Wednesday, October 14, 2015

Article Draft - It Is Starting To Look Like The Federal Government Has No Really Viable Plan To Properly Reset National E-Health For The Future.

With the appointment of Ms Sussan Ley to replace Mr Peter Dutton as Federal Health Minister - and the even more recent replacement of Mr Abbott by Mr Turnbull - there was some increasing expectation that effective remedies for e-Health woes and better health information use would emerge. The hope was that we might see a reset and adoption of a new evidence based direction for e-Health.
We have arrived in our present e-Health situation via almost 25 years of e-health effort which has been sadly, of recent times, really not been all they evidence based. The worst offender in this regard has been the PCEHR which was started in 2010 under Labor, launched in 2012 and three years later has seen such desultory adoption and use that the now Government is now seemingly wanting to force a PCEHR Record on all citizens who don’t choose to ‘opt-out’,  with all the risks to privacy, consent and security this entails. The work to date by both sides of politics has been pursued based on the rather dubious assumptions that electronic health is good for us and that great benefits are available for the Health Budget.
It should be stressed that the PCEHR is not the only health record system in operation in Australia; in fact, it is one of the least useful. Hospitals, GPs, specialists, laboratories etc., all have their own systems, tailored for their needs and appropriately partitioned as to content and requirements of the health professional user.
In the publicly available documentation on the system it quite clearly states that “The PCEHR System is intended to complement and not replace existing clinical information systems” and “The PCEHR is not a replacement for normal sharing of information between an individual and their healthcare provider” . I do not dispute the potential benefits achievable by using electronic health record systems, merely that the PCEHR will ever deliver any of them.  
Sadly in the last week or so there has emerged increasing evidence that there may not be as much change on the PCEHR front  as one could desire.
The evidence comes in three strands.
First, and probably most important, we had a press release from the Federal Minister for Health (Ms Sussan Ley) on October 9, 2015 entitled Developing a 21st century electronic health record system. This release outlined the composition of a new Committee which is charged with establishing a new Australian Commission for eHealth which is intended to take forward both the present national e-Health infrastructure and the National E-Health Record System which has, or will (depending on the passage of legislation) be renamed My Health Record from the previous PCEHR.
In the release the claim is made that “A functioning national electronic medical records system is essential to ensure doctors, nurses, pharmacists and other healthcare providers across the country had instant access to the information needed to treat patients safely and efficiently without having to gamble on unknowns in their medical history.” Sadly there is no evidence I am aware of that the proposed My Health Record will actually provide a working example of the system intended or deliver the benefits claimed (some $2.5Billion p.a. apparently).
Equally it is difficult to believe that a Committee made up mostly of the leaders of the failed implementation of the previous PCEHR to date, are suddenly going to develop the insight to deliver a new much better working system at this attempt. Surely a very substantial injection of new expertise and experience is needed and this has simply not happened. No real reset here.
You can read the full press release from this link:
The bottom line here is that we are going ahead, spending money and not really thinking hard about why the PCEHR System has been so unloved to date.
Second we had the announcement in early October of the criteria that were to be applied to select the sub-sets of the population who were to be used as the test populations for making the My Health Record an opt-out rather than an opt-in system. What this means is that for these test populations an individual record be created and populated by Government with available information from the MBS and PBS unless, after a public education program, the individual takes steps to notify Government they do not wish this record created.
The criteria for a population area to be included are outlined in the following quote:
“ To guide the selection of the opt-out trial sites the following criteria has been agreed by State and Territory Health Chief Executive Officers:
  • Site population of approximately 250,000-500,000.
  • Clearly defined geographical area so there is no confusion as to whether people are included or not.
  • Ability to confine communications, including electronic media, to the site.
  • Demonstrated existing eHealth capabilities and utilisation of eHealth services across local health services including General Practice, pharmacy, aged care services, and at least one hospital.
  • Higher than average PCEHR uptake by providers.
  • Strong clinical networks with a demonstrated commitment to the success of the trial - Primary Health Network/s, Local Hospital Network/s and any other relevant local health organisations within the trial site area.
  • Positive community engagement with, and local government commitment to, previous non-eHealth trials.
  • Not currently involved in, or minimal involvement with, other State, Territory and/or Commonwealth run trial activities (for example the NDIS).
  • Include a range of population groups (i.e. Aboriginal and Torres Strait Islander, CALD backgrounds.
  • At least one of the opt-out trial sites to include rural and/or remote areas.
You can read a fuller discussion of the plans from the link:
So in summary they want to trial the opt-out process where there is good support and some considerable opt-in to PCEHR use. Might it not also be a good idea to trial in one or two regions where this is not the case to get a good understanding of possible risks and issues?
To be utterly frank I have no idea how the demented, the very young and very old, the socially isolated, the psychotic, those with a sense of paranoia regarding intrusive, invasive Government and the technophobic are going to take all this - but we shall see I guess.
Writing in mid-October it is hard to see the trials up and running before the new year and then running for long enough to be properly evaluated and the broader scheme, if it is to come and all the ‘wrinkles’ can be managed before mid-2017. That may even turn out to be optimistic.
Third we had the following from a speech given by the DoH Chief Information Officer in late September 2015. To quote from the report of the speech to CEDA given by Mr Madden:
“But progress remains slow. While the review recommended opt-out be introduced from the beginning of this year, legislation allowing for the regional trials and eventual national transition was only introduced to the parliament last month.
Nonetheless, although it “needs some tweaking” and usability changes, “the good news for our government is they’re not up for a really big system build,” said Madden. “The system exists, it’s been there for three years.”
And it’s been improved from where it began. Whereas the prospective customer needed to endure clicking through 17 screens to prove their identity when it was first created, the system is now down to two.”
Mr Madden’s claims regarding benefits of the system are also, to my eye, and putting it gently, pure fantasy. To quote again:
“ It is expected that putting records online could save the Commonwealth $2.5 billion per year within a decade by reducing inefficiencies, with an additional $1.6 billion in annual savings also delivered to the states, according to the government.”
Here is the link to the relevant article:
Overall what all this reveals to me is an utterly clueless collection of bureaucrats who are steaming on attempting to implement an evidence free program in the absence of a coherent National E-Health Strategy and before any appropriate governance mechanisms are in place to look after the interests of what are a very broad range of stakeholders.
This is all going to end very expensively and very badly I predict.
Comments welcome


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