Monday, March 24, 2014

It Is A Truth, Universally Acknowledged, That A Wrong Strategy Leads To Bad Outcomes.

I was reflecting on the blog from yesterday. See here:

http://aushealthit.blogspot.com.au/2014/03/jamia-publishes-review-of-pcehr-program.html

In doing that, with apologies to Jane Austen’s great opening line in Pride and Prejudice, it seems we are all pretty clear that if you attempt to implement a flawed strategy you doom yourself to fail.

It seems to me that this is the core of the problem with the PCEHR. The strategy for the PCEHR was developed by bureaucrats and NEHTA and only after they had decided what the strategy would be did they seek serious clinical involvement. Sadly the strategy lacked any clarity as to what the PCEHR was for and who it was for and what the expectations were for both patients and clinicians as to how it would be used and add value.

Nowhere in the world has there been a health computer system that has successfully provided a computing solution that has served both the full needs of clinicians and their patients for the simple reason that each of these groups have very divergent requirements. The strategic assumption that such a system was either possible or appropriate is the key error.

No amount of clinician input was ever going to remedy such a basic strategic flaw. It is just like putting ‘lipstick on a pig’ as they say!

As I said to someone recently regarding flawed strategies ‘adding a better engine to a car with square wheels does not work’!

If the strategy is wrong then no good will flow over the long term and no amount of money, without strategic change, can succeed.

See if I am not right!

David.

3 comments:

Bernard Robertson-Dunn said...

David,

I think you're being a bit generous to say that the PCEHR has/had a strategy.

The Deloitte strategy of 2008 included this recommendation:

R-2.4 Adopt an incremental and distributed approach to development of national individual electronic health records (IEHRs).

The PCEHR is a single, big-bang, central electronic health record. So it's not based upon the Deloitte strategy.

The PCEHR, IMHO, had a project plan, not a strategy.

But it's still leading to bad outcomes.

Tom Bowden said...


Bernard's assessment is in my view -exactly on the mark.

If the Deloitte strategy of developing a bottom up, standards driven e-health system had been implemented, then we would have made some real progress.

My question is what now? It sounds as though the government wants to get the boat off the reef and refloat it. Are we going to let that happen?

I fear that if we do, it will be just a continuation of the past decade's lack of progress.

Kind regards,

Tom Bowden

Dr Ian Colclough said...

David,

I too have reflected deeply on the jaima article in yesterday’s blog. I have no issues with people having access to their clinical records – never have had. I have issue with a “Personal Controlled” record full of a whole heap of stuff lacking organisation and relevance pertinent to the immediate needs of an intelligent busy health professional.

I am a strong advocate of the Shared Personal Electronic Health Record provided the information contained therein is relevant, accurate, current, secure, tamper proof, easy to navigate in order to find the relevant ‘bits’ immediately and intuitively and where, once found, acted upon because the information can be TRUSTED – by the clinician and by other health providers and understood by the person to whom it relates.

That being so your comments describing the core of the problem with the PCEHR are precise and correct. Sadly no-one has been prepared to listen to the many experts who have made their views known and I do not expect they ever will.