Wednesday, June 18, 2014

I Am Not Sure Why Commentators Don’t Stick To What They Really Know. Really Does Not Help Their Arguments!

This appeared last week.

More vision on healthcare needed to rein in costs

Date June 9, 2014 - 12:07AM

Kim Oates

Better doctor-patient communication, as per the Open Notes project, could save billions of dollars and improve health in Australia.
Let’s have a more visionary approach to reducing health costs. While most see the need to reduce health costs, wouldn’t it be refreshing if our politicians and their advisers looked at more visionary ways of cost reduction instead of a $7 co-payment, a scheme which will become a cost-shifting exercise as patients reluctant or unable to pay this amount will just turn up at already overburdened emergency departments?
While it’s true that health costs are rising as the population ages, we aren’t all that different from other developed countries. At 9.5 per cent of GDP our health expenditure is a little above the OECD average of 9.3 per cent and well below the US at 17.9 per cent, the only OECD country without universal health coverage and with a strong focus on privatisation.
Tom Delbanco, a Harvard professor, has helped to reduce costs. He had the audacity to suggest patients have access to their medical notes. His colleagues were aghast, saying this would be time consuming for doctors and cause anxiety in patients. Delbanco persisted.
In 2011 he persuaded over 100 doctors to participate in the Open Notes project. Despite initial anxiety, by the end of the trial there was overwhelming support by participating doctors. They found it made doctor-patient communication more effective and actually saved time as better-informed patients did not make unnecessary visits.
Patients liked it too. Sometimes they were able to point out that their notes did not accurately reflect what they’d told the doctor, resulting in better treatment and often fewer tests. Most felt empowered by the trust and respect that came with having access to their personal information.
The recent Australian patient controlled electronic health record is an important step in this direction, giving people a summary of their health records, but the Open Notes concept shows patients exactly what the doctor has written. This makes doctors write better notes, avoids confusing abbreviations, makes patients partners in their own care and according to Delbanco, reduces the cost of care.
.....
Kim Oates is an Emeritus Professor of Paediatrics at Sydney Medical School, University of Sydney
Two much better other ideas from Professor Oates (who is a certified good guy) are here:
The paragraph in italics is the problem. I am entirely comfortable with the Open Notes idea, indeed it sounds like a very sensible thing to do, but the PCEHR is NOT, in any way, a step in that direction in my view. The Open Notes approach is dynamic and interactive and the PCEHR - as presently conceived - is quite the reverse.
My advice - stick to what you know when providing comment and leave commentary on the PCEHR to those who are rather closer to e-Health.
David.

2 comments:

Anonymous said...

It's quite simple David -When the commentators don't know what they don't know they don't know that what they are saying is meaningless because they don't know what else there is to know.

Terry Hannan said...

David, this is a very appropriate statement. “While it’s true that health costs are rising as the population ages, we aren’t all that different from other developed countries. At 9.5 per cent of GDP our health expenditure is a little above the OECD average of 9.3 per cent and well below the US at 17.9 per cent, the only OECD country without universal health coverage and with a strong focus on privatisation.”
In fact if one reads Prof John Wennberg’s work on variation the health cost inflation drivers in the USA Medicare/Medicaid are the same for all the OECD countries. This emphasises that the cost and quality drivers for health care are the same for systems that are public/private/public and private.
Adding to the inappropriate funding models we have in place the major factor in driving health costs and inappropriate variation is poorly supported clinical decision making i.e. the HIT tools are not focussed on this factor.
A second point I would like to make is that your comments on the PCEHR in comparison to OpenNotes is entirely correct. One aspect of this is that PCEHR is seen as a “document storage system” (as per the NEHTA web site) yet research has demonstrated that the “documents” we use now POORLY support clinical decision making.
My final point is about those writing on eHealth with some “authority”. I recently attended meetings where it became obvious that many involved in eHealth policy making, funding applications, government advisors, etc. have a poor understanding of “clinical informatics” yet these are often the loudest voices in the mob. Terry Hannan