Tuesday, January 28, 2014

I Wonder Do These Provide A Hint As To What The PCEHR Enquiry Might Say?

These appeared last week.
First we had.

Govt mulls PCEHR overhaul

21/01/2014
The Federal Government is considering its response to a review of the controversial Personally Controlled Electronic Health Records system.
The three-member review panel, which was chaired by UnitingCare Health Group Director Richard Royle and included AMA President Dr Steve Hambleton, delivered its report to Health Minister Peter Dutton on 20 December.
Though details of the report and its recommendations have not been disclosed, it is believed to suggest wide-ranging changes to the PCEHR to improve its clinical usefulness and encourage its adoption by patients and doctors.
Mr Dutton said the review looked into significant concerns about the progress and implementation of the PCEHR, and its report “provides a comprehensive plan for the future of electronic health records in Australia”.
In its submission to the review, the AMA called for a fundamental change to the system to reduce patient control.
The AMA said the ability of patients to remove or restrict access to information in the PCEHR undermined its usefulness, because doctors could not be confident that it provided the comprehensive medical information needed to make an accurate diagnosis or properly assess the safety of proposed avenues of treatment.
AMA Vice President Professor Geoffrey Dobb said the capacity of patients to remove information from the record without trace was a fundamental flaw of the system.
“To encourage use of the PCEHR, GPs, community specialists and emergency department specialists must be confident that it contains accurate, up-to-date information,” Professor Dobb said. “Without a fundamental change to increase clinical confidence, the PCEHR does not serve the best interests of patients. As a result, it would be rejected by many doctors, and would fail.”
The full article is found here:
Then we had.

The five most pressing health priorities in 2014


21/01/2014

Trying to identify just five top priorities in an area as complex and ethically fraught as health care is a tough challenge, but that was the task Australian Medicine set for seven of the nation’s leading health advocates and thinkers, including AMA President Dr Steve Hambleton, the nation’s Chief Medical Officer Professor Chris Baggoley, health policy expert Dr Lesley Russell and World Medical Association Council chair Dr Mukesh Haikerwal. Here they provide their thought-provoking and insightful responses.
AMA President Dr Steve Hambleton
1.  Make population health a cross-portfolio priority for all levels of government
Population health is not just about treating illness. It’s also about keeping people well, and all portfolios (Agriculture, Defence, Education, Employment, Environment, Finance, Foreign Affairs and Trade, Health, Immigration and Border Protection, Industry, Infrastructure and Regional Development, Social Services, Treasury etc) need to do their part to fight the threat of non-communicable diseases which stem from tobacco, alcohol, over-nutrition and under- exercise. 
2. Continue the investment in closing the life expectancy gap between Aboriginal and Torres Strait Islander peoples and all Australians
All governments need to keep up the investment, but not just in the health portfolio. There is stark evidence that investing in the social determinants of health and a good education, starting at birth, are major predictors of health outcomes.
3. Fix e-health and the PCEHR
We must be able to talk to each other in the same language -general practice, hospitals (public and private), public outpatients, private specialists, aged and community care. Too often the right message just does not get through. Let's get the (e) rail gauge right and use it. 
4. Reduce unwarranted clinical variation
The fastest way to save health dollars and achieve better outcomes is to (as Professor Lord Ari Darzi advised at the 2012 AMA National Conference) “close the gap between what we know and what we do”.  We know we are doing a good job and are very cost effective. If we embrace the move of learned colleges toward clinical audit and self-reflection we can make best practice even better.
5. Invest in research
The human papillomavirus vaccine will save millions of lives. Research delivered and refined the place of statins, also saving millions of lives. We need new ways of treating infections, perhaps more antibiotics or better ways to use the ones we already have.
Heaps of other views here:
To me these article suggest there are priorities for the AMA in:
1. Standards and interoperability.
2. Governance and control of clinical information
3. Data quality
4. Clinician Trust and Use.
Given both these articles have come out from the AMA after Dr Hambleton finished the PCEHR review for the Health Minister we can conclude these issues may have been canvassed in the comprehensive plan given to the Minister.
What is your take on these clues?
David.

16 comments:

Anonymous said...

My take is this. The bureaucrats are pouring over the document identifying the 'bits' they can get their hands on and preparing to turn them into some new and exciting projects which will keep them occupied for years to come.

Anonymous said...

It's a simple case of moving with the times and ducking the Treasurer's long knives. How else can we survive?

Dr David More MB PhD FACHI said...

I think most who read here hope you won't in your present incompetent, money wasting form!

This cycle of the same bureaucrats turning up endlessly and stuffing up endlessly really needs to stop IMVHO.

David.

Anonymous said...

What would you suggest? There are only a handful of public servants with expertise in ehealth. If we didn't do the ehealth work required by and for the department - who would? Are you suggesting 'they' just conjure up a whole new batch of public servants with experience in ehealth? Where would they find them? Do you get my drift?

Dr David More MB PhD FACHI said...

I suggest you - and the Secretary - all resign so some people who know what they are talking about can offer to assist. Since 1990 all the national e-Health initiatives have been pretty dismal failures as far as I can see - if there is an evaluation report or two to show otherwise we would all love to read it!

Not to be rude but the present e-health bureaucracy is way past its use by date.

David.


Dr David More MB PhD FACHI said...

BTW - there is no shortage of really smart eHealth people around - it is just that their voices are ignored and suppressed!

David.

Anonymous said...

Kate MacDonald reports in Pulse & IT (22 Jan) that release 5 of the PCEHR has been 'suspended' pending the result of the review. This makes sense; some had expected it to be implemented much earlier, but the Dept was pushing ahead with related meetings until very close to Xmas (and the review submission date).

Anonymous said...

"there is no shortage of really smart eHealth people around" ..... that may well be so but will they join the public service and work in the Department as ehealth experts if invited to do so?

Dr David More MB PhD FACHI said...


"that may well be so but will they join the public service and work in the Department as ehealth experts if invited to do so?"

Of course they would if there were decent governance structures and quality leadership was in place.

Right now that is totally absent in the view of most who know anything about e-Health in OZ.

David.

Anonymous said...

With due respect to the bureaucrats who have e-health expertise, all you need to do is engage actively and meaningfully with the those (many) people who have the expertise you don't. They won't, and indeed they shouldn't, come into the bureaucracy to work, because that allows them to speak 'truth to power' in a way you cannot. You need their brains not their muscle .

What you should stop doing is lining the pockets of the big consulting houses who know nothing about this area, but spin a pretty line, and who end up coming to us after they get their juicy contracts and ask for free advice on how they should deliver on what they promised you.

If you look at the way the US has forged ahead with meaningful use, it has created structures that draw in the talents of a wide variety of individuals, many from industry, health services and academia, to work on specific projects at high level (e.g. designing the rules for MU). Only one or two of them ever get drawn into being employed but the Feds.

Anonymous said...

Anybody who says "all you need to do is ...." doesn't understand the situation.

Anonymous said...

Oh I think we (outsiders) understand the situation pretty well indeed ... too well.

I just don't think the e-health bureaucracy is ready to admit what we can all see as plain as day. The PCEHR hasn't worked. It won't work. It was a (very expensive) mistake.

Still early on in the denial/acceptance process for you all I guess. Sorry about that.


Trevor3130 said...

http://www.inwmml.org.au/_uploads/_ckev/files/04%20Feb%2014%20eHealthFINAL2.pdf should be good.

Anonymous said...

Re the workshop Trevor linked to

Quote

At the completion of the workshop participants will have:

• An understanding of the current PCEHR functionality and how to exploit it
• An understanding of future funtionality and how it will help GPs have the right data at the right time for the right patient
• Increased knowledge of the benefits available to patients who use the PCEHR


It should be quite a short workshop. The PCEHR doesn't do much, the data is questionable/unreliable and the benefits to patients do not outweigh the significant costs and risks. Should take about ten minutes.

If Dr Swan asks any difficult questions it will just reinforce Mr Abbott's view that the ABC is out to get this government. Mr Abbott wants the ABC to stick to reporting the truth. Unfortunately, Mr Abbott thinks that the truth is whatever his government says. He cannot tolerate or understand informed dissent. Sad days for democracy.

Anonymous said...

Get real - this is funded by a Medicare Local which are funded by DOHA. This has nothing to do with the ABC. Norman Swan is there to sell the party line, pure and simple

Anonymous said...

Interesting that the interactive workshop starts with the question "Is the PCEHR the Emperor's new clothes?"