Wednesday, December 04, 2013

The AIIA Is Worried That The Gravy Train May Be Ending With Respect To The PCEHR.

The Aust. Information Industry Association’s (AIIA) Submission for the PCEHR Review is now available.
Here is the link.
The summary is short and sweet.

OVERVIEW

AIIA strongly supports the advancement of Australia’s ehealth agenda. In this context we support the  development of an electronic health record that consumers can use to share their health related  information with relevant clinicians across the health sector.
Noting the considerable investment that has already been committed to building the PCEHR the AIIA  supports this important asset to drive achievement of Australia’s ehealth objectives and quality healthcare outcomes.
AIIA strongly encourages the Government to leverage this critical infrastructure in the pursuit of a more efficient, effective and patient centric healthcare system. We do not support any consideration that investment into PCEHR be abandoned. Rather we strongly believe there is scope to open the system to innovation and mainstream third party applications (products and services) of value to clinicians and patients. In this regard we believe the ICT industry has a key role in realizing the return on the PCEHR investment
----- End summary
There are then a good few pages of comments on what has gone wrong, which are pretty interesting and identify many issues.
The additional comments are relevant as well:

Additional comments

We would also make the following additional comments.
Concerns have also been raised in relation to:
·         Inadequate project management disciplines to support execution of the project.
·         The complexity of relationships between DOHA, NEHTA and conformance and compliance arrangements (e.g. the CCAGG) has also resulted in a lack of transparency and clear accountability. This also needs to be addressed
·         The role and authority of the Independent Advisory Committee (IAC) has been ambiguous and while industry has been pleased to be involved, it has been unclear how the IAC has contributed to the PCEHR implementation process.
-----
All one can say about all this is that there are a huge governance issues that remain unaddressed.
The recommendations at the end are as follows.

Suggested improvements to accelerate adoption of the platform

As noted in the Overview to this submission, AIIA strongly supports the need to advance a digitally  driven ehealth agenda, including the implementation of an electronic health record. This is imperative to keep pace with global ehealth developments and essential to ensuring the competiveness and sustainability of the Australian health system against the imperative of our demographics.
On this basis  AIIA supports the ongoing development of the PCEHR but makes the following suggestions to drive the content and usability necessary to make it a valued product/service for clinicians and patients.
1. Improve the value of information in the PCEHR.
This will require a health care industry wide focus
on tackling high priority information domains such as medications management, shared health  summaries, pathology, diagnostic imaging , specialist letters and discha rge summaries.
2. To drive consumer take up transition the PCEHR to an opt-out scheme.
This needs to be done at an  appropriate time when the underlying PCEHR solutions and information content are at a reasonable  level of maturity.
In the meantime continued effort is necessary to target take up by key and high use cohorts (e.g. aged, chronically diseased, newborns, indigenous). Simplification of the registration process is also strongly advised.
3. Drive increased clinical use of the PCEHR, through a combination of improved system usability and content and by adjusting other longer term levers such as linking clinical accreditation to the use of electronic health records.
4. Improve the quality, usability and scope  of clinical and consumer technology applications.
This  requires

  •  Addressing the cost and red tape associated with external developers linking applications to the PCEHR infrastructure
  •  Opening up repository based solutions
  • Development of consumer portals to facilitate streamlined integration with PCEHR compliant solutions.

5. Implement a properly considered and sustainable commercial model for key stakeholders involved in the scheme (including government, clinicians and the IT industry).
This is necessary to stimulate innovation and drive sustainable IT investment in the national ehealth agenda.

  • Opening up the PCEHR platform will allow third parties to create many different provider and consumer portals across different platforms (smartphones. Tablets, smart TVs’ T-Box, X-Box etc). The official PCEHR provider and consumer portals are obstacles to wider adoption because there cannot be a one size fits all approach to a user interface. Enabling  mobile  based front - end solutions that are distributed through traditional app stores also offers a mechanism for software developers to be remunerated for their innovation.

Opening up the presentation layer and allowing innovative new front end and specialised interfaces to be created will drive innovation, improve usability and increase adoption by clinicians and consumers.
6. Implement more representative and transparent governance of the PCEHR (and national ehealth)  program, including greater industry, clinical and  consumer representation on key governance  forums and more effective engagement of jurisdictions to support  implementation of the program  at scale.
7. Implement a formal , transparent and authoritative change management  process that is developed and executed with industry involvement.
8. Clarify the role and authority of the Independent Advisory Committee (IAC) specifically in terms of how it contributes to the PCEHR  roll out and future development.
9. Strengthen key project management  and communication  disciplines.
In addition to the above suggestions we reiterate  the need to maintain and enhance PCEHR information  exchange foundations (as noted in the body of this submission)
----- End Submission.
So what the AIIA is saying is the PCEHR is a badly governed, unloved dog, needs a lot of fixing but we should continue on. I wonder who would really want that to happen? (Hint - maybe the Big End of the IT Town who can provide all the services!)
Or am I just too cynical?
David.

9 comments:

Anonymous said...

Wow!

More rent-seeking obsequious codswallop...

AIIA should hang its well-groomed head in shame.

Anonymous said...

All these submissions with all these words. Will the review team read and understand them, and will they act on any of the suggestions or recommendations? I doubt it. It's just a vent to release pent up steam. Everyone feel better now?

Anonymous said...

David,

You must of mixed this up with the Accenture change request for another $100m!

Anonymous said...

Will the review team read and understand them .....

It is reasonable to assume the Review Team will read all the Submissions then attempt to extract the overriding themes, concerns and suggested Recommendations.

They will probably make a genuine effort to draw some conclusions and make some Recommendations. It is at this point they will most likely come completely unstuck and it is at this point the whole exercise can so easily go completely off-the-rails.

We are only privy to some of the Submissions; there are no doubt many more which have not seen the light of day.

The Review Committee has to deal with many, many inter-related highly complex issues which they are not equipped to deal with because they do not have the necessary background and experience (except at a very general level) to do so. They will need some serious help if they are to come up with a credible Report.

Anonymous said...

"The Review Committee has to deal with many, many inter-related highly complex issues which they are not equipped to deal with because they do not have the necessary background and experience (except at a very general level) to do so."

So we have NEHTA and Health, who have demonstrated they don't have the competence or experience to deliver eHealth, the review team, who "do not have the necessary background and experience" and a minister doesn't know the first thing about implementing seriously complex system and who will be acting on advice from both.

The blind leading the blind.

Anonymous said...

12/05/2013 08:08:00 AM sums the situation up perfectly with one omission - the BIG PIGS are working hard to get their snouts back in the trough.

Accenture, KPMG, IBM, Deloitte and the rest of them will be desperately trying to ingratiate themselves to the Review Team - we can help you - it won't cost much - we are big - we have international experience and resources we can bring to bear to sort out the problems, we know how to deal with the little software vendors we do it all the time. Give us another chance - this time it will be different.

K said...

"The blind leading the blind"

I think we are all blind, really - truly, none of us really know what *should* be done - as opposed to picking holes in what is being done (that's all too easy)

But reading these comments... perhaps, rather than having a formal review, we should ask for anonymous comments.

Anonymous said...

I have read a number of these submission summaries now. Each group saying we think the PCEHR should work better for us. There is an elephant in the room. The elephant is that there is *still* no clear identification of who the PCEHR is intended to benefit. Until this is determined any efforts at increasing that benefit for one particular group or another is pointless.

There must be a clear statement of who is intended to benefit from the PCEHR and how that benefit is to be obtained. Is this patients? Is it clinicians? Is it public health reporting? Is it research? Is it other uses like law enforcement and insurance?

It is impossible to even determine the merit of these submissions without an understanding of this intended benefit.

Anonymous said...

When no one is sure what should be done then spending a billion dollars on a whim is reckless. It also stops us finding the right path because the government path is the only game in town. So the billion dollars is not just wasted, it actually prevents innovators from trying out hunches and finding the path. The large consulting companies are just parasites, they are devoid of innovation.