NEHTA Admits It Can’t Develop and Deploy a Shared EHR

In the latest version of a Newsletter from HealthConnect SA we find the following article from NEHTA

Health in Space

By Lyrian Flemming, Communications Officer, NEHTA

The digital age and the opening of cyberspace via the internet have promised to revolutionise healthcare. HealthConnect SA is a part of this revolution, and is watching the work being done by the Australian government on another revolutionary part of e-health, the ‘Personal EHR’.

Personal knowledge

Any encounter between a patient and a healthcare practitioner generates a large amount of information. Central to a smoothly functioning health system is how this information is managed and shared. Access to cyberspace should make this possible, and that is where the Personal EHR (Personal Electronic Health Record), previously named the Shared Electronic Health Record, comes in.

The personal EHR is a centralised personal healthcare record containing an individual’s health information that will be accessible by chosen health professionals. A national personal EHR scheme will allow for the electronic transmission of referrals, prescriptions, pathology requests, reports and discharge summaries beyond state and territory borders. Establishing an efficient e-system to share health information will have far reaching benefits for patients and practitioners.

Personal EHR benefits

Using the personal EHR, patient records will finally be truly portable. In an increasingly mobile population that is good news for health management. The personal EHR will potentially reduce unnecessary hospitalisation by allowing patients with stable chronic disease to self manage their condition. For the practitioner, increased access to information will assist in better meeting individual patient needs.

Dr Mukesh Haikerwal, past-President of the Australian Medical Association says, “The great benefit of the personal EHR is that people’s health information, useful for ongoing health management, will be assembled in one place for the first time, and be available to a healthcare provider anywhere in Australia. This facilitates better decision making by the practitioner.” This is just the beginning of what the personal EHR can offer. “The next step,” says Dr Haikerwal, “is to improve delivery of care by having access to what has already been done, so that you can build on it.”

Of course e-health and facilities such as the personal EHR do not happen overnight and they do not arise by chance. HealthConnect SA is playing an important role in developing local e-health solutions which will be incorporated into the national work being done by the National E-Health Transition Authority (NEHTA).

Making it happen

NEHTA was set up in July 2005 by the Australian Federal, State and Territory governments. Since then it has been working to put into place the infrastructure that will allow e-health to take off nationally.

Dr Ian Reinecke, CEO of NEHTA, says the work put into developing the foundations for a national personal EHR will result in substantial productivity gains in the health sector. “It is estimated that 25 per cent of a clinicians’ time is currently spent collecting data and information rather than administering care,” says Reinecke. “Up to 18 per cent of medical errors are estimated to be due to the inadequate availability of patient information, and preventable medication prescribing errors are estimated to cost $380 million per year in the public hospital system alone.”

For a shared, centralised system to work, there needs to be a unified terminology. NEHTA has been taking a leading role in national and international forums to develop a standardised terminology for the personal EHR that meets the local needs in Australia but will also allow the information to be shared internationally if necessary.

NEHTA has also obtained agreement from all Australian governments to develop a National Product Catalogue. This centralised database will allow those working within the health system to access essential information about health products from one reliable electronic source.

The other focus of attention for NEHTA is identity management. As part of the framework for the personal EHR, NEHTA is developing a system that will uniquely identify each healthcare provider in the country. To complement this NEHTA is developing an individual identification system to securely communicate any one person’s health information.

Privacy assured

One of the central concerns when it comes to sharing health information is privacy. As information is being exchanged across different health IT systems security is central to the success of the personal EHR. To ensure the security of the system NEHTA is incorporating privacy and security requirements from the outset. One result of the personal EHR will be improved patient privacy as there will be clear audit trails and tight authorisation procedures for access to records.

A carefully implemented e-health system has a lot to offer all levels of health in Australia from patient through to governments. The bottom line according to Dr Reinecke is, “Properly implementing the personal EHR will create an efficiently communicating healthcare system allowing individuals to share selected health information with clinicians wherever and whenever required.”

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I see this article as the one that essentially officially announces NEHTA has no real plans or capability to deliver the Shared EHR as contemplated by the old HealthConnect Program – as was a major part of its (NEHTA’s) initial raison-de-etré . Instead we are going to have a Person Health Record of the type offered by Google, MicroSoft Vault, MiVitals, My MedicalRecord and a host of others.

As best one can tell, the patient will be responsible for finding the information to be held in the record and uploading it to some, presumably outsourced, PHR provider.

Before analysing what is now being proposed let me say this article / release is one of the most bizarre pieces of spin released by NEHTA todate. Among the extreme oddities is this sentence. “Up to 18 per cent of medical errors are estimated to be due to the inadequate availability of patient information, and preventable medication prescribing errors are estimated to cost $380 million per year in the public hospital system alone.” I am quite unable to understand how any of this has any relevance to a patient held EHR. Patients don’t prescribe in hospitals or cause medical errors when I last checked.

If NEHTA is so worried about hospital prescribing errors why is it not pushing publically for Computerised Physician Order Entry (CPOE) to be implemented in all hospitals? That is proven to save both time and money (see a blog for later this week!).

Another amazing sentence is this: “It is estimated that 25 per cent of a clinicians’ time is currently spent collecting data and information rather than administering care,”. Frankly I would hope clinicians are careful and thorough collecting and analysing information and not just rushing around treating without adequate information gathering, history taking etc.

And just what the National Product Catalogue, mentioned a paragraph or two later, has to do with a Shared or Personal EHR totally eludes me!

If what is written above is correct then it has the following implications.

First, it seems NEHTA has no idea, or chooses not to disclose, where the information to be held in the patient record will come from and how its accuracy will be verified. As far as I can see there is no mention of clinicians of any sort contributing to the record. This is fundamentally different from HealthConnect where it was clinician generated event summaries of encounters, results and medications that were to be brought together to form a Shared EHR record.

Second, if information from a range of sources is to be held in the PHR how is it to be standardised and how is it to be coded and have terminology etc attached? NEHTA is not anywhere near having the answers to these questions and none of the local term sets are really ready – yet alone usable by patients! (I am told indeed that key staff involved in clinical information standardisation have recently resigned – I wonder do they know something we are yet to be told?)

Third, what clinician will be able to trust a patient held record without careful checking of the important facts which may influence clinical decision making. While having the patient record can and will often help – prudence and medical ethics require crucial information be checked and so the efficiency gains will be small I suspect. Additionally until any information in the patient’s record is downloaded into a clinicians computer decision support for areas like prescribing is simply not possible. I see no mention here of bi-directional data flows between the PHR and clinicians’ computers.

Fourth, in other places (e.g. the USA) where PHR’s are gaining some traction, patient’s insurance claims data, test results, prescription records and information from the clinicians EHR is often merged into an outline record which the patient can access and add to. For this to happen in Australia we would need Medicare Australia to make its coded claims and PBS data available for patient download to their record. I have not heard of many plans to have this happen and I seriously doubt it is likely anytime soon. Without such a data pre-load the PHR might as well be a patient maintained personal health blog!

Fifth, on the remote chance clinicians are to be contributing information, just what is in it for them and why would they bother? In clinical practice, time is money in our fee for service system, and so if information is to be uploaded who pays for the time and effort involved. The patient, the doctor, Medicare, NEHTA or someone else?

What has happened here is goes something like this I believe. NEHTA has realised the HealthConnect plan is just too complex, too expensive and too hard and so is proposing a largely useless cheap alternative which there are already some customer focussed organisations making a better fist of delivering. The use of a PHR as part of a patient portal backed up by the individual’s clinical physician maintained EHR etc is a great idea and is already in wide use in organisations like Kaiser Permanente. I see no evidence that this is what NEHTA have in mind and if this is actually what they plan it will be a 10 year journey at best.

Just why is it we get to hear about what seems to be a major directional shift in an obscure HealthConnect SA newsletter. The lack of openness and transparency of this organisation has clearly not changed despite the BCG Report. E-Health stakeholders deserve to know what is planned and how it will affect them. What is going on now with the lack of openness and exchange of information is frankly unacceptable.

What is also interesting is to look at the NEHTA contribution in the most recent Issue of Pulse+IT.

http://www.pulsemagazine.com.au/index.php?option=com_content&task=view&id=313&Itemid=1

Not a single mention I can find of EHR in any form. That is hardly coincidence can I suggest! The article is well worth a read for what is not there.

This is a long way from what NEHTA (through Dr Haikerwal) was saying in December:

http://www.australianit.news.com.au/story/0,24897,22935859-24169,00.html

Frankly this SA HealthConnect HealthClix article seems to me to be pathetic hype which is a desperate attempt to remain relevant as the e-Health caravan moves on driven by new, more patient and clinician centric, strategies that are presently being developed.

David.

The Weekly News will appear tomorrow.

D.