The following appeared on the Croakey blog site a day or so ago. (Croakey is the Health Sector Interest blog of www.crikey.com.au and is accessible from the web front page.)
The big bang lies with e-health proposals
July 28, 2009 – 11:19 am, by Croakey
Philip Davies, Professor of Health Systems & Policy at the University of Queensland’s School of Population Health, is encouraged by the National Health and Hospitals Reform Commission proposals around e-health. He writes:
“Much of the debate following the release of the National Health & Hospital Reform Commission’s (NHHRC) report A Healthier Future For All Australians will inevitably, and rightly, focus on issues of health care governance, funding and models of service delivery. Some of the Commission’s most far-reaching recommendations could, however, be those relating to e-health.
The Commission is to be commended for providing one of the clearest, most powerful and potentially most effective statements of how to move the national e-health agenda forward. Its key recommendation is that every Australian should be offered the opportunity to have a person-controlled electronic health record (PEHR) – a comprehensive electronic repository of health-related information generated by, and accessible to, themselves and their health care providers.
There’s not much new in that idea. The concept of electronic health records has been around for a very long time; but the Commission’s approach has two distinctive, new features.
First, it suggests quite categorically, that Governments should play no part in “designing, buying or operating IT systems” to support PEHR. That’s a job which, according to the Commission, can safely be left to the private sector. Governments, in turn, should focus on the essential tasks of defining standards for those PEHR systems and regulating their use. State and Territory Governments will also need to continue developing ‘in-house’ patient administration, communication and other IT applications to enable their public hospitals to interface with PEHR systems.
Second, the Commission proposes a series of deadlines for public and private sector health care providers to become e-enabled and able to write to, and read from, individual patients’ PEHR.
To reinforce the point, the Commission goes on to recommend that Government funding in the form of Medicare subsidies or direct payment for public hospital services should be withdrawn from any provider who fails to meet the relevant deadline.
Lots more here:
Now we all have to be a bit careful here.
Consider this recent article from the NY Times I cited the other day.
Op-Ed Contributor
Lost in the Cloud
By JONATHAN ZITTRAIN
Cambridge, Mass.
EARLIER this month Google announced a new operating system called Chrome. It’s meant to transform personal computers and handheld devices into single-purpose windows to the Web. This is part of a larger trend: Chrome moves us further away from running code and storing our information on our own PCs toward doing everything online — also known as in “the cloud” — using whatever device is at hand.
Many people consider this development to be as sensible and inevitable as the move from answering machines to voicemail. With your stuff in the cloud, it’s not a catastrophe to lose your laptop, any more than losing your glasses would permanently destroy your vision. In addition, as more and more of our information is gathered from and shared with others — through Facebook, MySpace or Twitter — having it all online can make a lot of sense.
The cloud, however, comes with real dangers.
Some are in plain view. If you entrust your data to others, they can let you down or outright betray you. For example, if your favorite music is rented or authorized from an online subscription service rather than freely in your custody as a compact disc or an MP3 file on your hard drive, you can lose your music if you fall behind on your payments — or if the vendor goes bankrupt or loses interest in the service. Last week Amazon apparently conveyed a publisher’s change-of-heart to owners of its Kindle e-book reader: some purchasers of Orwell’s “1984” found it removed from their devices, with nothing to show for their purchase other than a refund. (Orwell would be amused.)
Much more here:
http://www.nytimes.com/2009/07/20/opinion/20zittrain.html?_r=1
It also seems I am not the only one who cautions a bit of care.
Davis: privatising records 'dangerous'
28 Jul 2009
Former Conservative home secretary David Davis has slammed his own party’s reported plans to hand health records to commercial IT companies as “naïve” and “dangerous.”
Writing in The Times yesterday, the MP for Haltemprice and Howden said the first time he read about the policy his “heart sank.”
“The policy described was so naïve, I could only hope that it was an unapproved kite-flying exercise by a young researcher in Conservative HQ,” he wrote.
“If not, what was proposed was both dangerous in its own right, and hazardous to the public acceptability of necessary reforms to the state’s handling of our private information.”
A number of papers reported at the start of July that the Conservatives might give patients the option of transferring their health records to personal health record platforms such as those run by Microsoft and Google.
The reports followed a Centre for Policy Studies paper that recommended such a move, alongside a wider use of cloud computing and decentralised IT systems.
Much more here:
http://www.ehiprimarycare.com/news/5066/davis:_privatising_records_%27dangerous%27
Before we go rushing in to signing up the public to PEHRs we would want to be certain the information was not going into some nebulous cloud – but that it is in a secure, inaccessible, un-data-minable environment where the terms of service were such that the public would be entirely comfortable to have their information stored by whoever provided the service.
I suspect that may mean that only local, well established and technically very sophisticated providers will want to be involved and that if we want long term reliability and security there are going to be real costs! I think most would also like to be sure their information is actually held in Australia.
I am as keen as the next man to have patients be able to keep track of their health information and to have ownership of that information but this is not as simple as it is made out and as I have discussed in previous blogs, while be case for provider used EHRs / EMRs is robust, the same simply is not the case for PEHRs.
Commentators who do not grasp the difference, and the implications of those differences, really should not be leaping into print.
I also think it will be very important to think through the various interfacing and communications issues as well as ensuring that clinician workflow is not made problematic during information transmission etc. Timing of just when information is sent from the EHR to the PEHR may need careful thought.
Additionally, I think that any penalty regime to foster information sharing is likely to simply be counter-productive. The architects of a final plan need to think much more ‘outside the box’ to come up with an approach that works and the clinicians are comfortable with.
Can I also suggest that the economic fundamentalist approach of this commentator may not be the best way to move e-Health forward.
The idea of the PEHR is possibly a very good one but we do need to think carefully about how we go about it for the benefit of all. This needs to be fully thought through and all the wrinkles identified and resolved.
Hasten slowly.
David.
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