Sunday, August 31, 2014

So What Happens Next Now The Consultation On The PCEHR Review Has Finished?

Regular readers will be aware that over approximately the last 2 months Deloitte has been assisting DoH in consulting stakeholders on the PCEHR as produced by the Royle Committee the report of which was released in May.
There is a link discussing all this here:
About a month ago we had the astonishingly botched release of an online survey for the public and others (vendors and clinicians) to respond to. You can read about all that here:
and here:
There was also an article I published a month ago pointing out that the options for the PCEHR Review were pretty limited. See here:
Finally we have had a leak of a NEHTA Report dated June 2014 which basically said most GPs who were surveyed and were PCEHR enabled were basically not at all impressed and were not using the system.
Internally we know that present Government E-Health leadership are in denial on the usability and utility of the PCEHR and really seem, for some evidence free reasons, to think that the thing should rumble on.
We also know that many stakeholders (RACGP, Software Providers, many academics etc.) are aware there are major problems with the whole program and have been providing feedback to that effect, as I have been. See here:
So what happens next? It seems to me there are three basic options.
Option 1. - Abandon the whole PCEHR program and move back to a progressive funded implementation of a revised National E-Health Strategy with a collaborative approach with the private sector - accepting National Programs need to develop from the ground up and not top down.
Option 2. - Decide to announce consultation on a National E-Health Strategy Refresh and defer consideration on the fate of the PCEHR until the Strategy is developed, agreed and funded.
Option 3. - The Ostrich Option - pretend all is well and just continue with what is presently happening and going no-where.
I would be OK with Options 1 or 2 but fear we will get Option 3!
David.

15 comments:

Anonymous said...

The answer will be in finally having atomic data in the PCEHR, without the icing the cake looks dry and bland

Dr David More MB PhD FACHI said...

I may be wrong bit I don't think the geniuses who designed this nonsense had that in mind - anyway where are the atomic data sources that are interested in providing such information?

David.

Anonymous said...

Atomic data certain in seems to be making itself the new buzz word, good leadership is based on receiving and listening to good advice, must of the system architects are still about, so I make the assumption this is designed for, but I maybe wrong. Just what would be required to achieve this simple milestone

http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2034:pathology-sector-decides-against-authority-to-post-for-pcehr&catid=16:australian-ehealth&Itemid=327

Anonymous said...

Atomic data is hardly the new buzz word, its been around for >10 years in HL7 V2 but of course its not in the PCEHR. The stupidity of the "smartest guys in the room" at DOHA and NEHTA is slightly concerning if this is the best the a 21st century government can come up with. The have done for eHealth what the Iraq invasion has done for peace in the middle east. What we need is some real austerity where the government stops try to do things, as they are incapable of doing anything useful and in fact just get in the way of working systems.

Grahame Grieve said...

"Atomic data ... not in the PCEHR"

This is not correct. All the PCEHR documents are defined in a highly atomic fashion. Implementations can choose what level to claim conformance at. Levels 1A, 1B and 2 do not have any atomic data, and levels 3A and 3B do have atomic data. (Actually, this is a simplification, but it will serve for this comment)

All but a few systems that feed the PCEHR have claimed conformance at level 3A, so it would be expected that most documents in the PCEHR do have atomic data (disclaimer: I have no knowledge of which systems have contributed documents to the PCEHR, as opposed to which are certified to be able to)

It's true that we are not effectively able to use the atomic data that is in the PCEHR - but that's got more to do with lack of alignment within the community about the data itself than the PCEHR definitions or infrastructure. Any system can retrieve documents that include atomic data...

It's quite ironic that the one place where there is potentially enough agreement in the community to actually use the atomic data - diagnostic reports - the current plan is not to include that atomic data in the PCEHR. I will leave it to others to comment in the typically ill-informed fashion that happens here as to why - but I think it's very disappointing.

Dr David More MB PhD FACHI said...

So yet again failure of information governance, overall leadership and proper consensus building have resulted in a mess - is that the summary?

David.

Grahame Grieve said...

"is that the summary?"

It's not appropriate for me - a low level worker bee - to comment on the many and various causes for the PCEHR falling short of expectations. You can editorialise as you see fit.

Anonymous said...

Thanks Grahame, I take from this that it's not a technical problem but rather a strategic sales and marketing exercise, no different to any system that needs to educate its subscribers into taking up features and services. Maybe this is where the likes of Telstra can assist.

Dr David More MB PhD FACHI said...

"but rather a strategic sales and marketing exercise?"

Yup - much like putting lipstick on a pig...and selling snow to Eskimos.

Telstra succeeds because they have the best technical network to market to customers - but even they could not sell the rubbish that is the PCEHR to GPs and consumers as NEHTA's own research shows.

David.

Grahame Grieve said...

I figured I'd regret commenting here...

Describing things as a sales and marketing failure overlooks that this is a genuinely hard problem. Here's what I have said in public about this previously:

http://www.healthintersections.com.au/?p=1775
http://www.healthintersections.com.au/?p=1995
http://www.healthintersections.com.au/?p=2124

Dr David More MB PhD FACHI said...

"this is a genuinely hard problem" Agreed 100%.

That is why success requires a range of ingredients such as proper consultation, cross disciplinary expertise, great leadership, credible governance, well formed strategy and decent private / public sector co-operation.

Lining up these and the other necessary technical and standards ducks is a truly wicked problem.

David.

Anonymous said...

David,

Peter Fleming has publically and unequivocally stated that eHealth is NOT a "wicked problem"!

So you can be certain what the problem is and where the problems reside without question...

(Legal Disclaimer: statements made herein do not represent the views of the BLOG author/ mediator and any references to names of real or imagined individuals is purely coincidental...)

Dr David More MB PhD FACHI said...

Love the disclaimer!

David.

Anonymous said...

"A litany of failures from a dysfunctional culture"

That comes from the home insulation inquiry. Perhaps its the new model for the public service. I can't think of a better way to describe the NEHTA/DOHA partnership. What would a royal commission uncover?

Bernard Robertson-Dunn said...

Re: "Peter Fleming has publically and unequivocally stated that eHealth is NOT a "wicked problem"! "

Yes, It would seem that Mr Fleming doesn't understand what a wicked problem is.

Many times it's not the problem itself that's wicked, it's the way someone goes about solving the problem that makes it wicked - for that person.

The big test is this: "Can you demonstrate that the solution you propose (or have implemented) will solve the problem you have?"

If Mr Fleming defines eHealth as the gathering of as much Health data about a patient, without regard to its accuracy, quality and usefulness, then he may be correct.

However, if the definition of eHealth if the use of Information Systems to assist health care decision makers, then IMHO, it's a failure.

And the fact that there is no agreed definition of the problem of eHealth means that no one can demonstrate that a solution will solve that, undefined, problem.