Tuesday, February 11, 2014

Here We Get A Spectacular Example Of How Idiotic E-Health Governance and Delivery Is In Australia.

I was sent this document a day or so ago. It builds on the comments on Governance of OZ E-Health I made a day or so ago. The suggested citation is as follows:

Suggested citation

Australian Commission on Safety and Quality in Health Care (2009), Project Summary: National Guidelines for Safer On-screen Display of Medicines Information. ACSQHC, Sydney.
Amazingly the document is actually dated 4 December, 2013.
Here is the nub of what the project is about (Page 4):
“In addition, the Commonwealth Department of Health has funded a Personally Controlled Electronic Health Record (PCEHR) Clinical Governance Program which is managed by the Commission. The key objectives of the PCEHR Clinical Governance Program are to “seek to prevent the occurrence of clinical safety incidents” and “promote continuous quality improvement”. The Commission convenes a Clinical Governance Advisory Group to advise it on conduct of the program. The PCEHR Clinical Governance Program is also undertaking a series of four targeted safety audits of the PCEHR. The third clinical safety audit of the PCEHR includes a specific recommendation for the Commission to lead the development of “standardisation of the presentation of medicines information in the PCEHR”.
This project summary describes an additional element of the PCEHR Clinical Governance Program, which is the development of guidelines for safer on-screen display of medicines information for use in the PCEHR and across the healthcare continuum. Through the guidelines, on-screen medicines information will be provided consistently and clearly to assist safe and quality use of medicines and reduce medication error.”
Sadly the document is not on the web, presumably because the Commission is embarrassed by it.
Here is the study scope

4. Scope.

The project will describe minimum safety requirements for on-screen display of medicines information in all clinical information systems, including the PCEHR.
Application of the guidelines will be in all clinical information systems with medicines information across the healthcare continuum including health professional interfaces and consumer interfaces.
The guidelines will provide safety minima and are intended for:
·         health professionals and health services specifying, procuring and implementing electronic health systems and which include medicines information
·         general practice prescribing and other EMM software vendors
·         PCEHR and other national electronic medication management infrastructure
·         patient safety and risk management professionals.
The project will build on existing work including the Commission’s national standardisations and the National Health Service’s Common User Interface Programme.
The work may encompass supporting services including:
·         National Authentication Services for Health or similar authentication services in use
·         Clinical terminologies including SNOMED-CT AU and Australian Medicines Terminology.
To develop the specifications, the Commission will engage with:
·         principal working partners, the National eHealth Transition Authority and the Commonwealth Department of Health
·         other programs directly related to standardised communication of medicines information and which facilitate consistent communication approach between programs
·         key stakeholders, including GP and EMM software vendors
·         learned colleges and professional bodies.
The project is discrete and will not include other e-health programs, projects or working groups of the Commission that are covered under separate project plans. However expertise will be sought from existing Commission expert committees, groups or members as appropriate and in the context of the project requirements.
----- End Extract.
The project methodology is just amazing.
5.2 Project methodology
The project forms a component of the Commission’s PCEHR Clinical Governance Program which is funded by the Commonwealth Department of Health. The Commission’s Clinical Governance Advisory Group will provide strategic oversight of the project.
Consistent with Commission practice, a small working group of representatives from the Commonwealth Department of Health and NeHTA, and individuals with identified expertise, will be established to advise the Commission on conduct of the project. This group will develop the guidelines, seek expert support as required, engage stakeholders and inform key ehealth organisations of progress.
Further expert support will be sought as required and key stakeholders will be consulted to provide feedback on the proposed standard. Further detail on project stakeholder engagement is provided below in Section 6.
There will be four components to the project:
5.2.1 Develop draft guidelines document
The project will:
·         undertake preliminary research and investigation
·         contextualise the National Health Service Design for Safety: Guidelines for safe on-screen display of medication information for local application and to ensure local organisational and clinical resonance
·         incorporate applicable national standardisations including National Tall Man Lettering and Recommendations for Terminology, Abbreviations and Symbols used in the Prescribing and Administration of Medicines.
5.2.2 Iterate the document with the working group
The revised document will be considered by the project working group, advice obtained and adjusted accordingly.
5.2.3 Consult the document more broadly
The reviewed document will be subject to further consultation as detailed in the project stakeholder engagement proposal below in Section 6.
5.2.4 Obtain agreement on the document
The document will be forward to the Board of the Australian Commission on Safety and Quality in Health Care for endorsement as a national guideline.
----- End Extract.
So we invent the guidelines, run them past an internally focussed work group, consult and then have our Board approve them! Really incestuous really doesn’t cover it!
Now guess who the stakeholders are?

6.0 Stakeholders

6.1 Primary stakeholders

Department of Health and its PCEHR governance structures is a primary stakeholder as PCEHR System Operator and funder of the Clinical Governance Program. This includes the Operations Management Committee (OMC), which is the key governing body for the operation of the PCEHR. Other important stakeholders participating on the OMC include the National Infrastructure Operator (Accenture) and the Department of Human Services.
National e-Health Transition Authority is a primary stakeholder as designer and implementer of key elements of the PCEHR system. NeHTA also has extensive ties with the medical and EMM vendor community and has established panels for the vendors to receive funding to incorporate PCEHR specifications into their products. The NeHTA conformance compliance and accreditation function will ensure uptake of the guidance.
Both of these organisations will be invited to join the project working group as their support is essential to the successful delivery of the project.

6.2 Secondary stakeholders

Other stakeholders will be invited to provide feedback on the draft guidelines including:
        ·         Professional associations and learned colleges including:
o   Australian Medical Association
o   Royal Australian College of General Practitioners
o   Pharmacy Guild of Australia
o   Pharmaceutical Society of Australia
o   Society of Hospital Pharmacists of Australia
·         NPS MedicineWise
·         Consumer health associations including the Consumers Health Forum
·         Software industry peak associations, including the Medical Software Industry Association
·         Jurisdictions
·         Public and private, acute, primary and ambulatory health services.
----- End Extract.
So essentially NEHTA and DoH are the key and the fount of all knowledge - along with Accenture and local expertise is secondary. Seems they don't need any expertise other than their pretty obvious incompetence. We have a lot of expertise in Australia that is simply not being recognised or used. Bloody sad.

I guess ignoring all this skill and expertise that is why NASH, the PCEHR, and Health Identifiers have been such a huge success!
My view is that this document is a farcical tragedy!
How pathetic - no wonder it is not public! If I had written it I would bury it!
On the same topic of what is not public I wonder what has happened to all the other 3 PCEHR Safety Reports produced by this august Commission. Anyone know what they say - other than platitudes?  Just why are they not public - leaks welcome!

1 comment:

Anonymous said...

Idiotic, farcical, rubbish - stupid stuff it is indeed of no value to anyone at all.