Tuesday, March 03, 2015

Surely, After This Much Has Been Spent, And All We Have Is This Set Of Numbers, The Time Has Come To Pull The Pin!

This appeared late last week.

Taxpayers have spent more than $1 billion on a digital health record that doctors won’t use

  • February 27, 2015 12:00AM
  • Sue Dunlevy National Health Reporter
  • Herald Sun
AUSTRALIANS could have had a hip replacement, a knee replacement or a brain tumour removed for the money it has cost to create the shared health summaries on their e-health records.
The botched Personally Controlled e-Health Record has been operating for nearly three years but less than one in ten Australians (2.1 million people) currently has one.
And doctors have uploaded just 41,998 shared health summaries onto these records, which means most of the more than 2 million e-health records are empty.
The scheme has so far cost taxpayers more than $1 billion to develop, or almost $24,000 per shared health summary.
Launched by the previous Labor Government in July 2012, the Personally Controlled Electronic Health Record was meant to bring medical records into the digital age and contain an electronic patient health summary, a list of allergies and medications and eventually X-rays and test results.
The Abbott Government commissioned a review of the system just after winning office, but has failed to respond to its recommendations for more than 14 months.
The review called for the system to switch from an opt in to an opt out model to speed up the toll out.
If the $1 billion spent so far is to be salvaged and the scheme fully rolled out the government needs to provide direction and funding by June 30.
Health Minster Sussan Ley said she had been listening to doctors about their experiences with Labor’s e-health system as part of her national Medicare consultations and “the prognosis isn’t good for the previous government”.
“Unfortunately Labor’s rush for glory has ended up with a false start costing taxpayers and doctors in the long run due to poor implementation and take up,” Ms Ley said.
“Labor has left a complex, expensive mess behind and this is not an easy overnight fix, but we’re continuing to put the time and effort into getting the right outcome for all involved.”
Following the release of the review report, which found significant flaws in the system, the Government has been consulting widely with key stakeholders including consumers, healthcare providers, software vendors, professional associations and peak bodies.
…..
Opposition health spokeswoman Catherine King said the government’s review found e-health could save the health system $7 billion a year through fewer diagnoses, treatment and prescription errors, and in the process avoid thousands of unnecessary hospital admissions.
“This was clearly not the outcome the government was looking for, given its failure to act on the report for 14 months,” she said.
The committee was told only 7,645 of the 57,000 health provider organisations have so far registered to use the e-health record.
And just 274 of the 1,338 public and private hospitals around the country are connected to the e-health system.
A review of e-health by IT expert Karen Dearne notes there are an average 36 million GP consultations per day, but the PCEHR System Operator Annual Report found only a paltry 72 attempts by doctors to access e-health records each day.
The rollout of e-health records was growing strongly until late 2013 when the number of new records taken out each month began to slow considerably.
Lots more here:
There is very little to add as far as I am concerned - and surely before we waste any more money on a clear cut failure - we need to cancel the whole thing. As the Americans say - ‘this dog simply will not hunt’ and a dog it surely is!
David.

11 comments:

Terry Hannan said...

David, these numbers and assessments on the poor (inadequate) functionalities of the PCEHR project are verified by one of the female panellists on INSIGHT, 24th Feb 2015, [http://www.sbs.com.au/ondemand/video/396930115947/Insight-Saving-Health] who is the main carer for her cystic fibrosis son. She verbalises very clearly why the system is not working-and will never work.

Grahame Grieve said...

Terry, in this, you said that "a patient focused system is where the patient owns their own record" - but isn't it when they own their own care process?

Anonymous said...

No reasonable and sensible person well versed in the complexities of eHealth and with a deep broad understanding of the benefits that eHealth can bring to the delivery of an integrated primary care environment would say other than "terminate the PCEHR and freeze what little funding remains unspent".

That is the very first step before anything else of any value in progressing eHealth in primary care can be achieved.

Bernard Robertson-Dunn said...

IMHO, a patient centric health system has little or nothing to do with ownership of anything.

Patient centric means that the needs and requirements of the patient have the highest priority. The objectives, measures and outcomes of the system should all be related to the patient. All other aspects and stakeholders of the system should be of lower priorities.

If there are compromises or trade-offs in the system architecture and/or design, then these compromises or trade-offs must be made in such a way that any impact on the patient is minimised and acceptable to patients at large.

Is the PCEHR patient centric? Just look at the measures of success. They are all around numbers of registrations and participants, nothing to do with patient outcomes.

As the participants on Insight-Saving Health said. there's nothing in it for them. And that included GPs as well as patients/carers.

Anonymous said...

http://ehealth.gov.au/internet/ehealth/publishing.nsf/content/pcehr-benefits

Bernard Robertson-Dunn said...

Oh dear.

Deloitte have fallen into the benefits=value trap.

For example in Improved continuity of care they claim that "..a Shared Health Summary document will summarise the current health status of a patient so that this can be accessed by other health providers involved in their care, such as outpatient clinics and allied health professionals."

Without commenting on this as a benefit, I'd like to know how many times a year this benefit is of value, with respect to the number of health intervention incidents.

For a start, what does "current" mean. If someone had a health incident three months or longer ago, is it still "current"? If someone is receiving long term, on-going health care, won't they be seeing health professionals who have access to more detailed information than a summary of the health status?

This sort of "economic modelling" is highly suspect. What should happen is that they develop health care models before and after the availability of a system such as the PCEHR. That would then show how health care behaviours and outcomes could/might change. Only then would it be possible to do economic modelling.

The information provided at this link is totally meaningless. In effect it is saying "trust us, we are the experts". I, for one, don't believe them.

If decisions have been made predicated on this modelling, it's no wonder that four years into the fifteen year projections, the value of the PCEHR would appear to be negative, never mind 4/15ths of $11.5 billion.

And if anyone is wondering, I have a PhD and over 40 years experience in computer modelling.

Dr Ian Colclough said...

Bernard, one can only hope that the new Health Minister Sussan Ley will take a step back from the PCEHR imbroglio and engage privately with a few intelligent pragmatists like yourself (and I don't mean the big consulting firms with a vested interest in milking the bank).

If she elects to do so in private and ask three fundamental questions:
(i) What are we dealing with here?
(ii)How did we get into this costly mess?
(iii) What are my options?

.... she will very quickly be able to make up her own mind and chart a way forward which makes absolute sense and is affordable.

Dr David More MB PhD FACHI said...

Thanks Ian,

The inevitable outcome of working through those three questions is to just can the whole thing and stop wasting money. A totally new approach is needed - not trying to fix a ill-considered legacy disaster!

David.

Anonymous said...

Most eHealth proponents, practitioners and experts would agree with you David.

However, Dr Colclough has taken a more balanced, mature and reasonable, approach by suggesting that the first step is to allow the Minister the time and space to engage privately with a few intelligent well informed eHealth pragmatists.

In other words, please David, let her arrive at her own conclusions.

Her track record to date suggests she is a practical realist well ahead of her predecessor in her capacity to think and address the complex thorny problems in her portfolio.

Dr David More MB PhD FACHI said...

Sorry!

I do not think it sensible to deny reality. The thing is a lemon and needs to be re-thought.

Those who are reading here have often watched this fiasco evolve for the last 5 years and really want to see reality intrude on the fantasy that was the PCEHR's initial conception.

There is now even very serious doubt that even well designed Health Information Exchanges can make a positive difference - let alone this bastardised hopelessly compromised child of the concept.

See here:

http://www.fiercehealthit.com/story/hie-not-causally-related-cost-improvements-care-quality-benefits/2015-03-03

David.

Bernard Robertson-Dunn said...

People with very strong beliefs (political, ideological, religious, etc) do not change their beliefs based upon reality and/or evidence.

History shows that new ideas, new ways of thinking, new theories, etc only gain general acceptance when the old believers die.

In the case of politics and/or public service the way to change the people is to change the people.

When John Howard politicised the public service by putting departmental secretaries on contract he created a two edged sword. It became easier to replace a secretary, but made it harder for them to give frank and fearless advice.

As Paul Simon wrote

"I have squandered my resistance for a pocketful of mumbles, such are promises.

All lies and jest, still a man hears what he wants to hear and disregards the rest"
The Boxer.