The following has appeared in the News Ltd papers today. It seems clear this is a set of leaks from the NHHRC Final report.
Health records to go online
Article from The Advertiser
July 20, 2009 12:01am
EVERY Australian will be able to see their medical records online and keep a personalised "health diary" in a key reform promising better care and big taxpayer savings.
Family GPs and other medicos will be forced to link patient records to a proposed national database or miss out on Medicare payments, The Advertiser can reveal.
But Prime Minister Kevin Rudd's health reform body has called for patients, and not doctors, to have the ultimate say over who sees their medical records.
......
Central to the reform agenda is the introduction of a national electronic-health system, containing confidential and potentially life-saving information. To maintain privacy standards, medical professionals would have to get patient permission to access the data, which would be dispersed across the country.
New privacy legislation would protect the information from prying eyes. But emergency provisions could allow access to the data in times of medical crisis, such as after a car accident or during a serious allergic reaction.
Giving people access to their own records is seen as vital to ensure consumer acceptance of the proposed e-health revolution.
This would allow individuals to go online and update their medical records and add information relevant to self-management and healthy lifestyles.
Medical professionals have long hoped for a national e-health system, which could save up to $8 billion over 10 years by giving medical professionals better information about patients. The number of medical errors could be cut, chronic disease management would be improved and unnecessary duplication of tests and scans would be eliminated.
Under the commission's recommendations, it is understood every Australian would have an electronic health file by mid-2012, and all health care providers would have to accept data from other providers by January 2013.
Those without internet access would be able to view their records under proposed equality measures.
GPs, specialists, pharmacists and other allied health professionals would become "e-enabled" quickly to ensure the system worked.
The plan to deny Medicare payments to GPs who do not sign up to the system will anger the powerful doctors' lobby which hopes to secure incentives for its members to co-operate.
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More here:
http://www.news.com.au/adelaidenow/story/0,22606,25806145-5006301,00.html
In the following I will ignore all the points made other than the e-Health related ones.
On the basis that what is reported, and it is similar to what I have seen in drafts of the Final Report, this seems to be what the NHHRC has in mind.
Let me say clearly and directly I disagree with just about every aspect of these proposals.
To my mind these proposals lack an evidence base, ignore the major benefits cases of e-Health, are impractical as they guaranteed to really annoy most clinicians and suggest timelines that are utterly unrealistic.
I have made the arguments around most of these points here:
http://aushealthit.blogspot.com/2009/05/nhhrc-gets-e-health-very-badly-wrong-at.html
As have others – as covered here:
http://aushealthit.blogspot.com/2009/05/nhhrc-told-to-work-out-what-it-is.html
If the government can’t see that what we need is proper automation of our professional health services with point of care decision support, a dramatic upgrade of standardised, content rich, information flows between the various professional actors (doctors, nurses, pharmacists, allied health and so on), implementation of standardised secure messaging and e-prescribing, improvements in the business of health systems and quality leadership and governance of the way e-Health is managed and delivered we are, to be clear about it – stuffed!
If the final report does not recommend, and the government decide to agree to, run tracks both of implementation of the Deloittes National E-Health Strategy and developing a pragmatic approach to the deployment of Personal Health Records we will wind up in a humongous mess.
Take it from me, medical professionals have not been asking to be forced to contribute to patient held records. They have been asking to be given the tools they need to enable them to do a better job of caring for their patients.
This proposal, if true, is really just ‘magical thinking’ on the part of some very ignorant people in the NHHRC.
All I can do is hope News Corp have got the wrong end of the stick.
David.
12 comments:
All we are seeing here is a replay of the past. As is so often said, “the actors change but the play remains the same”.
The old actors have moved on; new ones have taken their place. And so in blissful ignorance, with neither corporate memory nor experience of the past upon which to draw, the new players do nothing more than recommend the same simple pathway as those who went before them.
What makes this all so tragic is that those who know better fail to make themselves heard. Most knowledgeable informed health informatics experts will nod in agreement at your words - “let me say clearly and directly I disagree with just about every aspect of these proposals” - yet, they will remain silent.
Your reference to the commentator of Wednesday, May 27, 2009 10:45:00 AM could not have said things more clearly. The issue is not that “most of those providing submissions are simply not clear exactly what is being proposed” it is more that they, like the Commission simply DO NOT UNDERSTAND”.
What conclusions can one draw from there being no recommendation supporting the implementation of the Deloitte National E-Health Strategy. This alone speaks volumes for the enormity of the ignorance of those who have pontificated on ehealth in this NHHRC Report.
But even more at fault than the Commission is Deloitte itself. For if it was prepared to take on the consultancy and accept the $1.3 million for doing the job it should equally well have been prepared to stand up and fight for the recommendations it made. Anything less should be taken as an indication Deloitte has so little confidence in its recommendations and its report therefore is not worthy of further consideration.
I can assure you Deloittes have worked very hard to explain their plan in all sorts of well informed forums and the reception has been very positive. It is the NHHRC and the Minister who, for reasons I don't follow, don't seem to understand a well as one might hope.
David.
Thank you for that reassurance. Something therefore is badly amiss. What could it possibly be?
Why has Deloitte not been able to get its message through to the NHHRC?
Has Deloitte sat down face-to-face with Dr Bennett, the Commissions Chair? or Has she been far too busy to make the time available to sit, listen and discuss the Deloitte Report?
This is a very important question because, as you can guess, given that the success of the health reforms are very much dependent on eHealthICT Dr Bennett, had she been listening and had she comprehended, would have invited Deloitte to meet with a number of her Commissioners including Dr Haikerwal to ensure they too heard at first hand the Deloitte message.
We need to know the answer to that question before we can proceed. Because the simple fact is that if Dr Bennett has not read the Deloitte Report and not had a face-to-face meeting to discuss the Report with Deloitte she should do so. And if she has done so then other questions need to be asked.
So, has she read it and has she met with them?
Has anyone seen this mythical Deloitte Report other than a short sanitised summary? Is there something in it that threatens the national security? Is it available under FOI? Why does the NHHRC avoid mentioning it? Is it on the nose? Why does NEHTA avoid mentioning it? It's almost as though it doesn't really exist, or if it does the parties that commissioned Deloitte to do the report wish they hadn't done so. Any other possibilities?
It has been quite clear from the very first leaks and pre-publications of the the NHHRC report that the NHHRC has been spending too much time with Microsoft and has caught HealthVault fever.
The concept of personal health records appears to have displaced rational eHealth thought at the NHHRC, despite the fact that any sound analysis must recognise the inability of PHRs to address healthcare professional access to reliable, trusted clinical data for those patients most in need (the chronically ill, indigenous peoples, the poor and the very young).
I agree. FOI is probably the only way. Maybe a number of FOI applications all at the same time might be a ay forward. How about MSIA and HISA and The Australian and the AFR all lodging separate applications.
Refer to commentator Tuesday, July 21, 2009 8:47:00 AM. The Microsoft scenario has credence. Which is all the more reason why the Chair of the NHHRC needs to dialogue with Deloitte. I agree with your earlier commentator - it is in the national interest to do so.
Quite frankly its high time the peak primary care medical body, presumably the RACGP, stepped up to the plate and got involved before its too late. Or are the doctors too busy looking up their proctoscopes?
David, few would doubt as you say that “Deloitte has worked very hard to explain its plan in all sorts of well informed forums and the reception has been very positive”. But the key question is have they had a full considered hearing from the NHHRC Chair and her Commissioners? What does Deloitte say?
I agree with your commentator Tuesday, July 21, 2009 6:10:00 AM.
The most important question(s) which should be answered right now is whether Dr Bennett has read the Deloitte Report, whether she has met with the authros of the report to discuss it in depth, and whether she has facilitated the authors of the report being able to meet with various members of her Commission to discuss the ramifications of their report. Surely Dr Bennett is not averse to making a brief statement to provide some clarity on this very important issue.
Maybe they just simply don't know how ehealth can help the health reform process. Could that be possible?
The report found here makes it so easy a 10 year old could work it out.
http://aushealthit.blogspot.com/2009/07/report-from-european-union-that-nails-e.html
Sadly I suspect they have not read it!
David.
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