tag:blogger.com,1999:blog-23447705.post669202573212633710..comments2024-03-28T17:49:03.998+11:00Comments on Australian Health Information Technology: It Seems I Am The Bug Finder In Chief for the NEHRS. I Just Don’t Believe What A Mess This Is!Dr David G More MB PhDhttp://www.blogger.com/profile/06902724829795199526noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-23447705.post-53588242812446682442012-09-16T17:48:48.040+10:002012-09-16T17:48:48.040+10:00"The tradeoff was that the system could be a ..."The tradeoff was that the system could be a system that many patients chose not to use (and therefore had no data for those patients), but that clinicians had full access to and control over. Or a system that patient groups were happy to recommend using, and that gives extensive patient control, but that therefore has some limitations on access for some clinicians in some circumstances.&Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-31993852571004927452012-09-16T09:55:01.048+10:002012-09-16T09:55:01.048+10:00This seemingly reasonable comment conceals a pleth...This seemingly reasonable comment conceals a plethora of assumptions required to make it seem reasonable, but nonetheless betrays the flawed justification for the PCEHR in the 1st place.<br /><br />Please spell out the assumed Benefits, the evidence that these Benefits are desirable and actively pursued by your defined set of stakeholders and the current evidence these "assumptions" Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-39096091476860888002012-09-12T14:46:19.475+10:002012-09-12T14:46:19.475+10:00All clinicians in a provider organisation will see...All clinicians in a provider organisation will see the same data, same as they do today within a hospital.<br /><br />Access controls are set by a consumer for a provider organisation, not individual clinicans.<br /><br />The broader question here goes back to the nature of PCEHR, and the tension between the various interest groups. Patients want access to and control over their record. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-66361170038709495082012-09-12T00:54:50.688+10:002012-09-12T00:54:50.688+10:00You missed the point. A clinician viewing a pcehr ...You missed the point. A clinician viewing a pcehr record may see a different set of data to another clinician because a patient can control what is seen by whom. But a clinician cannot see ithe audit log for a parient's pcehr- only the patient can see this. In a hospital, all clinicians involved in a patients care will see the same view, and will if needed have access to the history of Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-75211978791159726312012-09-11T08:42:31.957+10:002012-09-11T08:42:31.957+10:00Does a clinician in a hospital take a snapshot of ...Does a clinician in a hospital take a snapshot of the data they see at a point in time, knowing that any of a myriad of other clinicians in that hospital (or hospital system) may change the data?<br /><br />Does a GP in a large practice take a snapshot of the data they see on a patient's record, knowing that other GPs in that practice might change the records?<br /><br />The PCEHR system Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-40065552389793963602012-09-10T23:14:44.532+10:002012-09-10T23:14:44.532+10:00Does this mean that any clinician accessing the PC...Does this mean that any clinician accessing the PCEHR for clinical purposes, should ensure that their system takes a snapshot of what they viewed through the windows to conformant repositories and the national repository - that way they can confirm what they saw, as opposed to what they might see another day. The source data may change, and the consumer may change what the clinician can see. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-74931241981148500012012-09-10T16:22:42.475+10:002012-09-10T16:22:42.475+10:00". As some have noted, this is part of having...". As some have noted, this is part of having a federated architecture, which is what PCEHR was designed to be. And as others here are fond of noting, this is their desired architecture. It is not clear to me what the concern is over this."<br /><br />Ah yes garbage in garbage out, not our fault, we just display it.<br /><br />Ok, well how about I am concerned that the taxpayer has so Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-70652081150867963702012-09-10T14:10:16.897+10:002012-09-10T14:10:16.897+10:00"Exactly what is it that is supposed to be ha..."Exactly what is it that is supposed to be happening in the Medicare data that people are concerned about?"<br /><br />The concern is that even on the evidence of a really tiny sample there are some significant errors. Who knows how much of the data is current, reliable and correct?<br /><br />David.<br /><br /><br />Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-49913369031371643562012-09-10T13:28:19.669+10:002012-09-10T13:28:19.669+10:001. Medicare is not the primary feeder system. It...1. Medicare is not the primary feeder system. It is a conformant repository.<br /><br />2. As with all conformant repositories, the data that PCEHR displays is a window into that repository. As some have noted, this is part of having a federated architecture, which is what PCEHR was designed to be. And as others here are fond of noting, this is their desired architecture. It is not clear toAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-90311879297438668462012-09-10T13:23:26.412+10:002012-09-10T13:23:26.412+10:009/10/2012 09:47:00 AM why is government and NEHTA ...9/10/2012 09:47:00 AM why is government and NEHTA messing around like this instead of using the script exchanges which are already installed in almost every pharmacy and medical practice.<br /><br />Good question. Maybe it's because they wish the script exchanges would go away and take David with them.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-56045780530379474432012-09-10T09:47:57.150+10:002012-09-10T09:47:57.150+10:00I qualified first as pharmacist then studied medic...I qualified first as pharmacist then studied medicine. I currently practice in both capacities to break the boredom of each domain. I see escripts at both ends of the spectrum and I ask myself why is government and NEHTA messing around like this instead of using the script exchanges which are already installed in almost every pharmacy and medical practice.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-31817008272283392272012-09-10T07:46:38.200+10:002012-09-10T07:46:38.200+10:00I am confused now. I would have thought once a doc...I am confused now. I would have thought once a document or data item was published in the PCEHR then it stayed there? After all that is why we were sold this particular expensive architecture, with centralised repositories, instead of the distributed HIE approach that many would have liked to see, where data stays local and is just viewed.<br /><br />If the problem is Medicare changing its Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-54309812895071494772012-09-10T05:37:15.784+10:002012-09-10T05:37:15.784+10:00This is what you get from a the $1m a day team, th...This is what you get from a the $1m a day team, thanks! It is broken, unreliable and now we are defending it by blaming the users! What sort of useability testing has happened here? <br /><br />The software integrity of this system is very low. We were told this system was working in Singapore. What did that mean, did anyone check? What did they do to it to break it?<br /><br />We are about to Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-47231868409464661292012-09-10T00:06:30.479+10:002012-09-10T00:06:30.479+10:00Actually, it is probably a blessing when the syste...Actually, it is probably a blessing when the system is in outage, in terms of quality and safety. Makes a farce of the "medications" data sourced from the PBS. I also found mbs items in my record that were claims for my children- obviously a keying error when entering data for our Medicare card, but dangerous if a clinician acted on this data. We can only hope that the next phases Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-68579548048044612342012-09-09T22:45:30.500+10:002012-09-09T22:45:30.500+10:00So, unbeknownst to me - unless I log on daily to c...So, unbeknownst to me - unless I log on daily to check - the information in my NEHRS is just incorrectly (potentially) updated at Medicare's whim.<br /><br />Joke Joyce - really huge one!<br /><br />David.<br /> Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-36868935009678314372012-09-09T22:40:08.960+10:002012-09-09T22:40:08.960+10:00As with all data in the system, there is the abili...As with all data in the system, there is the ability to remove documents or to set security controls on individual Medicare documents.<br /><br />As with all documents, only the author can edit them, so the patient themselves cannot change the content, only remove the entire document. In this case, the author is considered Medicare, although ultimately Medicare only alter them if the pharmacist Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-65116448478505375342012-09-09T21:51:39.325+10:002012-09-09T21:51:39.325+10:00Notice that this error is coming (by the look of i...Notice that this error is coming (by the look of it) from Oracle 11g (R2 I suspect). This is a fundamental DB error at the database level. Which says to me that the application is not communicating with the Database correctly - not good for a $467m systemJim Cocksnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-41397916095997152872012-09-09T21:35:45.170+10:002012-09-09T21:35:45.170+10:00I strongly agree with Bernard and David. Any syste...I strongly agree with Bernard and David. Any system that gives you an error message such as "The Oracle Access Manager (V 11g) says: Error System error. Please re-try your action. If you continue to get this error, please contact the Administrator." has failed just about every web system design basic. A perfect advert for anyone wishing to know what is in use so they can more easily Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-86285074771157174042012-09-09T20:39:52.514+10:002012-09-09T20:39:52.514+10:00Fixed,
DavidFixed,<br /><br />DavidDr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-1413449388601882292012-09-09T19:34:47.497+10:002012-09-09T19:34:47.497+10:00Did you mean that you went into the future 12 mont...Did you mean that you went into the future 12 months and it was no better, not something I would be surpised about, or did you mean 2012.<br /><br />In fact I am a bit surprised that it would be even running in 2013 when I think about it. Back to the Tardis DavidAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-26378784020880169982012-09-09T19:20:21.125+10:002012-09-09T19:20:21.125+10:00Anonymous said...
"As with any data source, ...Anonymous said...<br /><br />"As with any data source, it can have errors, the right process to address those errors is to contact Medicare or your pharmacist."<br /><br />Where is this data correction capability documented? And what is the process if there is a disagreement/dispute?Bernard Robertson-Dunnhttp://www.drbrd.comnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-14429888673419470382012-09-09T19:16:20.979+10:002012-09-09T19:16:20.979+10:00@9/09/2012 06:45:00 PM
Sorry. Like all pharmacist...@9/09/2012 06:45:00 PM<br /><br />Sorry. Like all pharmacists his / her cashflow means quick submission.<br /><br />The issue is that the data is just wrong - I have not been asked - there is no edit functionality on this feed and I have a life to lead rather than discussing nonsense with Medicare.<br /><br />The system just does not work and is not reliable - despite what you say. Blaming the Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-85075621952873149102012-09-09T18:45:38.703+10:002012-09-09T18:45:38.703+10:00Your medications get updated as they arrive at Med...Your medications get updated as they arrive at Medicare. Is your pharmacist perhaps tardy in claiming? The system can only display data that has been provided to it.<br /><br />On the medications for your wife, were they on your record? If so, did you perhaps correct that with Medicare, or perhaps your pharmacist corrected it? If so, then the system will reflect that once it comes through.<brAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-29115437379751381062012-09-09T16:16:51.089+10:002012-09-09T16:16:51.089+10:00On 10/19/2011 12:13:00 PM, on this blog, I said......On 10/19/2011 12:13:00 PM, on this blog, I said...<br /><br />"Are there any standards for exceptions and error handling?<br /><br />It is one thing to define how a system is to work normally, it is far more difficult and time consuming to define what happens when the system goes wrong."<br /><br />When you get an error like this from the system software:<br /><br />"The Oracle Bernard Robertson-Dunnhttp://www.drbrd.comnoreply@blogger.com