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Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Monday, December 04, 2006

The Children of HealthConnect – How are They Going – Part 1?

It is clear, to all but the totally out of touch, that the transition of HealthConnect from a program to a “change management strategy”, which happened between late 2004 and mid 2005, after a secret and unpublished internal DoHA review, has meant the demise of the initial vision of a Shared Clinical Electronic Health Record for Australian citizens.

It is fascinating to read the three implementation plans / approaches for HealthConnect – dated November 04, June 05 and July 05. In the documentation we see the dramatic shift from a clearly serious project – a broad implementation plan for Australian E-Health - to vague ‘mumbo-jumbo’ in just seven months. This after four years and millions of dollars have been spent.

HealthConnect has three “Children” if one counts those projects which still carry the HealthConnect brand. In these posts I plan to review each of these and consider what has been achieved. An earlier post addressed the NSW HealtheLink project which no longer seems to be branded as HealthConnect on the basis of the press release announcing the initial patient recruitment in March 2006.

The first post considers South Australia. Tasmania and the NT will follow.

HealthConnect South Australia.

This series of initiatives are being delivered from the SA Health Department. The project office was established in July 2005.

The good first – the Project has a nice current web site that explains what is happening and what is planned.

HealthConnect SA is currently working on two major e-health initiatives: the Care Planning and Communication Trial and the roll-out of Broadband Security Packages to South Australian health providers.

With respect to the Broadband Security Packages it is hard to see what justifies these freebies and what distinguishes doctors from other professionals who would be happy to have free secure broadband access. With no requirements as to what is to be done with the connection it is hard to see this as anything other than a rort. I am sure lawyers, accountants and others wonder why they can’t have the same deal!

The $500 security review that comes with these packages is also questionnable. If the supposedly top 1% of the population intellectually cannot workout how to connect a PC to the Internet safely then who can?

The Care Planning and Communication Trial is a rather amazing initiative. It is planned that a service provider (Ozdocsonline) will sign up 50 practices in South Australia. It seems this will help them comply with the requirements for creation of care plans for ‘difficult patients’ which in turn will enable them to receive a higher Medicare payment for care co-ordination.

Using a web-interface to securely access a server in Sydney, the practitioner (and practice nurse) will create and store a patient record on the server in Sydney. The record will be made up of a patient clinical summary which is a MS Word Document created by a GP practice management system and ‘cut and pasted’ into the new record. The system then allows for the creation of planned actions (referrals, reviews, etc) which can recorded and also scheduled for review or action.

Having put a few of these together one can then print out a ‘care plan’ of actions for the patient. Also, where actions are required a non-secure e-mail can be sent to a specialist, podiatrist or whoever is asking them to log on-to the secure server to find out what they are required to do.

So, what do we have here?

What I see is a commercial, for profit (ie. Ozdocsonline), non-standardised and non standard, non NEHTA compliant, non guaranteed-data transportable, short term, privacy weak, functionally limited, exchange of MS word documents and a few other data elements which lacks the granularity in privacy control which is needed. Also, access to the ‘facility’ expires in 12 months unless the practitioner starts paying or moves to some non-existent prospective new system which at present does not exist.

Information held on this system does not interact with the practice management system. Unless the practice management system is regularly updated the two systems will rapidly diverge!

It is very difficult to see just what is in it for the practitioner or indeed other service providers other than the extra Medicare payment. Why go to the effort of logging on and doing all this when there are much simpler ways to go about doing the same thing?

In my view this is just the sort of non mainstream initiative which acts to prevent any real progress being made. Given that it has just started I am sure the evaluation report of early 2008 will make riveting reading – assuming it does not suffer the fate of so many other HealthConnect evaluation reports and is never published.

Also it is quite surprising to have the project established and underway prior to HealthConnect SA seeking applications from consumers interested in participating in a Consumer Reference Group to provide advice for its care planning project as of 20 November 2006. One would have thought that any well conceived and planned project would have had this Reference Group established long since and that it would have been involved in all phases from initial planning, project software selection, etc rather than confronting the Group with a fait accompli.

Independently I also hear GP consultation may not have been as robust and thorough as might have been expected.

Previous initiatives from HealthConnect SA have included development of a document on Change Management in E-Health for the GP Sector which identified that financial incentives had been a necessary but not sufficient driver of GP Health IT adoption (making a difference for patients also matters). This is hardly news given that the Practice Incentive Program and its predecessors have been shown to make a difference over the last 5-8 years.

Another initiative has been a High Level Connectivity Options Paper for HealthConnectSA which has as its most distinctive attribute the fact that it is classified!

The cover has the following statement.

“ This document has been re-classified as “C1 Low” Public Information and unrestricted access.

The complete document is classified “C3 High” Limited ‘need to know’ access and is available on application to the HealthConnect SA project office” www.healthconnectsa.org.au”

The document makes absolutely no startling conclusions and just why it is classified is really very strange. The fact that a classification system exists is a shock in itself for a health system organisation.

Overall the activity at HealthConnect SA seems to me to be either technically basic or very poorly conceived and well off the mainstream in terms of directions and standards adoption. Money is being wasted once again I suspect and I very much doubt very much of value will come of any of this longer term.

At the risk of repeating myself it is abundantly clear that the lack of any National E-Health Strategic Direction is a major contributor to the reasons why such ill conceived projects are given financial support – it should be obvious that just doing something for the sake of doing something is really not good enough.

David.

3 comments:

Andre said...

What I see is a commercial, for profit (ie. Ozdocsonline), non-standardised and non standard, non NEHTA compliant, non guaranteed-data transportable...

Nothing too dissimilar to current clinical software packages! Not setting precedents... Hopefully the project will inform the HI community at large of how care planning is embraced by both health professionals and those in care. Certainly feel that the technologies employed are redundant and not of importance, with the main outcome being the use and users of such systems.

Aus HIT Man said...

Thanks Andre,

I would agree if the project was not funded by my taxes and there were clear project objectives published which the outcomes could be assessed against. It would also have been good had there been a transparent procurement process. None of this has happened.

This is the sort of 'brownian motion' e-health initiative that only corrodes confidence in the whole e-health domain.

An old and important lesson - if you are going to do something do it once and do it properly.

David.

Anonymous said...

I'll also flag the insane tendering constraints for the evaluation framework for the Care Planning Trial (CPT). Sitting on these pre-tender meetings highlighted that the CTP was to be a trainwreck from the start - the tight timelines, pre-determined solutions and objectives gave the impression that the project was to happen no matter and under no constraints. Pre-ordained to be messy to say the least... Wonder if it was about acquiting monies in the bank?