Sunday, August 09, 2015

e-Health And Primary Care Into The Future. What is Being Discussed In This New Paper And Is It Based On Reality?

This release appeared a few days ago.

Primary health care reform discussion paper released

The Australian Government has released an options discussion paper ‘Better outcomes for people living Chronic and Complex Health Conditions through Primary Health Care’.
Page last updated: 04 August 2015
4 August 2015
Consistent with the Abbott Government’s commitment to reforming primary health care, the government today released an options discussion paper ‘Better outcomes for people living Chronic and Complex Health Conditions through Primary Health Care’.
Minister for Health Sussan Ley said the discussion paper considered possible reform options which would inform the government’s development of a healthier Medicare to support people with complex and chronic diseases and keep them out of hospital longer.
Ms Ley said options in the discussion paper included enrolling people to a single provider who would coordinate the multi-disciplinary care the patient received rather than the patient coordinating their care, set chronic disease payments for a defined package of care rather than individual services and international methods of best practice.
Lots more here:
In the main discussion paper we find this:

Theme 2 — Increased use of Technology

What do we want to achieve?
An efficient and integrated health system that embraces cost-effective technology to improve patient management across the whole health system, and empowers patients with chronic and complex health conditions to participate in their care and incorporates convenient and accurate monitoring and feedback.

Possible Options

2.1 Patient Participation
Appropriate use of accessible health records and  other technologies can have a positive impact on patient outcomes and their need for services.
Through new platforms such as My Health Record, patients will be able to access much of their health information, promoting greater involvement in the delivery of their care.
Advances in medical technologies mean that home-based self-testing and self-monitoring options are more readily available and decreasing in price.
Education and ongoing support could be developed for patients and health care professionals in order to maximise the benefits of the technology.
Insurers could also be further encouraged to partner with primary health care providers to support the use of home-based monitoring and health record technologies. Some insurers already include access to health aids and appliances for the management of chronic and complex health conditions that the primary care providers may not be aware of.
Confidence in the security and privacy of health information systems is essential. High levels of security and multiple levels of access control are built into the My Health Record and secure messaging is available for data generated between care team members and to patients, but its use is variable.
2.2 Enhanced Team-based Care
Electronic health records, like My Health Record, will play a critical role in supporting team-based care by ensuring that health care professionals have ongoing access to up to date information on their patients’ conditions and treatments, (subject to patients’ consent).
These records complement existing tools used to support team-based care, such as web-based information portals that can also schedule services and allocate responsibilities according to a care plan. Appropriate use of telehealth or video-conference consultations can also be used to effectively address local service gaps.
Greater use of encrypted communication between health care providers is needed to ensure privacy and security of sensitive health information. Existing systems are well placed for further development to support this communication.
Targeted education, training and support for cultural change may be required to accommodate new processes, and link to existing systems across health sectors.
For example, integration of care team and case management technologies with clinical information systems from hospitals will improve discharge planning and support continuity of care for patients with chronic and complex health conditions.
2.3 Emerging Technology
Advances in medical technologies, including software, smart phone applications, self-testing and point of care testing, can improve convenience and efficiency. These technologies may decrease the need for dependence on pathology labs and repeat testing by providing convenient alternatives for patients and health care professionals.
Improving the quality and frequency of information sharing and communications between health care team members will improve condition management and patients’ outcomes, as well as better support health care providers to share necessary information consistent with legislated and clinical requirements. Software compatibility across health care providers remains a challenge.
While there are major potential gains to be realised from new technology, education is required to ensure testing and monitoring devices are appropriately used, deliver value for money, and that the storage and communication of health information with new devices is secure and compatible with national standards.
2.4 Cultural Change
Primary Health Networks and Local Hospital Networks could be further supported to progress cultural change within the health care system to facilitate system-wide use of electronic health records and other technologies.
Questions — Use of technology
How might the technology described in Theme 2 improve the way patients engage in and manage their own health care?
What enablers are needed to support an increased use of the technology described in Theme 2 of the Discussion Paper to improve team based care for people with chronic and complex health conditions?
The document can be had from this link:
Under the heading Digital Health in an associated (much longer) Background Document we get the following review of Australia.(pp80+ etc.)

7.1.1 Australia’s system

Australia has a long history of investing in digital health and embedding it within the broader health  care system, at both the national and the state level. In 1993, the National Health Information Agreement (NHIA) came into effect,317 and the Australian Government has since supported primary health care practices in implementing IT systems, electronic medical records and digital health through the Better Practice Program and (from 1998 onwards) the PIP.
Since 2000, Australia’s system has undergone four major changes:
In 2000 and 2003, respectively, HealthConnect and MediConnect were established to leverage different health systems in Australia and trial initial standards for the implementation of EMRs.
In 2005, the National eHealth Transition Authority (NEHTA) was created to drive digital
health initiatives, supported by both the Federal Government and state governments.71NEHTA’s purpose is to lead the uptake of health systems of national significance, and it has been building the foundations for a national EMR since 2010.318
NEHTA has established documentation and recommendations for terminology and secure messaging standards; made progress in encouraging vendor support for including specifications and standards in releases of their software products; established the elements of My Health Record; and collaborated on establishing the Unique Health Identifier (UHI) proposal.318 The Australian Commission for eHealth will replace NEHTA in July 2016.319
In 2011, the Australian Government introduced the specialist telehealth initiative, with the dual aims of improving access to health services and up-skilling health professionals in rural and remote locations. The initiative included payment of a $6,000 incentive for joining, a $60 service incentive for specialist telehealth consultations, and a $20 telehealth bulk-billing incentive. These amounts were paid in addition to the usual MBS consultation schedule.320
The telehealth initiative also provided financial incentives to eligible residential aged care services to enable participation in telehealth consultations with specialists, consultant physicians or consultant psychiatrists. While the financial incentives ceased in June 2014, health care professionals continue to receive higher Medicare benefits for telehealth services.321
To date, the Australian Government has not introduced incentives for telepharmacy services or telehealth to the home in the primary health care setting.322
In 2015, the Australian Government launched the personally controlled electronic health record (PCEHR, recently renamed My Health Record). By May 2015, approximately 2.25 million people and over 7,700 health care practices had registered to participate in the system, although utilisation of the records by health care professionals remains variable.
Despite these major transitions, opportunities exist to expand the use of digital health elements. Firstly, Australia still relies heavily on physical health care, with limited scope for—and uptake of—telehealth and mobile health consultations.307,321
This is especially true in rural areas, where educational and administrative uses of telehealth are strong, but the use of telehealth technology for clinical applications has been limited due to bureaucratic and procedural barriers, as well as participant hurdles.323
Secondly, limited subsidies for remote monitoring devices have restricted consumers’ ability to self-manage their chronic conditions. For example, while the MBS funds insulin pumps, continuous glucose monitoring devices and sensors are not currently available for subsidy.324
Finally, although financial incentives have been introduced to encourage practices to use EMRs, actual activity around electronic medical records has been limited. Approximately 2.25 million people have registered, but only 1,727 specialist letters have been written, and only 30,300 consumers have viewed their records.325There has also been limited uptake of clinical decision-support tools beyond those integrated into clinical information systems.326
The full paper is found here:
I am not sure what others make of the e-health components in these papers but to me that are superficial, uninformed, unduly optimistic and basically flawed.
There seems to be a view expressed in the first extract that seems to basically ignore all the GP based computing and secure clinical messaging that is already in place and to seem to be asserting that the Government’s e-health system is the ant’s pants. This is despite the Health Minister saying as late as lat week that the PCEHR was distinctly a ‘work in progress’. We all know the PCEHR is essentially rubbish.
The second extract just utterly glosses over what has happened over the last 15 years in e-health and seems to pretend what has happened over this time has all be beautifully planned and executed. Anyone who has been watching as I have been knows just what utter rubbish that is. The history of the last 15 years has been characterised by vaulting ambition and atrocious execution - and it still goes on!
We need to have some responses to this paper that point the facts out!


Anonymous said...

In 2015, the Australian Government launched the personally controlled electronic health record (PCEHR, recently renamed My Health Record).

That would be 2012, and is now referred to by the department as MyEHR, it is still the PCEHR according to MyGov

Anonymous said...

Its all very post modern. Generic managers who can't actually tell if what they have been managing is actually working somehow feel that if they keep saying that "its all working" and run some education programs and produce even more glossy PDFs that the problem will somehow respond to this good "management" practice and all will be well.

Its not dissimilar to the review of NASA which found that NASA managers were expecting people to defy the laws of nature. It didn't work.

No matter how nicely you talk to the compiler or tell it you have a ministerial and you had better compile this rotten code it does not work. It will never work and its costly the country (and lots of other countries for that matter) a huge amount. You cannot drive an ehealth program by decree from the top floor of an office block in Canberra unless you really deeply understand what you are doing. I guess maybe they are hoping for a promotion to another department before this comes crashing down. Its worked before...

Juanita said...

Same tired old e-health story, replete with euphamisms and marketing generalities, new day, Minister, political party etcetera ... So much work for effective health informaticians to do ... sigh ...