Sunday, September 28, 2014

NEHTA Produces A Guide For GPs Using The PCEHR - Very Interesting Indeed And Not Good.

This appeared just a few days ago - Document created 23/09/2014:

eHealth Guide for General Practice

Getting Started with eHealth – A guide for General Practice is designed for practices or organisations using the eHealth record system through their clinical software.
Getting Started with eHealth – A guide for General Practice
This guide will show you how to:
  • How to link local patient records with their Individual Healthcare Identifier
  • Patient consent and patient privacy controls
  • Clinical documents
  • Assisting patients to register for an eHealth record
  • Becoming familiar with the system
  • Help and support contacts
How to order brochures and factsheets
If you are interested in ordering printed brochures from us, please provide the following information within an email to ask@nehta.gov.au
  • Organisation
  • Name
  • Street Address
  • Email Address (if different from the email address you have used to request brochures)
  • Phone Number
  • Quantity (minimum is 50)
NOTE: Orders will be received within 5 working days.
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Here is the direct link:
Looks like having a GP as the NEHTA new chair has reminded NEHTA that writing obscure 100+ page documents for GPs just guarantees no one will ever read then and makes sure they continue not to make a difference.
In January we had this wonderful document released - and it was Version 2.0:

eHealth Clinicians User Guide

This eHealth Clinicians User Guide includes material that is relevant to both general practices and private specialist practices, however other healthcare professionals, e.g. allied health and in aged and community care, may also find this guide useful.
The eHealth Clinicians User Guide supports medical practices in navigating the complexities of eHealth (including the national eHealth record system) from planning, preparation, registration and implementation through to meaningful use. It covers key eHealth topics of interest to medical practices (including quality improvement) and focuses on the foundation products (e.g. Healthcare Identifiers, NASH, Secure Message Delivery), the national eHealth record system and other functionality currently available and being released by software vendors. Importantly it includes practical step-by-step implementation advice.
Through use of this guide you should reasonably expect to understand the benefits to your practice associated with adopting eHealth as well as some of the Organisational and Governance changes required. It also outlines some of the prerequisites for implementation and use of the eHealth features. It includes practical quick reference checklists for practice staff and links to additional education and support resources.
The eHealth Clinicians User Guide is also available in a web version at: http://www.nehta.gov.au/for-providers/about-ehealth-guidance
This was a wonderfully brief 157 pages long and as I said at the time:
“My guess is that this fiasco will be the end of any GP co-operation with the NEHRS / PCEHR.
DoHA has always wanted to reduce the cost of PIP and this will certainly do it!”
The real gem in the new document is the 54 step roadmap found in the document from page 16 and for the next few.
The rest of the 157 page document is just non-clinical jargon laid on non-clinical jargon.
That pages 125 to 134 are a Glossary shows just how clinician friendly this is!
There a links galore that one presumes are meant to be followed and so it just goes on.
The author is - not unexpectedly - a consultant hired by NEHTA.”
Here is my link to the blog where I described it and made these and other comments.
The new guide is just 9 pages and clearly written. This actually results in a useful document that is readable and allows a reader to grasp just what is going on with the PCEHR and, very probably, why one should not be involved.
This quote make it clear to me:
Page 4:

Viewing an eHealth record

 Who can view an eHealth record?

·         Any person involved in an individual’s care, who is authorised by the healthcare organisation can access an eHealth record. For example, reception staff, registered nurses, doctors. Your organisation may choose to limit access to clinical staff. Check with your organisation’s eHealth champion
·         Access is not limited to healthcare providers with a Healthcare Provider Identifier-Individual (HPI-I). Your organisation may authorise other staff who need to access the eHealth record system as part of their role in healthcare delivery (for example, an Aboriginal health worker who does not have a HPI-I). However, only providers with an HPI-I can author and upload clinical documents.
·         Organisations can authorise their staff by writing their details in the organisation’s eHealth record system security policy. Sample policies can be found on NEHTA’s website.
To me having even the possibility of non-clinicians accessing my PCEHR (see first paragraph)  - where another provider may have uploaded any information over which I might not have control (e.g. the intern uploading a discharge summary) means I would advise any sensible person to just say away!
I also have to say this rather surprised me… (Page 7)
Who can create a Shared Health Summary?
  • a registered medical practitioner
  • a registered nurse
  • an Aboriginal and Torres Strait Islander health practitioner registered with AHPRA
I had thought that it was doctors who created Shared Health Summaries (And the Aboriginal care providers) rather than nurses. To me having nurse created shared summaries further invalidates the utility of the record. How long before receptionists are adding and updating shared summaries?
The document then goes on to say that a nurse uploading a Shared Summary becomes the patient’s Nominated Healthcare Provider! Just how does that work?
At the least all shared summaries need to be created by doctors if other doctors are to be expected to trust them which I understand was the intent of the PCEHR. Nurse shared summaries just invalidate the whole thing in my view. I must have just missed this point in older documents!
My advice is for everyone to share their clinical information with their doctor and not with the PCEHR! Even better still don’t create one of these records until the controls are such that you are totally comfortable with what information may wind up in it - now and in the future.
It just seems to be getting worse…
David.

15 comments:

Anonymous said...

?clearly written? You really think so? Did anyone check it before it was published? This is how it defines an IHI:


"• An Individual Healthcare Identifier (IHI) is a 16 digit number that uniquely identifies an individual
for the purposes of health services. It is allocated to all individuals enrolled in Medicare, who hold a
Department of Veterans’ Affairs (DVA) treatment card."

I think they left out a very important little word - 'or'. As it stands this sentence says you have to have to have served in the war to have an IHI.

Also - there is the dreaded use of the apostrophe for plurals:
"...check that your organisation is able to assist
patient’s to register for the eHealth record…."

A bit shoddy - we expect more for all the money we pay these consultants via NEHTA!

Anonymous said...

The ehealth clinicians guide is utterly unintelligible rubbish!!... what sort of proof reading / quality control did this have ? NEHTA's ineptness is monumental ... it would be funny if only it didn't have such serious consequences ... so much money wasted.... it would be far more productive for NEHTA to shut up shop and stop the waste !!

Anonymous said...

It is fair and reasonable to hold the RACGP and AMA to blame for perpetuating this nonsensical waste of public funds. The longer they continue telling the DOH and Government the PCEHR should be continued the longer it will be so. The moment they say "stop this nonsense now, stop this waste of money, then go back to the drawing board" the sooner Government will take notice. $140M buys 20 million $7 co-payments. With over $1.2 billion having been wasted by the NEHTA/PCEHR fiasco we have burnt 171 million co-payments. The peak medical bodies have much to be ashamed of.

Anonymous said...

... and the new Chair of NEHTA was Past President of the AMA.... and NEHTA's lead clinical advisor was (until he resigned) past President of the RACGP. Informed, intelligent, leadership? You be the judge.

Dr David More MB PhD FACHI said...

"?clearly written?"

Well compared with the earlier 150+ page version - I, for one, could make it to the end - and broadly understand what I was being told!

David.

Anonymous said...

...... and broadly understand what I was being told!

That's good David. And did you believe what you were being told?

Dr David More MB PhD FACHI said...

Reading the blog should help you with the answer to that!

David.

Summary - It is rubbish!

Anonymous said...

I am sure this is just the start as they all scramble to make themselves relevant after years of doing nothing due to the PCEHR, my money is on a raft of rushed implemtation material, hacked architecture and technical solutions looking for a problem, NEHTA is showing the classic signs of a organisation that has no internal strategy to glue activities together and provide a purpose, this also is why there is probably not the right level of assurance to meet demands leading to poorly reviewed material and publication gates that are not properly managed. Their transition cannot start soon enough IMHO

Anonymous said...

Indeed David, but do the AMA and RACGP know that? And does the new Chair of NEHTA know that? And what are they all going to do about it?
Nothing is my bet. They will just sit on their thumbs and preserve the status quo and say they are showing leadership.

Anonymous said...

That is why the peak medical bodies are ineffectual and irrelevant when it comes to dealing with such a complex issue as NEHTA an the PCEHR. Oh, we'll have to poll our members to see what they thing before we can move forward. ..... and they call that leadership. The bureaucrats play the like pin ball machines.

Bernard Ronbertson-Dunn said...

In an interview with PulseIT magazine in August
http://issuu.com/pulseitmagazine/docs/pulseit_august2014/08?e=6528534/4359611

Dr Steve Hambleton makes some very interesting comments:

"What is eHealth? It is probably one of the sector's most discussed and yet misunderstood terms. This is disappointing because few developments over the coming years will have as much impact on how patient care is delivered."

and

"Much of the planning and development conducted by NEHTA since 2005 has now been delivered. However, it’s too simple to define the promise of eHealth by the complex technologies that will enable and support connected care. This is ultimately not about technology; it’s about people. People like you and me, people that share the eHealth goal of safer, quality healthcare for all Australians."

Unfortunately he doesn't actually define what eHealth is. Saying that the promise of eHealth is about people not technology is simplistic cargo cult thinking - a term I've used before and nothing I've seen since has disabused me of this opinion.

It's very sad that the person now leading the initiative to deliver the promise of eHealth doesn't seem to understand what eHealth is, what it can do and more importantly how, done properly, it is a massively disruptive initiative.

That disruptive impact is more than likely to be its own downfall. Some people (patients and carers) will just ignore it because it is too complicated to use - just look at the FAQs, others will see it as a major threat to their current practices and behaviours.

This mixture of apathy and distrust that currently surrounds the PCEHR indicates to me that the eHealth journey from promise to reality is going to be long and hard. The real problem is that the people navigating the current journey have started in the wrong place and are going in the wrong direction.

K said...

"It's very sad that the person now leading the initiative to deliver the promise of eHealth doesn't seem to understand what eHealth is" - lack of clarification in a trade press article is not evidence of a lack of understanding.

David, perhaps you could invite said esteemed Dr to be interviewed for this blog on this subject?

Bernard Robertson-Dunn said...

K said:
"lack of clarification in a trade press article is not evidence of a lack of understanding."

To clarify: The article was not a press report, it was not an interview; Dr Hambleton wrote it himself.

To start off an article with a claim that eHealth "is probably one of the sector's most discussed and yet misunderstood terms" and then not offer to address that misunderstanding is IMHO most puzzling and informative.

The suggestion to David for Dr Hambleton to be interviewed is a good idea. Maybe he could then clarify what he thinks eHealth is, other than a promise "about people".

Dr Ian Colclough said...

Dr Hambleton's role is to Chair NeHTA's Board of Directors. With the approval of other Directors the Chair could also elect to be a hands on Director and manage the Executive on a day to day basis.

The Board is responsible for defining the strategic direction and establishing measurable objective criteria comprising goals and objectives which align with the Board's strategies.

NeHTA's Executive is responsible for implementing those strategies and accounting to the Board on the stepwise progress made in meeting the goals and objectives as determined by the Board.

However, I am unaware of any evidence forthcoming from NeHTA in support of those principles. That troubles me greatly.

Anonymous said...

Dr Hambleton chairs a Board of Departmental Secretaries who know next to nothing about eHealth so from that perspective he is neutered. To be effective he needs to build a small advisory eHealth cohort of experienced people who can act as a sounding board to help him find the most appropriate way forward out of this mess.