Sunday, August 21, 2016

Why Is The Government So Hopeless In IT Delivery? Wish I Knew….

This popped up in my scans yesterday.

NQ Primary Health Update

My Health Record latest news

Did you know that an individual needs to have a myGov account to access My Health Record? People can either log in via their existing account and link their My Health Record to their myGov, or they can take a few moments and create their own MyGov account.
There is a simple step by step guide at www.myhealthrecord.gov.au/stepbystep to support people to register or access their My Health Record for the first time.
Even though there are several Government services are on myGov, such as Medicare and the Australian Tax Office, it is only registered healthcare providers involved in a patient’s care who can access the My Health Record system.
For GPs who are using Best Practice and Medical Director software, we have been aware that they are undergoing some upgrades which is resulting in some error messages when accessing the My Health Record system. If you are receiving error messages, please contact your clinical software provider for assistance.
There is a huge amount extra found here:
I noted two things – First, from August this year, it does still seem myHR integration with GP practice systems is having a few issues.
Second, while reading I noticed the comment on MyGov. This prompted me to recount the silliness I encountered just yesterday trying help here to use MyGov to claim a small Medicare refund.
She was not enrolled in MyGov so the process of signing up was its usual intrusive self.
Once in we linked Medicare and found a range of extra details were needed including my birthday etc. as my name is the first entry on our family Medicare Card.
Once finally in we started the process to claim back our $50.
We entered the various details (Provider Number, Date of Service, Amount Paid, Medicare Item No etc.) thinking we must be getting close given we had provided all the banking details for the deposit etc.
We were also told to scan the bill, as we would need to upload the .pdf etc. (What do you do if you don’t have a scanner etc.?)
We hit complete and were then told that for this item number we could not claim via MyGov but had to use the Express Plus Medicare Billing App.
Here is the website for these marvels.
Well talk about customer hostile nonsense. Just what do you do if you don’t have a smartphone or can’t seemingly get it installed as the phone is demanding an Apple ID and password that my wife never uses and has probably been lost!
You are told to call a number and hope for a better outcome!
So the bottom line is the Medicare Offices have basically gone and the replacement assumes you have a smartphone and know all about how to use the App Store etc. etc.
What a massive fail at so many levels. Who would voluntarily get a myHR if you had experienced the Census or this sort of nonsense!
David.

8 comments:

Anonymous said...

I always thought those libertarian types were Red Necks, asking for smaller government, but as time goes on they have been proven correct.

Imagine where eHealth would be be now without Health Connect, Nehta 1,2 and 3 and now "The Agency" They have contributed nothing, picked winners, bankrolled international companies and destroyed the standards process.

They have useless provider identifiers and completely made AMT useless by making it divorced from snomed-ct and lacking in semantics of its own. SMD is an over-engineered mess and when they made it a standard they stuffed it up by arbitrarily changing pieces so that its now broken. The PKI infrastructure we had was trashed because of silly choices in SMD and they donated $20M to IBM for not creating a new one, even though they "legally fulfilled" their contract!!

This is amateur hour at best and worse than that they have damaged what was a vital, competitive, innovative industry. We managed to adopt HL7V2 pathology before they came to help and nothing much has happened since. Yes health IT is hard, but when the drongos take over its impossible. Despite the appalling record the Hubris ticks along as if they had done a wonderful job. This makes #Censusfail look like a minor hiccup but no one seems to care or hold people to account. Lets hope when the big correction comes these people are the first to go. That's what we need, some clean air free of drongos.

Anonymous said...

When you see those longest with and closest to the project flee like rats from a sinking ship, that's when you know time is up.

We live and hope.

Bernard Robertson-Dunn said...

IMHO, it's because they think it's just IT. It isn't. IT is part of the solution but the bigger problem is much more than technology.

Everyone from the WHO downwards talks about "patient-centric" health and they all have their different interpretation of it.

Health/NEHTA thought it was a humungus, centralised, patient health record. DHS, Centrelink, etc all have their own technology focused perspectives.

What patient-centric should mean is that the systems must be viewed from the perspective of the patient. That doesn't necessarily mean that the patient is the main user, or that the needs of the patient are paramount. It means that, among all the other stakeholders, the patient must be included and their requirements given equal weight. and sometimes greatest weight.

At the moment the patient is an after thought. Even the PCEHR/MyHR falls into this trap. It is easy to say that the MyHR is all about the patient when in fact it isn't.

If it were patient centric it would be aimed at the health of the patient and their capabilities in the health care process, not at some abstract thought that patient data, in the hands of the patient would magically result in better health care.

In my long experience in failed government IT projects, I've seen two major reasons for those failures:

1. They didn't think it through.
2. Vested interests.

Or both.

Dr Ian Colclough said...

Well said Bernard. On numerous occasions so many us with deep, abiding, practical experience in health information systems have tried to engage with the Department and NEHTA on such basic fundamental principles in the hope they might comprehend. So far that has been to no avail. There is the possibility however that one day someone will understand, will listen, will ask questions and will even ask for help. The only unknown in that equation is when.

Bernard Robertson-Dunn said...

If you've ever wondered what a GP sees (and can do) when they create a MyHR health summary, have a look at this simulation training:

https://www.digitalhealth.gov.au/using-the-my-health-record-system/digital-health-training-resources/on-demand

I used Medical Director and eventually worked out how to create a Health Summary.

I can't say I'm impressed with what it spits out. It's CDA format so you are limited to what you can put in there.

It really is a summary. Anything complex and IMHO the details would get lost.

For a start there's no narrative of any kind, either for a condition, or for a treatment.

So if a patient has a couple of on-going conditions it can become quite confusing especially if the patient is taking multiple medications, and is having multiple treatments from multiple service providers.

It's the conundrum and paradox of health information. You want standardisation and structure, but by doing so, you have to simplify. And when it come to the complexities of health care, simplification can be dangerous.

Dr Ian Colclough said...

August 22, 2016 2:18 PM said: "it can become quite confusing especially if the patient is taking multiple medications".

Medication misadventure and adverse events are the major cause for unnecessary and avoidable hospitalizations. Here are some facts:
• 26% - 87% of ambulatory care medication records are incomplete
• 42% of GP referrals to specialists were incorrect in dosage and number of medicines prescribed
• 4% of public hospital admissions are due to medication errors in patients with a complex chronic illness
• $2 billion will be saved annually by eliminating preventable hospital admissions [DoHA].

If the Department focussed just on addressing the deficiencies in medication management and the provision of a complete medication management record for every patient then a huge advance of benefit to health providers, patients and the entire health system would be realised. This goal is achievable. The only obstacle to bringing that about is that the Department does not understand how to make that happen and does not seem to want to work with people who do. It is not that hard and it is not that costly.

Anonymous said...

Anon 21 August: They have useless provider identifiers and completely made AMT useless by making it divorced from snomed-ct and lacking in semantics of its own.

I am confused/concerned with this statement. The Agency NCTIS states that its information and terminology products enable. System interoperable healthcare. If AMT is lacking in semantics then how can they claim to enable interoperable systems?

I think evidence of what exactly this NCTS project has actually delivered in value other than what seems to be a CISRO product placement exercise.

Anonymous said...

Bernard the training system you used is a prime example of a good idea handed to an unimaginative manager and a simptom of the (hopefully) old world. The ADHA CEO seems to have an understanding of innovation, I hope he can see past the self promoters and ego strockers