Tuesday, January 27, 2015

Article Draft : Government And The Bureaucracy Are Making Progress In E-Health Harder Than It Should Be. The Need To Simply Get Out Of The Way!

Looking back at 2014 it seems to be clear that as far as e-Health is concerned it has been largely a wasted year as far as the national initiatives - such as the Personally Controlled Electronic Health Record  (PCEHR) - have been concerned. It seems to me there is at least some small hope things might just be a little different in 2015.
Despite all the propaganda that tends to be encountered from Government and its agents the goal of ‘e-Health’, or what might be better termed Health Information Technology Deployment and Use, is to safely and securely provide relevant health information to those who need it for decision making in the care of and support of patients. This can be via the provision of record keeping systems for patient information as well as a range of information communication and sharing systems which make available at health information where it is needed with security, integrity and privacy.
In 2010 ,for reasons best known to Ms Nicola Roxon, the then Health Minister, set out to create a national centralised system of patient records, and this system was to operate in parallel with the record keeping systems that were being used by doctors in their practices. The benefits of such a national system was to have a patient’s record available wherever and whenever needed via the internet. The system began operation in June 2012, and when the Government changed in late 2013 one of the first acts of the new Health Minister (Mr Dutton) was to commission a review of what had by then become a $1Billion program.
The Review was completed in December 2013 and released publically in May 2014. At the time of writing (late January, 2015) there has yet to be a Government response to the Review which, among other things recommended that there be a radical shake up in the leadership and governance of the sector, a change in the law to have an electronic patient record created for every citizen unless they specifically opted out of a record being created, rename the system MyHR, oblige doctors to upload clinical documents to the system and the disbanding of the National E-Health Transition Authority (NEHTA).
You can read the summary of all the recommendations of the review here:
All this was intended to happen by 1 January 2015 - but clearly most of the recommendations have not been actioned and, as far as I know, there is no time line for action.
The situation has now been further complicated by the Governmental re-shuffle just before Christmas 2014 where Ms Sussan Ley became Federal Health Minister and has found herself deeply embroiled in the public debates around the sustainability of Medicare and Co-Payments.
The hiatus in strategic direction for e-Health in Australia since the change of Government (Sept. 2012) has not been without consequences. Among these has been, with an abiding and single minded focus on the PCEHR / MyHR, a total lack of Government decision making in other important and related matters and deep frustration on the part of private providers of services in the sector who have had, essentially, no idea what is coming next as well as a series of demands for system changes in their systems to suit the needs of the MyHR with little, if any, financial compensation.
Having now seen two and a half years of operation of the MyHR system it is pretty plain the system is an expensive failure despite all the claims of Government. What is now needed, in my view is a five point action plan to be implemented.
The action points are:
Action One:
We need an updated National E-Health Strategy that consults all stakeholders properly and provides the  governance, leadership, strategies, technical standards and managerial pathways to actually achieve the goals needed by those working in the health sector and their patients.
This Strategy needs to consider and review both the PCEHR Review and the input of all other relevant stakeholders. Both private and public sector need to be fully involved.
We then need the Strategy to be properly funded and led - as did not happen with the 2008 version.
Action Two:
We need to recognise that there are two distinct clients for e-Health systems and services and that their needs are not by any means the same - meaning that different systems are required for each. The professional clients (doctors, nurses, allied health etc.) need systems that enhance their clinical capabilities, improve record keeping and facilitate their secure sharing of clinical information to improve patient care and safety.
The consumers need systems to allow them to record their own information while at the same time having access  to, ideally, the live clinical systems so they can better engage with and understand and contribute to their care.
It is obvious the present PCEHR/MyHR  does neither of these things well.
Action Three:
We need to recognise we don’t need a single monolithic System but that we need an e-Health ecosystem where health information flows efficiently, accurately, securely and privately between appropriately credentialed actors within the health system and to and from consumers.
Action Four:
Before anything more is done or spent actually undertake a proper in depth peer-reviewed evaluation of what e-Health in all its guises has achieved in Australia and what has been achieved in the rest of the world that might be applicable to Australia. This research should inform what comes next.
Action Five:
We need to understand that no-where in the world has a transition to e-Health been easy, uncomplicated, pain free or without missteps. As we increasingly realise, getting this right is a very considerable and some might suggest near impossible challenge that takes lots of time, lots of money and dedication - as well as quality leadership and governance for success. E-Health is not something for generalist bureaucrats and technicians to have repeated goes at and repeatedly fail at!
Crucial to fixing the Government created mess we are now in is that the actions listed above are treated as an indivisible action plan and that the Minister is fully involved and supportive. The bureaucracy also needs to grasp they have a very imperfect grasp of what is needed and listen much more closely to experts and other stakeholders and get out of the way!
I can see no other realistic way to provide direction and give stability and certainty to all involved in E-Health so that they can move forward, invest and innovate with confidence. To just wander on as we are presently doing is just not an option. It is clear that there needs to be major change so the Government stops being part of the problem and becomes part of the solution and this change really needs to happen soon!
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Comments welcome:
David.

1 comment:

Anonymous said...

The short-term view of "transition" needs to be dropped and replaced with an organisation representing all of the stakeholders to oversee the long-term development and implementation. An organisation that can "own" HW/SW/standards/terminologies/classifications/maps/specs and all of these require the org to monitor, action, research and update. The org needs to: "monitor" current and future eHealth initiatives; take "action" to handle problems and future improvements; fund the ongoing "research"; and "update" the technology/standards/terminologies/...

You could increase your idea of two types of clients. Other stakeholders and potential clients include: government agencies; software developers; commercial researchers; academic and not-for-profit researchers. Even within the "clinical" user domain there can be different needs by those "entering" data and a different health professional who wishes to "view" the data. Eg. A hospital and a specialist may want a different view of the same data supplied by a GP (like snapshot vs timeline).

Standards, terminologies, classifications and maps need ongoing funding and support which is currently too little from the Government money.

Just having data computerised does not necessarily make it usable or save money. Just having a code for everything does not make it ready for research.