Sunday, January 19, 2014

In The Oddest Of Places We Discover Just Why The Government Is Pushing The PCEHR So Hard!

I found this as I was checking the Health Department web site for news. From the review date this page is clearly very current. The section that really matters is at the bottom of the article.

eHealth

Reviewed: 13/01/2014

Overview 

Electronic health (eHealth) is the combined use of electronic communication and information technology in the health sector. An eHealth record is an electronic health record that contains a summary of your health information.
Each time you visit your doctor, a hospital or other medical facilities such as imaging and radiology clinics, important information about your health is created and stored in separate files – which may be paper or electronic – at each of these locations. However, even if your health information is stored electronically on a computer at some or all of these places, many of these systems are not connected which makes it difficult to share your health information between your different healthcare professionals.

Personally controlled electronic health record

A personally controlled electronic health record (PCEHR) will enable better access to important health information held in dispersed records across the country. It will allow you to set your own access controls and specify what information can be viewed and by whom. You can also add your own notes, and allow healthcare professionals to view this information and to also add new information to your record. This increases the ease of sharing health information. You can also access it whenever you need to, from wherever you are, using a web-enabled device through the consumer interface portal, even if you are travelling interstate. However, specific ‘applications’ are not being provided for mobile devices such as iPads, tablets and smartphones.
A PCEHR will not be automatically created for you. If you choose not to have one, you will still have the same access to the health system as you currently do. If you choose to have a PCEHR, then you must register in one of the following ways:
  • online at the eHealth website
  • over the phone by calling 1800 723 471 and selecting option one.
  • in person by visiting a Department of Human Services service centre that offers Medicare services
  • in writing by completing a registration application form available from a service centre offering Medicare services, or from the eHealth website. Once the form is completed you need to post it to: Personally Controlled eHealth Record Program, GPO Box 9942, in your capital city.
Your PCEHR will not replace your existing health records, but information can be added when you see a doctor, get a new prescription or visit a specialist. This will build up an overview of your health over time, allowing better access to your health information, better healthcare delivery and greater involvement in your health choices.

Caring for someone else

If you are caring for someone who may not be able to create and manage a PCEHR on their own behalf, but it would be beneficial to have their health information in one location, you can apply to be their authorised representative. The PCEHR system will need to verify your legal authority, and once this process has occurred you will be given the same access and controls as the individual. There can also be more than one authorised representative. For more information go to yourhealth.
There are also strong security and privacy safeguards to keep your information safe. For example, you will have a user ID and password to access your PCEHR, and you can also see who has accessed or updated it. If you think that someone has accessed your information inappropriately you can contact the eHealth helpline by calling 1800 723 471.
Healthcare organisations can also register to participate in the eHealth record system and authorise doctors, nurses and other appropriate users within their organisation to view patient records through the secure online provider portal.
For more information go to public learning, or call the eHealth helpline on 1800 723 471
SourcesDepartment of Health and Ageing (General consumer FAQs, The PCEHR Consumer Booklet, Concept of Operations: Relating to the introduction of a Personally Controlled Electronic Health Record System, Personally controlled electronic health records)National eHealth Transition Authority (eHealth records, What is an eHealth record?, What is eHealth?)

Facts and figures

  • The Australian Government’s PCEHR system was launched on 1 July 2012.
  • The estimated net direct benefits of the national PCEHR system are expected to be approximately $11.5 billion over the 2010 - 2025 period. This comprises approximately $9.5 billion in net direct benefits to Australian governments and $2 billion in net direct benefits to the private sector (households, doctors, specialists, allied health clinics, private hospitals and private health insurance providers).
  • The forecast reduced avoidable hospital admissions and doctor visits due to more effective medication management from 2010 - 2025 is approximately $10 billion.
  • The forecast improved continuity of care benefit from 2010 - 2025 is approximately $11.5 billion.
SourceDepartment of Health and Ageing (Expected benefits of the national PCEHR system, Personally controlled electronic health records)
The page is found here:

There are more details on the projections here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr-benefits

It is the facts and figures that caught my eye. I had seen them ages ago but had not picked up what they might mean - especially with the focus on and nature of the benefits being made so clear with the Department re-publishing them so recently. Thanks to a mate for spotting the source!

A few points need to be made.
1. It seems the Government is wanting, and planning to collect,  the vast majority of the planned benefits with very little left for everyone else. It is absolutely clear from this that the PCEHR is not a program designed to benefit patients and clinicians.
2.  The start date of the study (2010) is before the PCEHR was a twinkle in anyone’s eye - so this is almost certainly information based in NEHTA’s IEHR which was very different to the PCEHR.
3. The PCEHR is really not a medication management system - although it may be a medication recording system.
4. The PCEHR as of 2014 is hardly a widely used system so it is likely these forecasts are way too optimistic.
The bottom line here is that the PCEHR is a system being pushed on the public and clinicians for the benefit of the Government on the basis of amazingly rubbery and obsolete figures.
What a farce and what a surprise the Department is still pushing this nonsense after the change of Government. Is there some news here?
David.

13 comments:

Anonymous said...

All spin, no reality. It's called politics.

The sort of stuff that Christopher Pyne would latch onto. No evidence, no facts - all smoke and mirrors.

Anonymous said...

Bureaucrats hard at work - squirrels in a cage with no door - well protected and isolated from the real world. They can't get out, they can't go back, they can't stop, and they can't get off the bottom level.

Keith said...

These numbers, based on a report by Deloittes, have been bandied around by various health ministers and others for about the last 18 months. This "research" has to rate as some of the sloppiest and dishonest work ever to be fed to the Australian public.

1.In order to come up with a positive result the savings are projected over a period of 14 years! This alone should make the reader immediately suspicious, when most government departments (even Treasury) can't predict an outcome for the current year with even 2-digit accuracy.

2. The methodology requires estimating health costs over that period without the PCEHR, and again with the PCEHR and comparing the two. That is, they come up with two very large and very rubbery figures and subtract one from the other. Notwithstanding the obvious uncertainties inherent in this process, Deloittes then quote the saving to five digit accuracy - $11.545B!

3. No quantitave assumptions about participation rates, either of practitioners or public, are given, even though the results obviously depend critically on how much the PCEHR is actually used.

4. About 90% of the savings come from a reduction in hospital admissions brought about by medication errors and adverse drug events. The idea that a significant number of medication-related hospital admissions are preventable can be traced back to a pair of papers by Elizabeth Roughead and Susan Semple. I have no problem with their conclusions, but they have been widely misquoted and misinterpreted. It is unlikely that the incomplete and relatively untrusted medication record in the PCEHR would prevent many of these admissions.

Anonymous said...

"It is unlikely that the incomplete and relatively untrusted medication record in the PCEHR would prevent many of these admissions."

More likely to cause more admissions...

Anonymous said...

Complete rubbish - all off it, every word.

Bernard Robertson-Dunn said...

It would seem that the government is trying to justify the PCEHR along the lines of better health care and at a lower cost, both excellent goals.

However, IMHO, there is a huge gap between the claim and reality.

Is there publicly available any justification for the government's claim? Something that shows cause and effect?

Without a credible and justifiable explanation of how the PCEHR will achieve these improved health outcomes at lower cost, then it's just cargo cult thinking.

Dr David More MB PhD FACHI said...

"Without a credible and justifiable explanation of how the PCEHR will achieve these improved health outcomes at lower cost, then it's just cargo cult thinking."

I could hardly have put it better myself. Keith, of course nailed the truth in his comment I believe!

David.

Anonymous said...

Don’t worry. ;) A review has occurred and the report is with the Minister. Surely it will say: ‘the goalposts have been changed (from the iEHR) and so now we need to re-do the sums, else we don’t know what to aim for’. We already know we are measuring the wrong things (the numbers of people ‘signed up’). When we know what we are aiming for, and we are measuring it, the PCEHR will succeed.
(reminds me – didn’t we pay the Benefits Realisation Partner to do this?)

Anonymous said...

I think the term "Cargo Cult" captures the DOHA and NEHTA management think extremely well. All this IT stuff is magic to them and they just want more of it.

This quote from Wikipedia covers it:

The term "cargo cult" has been used metaphorically to describe an attempt to recreate successful outcomes by replicating circumstances associated with those outcomes, although those circumstances are either unrelated to the causes of outcomes or insufficient to produce them by themselves. In the former case, this is an instance of the post hoc ergo propter hoc fallacy.

This explains much, they are creating the impression of doing something and hoping that the "cargo" will magically appear because they appear to have recreated all the appearances of knowing what they are doing. A bit sad really.

Anonymous said...

Contemplate this all ye who loiter here -----
---- the 'revamp' of Medicare Locals into 'whatever' will embrace a 'relaunch' of the PCEHR aligned with a 'remodeling' of NEHTA's operations under 'tighter' control of DOHA and the Departmental Secretary
---- and the world will spin one more time while the squirrel in his cage struggles to reach the next rung ahead.

Anonymous said...

Certain people should be careful what they wish for. There will be fewer managers to blame when there's "tighter" control.

Anonymous said...

When you've got yourself into a big hole, you can't get out by digging harder.

Anonymous said...

Who would have thought that a modern day Cargo Cult would be discovered in the DOHA in Canberra. They have built a shell of a system and all the expensive hangers on to make it look like a real system and now they are waiting for some "cargo" to appear! Shame that the system itself was not engineered because they have all the trimmings of a real system, even down to a promotional truck. This system is a cost to the health system, it will never deliver "cargo", but they are not educated enough about eHealth to understand that. No wonder they dislike experienced software people so much, they have not understood the belief in "cargo will come". Its not a PCEHR but a "CCS"