Wednesday, November 27, 2013

There Seem To Be A Lot Of Docs Not Happy With The Way E-Health Is Being Run.

This appeared a few days ago:

'We got screwed over': e-health GPs speak out

20 November, 2013 Paul Smith
"We got screwed over, didn’t we? We didn’t realise. We were there in the middle of it all trying to make it work, but we were like the woman with the abusive husband, thinking every tomorrow would be a sunny day.”
This is one voice of the many senior doctors who joined the National E-Health Transition Authority to create Australia’s personally controlled electronic health record (PCEHR) system.
It was envisaged that the system would help track patients’ labyrinthine journeys through the health system. One of its central aims was simply to save aeroplanes of patients from falling out of the sky as a result of the two million medication misadventures that happen each year.
The lesson etched in capital letters across the tombstone of every dysfunctional high-cost e-health project around the world has yet to be learnt here, these doctors say. And the lesson is simply that you are wasting your dollars unless you make a system that doctors can trust and use, that offers clear, real-world improvements to their care of patients.
The narrative arc of Australia’s e-health panto-tragedy is reaching a critical phase. The PCEHR is not quite buried. But the new Federal Government’s review of the system — announced this month — is being sold as one last chance to rewrite a script where the corpse is resurrected.
Australian Doctor recently spoke with the main clinical players to get an idea of what has gone wrong and what needs to be done about it. Many of them preferred to remain anonymous, but their stories tell a tale of bureaucratic bungling, expensive errors and minimal understanding of what doctors want.
Chasing the numbers
One measure of the political sensitivities wrapped up in the PCEHR is the effort and expense that was lavished on signing up patients. The government had declared it wanted 500,000 patients registered by July this year. And in politics, when you give bureaucrats a target,  the target gets met — however ludicrous the means employed.
Recruiters were sent out to Medicare offices to get people to put their names down. There were recruiters also camped out in EDs, signing up relatives of those needing treatment. The target was met, just, and the political blushes avoided.
Today, there are more than one million people registered. But who are they? And what benefit has that registration gained them? The joke is that the backpacking community is fully on board with a PCEHR. The problem is that backpackers and many other registrants have no immediate need for e-health records. And so there is no incentive for doctors to enter and curate the information onto the system.
As once clinician put it:
“What we wanted was a group of frequent flyers in the system, those going in and out of hospital, through the hands of different doctors." 
"You, as a doctor, would have seen benefits in terms of the care of the patient. Signing up young people with no real health problems ... what is the point?”
The problem is borne out by the numbers. How many GPs have become nominated providers managing a patient’s e-health record? There has been no response from the Department of Health to that question. How many patients have a ‘live’ shared e-health summary? Australian Doctor has been told about 4000. It is these numbers that furnish Health Minister Peter Dutton’s calculation that the PCEHR is costing $200,000 for every patient it is currently supporting.
Many more war-stories (some which seem a bit exaggerated - possibly by frustration) are found here:
What this really show us is that it is very easy for a reporter to find a good number of doctors who have had contact with Government run e-Health have had very bad experiences.
While ever Australian e-Health is being run in a fashion that leads to outcomes like this we can be sure no progress will happen. The big picture, governance, legislation and trust are all important.
I hope the review team are listening.


Anonymous said...

These doctors were mostly spivs of the highest order, paid six figures sums by NEHTA to lend their "reputations" to the PCEHR. They had no health IT or informatics domain experience, let alone expertise, were more than happy to take the cash, but like so many associated with this project, delivered zero value.
When the election loomed, and it was clear beyond doubt that NEHTA would rightfully be in the crosshairs, they jumped ships like the rats they were.
Now they're having a whinge, but perhaps they should first consider refunding the cash they were paid?

Dr David More MB PhD FACHI said...

Hang on! I think that is a bit too sweeping. Some were experts and some not. I don't think that was really fair to the better or them.


Anonymous said...

My experiences and first hand knowledge from the commencement of the PCEHR project and well before confirms that this article is a very close portrayal of the truth of the way things have been run.

No matter what the outcome of the current review if the people who have been in charge remain absolutely nothing will change...... not even a single spot on a solitary leopard.

Dr David More MB PhD FACHI said...

"No matter what the outcome of the current review if the people who have been in charge remain absolutely nothing will change...... not even a single spot on a solitary leopard."

Absolutely correct.


Anonymous said...

Sorry David, I don't often disagree with you but on this occasion your commentator above is quite right. Spivs, salespeople, they were.

If they had any semblance of the slightest understanding and experience in what is involved in developing ehealthIT systems, (design, development, project management, deployment, quality testing, phased implementation, etc.) they would NOT have run round the country promoting, promoting, promoting to anyone who would listen of the urgent need to get on board and use the system.

This act of absolute stupidity has done more to discredit eHealth's credibility than any other single act.

Mukesh and his mates should have known better and they should have pushed back and said it is too, too, early to beat the drum about something that hasn't even been developed, let alone tested.

Instead, they took the money, and the more they were paid the more they beat the drum. They didn't know better because they were inexperienced; basically IT naive clinicians who thought they knew it all and you can bet they are now edging to get back on board for another trot round the circus ring. How about some new blood.

Dr David More MB PhD FACHI said...

I do agree that the overall outcome of the group's contribution was very poor but equally I do think SOME of them were working to try and fix the unfixable.

We all know they ultimately failed and took way too long to come out and say it was hopeless.


Anonymous said...

..... fix the unfixable .... mmm - isn't that an oxymoron? Even so, it looks as though that is what the PCEHR review Team is focussed on - so are we off on another goose chase?

If something is unfixable - does it not follow that it cannot be fixed?

Dr David More MB PhD FACHI said...

"so are we off on another goose chase?

If something is unfixable - does it not follow that it cannot be fixed?"

Whatever, but I fear they are probably planning to try and fix it and yes that does mean another expensive wild goose chase I believe!

They need to cut their losses.


Bernard Robertson-Dunn said...

Projects are all about assumptions and decisions

In my experience projects go wrong when an invalid assumption or bad decision is made. Once one of these occur, unless it is detected and corrected the project will fail. The earlier in a project this happens, the greater the impact and the harder it is to detect.

In the case of the PCEHR, there seem to have been two questionable assumptions:

1. That a computerised health record, based upon current practices will deliver improved outcomes.

2. That it is possible to develop a big bang solution that satisfies multiple stakeholders with differing and opposing requirements.

In the case of the first assumption, I have seen nothing that justifies this other than naive belief. I have seen no logical explanation of how and why this is a valid assumption.

In the case of the second assumption, to those who understand what it means, it is obviously incorrect. The great difficulty is that those in charge don't understand this. We will see if this is true of the review team, if we ever get to see their conclusions.

Anonymous said...

They need to cut their losses.

I presume you mean lose it down?

I think you may be whistling in the wind on that one David if the AMA submission is anything to go by.

The AMA makes some good points, however, careful scrutiny will reveal they too don't really (get it) understand what they are dealing with except at a very superficial level.

Dr David More MB PhD FACHI said...

Yes - close it down after putting in shared regional information exchange hubs. See my submission a week or so back.


Anonymous said...

..... after putting in shared regional information exchange hubs

Sounds simple. And where are these RIEH going to come from?

Who will establish them? Who will run them? Who will fund them? Will they be viable? Will they all be the same ie standardized? What software will they use? Who will develop the APIs? How will they be updated? Who in the eHealthIT industry will be involved in getting them up and running? Will all the RIEHubs be the same or will they be different? Who will access them? aaaahhhhh so, so many questions to be thought through.

It's so easy to say isn't it David? ----- but not quite so easy to do. Sounds like you are suggesting we adopt the US model!!!!

Dr David More MB PhD FACHI said...


Just let the private sector do it as they are already doing in a number of locations and get big Government out of it. If health information exchange is of no use it won't happen - if it is useful it will!

Done right I think it can be - again read the full set of ideas in my submission.


Anonymous said...

David, I think most intelligent and experienced ehealth practitioners would agree with you. I do.

However, the start-up development cost is not insignificant. It is also a high risk exercise. But that shouldn't deter the brave and courageous from going down that path.

While you advocate getting big government out of it - are you in favour of big government providing some 'funding' to assist the private sector or would that simply open the way for meddling bureaucrats to wield another rod but in a different form?

Dr David More MB PhD FACHI said...

Some are underway with no Government help. I would rather see that with a little supporting grant payments to get started and develop capabilities if needed. Make it competitive and have those who do a good job prosper.

This is what the 2008 Deloittes Strategy suggested as I recall.


Anonymous said...

My real fear is the Review Committee will miss the point entirely and fail to understand that the foundations are NOT IN PLACE despite years of rhetoric.

The CeHA sums it up precisely in their submission - as follows:

....... The submission states that while even the AMA president is suggesting the foundations are in place and all the PCEHR needs now is improved usability for clinicians, this is not actually so.

“Through our extensive discussions and analysis, we have concluded there is a dramatic gulf between the rhetoric and the reality.

“It appears the gulf between the vision of what the PCEHR could provide, and what it is currently capable of providing, is profound.”

Andrew McIntyre said...

Allowing point to point communication with a lot of work improving the quality and detail of the content would allow us to build up quality data and easily transmit it to where it was needed.

I don't think a shared repository is the holy grail at all - what we need is good quality data that can be moved at will. It not sexy and mostly invisible but its a much cheaper strategy. The PCEHR suffers from a lack of quality data to store there. If they had instead spent (a lot less) money on quality improvements in the existing standards, a Personal health record would have been much easier to build, when the data maturity was there. What we have now is a system where nothing really works properly and the whole is less than the sum of the parts.

Bernard Robertson-Dunn said...

An early, architectural decision.

Do you create a large central repository of data that may or may not be complete and/or accurate in case it is needed?


Do you create an interchange mechanism such that all the current data is moved to where it is needed when and only when it is needed? You may still not know how accurate it is.

Has that question ever been asked and analysed and the consequences of each option been identified?

It's obviously been answered, you can tell by the structure of the PCEHR. What we don't know is the thinking behind it - if any. It may have just been an assumption made by a manager with no expertise in architectural decision making.

It's another one of those questions with enormous implications for the answer.

Anonymous said...


Apart from any prior analysis that may or may not have been conducted, which content we are most likely never to see, the biggest question revolves around what individual or group of individuals has actually "made this PCEHR decision", and how on earth they may be held "Accountable" for this Taxpayer funded eHealth travesty!

It would be absolutely no surprise if the analysis and recommendations from "Architects" were one way and the managerial bureaucrats decided to go another way, knowing full well their day of reckoning and "Accountability" would never arrive!

Just think of the recent QH Payroll debacle and its inquisition to see this dysfunctional dynamic played out at tremendous Taxpayers' expense...

Bernard Robertson-Dunn said...

Or, as I quoted in my submission to the review team.

“Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them.”

Laurence J. Peter

Anonymous said...

Implying the Decision makers exercising their decision making authority to deliver the PCEHR in its current guise with all its avoidable problems were:

Neither "highly intelligent" nor "well informed" or both!

But more appropriately, and to utilise the same Wicked Problem resource:

”The command and control paradigm of management reinforces blindness about the true nature of the problem. Inherent in this paradigm is the idea that a person in charge gives the solution (the right solution, the only solution) to other people, who are in charge of implementing it. To function in such a hierarchy often means to collude in systematic denial of the complex and ill-structured dynamics of wicked problems, a phenomenon dubbed ‘skilled incompetence’ by Chris Argyris (e.g. Argyris and Schön 1996).”

”Prof. Halton” and her cohort of eHealth decision making collaborators are ”skilled incompetents” personified!