Sunday, November 22, 2015

NEHTA Reveals Just How Clumsy The PCEHR Will Always Be. It Is Just Going To Be An Ever Bigger Pile Of Separate Documents.

NEHTA published this little piece of ‘news’ last week.

Shared Health Summary Versus Event Summary

Created on Tuesday, 17 November 2015
In the eHealth record system, the Shared Health Summary and the Event Summary are two separate clinical documents – you can find the different features of each one here.
Link is here:
Here is the main contents of the document
Shared Health Summary
What is it?
Represents a patient’s health status at a point in time. This will include known information in 4 key areas: patient’s medical conditions, medicines, allergies/adverse reactions and immunisations.
A patient has only one current Shared Health Summary at a time.
Who can create and upload?
Shared Health Summaries are prepared and uploaded by a patient’s Nominated Healthcare Provider – the patient’s regular provider.
They can be either a:
• Medical practitioner registered with the Australian Health Practitioner Regulation Agency (AHPRA)
• Nurse registered with AHPRA
• Aboriginal and Torres Strait Islander health practitioner registered with AHPRA.
When to create?
Examples include:
• When completing a patient health assessment (e.g. GP Management Plan, 75+ Assessment, child health check)
• Significant changes to a patient’s health status in any of the 4 key areas: patient’s medical conditions, medicines, allergies/adverse reactions or immunisations.
The Shared Heath Summary should be created in consultation with the patient.
How to create?
Software demonstrations can be found here:
Where to go for more details? uploading-a-shared-health-summary
Event Summary
What is it?
Captures key health information about a significant healthcare event that is relevant to the ongoing care of the patient, e.g. indicating a clinical intervention, improvement in a condition or treatment has been started or completed.
Who can create and upload?
Event Summaries are intended for healthcare providers who are not the patient’s regular provider/ Nominated Healthcare Provider.
They can be created and uploaded by any healthcare provider with a Healthcare Provider Identifier – Individual (HPI I) who is working at a participating healthcare organisation and involved in the patient’s care.
When to create?
Examples include:
• Patients visiting an after-hours medical service
• Holidaying patients
• Patients visiting from another area
• Patients receiving an immunisation or flu vaccine.
Generally, an Event Summary is used when it is not appropriate for the healthcare provider to create and upload any of the following:
• Shared Health Summary
• Discharge Summary
• Specialist Letter.
How to create?
Software demonstrations on uploading an Event Summary will be available soon. Check the NEHTA website for details.
Where to go for more details? uploading-an-event-summary
NEHTA website features-of-the-ehealth-record-system/clinical-documents
NEHTA guide
----- End Extract.
So what the patient record will be is a single summary and then an ever increasing pile of unco-ordinated event summaries.
Given the event summaries will just pile up in some random temporal (not clinical) order it is hard to be sure just what value all of these documents will add and how useful they will be - rather like last week’s newspaper.
If you are looking to provide clinical utility for most of the stated purposes of the PCEHR all that is needed is the Shared Summary. Of course you can create a huge pile of results and prescriptions but how often, if ever, is anyone going to actually wade through all the junk to find something relevant, rather than just ring the relevant provider etc?
The only reason a national system would want the results of billions of blood test results has to be for some - unannounced - data mining project or the like.
Without a clear plan as to how the information will be managed and organised within the PCEHR - which at present seems to be a ‘State Secret’ - the system is a joke. Take it from me DoH and NEHTA have no clue on this. They seem to think we will aggregate and you (the GP) will hunt through - with the clumsiest interface imaginable!  They are dreaming!


Bernard Robertson-Dunn said...

re: "Shared Health Summaries are prepared and uploaded by a patient’s Nominated Healthcare Provider – the patient’s regular provider."

So, if you are a constant traveler or a grey nomad, when it might actually be useful to have a central health record, you won't have a regular provider to manage your shared health summary.

And if you always see your regular provider, you won't need a Shared Health Summary. In fact your regular provider will only be managing your Shared Health Summary in case you end up seeing a different provider.

So what's the incentive for the regular provider to spend non-productive time and effort? Altruism? When under pressure from the government to reduce costs?

And for all those folks who are forced to have a health record, even though they don't need one, and know nothing about having one, they won't have a Nominated Healthcare Provider or a Shared Health Summary.

Unless I've misinterpreted what the government has told us about the opt-out trials. Oh, apart from stuff buried in their eHealth Bill submission, they haven't told us anything. That will be a surprise worth waiting for.

Anonymous said...

unannounced - data mining project or the like.
If this comes about it will be by accident or opportunity rather than any long term strategy. The Governments of Australian need to be enlightened as to better options moving forward. Unless the executive and his merry band of product Architects are provided the chance to work in another industry the current state will simply lead to an end that will scar many a career in Canberra.
I also feel people could be a little more helpful in this blog, it can come across as a negative venting site (which reflects the mood), however, posting some positive examples of national solutions might help some in power to explore these options.
There is no easy answer, but then there rarely is at this scale of challenge.

Trevor3130 said...

O Ye of little faith! A big - humungous! - pile of uncoordinated data? No problem, if this article in Economist is on the money.
Out of the box.The open-data revolution has not lived up to expectations. But it is only getting started.

ONE night last year Jim Rich came home from a basketball game in Texas with an excruciatingly painful leg. His wife Rosemary, a nurse, feared he was suffering something worse than a bad bruise. She entered his symptoms into iTriage, an app, and found references to compartment syndrome, which can cause paralysis and gangrene. That convinced her husband to go to hospital immediately, says Mrs Rich. He had emergency surgery a few hours later.
It is impossible to predict where the open-data revolution will lead. In 1983 Ronald Reagan made America’s GPS data open to the world after a Soviet missile brought down a South Korean airliner that had strayed into Soviet airspace. Back then, no one could have guessed that this would, one day, help drivers find their way, singles find love and distraught pet-owners find their runaway companions.

Sounds like a job for Digital Transformation! Move out of the way, please.

Anonymous said...

I well understand November 22, 2015 4:43 PM' comment calling for people to be "a little more helpful in this blog as it can come across as a negative venting site (which reflects the mood,) however, posting some positive examples of national solutions might help some in power to explore these options.".

However history has shown that those in power do not take any notice of any constructive criticism; there is no reason for them to change their ways and do so now.

A more preferable course of action would be to bring some of those people who have made valid comments, many of which are very constructive, to meet with the relevant politician(s), senior bureaucrats, to help them better understand the issues of major concern. Having said that I am not optimistic that will ever happen.

Anonymous said...

Sigh. You don't need big data to diagnose compartment syndrome. Its a few symptoms that you can build into a vanilla expert system.

Man, the level of hype and lack of even a basic understanding of what has already been achieved by computer science and informatics over the past 50 years is astounding.

Have we reached peak big data yet? Please Please say we have so we can just get back to doing our work without all the hype, opportunists, and gougers getting in the way of the rest of us trying to do something important to improve the quality of health care. Yes we love our data, big and small, but there are just one or two other teeny things we need to work on also ...

Anonymous said...

The doctors have no idea what is in store for them. Wait until this fiasco fails. The government will blame the doctors big time. You the consumer have a My Health Record which your doctor is not prepared to use for any number of reasons; he's too busy, he's not interested, he wants more money, he won't let you have control, and so on and on and on. The doctors are to blame dear patient and you are the victim of this inexplicable act of selfishness.

John Scott said...

We are rapidly approaching an inflection point in e-health.

We began the most recent journey with Health Online following the overseas trend. The idea was to focus on Electronic Health Records using a government-led approach. It has not achieved the success we seek and cost us a fortune. We are not alone.

The Canadian experience is shaping up to resemble the UK's. David Cameron not too long ago abandoned a $20-billion national health information plan.

The Minister's recent 're-booting' of ehealth could be understood as taking the next technology extension--so-called Big Data accompanied by Apps.

We need to get back to where we first started our journey in Australia--back to 1991. Back to a time when the focus was on care delivery and the challenge was to work out how to work together. This was the Health Communications Network initiative. It was successful; it was cheap ($7-million over 5 years); it was collaborative to the bone. And, it was ground-breaking not the least because it sought to define the proper role of government in the digital health economy. The decision to sell it off was short-sighted.

So, while the technology has gone ahead by leaps and bounds, we don't know how to work together and the costs and indeed the embarrassment continue to pile up.

Trevor3130 said...

We are rapidly approaching an inflection point in e-health. (John Scott)
Too late, already. Look in the rearview mirror.
From The internet of (caring) things
But the emergence of commercial cloud-computing platforms has removed the need for these expensive, dedicated computers, which has in turn helped make healthcare one of the latest industries to be “disrupted” by digital technology. Indeed, the market research company MarketsandMarkets predicts that the healthcare cloud computing market will soar in value in the next few years, rising from $3.7 billion today to $9.4 billion by 2020.
OK, that's a blatant plug for companies flogging their "cloud" apps, but the preceding paragraph
These so-called “data silos” are not only expensive, they also stymie doctors who need to access patient data from multiple locations, and make it hard to utilise the data for wider epidemiological studies, too.
is pretty much where we were in 1991, when the bulk of digital health data was in pathology systems. Then was the time for Govt to step to mandate that pathology data be kept in a form that made it possible for any patient, anywhere in the nation, to have all their laboratory displayed in the one record in cumulative fashion.

Bernard Robertson-Dunn said...

John Scott said...

"We are rapidly approaching an inflection point in e-health.
So, while the technology has gone ahead by leaps and bounds, we don't know how to work together and the costs and indeed the embarrassment continue to pile up."

That's not an inflection point (i.e. things will change and start to get better).

IMHO, things will just get worse and we are probably about to go over a cliff.

The Government's proposal to make eHealth records available on mobile devices via third part apps is so bad (but in line with the thinking behind the PCEHR) that it will most likely end up in a debacle of momentous proportions.

john scott said...

Bernard, the term inflection point or more particularly Strategic Inflection Point) is often attributed to Andy Grove of Intel Corporate. He described it as: "A Strategic Inflection Point is that which causes you to make a fundamental change in business strategy. Nothing less is sufficient." (Source: Academy of Management, Annual Meeting, Andrew S. Grove, Chairman of the Board, Intel Corporation, San Diego, Calif.
August 9, 1998)

Your description of the PCEHR heading for a cliff would seem to qualify.

Bernard Robertson-Dunn said...


It would seem that Andy Grove forgot his maths after doing all that chemical engineering and learned management speak.

In mathematics an inflection point is a point on a curve at which the curve changes from being concave to convex, or vice versa. To use it to mean a cause of something smacks of hyperbole.

It will be interesting to see if AceH goes for a fundamental change in strategy. Although they don't seem to have much of a strategy of their own. Talk on the street is that Paul Madden wrote the strategy for ACeH well before it came into operation.

john scott said...

Bernard, I suggest we are dealing with what the Minister believes is the truth; that is, that the PCEHR is the right way to achieve our ehealth goals.

This is where pragmatics comes into play.

The philosophy of pragmatism comes the U.S. scientist and logician Charles Sanders Peirce (1839-1914). William James further developed the theory of pragmatism in 1907. For James, an idea or belief is true so long as it is useful.

He said:
• The truth of an idea is not a stagnant property inherent in it. Truth happens to an idea. It becomes true, is made true by events.
• As long as people accept each other’s truths, they are passed on from one person to another without question.
• Truth lives…for the most part on a credit system. Our thoughts and beliefs ‘pass’ so long as nothing challenges them, just as bank-notes pass so long as nobody refuses them.
• It’s only when something materialises, a new discovery, event or circumstance happens to break the spell of ‘truth’ that the public may begin to discredit one truth and move on to the next.

There is a growing body of evidence and public opinion that the current strategy is deeply flawed and we should stop what we are doing and move on to a better strategy.

The real question we face is: From whom does the Minister have to hear that the idea of the PCEHR is wrong / discredited and, that she and the government need to move to a new paradigm and policy reform narrative?

I don't know the answer to this question. I do know that it is only when the Minister makes this decision that we can begin to move on.

It is this reality that prompted me to suggest that we are nearing a Strategic Inflection Point and to suggest we revisit the paradigm and policy reform narrative that anchored Australia's original ehealth efforts.

The Minister will need Plan B and from a risk management perspective the sooner the government realizes its vulnerability the sooner it can begin to canvas what Plan B might look like.

Trevor3130 said...

The answer to What Martin Parkinson's return means for the public service may have a lot to do with the future for AcEH. I mean, just think of that future had Jane Halton ascended to the top job.

If Parkinson cares to look, he may find that the revolving door through which Govt employees, lobbyists and contractors pass is also a source of perversion of effort.

If Parkinson does have Turnbull's ear, he may want to enquire why there are Huge variations in surgery and mental health treatment across Australia. So, today Govt is writing its own headlines to declare "a blueprint for reform that puts the individual at the centre of our mental health system". This includes a "new digital gateway to online mental health services". What? Is the NEHR off the radar, because it is so flawed that to mention it in the context of new, broad initiatives would be damaging to the 'agenda'?

Bernard Robertson-Dunn said...


I was only arguing about the definition and use of the term Inflection Point. The rest - we are in agreement.

It's worth pointing out that the PCEHR is not the only initiative this government has developed a tin ear for. Here's an analysis:

Government haste lays waste to consultation
Leanne O'Donnell
23 November 2015

Inadequate consultation and seemingly unnecessary haste in drafting and passing certain laws has been a shared frustration linking diverse policy issues in the past year.

Trevor3130 said...

Ross Koppel in The health information technology safety framework: building great structures on vast voids -

How do these errors relate to HIT? Answer: they are intimately related because the isolated and fragmented data—needed for patient care—are defeated by:

followed by a list that, if it applied to the building of a new aircraft, the clear message would be "Stop! Now! To continue risks total failure." He also writes

We know that HIT systems are fragmented, usability is often primitive, and interoperability is promised on a ten year plan when it should have been a requirement a decade ago.

john scott said...

I would add to Trevor3130’s comment that the whole intellectual edifice for E-Health that has held sway for the past decade is collapsing both overseas and here in Australia. It is not just HIT that is in crisis. The whole of E-Health is in crisis.
Crisis is commonly understood as a DRAMATIC AND PAINFUL deviation from a well—established norm. Reversion to the mean is, however, expected and then the crisis will be over.
One may also imagine a crisis in a very different way, as the stress that accompanying the birth of a new state of affairs. In this view, the old order no longer exists but is largely destroyed as our circumstances are transformed.
One must hope for new thinking to replace the old. But creativity is unpredictable under the best of circumstances. And Canberra policy elites rarely have the skills, the inclination, the time, or the space for real thought, much less creativity.
Coping with this crisis is however only the immediate task. Without a considered worldview, it is difficult to think about the reform of E-Health policy. The starting point for a new worldview is a focus on the human social networks of health and how their communications lead to safe, high quality and efficient care delivery.
Clinicians, particularly those treating patients with chronic conditions, need a way keep one another up-to-date and work together to achieve the best patient outcomes. The real benefit is to be able to clearly communicate to patients what their holistic treatment plan looks like and what part they play in achieving their personal outcomes.
The introduction of a new way of thinking and acting, where the human relationships and human communications are purposefully separated from and then integrated with technology offers significant opportunity and realisable benefits.
Health and IT are not incompatible spheres. However, the connection between the electronic ‘E’ world and the physical human world of ‘Health’ requires very careful attention. The ‘hyphen’ in E-Health represents the ‘connection’ between what people are doing in the human social networks of health and what technology can assist them to do.
The ‘connection’ between the two spheres stands as the table at which we gather to work out the boundaries of our mutual interest and how to go forward—together and separately—to identify and resolve the issues that impede progress of E-Health in Australia. Some issues can only be resolved by Health; some issues can only be resolved by IT. Some issues can only be resolved by government and are best advanced on advice from the two spheres working together. The progressive resolution of issues brings into reality a new way of thinking about ourselves and our proper relations to each other.
Hence, it is the ‘connection’ that should be the locus for government policy and strategy.