Tuesday, December 10, 2013

Another Thought On The PCEHR Review. What Happens After The Review? Updated 12:00pm 10/12/2013

Was thinking about the review and the possible outcomes from the current review.

My mind then wandered to the practicalities that might need to follow.

I anything is planned in the way of trying to modify / fix the PCEHR then it would be foolish not to attempt to do it properly.

Inevitably this would then have to be a consultative, thorough, technically complex and hardly short or cheap effort.

To me this suggests that the review team has a rather binary choice in front of it. It can either

1. Can / Kill the PCEHR and work on all the other e-Health things that need to be fixed.

2. Specify major change to actually attempt a proper fix and then undertake properly a large, complex, expensive, time consuming and risky project to fix the both the central system and all the associated practice systems while keeping something running in the mean time.

The second option would be hard to recommend I reckon given the track record of many of those involved who, almost inevitably, would be involved again!

The downstream implications of what the short review recommends has not really been given enough thought I believe.

What do others think? This seems like a big largely unmentioned issue to me.

David.

Addendum: I just have to say that the risks of any project to try an fix the PCEHR from this point really must not be underestimated. An obvious problem is that a small fix almost certainly won't work and the major re-design will really require a project that will be close to the scale, complexity and cost of the original PCEHR to date. Essentially that seems to suggest spending little will be a waste and spending what would be needed may very well cause a cash strapped Government heartburn.

Is that why Mr Dutton keeps lashing out at the PCEHR?

See here for yesterday's comments:

http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;db=CHAMBER;id=chamber%2Fhansardr%2F5f0f5c44-95ba-4857-8d00-f969c7b99627%2F0096;query=Id%3A%22chamber%2Fhansardr%2F5f0f5c44-95ba-4857-8d00-f969c7b99627%2F0000%22

D.

13 comments:

Bernard Robertson-Dunn said...

I'll repeat my analogy - If a house is built in the wrong place, no amount of tinkering with the building can change the house such that it ends up in the right place.

In the case of the PCEHR, the problem is with the fundamentals - the lack of understanding in the information domain.

They can play about with the technology as much as they like but they won't address the real issue - the answers to the following:

1. what information is needed by whom, to assist them doing what jobs in order to achieve what health outcomes?

2. How can existing processes be improved because of improved information management?

3. what is the lifecycle of the information?

4. what protections need to be put in place to prevent misuse of the information without negatively impacting (1)?

5. what is the status (accuracy) of the existing information? What needs to be done to accommodate this status (e.g. ignore bad data, clean up bad data)

It's all about the information not the technology.

Any set of recommendations that do not start by addressing the information issues will, IMHO, be worse than useless.

Anonymous said...

The review team does not have the expertise to even contemplate attempting point 2.

And, as you rightly observe, if those who created this disaster are involved again we will get the same result. The perpetrators of this disaster can't think of new ways to approach the problem because they are so emotionally wedded to the old ways that got us all to where we are today.

Anonymous said...

I understand your house analogy but unfortunately some buildings have been relocated using big trucks. Sometimes they have been split-up, moved, put on new foundations and rejoined (refinished). [insert small smirk] I'm not being serious, just a little cheeky, so take it with a sense of humour.
~~~~ Tim C

Anonymous said...

Wouldn't it be refreshing if this kind of scrutiny (politically motivated though it may be) was executed and attention brought to the dysfunctional implementation and outcomes of the PCEHR for the $1B in taxpayers expense at the regularly scheduled Senate Estimates committee meetings?

Why is this so, and why is it not so for Senate Estimates??

Prof. Halton, her DOHA cohort and NEHTA shills should be subjected to this level of interrogation and held accountable for these dismal facts!


Bernard Robertson-Dunn said...

Tim C said:

"I understand your house analogy but unfortunately some buildings have been relocated using big trucks."

You are quite correct and it fits my analogy exactly. It is important to understand that those who move buildings have a different set of skills, experiences (and tools) from those who built the thing. It's also much harder to move a building than to build it in the right place to start with.

Or to quote another saying - it takes a lot more skill and expertise to fix a problem than it took cause it.

Anonymous said...

Reading this article and associated comments, Are the problems with the underlying healthcare processes - noting the comments about a lack of information support people providing healthcare; even a lack of common understanding of what is required; and Dr More's persistence theme (my summary) of ensuring a care team has the right information at the right time, i.e. accurately and timely communication within a healthcare team.

I would to like to hear comments about if have correct environment to fund/encourage and make use of our precious healthcare expertise to provide effective healthcare into the future.

The PCEHR (a repository of some healthcare information) seems secondary to the broader issues.

Dr Ian Colclough said...

12/10/2013 06:00:00 PM asked "if have correct environment to fund/encourage and make use of our precious healthcare expertise to provide effective healthcare into the future."

I assume you are asking specifically about the ehealth environment and ehealth expertise.

The answer to your question is a resounding NO - we do not have the right environment or the right policies in place to optimally harness the expertise to deliver effective ehealth solutions for the nation.

Whenever I have raised the issue and suggested some alternative approaches I have been treated like an heretic and the only response the bureaucrats have been able to come back with is - OH, WE CAN'T DO THAT BECAUSE WE HAVE NEVER DONE IT THAT WAY, WE HAVE OUR PROCESSES AND THEY MUST BE FOLLOWED.

Boxed in thinking has never solved a wicked problem. I'm sure Bernard Robertson-Dunn will agree with me.

Bernard Robertson-Dunn said...

Dr Ian Colclough said

"Boxed in thinking has never solved a wicked problem"

If by "boxed in thinking", you mean a sequential, linear, "here's a solution that has worked before, so it must be good", "just follow the process and out will fall a good solution" approach, then yes, I agree completely.

Anonymous said...

What happens after the review?

You might be best looking at what is happening during the review! DoH are making a huge mess of things

Eric Browne said...

bernard wrote:
"Or to quote another saying - it takes a lot more skill and expertise to fix a problem than it took cause it."

Moreover, some problems just can't be fixed, just as some houses can't be relocated.

For example, my house can neither be fixed, nor relocated - http://blog.healthbase.info/?p=289.

Emma Hossack said...
This comment has been removed by a blog administrator.
Emma Hossack said...

It reminds me of another failed project, the Qld Health Payroll fiasco. Originally an $80B project, down the track with fixes running at an estimated $1B, its still not working. Applying more resources to fix the PCeHR would be like applying lipstick to a pig

Anonymous said...

"I understand your house analogy but unfortunately some buildings have been relocated using big trucks."

Perhaps a recommendation of the review could be to make use of the PCEHR truck for this purpose? Where is that truck now we need it?