Sunday, December 04, 2016

AusHealthIT Poll Number 347 – Results – 4th December, 2016.

Here are the results of the poll.

Do You Believe The Usability, Safety And Utility Of The myHR Has Been Significantly Improved In The Last Year?

Yes 5% (6)

No 93% (111)

I Have No Idea 3% (3)

Total votes: 120

A huge majority seem to think there has been little to no progress with the myHR!

My observations very much confirm that view.

A very large turnout of votes.

Again, many, many thanks to all those that voted!



Bernard Robertson-Dunn said...

Re this week’s poll question. At the moment the MyHR is a secondary, non-critical system. If it goes down or is unavailable for days on end, who cares? If you add functionality and make it an essential part of health care, (i.e. part of a patient centric system) you vastly increase the complexity, cost and risks of the system – IMHO, un-necessarily.

AFAIK, the MyHR system is a single instance in a single government provided data centre with DR somewhere else. This is based upon the RFT that was issued for the MyHR and Health’s requirements for data centre space. The annual report talks about availability excluding scheduled downtime - in other words it is not available 24/7.

If MyHR were to be a critical component of the health care system it needs to be a) available non-stop, 24/7 and b) distributed. It would need to meet these requirements in order to avoid power failure and communication problems and to achieve high levels of availability, resilience and reliability.

A much better architecture is to have local, point of care support for health professionals (i.e. for each health care service provider, medical practice and/or GP). This avoids single (or few) points of failure and the ability to work autonomously in the event of a communications or widespread power failure.

Each health care service provider makes their own arrangements for availability etc, whereas a central system has to provide service levels at the highest level for everyone, if they need it or not. This is very expensive, risky and wasteful. My estimate is that they would need to spend twice as much again as they have already spent and even then the risks would be high.

I can see no advantages to a centralised health care information architecture and many potential problems. Neither can I see MyHR ever becoming a critical part of the national health care point-of care system. There will always be a need for local autonomy, especially in times of widespread emergencies such as bio-terrorism, epidemics, natural disasters etc.

Andrew McIntyre said...

I would agree, the fundamental requirement that we have is reliable transfer of good quality data that can be understood by the recipient without loss of fidelity. Ideally the data should be as atomic as possible and labs have led the way with this, although there are ongoing plans to improve the terminology and standards compliance.

I fear that we will end up with pdf healthcare, which is like a glorified fax system and adds nothing to automated decision support.

For the PCEHR/MyEHR to function as a patient repository it should be full of data in its native form, which in reality is HL7V2, but its like a giant picture archive, with no indexing.

The way to achieve progress is to improve receiver and then sender compliance and develop templates for common clinical problems that are widely shared between practitioners. Atomic radiology reports and histology reports, along with a patient summary that is widely supported (ie the basis of a Virtual Medical Record) would also be very useful, once people can reliably consume and produce compliant messages.

If you had this then providers could easily transfer patient data in a form that was immediately usable and suitable for decision support. The PCEHR could then receive copies for the patients use, but in reality provider to provider messaging is much better for privacy and avoids any single point of failure or vulnerability.

Because the basics have not been attended to nothing works to a level that can actually save the government money and to save face we end up dumbing down transfer to pdfs and that will never lead to the projected savings or advances that eHealth could potentially offer. In construction getting out of the ground means you can expect reliable progress. The PCEHR is build on swampy ground and the owners didn't understand the need for solid foundations and insisted construction start without being sure the ground would take the weight. With subsiding buildings its often cheaper and better to knock them down and start again, the PCEHR is in danger of being a money pit, that remains unsafe to enter.