Friday, July 17, 2015

It Looks Like We Are Spending Way Too Much To Get Much Too Little With The PCEHR.

This appeared a few days ago.

Wales rolls-out patient portal

8 July 2015   Thomas Meek
Wales is nearing the complete roll-out of its My Health Online portal for online bookings and repeat prescriptions.
In its latest newsletter, the NHS Wales Informatics Service says the service needs to be implemented at one more GP practice in the Aneurin Bevan Health Board area and this will occur within the month.
Once completed, My Health Online will be live at all 458 GP practices in Wales, offering patients the opportunity do a variety of health-related tasks online, including booking appointments and ordering prescriptions. 
NHS Wales Informatics Service said that more than 130,000 patients have registered for My Health Online and that interest in both the ability to book appointments and order prescriptions is “growing.”
The service, which is available in both English and Welsh, was launched in 2011 backed by £1.7 million of funding from the Welsh Assembly Government.
The first practices to sign up were using patient record systems from Emis and INPS. The service has since been extended to work with other system suppliers iSoft and Advanced Health and Care.
In addition to using the service to book appointments and order prescriptions, patients can update general details, such as their address and get access to advice and information on managing health conditions.
More good news here:
What a wonderful story. For a few million dollars the people of Wales seem to be getting a portal which will do much more than the PCEHR, providing functionality  that we know people want (prescription repeats, appointments etc.) as well as giving access to patient details and records.
Yet again it is hard to argue the Australian Public has been given either a cost effective or useful system for a quite an absurd amount of money.
If we can have Royal Commissions on Pink Bats and Unions what about one on the last decade of Public E-Health in Australia - billions have been spent and it is hard to know what we really have received for it! Not much I can see!
David.

14 comments:

Anonymous said...

And all the while we still have the same clown responsible for the concept of operations, then break down and ultimate demise of NEHTA architecture, tiger teams for standards development still at the helm of strategy and architecture in NEHTA. DoH you want change for the better, it won't happen under that team. I bet the are bantering agile for policy and clinical community engagements.

Anonymous said...

I agree a lot has been spent to get to where Australia currently is regarding eHealth and the PCEHR has diverted focus and resources from other areas of eHealth needs, however; Wales is just a part of the UK, it is much the same as thinking that the NT eHealth system will work for the rest of the nation.
A lot of trust and respect has been lost over the past four years and NEHTA seems to have lost control of itself operationally, ACeH holds the potential to repair this but only if it manages to leave the past mistakes and poor leadership behind, if the same figureheads move across then terminology and informatics along with architecture and specifications will remain stagnant for many years to come.

Anonymous said...

Both Anonymous, nothing will change, no one will listen, if it is still the same by December as far as executives covering eHealth products and services then you will know the future.

Bruce Farnell said...

This is my summary: "So much was owed ($$$) to so many for so little."

Where do I go to get my money back?

Anonymous said...

Hi David, it has been a while since I visited your blog, good to see it is still alive and kicking, I have recently returned to ehealth and can't believe old daffy is still running architecture, still no surprise a self promoting salesmen always survive.

Keep up the good work David

Bernard Robertson-Dunn said...

I have tried to make sense of the architecture of the PCEHR from the available documents and occasional conversations with people who hove been involved over the years and have come to this conclusion:

If there ever was an architecture, NEHTA is no longer the owner of it. Which is why the publicly available architecture documents are old, inconsistent and half-arsed.

This is because they have bought a set of products and the vendors now own the architectures. And they aren't going to share anything, if they can get away with it - which they can.

It's classic government procurement practice. Create some requirements that feed the RFT, buy a bunch of products that may or may not implement all the requirements, but don't rework the requirement documentation.

The upshot is that nobody in government now actually understands what the system does or how the system works.

It was bad enough that they didn't really understand the problem (NEHTA's view of the problem is that all they need to do is provide a big, electronic filing cabinet. A stupidity of a high order and naivety), the requirements they came up with and which went into the RFaT now bear even less of a relationship to what is required to support better health care decision making.

Anonymous said...

Hi Bernard, I can find no new alternate Architecture for PCEHR V2 just months out from the trials, seems a little risky to me have you heard or seen any? Not the sort of thing you should or make up along the way.

Bernard Robertson-Dunn said...

Paul Madden has publicly stated that, apart from some enhancements NEHTA have already been planing for the system, there will be no changes before the trials.

This is in spite of all the reviews that have been conducted saying that clinicians want improved "utility". This is code for "the system doesn't actually do anything useful when it comes to supporting health care decisions".

My understanding is that, apart from testing the waters of public opinion (the trials) nothing of substance will happen until ACeH gets going.

Anonymous said...

It's classic government procurement practice. Create some requirements that feed the RFT, buy a bunch of products that may or may not implement all the requirements, but don't rework the requirement documentation.

Bernard, I believe the DoH contracts NeHTA to do this, the failure is that of NeHTA, it is not the fault of the architects and analysts, but those responsible for maintaining architecture discipline. This failure will cost tax payers plenty in the near future and someone needs to be held to account.

Bernard Robertson-Dunn said...

AFAIK, the PCEHR contract is with DoH, so it falls under government procurement laws.

Most of these business case/RFT/contract processes are run by project and public service managers who don't understand what it takes to define what a system is supposed to do. Which is why, in this case, they don't understand the difference between Information Technology, Information Systems and automation and support of work practices.

Health care is not like most business or government processes, which can be relatively easily modelled and implemented in software. Most GPs and health specialists can't describe their thought processes when they a) diagnose problems and b) proscribe care/treatment.

Health care is a poorly understood art form that does not lend itself easily to automation.

Project and public service managers are process driven people - apply a standard set of procedures and you get a known answer. In the case of health care and the development of health care systems, this does not apply.

The word that describes this is Hubris, which is a form of prejudice and reminds me of this quote:

"Prejudices are rarely overcome by argument; not being founded in reason they cannot be destroyed by logic."
Tryon Edwards (1809–1894)

Anonymous said...

Paul Madden has publicly stated that, apart from some enhancements NEHTA have already been planing for the system, there will be no changes before the trials.

Considering there is no strategy or any sort of annual plan by NEHTA to be referenced the above statement leaves the boundaries to the imagination. This is for me at least, a symptom of my now long lost trust in EHealth leadership. I doubt even if plans exist that they are followed for very long and it is more about personal gains, bullying and one upmanship.

Anonymous said...

Paul Madden has lots of plans and strategies. Mostly with him as the beneficiary. As soon as he sees trouble ahead, he will springboard off into something better.

Anonymous said...

Paul Madden is in the same bed as Dr Hambleton - neither have anywhere to go except to keep beating their drum louder and louder in the hope that everyone will hear them and believe them. The problem is lack of leadership. A good leader who knows what he is talking bout and has the track record and experience to back it up would say STOP - STOP right now - FREEZE everything - STEP RIGHT BACK and let's have another look, objectively and intelligently, at this monumental fiasco which is fast becoming the laughing stock (NOT the envy) of the the eHealth world.

Anonymous said...

This is a view worth consideration, http://lockstep.com.au/blog/2015/05/11/pcehr-opt-out