A few days ago I was told that the South Australian HealthConnect Project has suddenly burst into life after a period of relative inactivity. Intrigued I thought I should have a look and see what was going on and I found that recent activity was indeed in evidence.
Those who have been following the HealthConnect saga will be aware that it has been Tasmania, the Northern Territory and South Australia where projects have been initiated. In South Australia (SA) there are two streams of activity. The first is an extension of the Broadband for Health Project for SA with some extra support on implementation of security.
The second, and more interesting, is the planning of a project (to go live in November 2006) to provide a basic Shared Electronic Health Record (SEHR) (accessible by the GP, Patient and other Carers) to assist in the communication and sharing of patient specific health information to better co-ordinate and deliver care.
The SEHR and messaging environment is to be provided by Ozdocsonline. They can be found at Ozdocsonline.com.au.
What a very good idea I hear the loud cries – and I cannot but agree. As always, however, the devil is in the detail.
Before discussing that detail, let us briefly consider what attributes we would expect from a Commonwealth / State Government funded Shared EHR Project. I suggest we would expect at least:
1. The use of an open, rather than proprietary, SEHR and messaging platform.
2. Adherence to the national technological standards directions being defined by NEHTA.
3. Interoperability and synchronisation between the GPs local Electronic Health Record and the SEHR record to the extent that both contain the same information to ensure patient safety.
4. At least a HeSA level of security for information flows between the systems of the various users of the SEHR to ensure clear accountability on the part of all users regarding the information stored in the SEHR.
5. Use of the necessary coding and terminology sets to ensure information was captured in a comparable and computable form.
6. Access to the service would be free to the patient (ideally).
What is proposed is that the Ozdocsonline portal will become the central, and proprietary, access point from which patients and their carers will contribute and retrieve information – largely in the form of free uncoded text. The shared record will consist of some key demographic information and then a series of entries (which are either unstructured encounter documentation or itemised action plans) which, it is hoped, over time will become a useful record.
Now, while I am a long time supporter of the idea that progress will only be made in e-health if the various actors just get on with it - this proposal frankly seems a bridge to little!
Among the issues I also see around the planned operation of this proposal are:
1. The patient is apparently charged a fee every time they leave the practitioner a question, prescription repeat request and so on. (Ozdocsonline collects the funds and remits to the GP monthly).
2. The practitioner will need to record information twice – in their computer system and in the on-line system. This may slow the GP down just a little and lead to quite slow adoption.
3. The use of clear text e-mail to let the various actors in the operation know the other has made a referral, a change or whatever. This has the possibility of leading to a deluge of e-mail and further delay for the GP, as well as providing some information, some may not want disclosed, to others.
4. The proposal does not meet the expectations for a publicly funded SEHR trial given the learnings already made in this area so far (e.g the importance of information coding, the importance of client GP systems etc).
It is clear to me that this plan – as presently evolved – is seriously underdeveloped and quite inconsistent with even the broadest outlines of where e-health in Australia should be heading.
I find it amazing that the funding for Development of the Web Based Community Care Plan Management Tool Ozdocsonline is coming from the iTOL program in the Department of Communications, Information Technology and the Arts, rather than the Commonwealth Department of Health. Maybe that explains why the special health privacy and standards issues have not been addressed as one might have hoped.
The motivation for this project is excellent, and if well executed it could make a difference. However, sadly the currently plan for its conduct is, I believe, badly flawed and needs serious review.
David
No comments:
Post a Comment