Wednesday, May 27, 2015

Now Here Is A Way Of Replicating Most Of What The PCEHR Was Meant To Do Without A Huge Centralised Database.

This article appeared a little while ago.

Records access target hit

19 May 2015   Thomas Meek
Nearly all GP practices in England are able to offer a variety of online services to patients, including access to a summary of their record, appointment booking, and ordering repeat prescriptions.
Data published today by the Health and Social Care Information Centre appears to justify the “optimism” expressed by NHS England in March that that the government’s target for online access to medical records would be hit.
That is 96.8% of the total 7,813 practices in England and translates to a potential user base of more than 55 million people.
The publication of the figures comes five years after the Conservative Party pledged in its 2010 election manifesto to allow people to “check your health records online in the same way that you do your bank account”.
The initial plan was to provide patients with online access to their full patient record by 31 March 2015, but these plans were later scaled back to require GP practices to provide access to the information held by the Summary Care Record by this date
The latest figures show that the target of 95% of practices was hit; although 197 practices had still not enabled the functionality by the end of March, while a further ten had no functionality in place.
All the practices with no functionality have Microtest as their system supplier and are primarily in the Devon, Cornwall and Isles of Scilly area, while the trusts that have functionally but have not enabled it are divided between TPP, Emis and INPS.
The number of patients actually signed up to view their records online remains relatively low, at just over 2.5 million, or 4.5% of the total number of registered patients. However, this is a big step forward from the end of December, when just 750,000 patients were signed up.
Usage is picking up too, with patients accessing their summary information 231,091 times from January to March 2015, compared to 50,189 times for the three-month period ending 31 December 2014.
Lots more information and details are here:
So what we now have in the UK is that most people who want it can have access to a summary of the record held by the GP as well as the capacity to arrange repeat prescriptions and appointments etc.
Given this access is provided on-line by your local practice it would seem that something that is even more useful and accessible than the PCEHR has been created without the issues around centralised systems and the risk of large security breaches and so on.
It also totally avoids the issues around replicated records where all sorts of inaccuracy can come in.
I wonder was an approach of this sort considered before the extra half billion dollars was thrown at the PCEHR?


Bernard Robertson-Dunn said...

The NHS model in the UK is significantly different from that in Australia. In the UK, if you want to use the NHS, you need to register with a local GP. That means your GP is your one and only contact with the NHS and so your Health record can be associated with, and managed by, and stored by, that GP.

Australia does not have the same system. You can go to any GP or medical centre who will see you. And, as you know, you can go to several or many.

The UK system won't work in Australia because there is no mandated single point of contact with the health services system. The PCEHR is an attempt to overcome this (different) problem, however the solution still relies on the patient's GP as being the interface into the system. But as we know, the patient doesn't have "a" GP.

In other words, the solution doesn't match the problem.

It's a case of "here's a solution, it works somewhere else, let's use it here".

It's one of the many fundamental flaws in the PCEHR/myhealthrecord, brought about by, IMHO, a lack of understanding of, not only Australia's problem, but the problems other countries face and why their solutions don't fit easily into our environment.

Dr David More MB PhD FACHI said...


The vast majority of chronic and complex patients - the target of the PCEHR - do tend to stick with one practice.

I would not be quite so quick to dismiss the idea.


Bernard Robertson-Dunn said...


I'm not dismissing the idea, I'm pointing out that a) the PCEHR doesn't solve Australia's problem and b) the UK idea won't form the basis of a national health record system.

Also, the UK idea won't address the "away from your GP" problem, which is one of the main selling points of the PCEHR.

Dr David More MB PhD FACHI said...


Being on line - this access to a record does get over the away from GP issue.

The issue of whether you need a NRS is the core one. I think the downsides are bigger than any upsides.


Bernard Robertson-Dunn said...

"Being on line - this access to a record does get over the away from GP issue."

The patient seems to have remote access, who else does, without going through the patient, who may or may not be in a fit state to provide login details?

Dr Ian Colclough said...

Bernard presents his reasonable argument quite clearly (May 28, 2015 9:54 AM) . How refreshing. He correctly concludes that:
1. the solution doesn't match the problem.
2. It's a case of "here's a solution, it works somewhere else, let's use it here".
3. It's one of the many fundamental flaws in the PCEHR/myhealthrecord, brought about by a lack of understanding of, not only Australia's problem, but the problems other countries face and why their solutions don't fit easily into our environment.

On the other hand David posits (May 28, 2015 10:03 AM ) that:
4. The target of the PCEHR are the vast majority of chronic and complex patients.

With respect on point 4 I disagree as the PCEHR is intended to be for ALL AUSTRALIANS; that includes children, adults and the elderly, the worried well, the acutely ill, and the chronic and complex; including when patients are “away from their GP(s)” and from their various specialists (note the plural here).

As David astutely observes (May 28, 2015 10:33 AM) the core issue is whether you need an NRS.

Government has consulted extensively, but it has not listened carefully, it has ignore a great deal of very sound advice and it most certainly has not understood the problem. Along the way very many consultants have fed from the trough of deep confusion which has followed.

The entire project went off the rails a long time ago when the answer (be it the conclusion) was first posited; this was then followed by lots of poorly thought through arguments created to justify the answer in order to tap the Government’s coffers to develop and deploy a system that was intended to resemble the ‘answer’ which those promoting it did not understand.

Therefore, regardless of how much has been expended to date and how much more has been budgeted to be spent, the highest priority is to return to the fundamental question as the very first step – what is the problem?

Is the problem real or imagined? Can we dissect it into (its) precisely understandable parts? Can we dissect those parts and so on down to some acceptable granularity which is comprehensible and logical? Perhaps others will agree.

And who should we use to do that? Get that wrong and the project will fail once more. We’ve been there before at least 4 times on a grand scale according to my records; each time for the same reasons!

If the bureaucrats can’t think outside the square they will forever remain imprisoned within it and the taxpayer will pay dearly.

Dr David More MB PhD FACHI said...


I agree the unconscious pose a problem - but there is always the telephone.

Overall there are a range of ways of skinning the cat - and with sensible use of cloud services there may be even better ways.

If you are a Government fixated on control of patient information so you can mine it - then there are few lateral approaches - but if you want to solve the problem of access to and sharing of relevant health information there are a vastly larger number of choices!

To Ian To me there are actually 2 questions - none of which are properly answered with any current proposals. 1 Who is this system for and 2. what problem is it to solve (or try to)?