Tuesday, December 17, 2013

For The Record - Mr Dutton’s Second Whack At The Labor PCEHR. Is He Trying To Saying Something?

From early last week - we have in Hansard the following.

Hospitals (and the PCEHR)

Mr LAUNDY (Reid) (15:09): My question is to the Minister for Health and, given today's sitting arrangements, I am looking forward to hearing the answer. Will the minister inform the House of how many patients are treated in private hospitals across Australia every year? What percentage of the estimated 95,000 people who have private health insurance in Reid can expect to have important information in their electronic records accessed and updated if they present at a private hospital for treatment?
Mr DUTTON (DicksonMinister for Health and Minister for Sport) (15:10): I very much thank the member for Reid for his question. He is particularly interested in getting better services for the people of Reid. I have been able to detail some of the achievements of the former health minister—or, rather, the Acting Leader of the Opposition, with all the qualities of Julia Gillard sitting in that chair. She is fully behind the leader She is fully behind Bill Shorten—just like Julia Gillard was behind Kevin Rudd! Remember him?
Ms King: Madam Speaker, I raise a point of order on relevance: he was asked specifically about the electronic health record, and I ask you to draw him back to that question.
The SPEAKER: Thank you. The member can resume her seat.
Mr DUTTON: A fair point of order, Madam Speaker. The member rightly points out that in his electorate he has 95,000 people who hold private health insurance. Bear in mind that the member for Sydney, the former health minister, claimed that it was a great day for the country—the rollout of the personally controlled electronic health record, referred to affectionately as the PCEHR.
When you consider that 95,000 people within just the electorate of Reid have private health insurance, you would have thought that one of the achievements of the member for Sydney would have been that private health insurance patients, when they went into a hospital, could have had their record accessed and updated in that private hospital. We know that around 40 per cent of hospital patients are treated in private hospitals. And yet I explained to the House last week that, in the formation of the personally controlled electronic health record, the previous government forgot to speak to doctors and public hospitals about this record. But now it turns out that they forgot to speak to private hospitals. I will ask for the help of my colleagues here: you would have thought that, of 95,000 people, what—50,000?
Mr Hockey: Forty thousand!
Mr DUTTON: No! Let us say 20,000 of the 95,000—
Government members: No!
Mr DUTTON: Do you think 20,000?
Government members: No!
Mr DUTTON: No! They are too generous; not even 10,000, not even a thousand, not a hundred, not one—not one patient! Unbelievable! Do you know that this former government, this former minister who wants to be the Leader of the Opposition, spent $1 billion on the personally controlled electronic health record. About 10,000 Australians had a record uploaded by their doctor. But we know that people who go into emergency departments and people who go into private hospitals cannot have their record accessed, in many cases, except in, out of the 150 electorates, just one electorate—
Government members: Which one?
Mr DUTTON: Now my colleagues ask, 'Which electorate?' It was one electorate: the electorate of Sydney. But they did not get around to the other 149.
Mr Truss: I move that further questions be placed on the Notice Paper.
Here is the link.
Here is the official info on Mr Laundy.

Biography for LAUNDY, Craig Arthur Samuel

Member for Reid (NSW)
Liberal Party of Australia
Parliamentary Service
Elected to the House of Representatives for Reid, New South Wales, 2013.
Born 16.2.1971, Sydney, NSW.
Qualifications and Occupation before entering Federal Parliament
BEcon&Fin (UNSW).
Link here:
Clearly a Dorothy Dixer followed by a choreographed effort to attack the Opposition at the expense of the failure, so far, of the PCEHR.
What is going on here?  My guess we are being softened up for either:
1. Shutting down the PCEHR.
2. A major revamp of the PCEHR.
The level of this attack does not seem to suggest a small tweak or two. To say both have risks is an understatement!
What do others make of these comments?


Anonymous said...

There are three options
1) Shut it down, then blame the waste and lost opportunity on the Opposition
2) Major re-vamp, and if it doesn’t work, then blame the Opposition because it is hard to revamp something that is bad to begin with
3) Leave it as it is, a useless lump of a thing, and blame its uselessness on the Opposition
There is not enough money to do a major revamp and there is a risk that they too will get it wrong and will share the blame.
It is difficult to shut it down, long legal battles with Accenture and Co, and the lingering thought that perhaps it could have worked? And what do you do with the records that are already there. There is a risk that someone may die because no one could look at the record and there was actually an allergy there….
So they are better off leaving it as it is and using it as a constant reminder of how stupid and silly and wasteful the Opposition was and is. Such a gift!

Anonymous said...

The longer they leave it as it is the sooner they end up wearing the opprobrium for its failure. Your option 1 is the only one that makes any sense.

Anonymous said...

Shut it down, shut it down, shut it down. At this point in time, even Accenture et al would be glad to walk away with what's left of their reputation still (somewhat) intact.

Terry Hannan said...

From my understanding of the dynamics of health care [Hannan TJ, Celia C. Are doctors the structural weakness in the e-health building? Intern Med J. 2013;43(10):1155-64. Epub 2013/10/19.] the PCEHR is the wrong, inexpensive, unsafe and insecure model for the effective change of health care delivery. We need a more enlightened, guided and long-term (at least a decade) directed e-health project that is nationally focussed. The guiding lights for this project must be a collaborative group that understands "health informatics". Seek guidance from those who know and who have done it. A good place to start is the UNSW Australian Centre for Health Innovation with the Coiera's, Westbrrok's, Braithwaite's and others. There are a few others who should also be on the direction of such a national e-health project but there are also others including politicians and administrators who need to possibly eat some "humble informatics pie" to make the project achieve success. If not Australians will remain with inadequate, costly and less than adequate quality health care. Soe4m of us are willing to put our shoulder to the wheel and challenge to current state of affairs and try and steer the e-health boat in the right direction. Just ask!

Anonymous said...

Accenture, why worry about their reputation... it will just be another failed National eHealth rollout to add to their other failures...It is already trashed..

If Accenture or any other companies involved with the PCEHR get a gig in health again, anytime soon, then we have learned nothing from this failure..

Enough about protecting reputations and trying to gain political capital... shut the bloody thing down and start again if you want to take the risk...

But if they do please do so with people that build solutions to cover all stakeholders and make the system meaningful for ALL the users... engage, engage, engage..

Bernard Robertson-Dunn said...

@Terry Hannan's comments about health informatics.

I agree totally.

Health information systems (that's IS, not IT) is all about making better medical decisions to achieve better health outcomes.

That means understanding health information and developing new ways to use that information to make better decisions.

The PCEHR that has been implemented is a very simplistic, technology focused database with connections to other databases. It is not underpinned by an understanding of health information, how that information can facilitate better medical decision making and a change program that implements better decision making.

Health decision making is much more than just accessing and sharing a blob of health data, personally controlled or not. In fact the personally controlled aspect is probably the worst aspect of the whole system, it creates so much uncertainty in the minds of medical decision makers that they are inclined to just ignore it.

IMHO, what should happen is a new start, with none of the individuals who have been in management positions playing a part. It is likely that these individuals are so sure of themselves that they can't learn the lessons of the past. If we are to move forward, those lessons need to be learned.

K said...

BRB: "It is likely that these individuals are so sure of themselves that they can't learn"

You're sounding very sure of yourself. And it doesn't seem to have occurred to you that when you say, "It is not underpinned by an understanding of health information", this is terribly simplistic. There was much understanding, and a lot of work done (that you haven't apparently read). Simply throwing "understanding" at the problem won't actually solve anything, because the lack of it wasn't the problem.

The problems were ambition, timeframes, conflicting views of the requirements that couldn't be reconciled, and politics. How do you propose to solve these things?

btw, It's evident from the deep and insightful comments of the current minister on the subject that things are going to get a lot better.

but hey, look on the bright side- it's only a little amount of money. Just a billion. Nothing.

Bernard Robertson-Dunn said...

K said:

"There was much understanding, and a lot of work done (that you haven't apparently read)"

That's because I haven't been able to find it, and I've asked about such material before. I've been commenting based upon documents I've found on the NEHTA website.

Tell me where these documents are and I'll read them. I'll even change my mind, if they are what you say they are.

Anonymous said...

“The problems were ambition, timeframes, conflicting views of the requirements that couldn't be reconciled, and politics. How do you propose to solve these things?”
Wow this is Project Management 101 - these are critical show-stopping project risks and issues! Especially “conflicting views of requirements that couldn’t be reconciled”. There may have been lots of deep understanding by some, and lots of documents written (despite the fact that this has not been able to accessed by the public), but these are all worth absolutely nothing if the system was built based on conflicting irreconcilable views of the requirements.
One day, this experience will become an excellent example of what can go wrong, to be used in project management training. A side benefit of the PCEHR that was never envisaged.

Bernard Robertson-Dunn said...

K said...

"BRB: "It is likely that these individuals are so sure of themselves that they can't learn"

You're sounding very sure of yourself."

Here's one reason for my comments:

An Insider's Comment on NEHTA's Performance

It was written in 2009. How much would you say they have changed?