Sunday, October 18, 2009

The NEHTA Spin Cycle Tangles Itself Up!

The following note appeared on the web site a few days ago.

NEHTA misquoted

Person-controlled records (link)

The 6minutes adaptation of the story included a misquote from Peter Fleming ‘NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records . He did not say this nor was he quoted as saying this in The Australian article.

This has lead to an assumption that ‘person-controlled records’ is the same as the commonly known personal health records – records that are initiated and maintained by individuals.

Peter’s comment in The Australian article pertained to a design change of the proposed ‘person-controlled records’ system also technically known as the Individual Electronic Health Record (IEHR).

Previously, the design of the ‘person controlled records’ / IEHR focused on an e-health record for all Australians held on a centralised database. NEHTA is now working towards a system whereby, given medical information is currently stored in a number of different repositories and locations (private and public), information would be drawn from these existing sources through a single interface. This approach is preferred as it is able to be adopted more quickly to meet the needs of the Australian healthcare sector.

The work NEHTA is doing on healthcare identifiers, secure messaging and other technical standards would support a rollout of ‘person controlled records’ / IEHR by 2012, pending the decision by COAG on the business case put to it by NEHTA.

‘Person controlled records’ / IEHR records will be healthcare provider generated with healthcare providers owning and populating the records, and individuals controlling providers’ access to the information the records contain.

More here:

15 October 2009

This was published in response to a short news item published a day or do earlier.

13 October 2009

“NEHTA chief executive Peter Fleming says the original vision of a single e-health record system has been abandoned in favour of a Google or Microsoft-hosted "person-controlled" records that can be adopted more quickly, writes The Australian.”

This is a very important statement from NEHTA, but not necessarily a good one.

What they are saying is that their IEHR will, using the IHI as a key, pull together a collection of patient information, format it, and with patient / consumer authorisation make what they can find available to a treating clinician.

Why may this not be a good idea?

Firstly experience overseas shows that such ‘assembled from source systems’ display approaches tend not to be sufficiently complete for clinicians to rely on them.

Second as we now know that the implementation of the IHI will be both phased in, and optional in actual use, the likelihood of safely and reliably assembling a reasonably comprehensive record for use by a new treating clinician can’t be very high anytime soon.

Third it will only take a few errors in allocation of IHI’s to individuals or clinical documents to have the wrong information retrieved. This will cause all sorts of issues regarding ongoing use of such a system.

Fourth the entire concept relies on healthcare providers making information available when requested but then being in the position of needing to seek consent from the patient to view other details on that same patient that may be held elsewhere. Once a patient says no the clinician will just go back to basic Q&A to obtain information in the old way – and all the potential benefits of a shared system are lost.

Fifth, of course no provider can be expected to open their systems for external lookup without both compensation and warranties as to security, now and in the future, of the requesting system.

Last all the issues of currency, which document is the most current and reliable etc will quickly emerge – as will all the issues about the information quality and format of the data that is being shared.

Take it from me to get all this right is, at best, a 5-10 year journey despite what NEHTA says about it being ‘adaptable quickly’.

I will watch with interest as all these issues are recognised and then, possibly, addressed.

Does anyone reading this believe NEHTA actually knows what it is doing? I certainly don’t.


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