Sunday, November 03, 2013

Minister Dutton Announces A Very Brief Enquiry Into The PCEHR. Too Short To Be Useful or Real I Fear.

This was released earlier today.
Hon Mr Peter Dutton MP
Minister for Health and Minister for Sport
3 November 2013
Federal Government to review electronic health records
Federal Health Minister, the Hon Peter Dutton, today announced a review of Australia’s struggling Personally Controlled Electronic Health Records program which has failed to attract enough doctors to participate in the project.
“While the previous Coalition government laid the foundations for ehealth by getting computers into doctors’ practices, Labor comprehensively messed up the next stage and has wasted over a billion dollars in its failed attempt at the second phase - moving to personal electronic health records”.
Mr Dutton said a year after the introduction of the electronic health records system only a fraction of Australians have established a record and for those who have, only a few hundred doctors have added a Shared Health Summary.
“This defeats the purpose of having a national, electronic system that is meant to help save lives.
"The government fully supports the concept of electronic health records but it must be fit for purpose and cost effective. 
 “I am therefore announcing today a review of ehealth records to be chaired by Richard Royle, Executive Director of the UnitingCare Health group in Queensland.
"Mr Royle holds a Bachelor of Arts and Masters of Health Administration degrees, and is an active member of the Executive Team responsible for all of UnitingCare's services in Queensland, including Bluecare and UnitingCare Community, as well as UnitingCare Health.
"In addition, Mr Royle is Vice-President of the Australian Private Hospitals Association and he brings more than 30 years experience in management of public and private health services to the position of Review Chair. He is also overseeing the implementation of Australia’s first fully integrated digital hospital in a pilot project at Hervey Bay in Queensland.”
Mr Dutton said Mr Royle will be assisted in the Review by Dr Steve Hambleton, president of the Australian Medical Association and Andrew Walduck, Chief Information Officer of Australia Post.
"The Review team's expertise encompasses information technology, patient and medical services and business administration which I believe is the right mix to put the electronic health records program back on track."
The Review panel will invite submissions from the public along with key stakeholder groups including peak clinical bodies. The Review will report back to Minister Dutton by mid-December 2013 after which the government will consider the recommendations and respond.
Media contact:  Kay McNiece, Minister Dutton’s Office, 0412 132 58

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.
There is some coverage here as well.

Govt launches e-health records inquiry

9:06am November 3, 2013
Health Minister Peter Dutton said the system cost $1 billion but so far only a few hundred doctors were uploading patients' records into it.
Mr Dutton said there were savings to be made in the health budget through the electronics records system.
"The problem is that the former government spent about $1 billion in this area and the number of people actively using the records numbers in the thousands," he told Sky News.
Mr Dutton said the inquiry would examine, the funding, contracts, governance arrangements and contracts.
"If we don't get it right, I suspect we are going to be having the same discussion in five years time, having spent more money but no patient outcomes," he said.
Mr Dutton said he wanted to make sure the money being spent was spent efficiently.
"At the moment it's a meaningless record, doctors won't embrace it, they are not populating the information, patients are missing out and taxpayers are copping the cost," he said.
Full article here:
So what do we have here:
1. A six week enquiry.
2. No specific e-Health expertise in the key staff.
3. No Medical Software industry representation on the Committee.
4. Very little time for anyone to prepare submissions or be consulted.
5. No apparent commitment to release the outcome of the enquiry.
The question that has to be asked is - “Is this the Clayton’s Enquiry? - the one you have when you are not actually having one” . This comment from Mr Dutton - apparently on Sky News - would seem to suggest so.
“Mr Dutton said he wanted to make sure the money being spent was spent efficiently.
"At the moment it's a meaningless record, doctors won't embrace it, they are not populating the information, patients are missing out and taxpayers are copping the cost," he said.”
Additionally, how could it be possible to properly review a 2.5 year $1 Billion program in less than six weeks?

There really have to be very big questions around all this. What changes could be made to make this flawed idea useful? What are the implications of just hoping all will be OK in the end? What would happen if it was just closed down? Is there anyone who should be held accountable for mislaying a $billion? Can this thing ever deliver real clinical benefits? Is the PCEHR just a way for the Government to collect and mine private information? What has been the damage to the Aussie e-Health sector while all this goes on?

Six weeks is a joke really!
While I will probably make a submission this has to be a con with a pre-determined outcome.


Trevor3130 said...

The clue could be at Ministerial Review of Victorian Health Sector Information and Communication Technology. See, the pdf will take approximately 2 minutes to download using a 56K modem. Maybe the findings from Dutton's review will be an excuse to just mark time on the spot for a while, till things become clearer. Which would be pretty much the same as heading backwards. If that's the case, maybe they'll go right back to the start, forget about shunting massive files around by fibre, and work from a couple or three rock-bottom, basic principles and necessities. That is, have a time for a truly deliberative process that stands up to scrutiny that can followed by punters with dial-up modems.
There are a couple of storm-clouds building that may well rain down hard on the immediate future of HealthIT. One is the wash-out from the "debacle" of the ObamaCare registration technology. The other is the blow-up over surveillance, and how individuals and companies may be reacting. Guardian news has a wonderful piece on the intrusiveness of, and blatant lies & obfuscation being told about, NSA.
Internet companies have given assurances to their users about the security of communications. But the Snowden documents reveal that US and British intelligence agencies have successfully broken or circumvented much of online encryption.
Much of this, the documents reveal, was not done through traditional code-cracking, but instead by making deals with the industry to introduce weaknesses or backdoors into commercial encryption – and even working to covertly undermine the international standards on which encryption relies.
Computer security experts say that by doing this in their quest to access ever more data, the intelligence agencies have compromised the computers of hundreds of millions of ordinary internet users, and undermined one their other key priorities – protecting the US and UK from cyberattacks.
(Too long, I know.)

Saul Kamen said...

David, for once I agree with you.
What can be achieved in 6 weeks without any eHealth expertise?

The outcome is predetermined by the terms of reference:
· The future role of the private sector in providing solutions

· The policy settings required to generate private sector solutions

Looks like the PCEHR will be handed to the private sector with no guarantees for patient privacy and confidentially.

Bernard Robertson-Dunn said...

IMHO, the terms of reference say it all.

"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:"

So, the review will be into the implementation of the health record system. Unless the review team takes a wider view of health information, they will not ask the questions "what health information problems does the PCEHR solve?" and "has the PCEHR solved these problems?"

As I have asked before on this blog, what does a national ehealth record system do that local, health provider systems either do or can do? Especially when the national system does not guarantee accuracy or currency. It would seem that this question is out of scope, but it is one of the more critical questions.

Whoever wrote those terms of reference either does not understand the difference between problem and solution, or does understand the difference but does not want the problem questions to be asked.

To go back to my car metaphor. The review is the equivalent of sending your car off to a mechanic who will deliver a report on the state of the car. The mechanic will not tell you if it is the right sort of car to tow a caravan - because you won't have asked them that question.

Notwithstanding the inappropriateness of the terms of reference taken as a whole, I have some questions about the first one:
"The gaps between the expectations of users and what has been delivered"

Who are the "users"?

What are their "expectations"?

Have these been defined in the review?

Have these been defined in the PCEHR documentation?

Is the review team expecting users to make submissions answering this question?

How will the review team know if all user types have had their views represented?

If there are groups of potential users who refuse to use the system are they to be included as "users"?

How will the review team know they have got all their views?

Anonymous said...

The scope of this inquiry and its terms of reference need to include an inquisitorial view into the taxpayer expenditure and the outcomes achieved if any by both the Wave#1 and Wave#2 eHealth sites as part of the broader PCEHR program!

The panel in its six week review needs to follow the money and have a very sober view of what benefits have been gained if any from the over $1B in taxpayer funded investment.

Any lack of cooperation or active obfuscation by DOHA and/or NEHTA will need to be treated with the greatest of suspicion.

Bernard Robertson-Dunn said...

Here's a suggestion for the review team that they should be able to complete in six weeks.

Ask for a copy of the business cases that were used to justify the funds for NEHTA and the PCEHR.

In that business case there should be an identification of the health outcomes that were to be achieved by spending these funds.

Not benefits, not vague things like improved access to health information, but real health outcomes - things that could not have been achieved without the PCEHR. Lives saved, faster, better health service delivery all that sort of stuff.

Then ask anyone and everyone what health outcomes have been achieved. At the individual level.

What people, how many (we don't need to know their names, just that they exist) and how did the PCEHR enable these better health outcomes. And if the PCEHR was used, but was not a major factore in achieving the health outcome, then that case does not count.

One week to get the business cases, four weeks (overlapping with the request for business cases) for people and organisations to respond to the request for information, one week to analyse and one week to write it up. Job Done.

Probably the most important numbers are:

The first year operational cost divided by the number of improved health outcomes.

The first year operational cost plus, say, one tenth of the setup costs divided by the number of health improved outcomes.

If they wanted to do a bit more work, they could look at the value of the improved health outcomes and relate that to the costs.

Just trying to be helpful, after all, the first term of reference is about expectations of users. My expectation is that the PCEHR delivers value for money. Not exactly a revolutionary concept.