Sunday, October 30, 2016

It Seems The Pharmacists Are Not All That Keen On The myHR – What A Surprise!

This appeared a few days ago.

Why pharmacists are saying no to the e-health system

25 October, 2016
The government’s $1 billion e-health record system could be heading for white-elephant status in community pharmacy – with fewer than 5% using it in any given week.
Only about 1250 pharmacies are registered for the system, previously known as PEHCR and now called My Health Record. And only 20% of these view or upload information in any seven-day period, according to the department of health.
It says that once fully rolled out, the system will enable automatic uploading of dispensing information to a patient’s e-record. Pharmacists will be able to view a patient’s medical history – including shared health summaries and hospital discharge documents.
This would improve efficiency and reduce the risk of medicines misadventure, says the health department. But it admits that only 45% of pharmacies have software that’s compatible with the system.
The Pharmacy Guild is not opposed to the system, but its King Review submission suggests that the government pays pharmacies to participate.
Currently only general practice is incentivised to use the system.
Kos Sclavos, the Guild’s Queensland vice president, says: “Doctors are getting paid, and pharmacists are saying why should we do anything? We’re not getting paid.
“There needs to be some consistency across the health professions, if they (the government) see pharmacy playing a role,” says Mr Sclavos, who was part of the original consultation group on the system.
He says participation costs pharmacies time, money and effort, and many resent the expectation they will do it for free.
He says pharmacy banner groups are discouraging members from participation until the issue of payments is sorted out, something which they deny.
Terry White Chemists has a policy of neither encouraging nor discouraging participation.
Spokesman Jeff McEvoy says that without payments it would be “very hard” to promote.
“We fully support the Guild’s stance on funding,” he says.
“No one can expect someone to do more for less.”
Health informatics experts say it would make sense to pay pharmacists to use the system if it was working, but it’s a moot point because it is not.
Dr David Glance, director of University of West Australia’s Centre for Software Practice, says despite hefty investment the system has “failed since its inception” and does not enjoy support from GPs or patients.
More here:
This is all a little confusing I must say. Readers will recall that there are two electronic prescription exchanges (Medisecure and eRX) that have been operational for a few years and which, if used, create a record that goes to the myHR.
There is heaps of information here:
and here:
Under the 5th and 6th Pharmacy Agreements there is funding for scanning printed e-prescriptions that is paid to pharmacists and the ePIP incentives are linked to e-Prescribing as well.
Additionally we have automatic feeds of e-prescription information to the myHR where an e-prescription is used.
So it rather seems we have the situation where heaps of information is flowing into the myHR from the PBS System and the e-Prescribing systems but that it is partial and incomplete, and of little apparent use.
Yet again it seems to e-Health ecosystem, centred around the myHR is not seemingly delivering as it was intended.
I wonder might the ADHA stand back for a moment – and map out the e-Health information flows and work out where value can actually be found – and work those conclusions into the planned new National E-Health Strategy.
There have been all sorts of new actors emerge in the private sector that will eventually need to be recognised and integrated practically and functionally for the benefit of patients and clinicians. One recent announcement is here – and it is just one of many:

Thodey, Bassat back UHG health info bridge technology

  • The Australian
  • 12:00AM October 25, 2016

Damon Kitney

Seek chief executive Andrew Bassat and former Telstra CEO and now CSIRO chairman David Thodey have taken strategic stakes in a Melbourne health technology company allowing corporations, doctors and insurers to share medical records online.
Unified Healthcare Group, whose “medEbridge’’ online platform is used to send requests for medical reports and files from insurers to doctors, is now preparing to launch a multi-million-dollar capital raising to bankroll its growth plans after securing the support of Mr Bassat and Mr Thodey.
In June the company secured the exclusive support from the Royal Australian College of GPs for the exchange of health information from GPs to businesses and government agencies.
“The support of the RACGP, the peak body representing the 30,000-plus GPs, is very important for UHG to achieve its objectives to improve the interactions between businesses and healthcare providers,’’ said UHG chief executive Brandon Carp.
“We are confident with our strategy and vision to be the go-to platform connecting businesses and healthcare providers.
“And to accelerate the growth we will be raising a multi-million-dollar sum to drive increased sales into new business sectors, expand the healthcare provider marketplace and potential ­bolt-on acquisitions.” An information memorandum for the issue will be distributed to potential investors in the coming months.
 “This is a classic two-sided marketplace, the more traction you have with healthcare providers, the more opportunities there are with businesses and vice versa. There is a real network effect that operates here,” Dr Carp said.
More here:
The need for a rational well-thought out and well consulted strategy could not be greater – before we wind up with an ill co-ordinated and overlapping collection of only partially useful systems.
If this is co-ordinating role is not taken seriously and undertaken sensibly and fairly we are at risk of having more failures and bankruptcies than is reasonable.


Anonymous said...

I would contend that we need a system that people want to use as it helps them in their job. The idea of demanding payment to use it is silly. It suggests the underlying system is a dog. People will use things that they can see benefit from, no one sees benefit from MyEHR. Its also a threat to privacy. Pharmacists and other allied health providers should not have the right to view every document in your health record, its should be on a needs to know basis. Does your podiatrist need to see you STD check?

Anonymous said...

I can understanding funding for training and system enhancements but reason if you need to pay people to use it then one I am yet to even see any useful decision making analysis based on the data captured other than perhaps how little AMT spreads let alone any ground breaking analysis of data that delivers results for population health

Anonymous said...

1. Pharmacists will not pay more for software that integrates data from MyHR into existing workflow. Any benefits from recognising and preventing drug interactions, allergies, therapeutic duplication etc accrue to hospitals not seeing those patients admitted, and not the pharmacy.
2. Software vendors will not invest in creating this functionality that their customers will not pay for. Vendors may lack capacity and even capability to develop.
3. Like other areas of health software, there is nothing like a traditional market when it comes to dispensing software. Changing software has huge costs: it disrupts the business, staff require training, and hardware often needs to be upgraded. Pharmacies that are part of a banner group may not even be allowed to change, even if they want to. There is 0% chance that one innovative product connecting to MyHR will cause all other vendors to provide the same capability.

Anonymous said...

4. The reason that dispense records sent to one of the 2 prescription exchange services are not able to populate MyHR is that IHI/HPII/HPIO numbers are not provided. HPIs are easy to set in a system, but IHIs require one additional piece of information not traditionally recorded when dispensing - dates of birth. Without these, even systems connecting to the HI service cannot obtain or verify IHIs. No IHI = no dispense record for MyHR.
5. Thankfully, electronic prescriptions are populated with dates of birth from the prescriber's system. In theory, there is no reason why dispensing systems could not automatically populate any missing DOBs (and verify any existing ones) without interrupting dispensing workflow. Enough information would then be present to obtain IHIs.
6. Electronic prescription fees are payable only for PBS prescriptions which were originally prescribed electronically. This incentive should be unlinked from PBS status and origin of prescribing and instead be dependant on the details returned to the exchange containing enough information (IHI, HPII & HPIO) to generate a dispense record for MyHR.

Anonymous said...

7. Criteria for this incentive could also drive the uptake of AMT by making the provision of coded medication identifiers a necessary condition for payment.
8. Despite incentive payments to pharmacies, the quickest and cheapest way to get vendors to make the necessary changes to software is to pay them directly. There is precedent for this: when PBS Online was introduced vendors were paid for the development work and support. The savings to government by not manually processing hundreds of thousands of disks each year easily dwarfed these payments to vendors.

Anonymous said...

Maybe we need a strategy that is driven by delivering value to everyone, not just the government. That would be a change.

Anonymous said...

The ADHA has NO STRATEGY for eHealth.
The Department has NO STRATEGY for eHealth.

A piecemeal DRAFT strategy containing a mishmash of disconnected thoughts which came into the public arena a few months back is NOT A STRATEGY and most certainly should not be used to determine the way forward for the ADHA.

Yet, in desperation the ADHA leaps in to embrace Secure Message Delivery holus bolus in the hope a solution will emerge to give it some credibility.

The bureaucrats are so conflicted with what outcomes they want to see for themselves (the bureaucracy) they have repeatedly demonstrated they have no understanding of what outcomes are needed to achieve success in the market.

STEP 1: is to develop a strategy which is acceptable to and will be supported by the most important 'element' in the market. That element is the essential, fundamental, grass roots, pivotal, health service providers who must first use the system before others can get any benefit from it.

FOR THEM TO USE THE SYSTEM it must save time, eliminate duplication and be of real benefit to the health service provider as the initial user. Once seamlessly embedded into the health service providers' routine workflow processes others will be 'embraced' by the system (such as consumers) providing them with benefits also.

Secure Message Delivery is a solution to a problem. There are many problems and SMD it is but one problem. Equally well OnLine Appointments is another example of a solution to a problem. These and many more like them are all APPLICATIONS linked to FUNCTIONALITY.

But the essence of success lies first and foremost in clearly and precisely defining and THINKING BACK FROM AND THROUGH the long, medium and short term strategies required to deliver the vision in a MANNER which is very tightly governed every step of the way.

Grasping at straws as ADHA is now doing reflects their lack of understanding and is no different from what NEHTA and the HEALTH DEPARTMENT have been doing for the last decade at an estimated cost now approaching $2Billion.

At the risk of repeating oneself the FIRST STEP (1): is to develop a strategy which is acceptable to and will be supported by the most important 'element' in the market the health service provider(s).

Bernard Robertson-Dunn said...

re: "A piecemeal DRAFT strategy containing a mishmash of disconnected thoughts which came into the public arena a few months back is NOT A STRATEGY and most certainly should not be used to determine the way forward for the ADHA."

Totally agree.

If anyone is interested, this is the Australian Privacy Foundation's response to that draft strategy.

The main concerns were:

"There are no References to Earlier Initiatives
The strategy seems to have been developed without reference to earlier initiatives. We specifically refer to the previous National Strategy issued in 2008, the Royle Review and the large body of feedback on the eHealth Legislation in June 2015. A number of key participants in the health, informatics and privacy domains expressed some serious concerns about the system and the proposed opt-out trials which appear to have been completely ignored by the Department since then. The feedback certainly has not been referenced or incorporated into the draft strategy.

In addition, we also draw attention to the considerations by several Senate committees regarding the eHealth bill of 2015. The Parliamentary Joint Committee on Human Rights and the Senate Standing Committee for the Scrutiny of Bills each raised significant concerns about the bill, especially regarding the proposed change to opt-out. Not including references to these committees, the issues raised and the way the strategy has incorporated the views of these committees is a significant and unwise omission."

Other headings are:
"The Purpose and Audience are Unclear"

"The Document Lacks Flow, Coherence and Analysis"

"A National Electronic Health Record Privacy and Security Framework is Needed"

Whatever strategy ADHA comes up with, we will be looking to see if the concerns in the submission have been addressed.

The one thing ADHA could do that Health never seemed to do is to listen to and respond to feedback - and that includes this submission

Anonymous said...

"A piecemeal DRAFT strategy containing a mishmash of disconnected thoughts .."

The Health Department did have a strategy. It was to close down NEHTA and relaunch it under another name - the ADHA moving many of the NEHTA employees across to the new entity then continue pushing My Health Record into the market. Nothing really changed there.

The other part of their strategy was to develop a Draft Strategy document which has been described as a "A piecemeal DRAFT strategy containing a mishmash of disconnected thoughts .." and then give it to the new CEO of ADHA to review, revise and implement.

Poor chap, he was well and truly set-up. Now he has to be seen to be doing something without a well crafted and thoroughly thought through strategy to follow.

The reason we keep seeing a repeat of such scenarios is because the Department lacks any industry knowledge and understanding of what eHealth is all about, then sets about employing fast talking international consultants to develop a strategy document for the Department to work with, and when it gets given the 'report' it launches it as the new revised eHealth strategy without having the knowledge and capabilities to judge the merits and worthwhileness of the strategy so developed.

Will they never learn.

Bernard Robertson-Dunn said...

"Will they never learn."?

Not while they belong to the same club as those other intellectual giants - climate change deniers, denigraters of science and evidence based reasoning.

Anonymous said...

The processes of information exchange follows:
Health Professional -> EMR\EHR -> EMR\EHR output -> message\report -> optionally another EMR\EHR -> to another Health Professional.

The first thing to fix would be the standards for: minimum data; templates for data structures stored; classification and terminology systems.
.. A lot of work and enforcement is yet to be done.

Secondly, the secure messaging methods and standards.

Thirdly, the templates for data to be shared.

Without these you have no way to reliably integrate, analyse and extract\display the information requied by another Health professional.

The current situation is like trying to encourage people to use cars in a country with no fuel and no roads.