Sunday, September 27, 2015

What Utter Hipocracy - DoH is Really Just Policy Nonsense!

We have the spectacle today of the Government releasing the review of MBS Items for value for money and clinical utility. They are demanding evidence that things are useful, safe, make a difference and actually work etc.

See here for all the details:

http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSReviewTaskforce

At the same time we have a proposal on ePIP - to spend more money on the PCEHR. This is an that is an utterly evidence free proposal as there is zero evidence on what the PCEHR can do and deliver - if anything!

See Today's blog for links:

http://aushealthit.blogspot.com.au/2015/09/is-government-outsmarting-itself-with.html

Seems we have an ongoing fiasco of lack of intellectual capacity and honesty from a hopeless bureaucracy! Just exactly what is the evidence that the PCEHR is or can make a difference to patient care or costs? We are all waiting!

How about a value for money and quality review of the PCEHR? We need it! BTW  the review of the MBS Schedule is a perfectly reasonable thing to be doing - the trick will be to have the evidence properly assessed and valued. There is no way the bureaucrats who keep wasting money on the PCEHR can be expected to get the MBS Review even close to right!

Pretty sad.

It is also ridiculous to see the instant politicisation of what really should be a scientific, evidence based review. A pox on all their houses for this.

David.

6 comments:

Dr Ian Colclough said...

I have read this Discussion Paper carefully which seems to reflect the views of the PIPAG. The nub of the problem is the politically unacceptable low level of use of the PCEHR. The deep seated belief seems to be that a revised version of ePIPs will fix the problem. The mechanism to achieve that is this Discussion Paper which presents some proposals based on feedback provided by PIPAG in August 2015 which the Department has relied upon to develop the discussion paper and set a new direction for the five ePIP requirements.

Proposal 1 - Criteria for Change states that "it is proposed that criterion 1-4 [in Attachment A] do not change as part of this review".

The inference here is that the roses in the garden smell lovely so let's not change criteria 1-4 and focus the discussion paper on the fifth criteria "Personally Controlled Electronic Health (eHealth) Record System.

The problem I am wrestling with here is the leaning tower of Pisa issue. If the first four foundation blocks are faulty, and I have seen no evidence to suggest otherwise, then the fifth block [PCEHR] will continue crumbling until the foundations 1-4 are in place, widely used, reliable, effective, secure and robust.

The only reasonable conclusion I can come to is that the best chance government has of getting solid eHealth runs on board in a short measure of time is to put our scarce resources into Requirement 4 as the highest priority. There seems to be a reluctance by the Department to put resources into driving eScripts firmly into place to give us all, the infirm, the chronically ill, the young and the healthy, a national electronic medication record.

Dr David More MB PhD FACHI said...

Ian,

You are assuming the Department has any capability to implement anything. Talk about the triumph of hope over experience!

They should just stop it all totally, get out of the way, and leave the private sector to meet the needs that might make a difference!

They have had 20 years to show they can add any value and we are still waiting! Enough is enough!

David.

Bernard Robertson-Dunn said...

The premise behind the government's review of the MBS is that too many tests are being ordered often with limited or no benefit and that many services being performed that do little for the patient.

So, what should eHealth and the troubles facing the government re spiraling costs of the MBS in common?

My answer IMHO, is - better clinical decision making.

None of the current initiatives coming out of the department of Health even acknowledge this, never mind try to address it.

The PCEHR is a dumb database with so many inherent problems and little benefit that it's not being used. The ePIP cudgel is being used to force doctors to become less efficient by spending time populating the disliked PCEHR and the MBS review is being interpreted by the AMA as an attack on the integrity of doctors (http://www.smh.com.au/federal-politics/political-news/turnbull-government-announces-medicare-services-review-20150927-gjvzrx.html)

If there is a strategy behind all this it's a bit like throwing mud at a brick wall and watching what sticks. Unfortunately, all you'll end up with is a brick wall you can't see any more, which is a real problem if the issue was the brick wall.

Dr Ian Colclough said...

That's not correct David. I have made no assumptions about the Department's implementation abilities. In fact it has always been my view that Department should not be involved in trying to dictate outcomes through the use of artificial incentives payments constructed to push square pegs into round holes in the hope an ill-conceived concept like the PCEHR will deliver a national eHealth record or parts thereof.

Rather the Department's role should be to implement Government Policy, manage the health budget and act as a source of well directed and well managed funds [a catalyst] astutely targeted to support innovative initiatives which have demonstrated their ability to deliver useful eHealth outcomes; and which clearly have the capability of attracting real traction and support from the grass roots of the market place (dare I say - the end users - the service providers).

The Department wants to be ubiquitously all things to all parties at all levels; yet in regards to eHealth it has over the years shown it is lacking the leadership, the skills, the expertise and the nous, to be just that. Consequently we have consistently witnessed many hundreds of millions of dollars repeatedly wasted on multiple failed eHealth 'events' (often described as initiatives); all emanating from the Department's floundering around in various sectors of the eHealth domain which it does not understand. All the while failing dismally to acknowledge, communicate with and embrace the real innovators who have the ability to take eHealth forward in this country.

Prime Minister Turnbull clearly understands what is needed to take Australia forward; but to make progress requires a major cultural change across the Department which continues to adhere to repeating the old ways of doing things and ending up in the same place with the same result.

Dr David More MB PhD FACHI said...

Ian,

What you have just written confirms my view they should be out of the space - and are clearly unable even to set a sensible policy - let alone make any headway with it!

David.

Terry Hannan said...

I am in Chile on sabbatical working on an eHealth project with a Dr Daniel Capurro a General Physician. On arriving what do I find?
A very functional Emergency Medicine EMR (eHealth system) and in the clinics that is used directly in patient care “by the clinicians” (doctors, nurses, pharmacists, etc.). It has a dynamic triage based interface with “record only screens” (no added applications). CPOE is direct. The system is paperless (an overnight switch 3 years ago from paper+EMR).
Patients register their appointments via the internet and arrive at the clinics and log on via a kiosk at which all directions and waiting times are shown to them.
The clinicians in their offices have direct access to the latest data and information as well as reports relevant to the patient. They update the records in the clinics.
Three years ago it was nationally legislated that all patients be given a copy of their record (the exact mechanisms for doing so are evolving).
When watching in real-time Dr Capurro who is also the CIO we see the waiting times in the Emergency department and clinics and he “is concerned” that the waiting time in the Emergency Department has expanded to 48 minutes!!!
Also it has functionalities via icons that show activities like an IV has been ordered 15 minutes previously and is still not running. Or an IV is running but antibiotics have not been given within the nominated time frame.
I am working on Order Sets for clinical workflows and one of the issues to be resolved is to reduce the variation in clinical workflow protocols because “the physicians are able to design and create their own workflow Order Sets” e.g. Abdominal Pain.
Although not used by the administrators and governments the system downloads DRG data DAILY.
What a joy it is to work in a ‘true clinical ehealth environment’.
On the 2nd November this system will be installed and linked interoperatively with a smaller sister hospital about 10 Km away.
Much preparation in IT and STAFF planning has occurred and on the day it goes live the HIT staff "sleep overnight there" and are on 24 hour call for support.
The POWER of the end users -NURSES - is a joy to see and experience.