical settings
The PCEHR is not designed to be used in the clinical setting - the present practice management systems are. It is an add-on that seems to add delay and extra work for not much benefit at this point. It is thus not all that much used
This would only score 2/10 at best.
  • Barriers to increasing usage in clinical settings
I can’t see that the PCEHR will ever replace the prime clinical systems and will only be used in those settings when it adds value to a consultation for the clinician or the patient. This will require removing all the medico-legal, privacy, security and usability concerns and then to have a network effect expand the usage base in that order. To me this will need a major re-design based on real consultation. It also won’t happen overnight and probably cost a fair bit. A business case is needed on the proposed new system.
This would only score 3/10 at best.
  • Key clinician and patient usability issues
See the discussions above - especially 1 and 4.
This would only score 2/10 at best.
  • Work that is still required including new functions that improve the value proposition for clinicians and patients
As above.
  • Drivers and incentives to increase usage for both industry and health care professionals
The key for clinicians is to ensure that using the national system is cost and workflow neutral while not exposing them to risk.
For industry there needs to be much improved governance and leadership which is not anti-private sector as NEHTA and DoH are presently felt to be - despite their rhetoric.
This would only score 1/10 at best.
  • The applicability and potential integration of comparable private sector products
This depends on what the final - as opposed to the present design of the PCEHR is.
  • The future role of the private sector in providing solutions
There are already private sector solutions (e.g. Extensia and CDM-Net) and these need to be looked at - with others to see what is possible
  • The policy settings required to generate private sector solutions
The main issue here is to stop NEHTA and DoH engaging in behaviours that are costing the private sector money while not providing reasonable conditions for private sector solutions to develop and flourish.
It is also important to remember General Practice is made up of many small businesses who are very cost sensitive and need reasonable compensation for the time spent doing any e-Health activities that are not clearly useful to them or the patient.
----- End responses.
I am interested in all views - as well as comments as to what also needs to be addressed - from strategy, leadership and governance down.
I am reminded of the following quote which seems to say it all.
“If a man does not know what port he is steering for then no wind will be favourable.”
Seneca (4BC - 65AD
Nothing has changed!
As a final note - this appeared the day before yesterday.

Standing Council on Health Communique - 8 November 2013

8 November 2013

Australian Health Ministers met in Launceston today for a meeting of the Standing Council on Health (SCoH). The meeting was chaired by Michelle O’Byrne, Tasmanian Minister for Health.

Items discussed included:

eHealth: Ministers welcomed the announcement by Federal Health Minister, Peter Dutton, that he had commissioned a review of the troubled Personally Controlled Electronic Health Records scheme. To be chaired by Mr Richard Royle, the Review Panel is expected to report to the Minister by mid December 2013.
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I wonder where the submissions go?
David.

3 comments:

Anonymous said...

And will the submissions be published?
We are yet to see any details of the review and its process with the deadline already looming...

Anonymous said...

What, from the most secretive and non transparent government in history?

Perhaps we should have weekly briefings from Scott Morrison on the PCEHR - "sorry but we don't comment on issues in a live-system scenario. We would not want to give out information that can be used by data-smugglers and potential privacy breachers."

Terry Hannan said...

David, I am not trying to sound like a scratched record (indicates my age) but what are Richard Royle's "clinical" credentials for health information systems?
Also my first hand experiences with Michelle O'Byrne re her enthusiasm for e-health were an official appointment in a coffee shop with more of the customers ogling her and handshaking than trying to understand e-health. Her last response to me was "can I take this system back to the premier and tell him (before Lara Giddings) that this will make him money?"