With all the excitement of the HI Service we have maybe let our attention on other areas NEHTA is meant to be addressing slip.
I was brought back to earth when I found these recent entries in the new publications area.
IHTSDO Update October 2009 10/03/2010
Medicare OTS Information Sheet 04/03/2010
Doctors in Training Dinner- 13th February 2010- Victoria- Sean Holmes 03/03/2010
Connecting Healthcare- 9-10 February 2010- Sydney- Mukesh Haikerwal 03/03/2010
The top one is a three page report on the meetings held by 5 NEHTA staff members for 5 days in Bethesda, Maryland, USA. Not that the location is mentioned as far as I can see. I hear Maryland is a very nice spot to visit for 5 days in early Autumn!
What is worse the meeting was held October 3-9, 2009 and we get a brief report all of at least six months later. Just pathetic. Hardly the level of communication we should see from a publicly funded organisation.
Grab the 3 pages from here:
http://www.nehta.gov.au/component/docman/doc_download/953-ihtsdo-update-october-2009
More amazing is the last presentation from Dr Haikerwal – The NEHTA Clinical Lead.
This is the explanation of the Personal EHR in a few slides:
Extract Begins – Sorry the Format is Hard to Read.
PEHR Explanation: 1
Smart use of data is at the core of a self-improving system
Key: nationally consistent standards
Data:
•Should drive Clinical decision-making
•Measure and improve health outcomes
•Measure and improve performance
•Transparent reporting
•Inform Planning
PEHR Explanation: 2
•All ‘users’ -consumers, health professionals, managers, funders and governments have a part and will benefit
•Access record: generate an audit trail to inform us when and by who record viewed
•Patient does not hold the infra-structure
•They will not be using a USB key
•They do control the access to the data
•This does not change GP/local/hospital records, use or ownership
PEHR Explanation: 3
CORE COMPONENT: HEALTH SUMMARY RECORD: like RACGP’s Maintained at the Patient’s choice of ‘Health Care Home’: Generally by the GP in the Practice setting (or other authorised source).All Providers are part of the System which will provide data that is:
•Technologically current
•secure
•standards driven
•quality assured
Being able to link data:
Consistently
Confidence of users (Providers & Consumers)
Consent and Confidentiality
PEHR Explanation:4
System FOR the patient / citizen at the centre of the information tree
The PEHR is a driver of the change: bold and clear expectations (from the health eco-system)
Our PEHR:
We citizens drive:
What is on it
Who we permit to access it and write to it.
Control access to our own health information
(what information shared and with whom including which health practitioners –trusted source); (add information: self carer alternative self-management (e.g. monitoring BP DM) (respected source)
Where and how health record stored, backed-up retrieved
Integrity of the data and provenance (who wrote the entry) is core
Can base decisions on this with PROVENANCE.
An entry can be added to or removed “in toto” from share not altered
PEHR Explanation:5
Understand and inform that our care is better co-ordinated
•within practices
•between providers
Outcomes and satisfaction enhanced if information about care:
•available at the point of care
•up to date historical information
•timely new interaction information
•accurate
Enabled greater e-Health environment: added functionality indexed allowing exchange of information from various data repositories.
PEHR Explanation:6
Patients controlling access to their own health information may be confronting: can be liberating!
Patients chose to access different practitioners at points in their life may choose not to reveal all the details of their health and health care.
This is regrettable and hampers their care and hinders the efforts of those treating them.
PEHR Explanation:7
A person-controlled electronic health record part of the broader e-health environment
Health performance metrics measurement and data enhance :
Health research and planning
Recognise, plan for and combat disease
Need ongoing development of e-Health records by health services
Must join up and integrate information across the care continuum.
General Practice consults: encounter remains on the practice/primary care organisation’s system.
PEHR Explanation:8
Add to the PEHR summary record (from the GPs, hospitals or other trusted sources) at the push of a button (with patient request)
Patient requests information to be stored on their PEHR
Copy resides on PEHR and in the Practice.
Accessed with patient permission by authenticated users
Enhance care co-ordination which is more complex
PEHR Explanation:9
PEHR full and comprehensive summary of patient history e.g. :
- Medications
- Allergies
- encounters with medical and other specialists
- pathology and radiology results and
possible access to images can be through it being used as a portal but it may not be complete if patients so desire.
Health professionals are aware that even today all records may not be complete.
PEHR Explanation:10
For best health care and outcomes available records on PEHR, should be:
- Comprehensive
- accurate and the concept of accurately recording
- up to date (requires data cleaning)
- PROVENANCE of entries is crucial
The veracity of the record as a trusted source must be assured to allow it to be a source of data when making clinical decisions.
The patient area for documentation by the individual, their carer or other authorised representative / advocate is a respected source and clearly annotated as such. It is a vital part of the record providing information to guide care.
End Extract.
I can’t imagine why Dr Haikerwal was provided with such confusing and vague material to present.
I have read this through many times and am still not sure what is being proposed. If interested I suggest a download of the whole presentation.
You can grab it from here:
Connecting Healthcare- 9-10 February 2010- Sydney- Mukesh Haikerwal
It is really time NEHTA came clean and explained just what it is they are on about and just what the plans if any are.
If they are proposing some form of centralised shared record – the blood sport going on between the British Medical Association and the Department of Health should provide some real pause for thought!
See here for links:
http://www.bma.org.uk/about_bma/BMAinthenews.jsp
Summary Care Record
The BMA’s press release outlining concerns with the rollout of the Summary Care Record stimulated significant interest and was covered by The Guardian, The Telegraph, The Times, The Daily Express, The Daily Mail, Sky News and BBC Online. Hamish Meldrum also appeared on Radio 4’s Today programme to discuss the issue further. The BMA and/or its representatives were quoted, mentioned, or interviewed in over 30 other broadcasts across the country regarding this issue.
Lots of excitement and worry.
David.
6 comments:
David, now you're just complaining for complainings sake. Whilst I'm sure it would have been much cheaper to send the 5 NEHTA reps to the local RSL club for a meeting, unfortunately the other 200+ _international_ delegates were at the actual _international_ meeting location, which was in Bethesda Maryland.
You're taking a pretty cheap shot implying that they've headed off for a holiday.
Andrew,
My point was why does it take 6 months to hear what was decided?
And why was someone who has left NEHTA sent to the US for a week?
No one said holiday, but given the lack of reporting value for money is a bit lacking.
David.
Well the report was dated 4 December and is marked 'confidential' so I presume it just took a while to work its way into a 'published' status. Who knows? Was it really important that you got the report in December? Did it affect your Christmas plans not knowing about the exciting news of LOINC / SNOMED integration?
I'm pretty sure that producing a 'report' is not the actual point of the trip though. I would have thought that the point of the trip is to represent Australia's interests in the development of SNOMED. And just like HL7 meetings etc, I presume anyone can represent Australia's interests. In fact one of the 'key outputs' of the trip is that 5 representatives have been appointed to IHTSDO committees, and most are indeed not NEHTA people (Jon Patrick etc).
There's plenty to complain about in NEHTA - just don't fall into the trap of complaining for the sake of it. It lessens the effect when you actually do have a point.
Andrew,
They actually made the report - useless though it was available on 10th March, 2010. That was my point. Why does this stuff need to go through a Board Meeting and then take months to publish?
Just why a report like this would be 'confidential' beggars belief!
A detailed report could also of helped those outside NEHTA follow what is going on. Sadly no such luck. Most HL7 Committee reports are much more detailed and explain what went on - as you know. And are produced more quickly.
If you are happy to me 'mushroomed' that is up to you - but when the public spend $50,000 or so sending people to a meeting like this - more than 3 pages is needed and within a month or so.
Just who else is there in the whole of OZ who is actually asking NEHTA to account for this sort of stuff? You know anyone?
No further comment on this. It is just a joke how they treat the whole e-Health community with contempt.
I see this sort of stuff as reflecting to total lack of proper governance of e-Health in Australia which is core to all our other problems. Hence I raise it.
David.
"I can’t imagine why Dr Haikerwal was provided with such confusing and vague material to present. I have read this through many times and am still not sure what is being proposed."
I am amazed that Dr Haikerwal was prepared to accept this material and present it. I too have very carefully been through what you have put up on your blogspot a couple of times. Like you I find it very confusing and vague verging on drivel with a mix of buzz words. After many decades in health informatics at the coal face I am concerned by this presentation.
Why? Firstly I think it verges on mumbo jumbo, it has no clear message and conveys a sense of 'confusion". Secondly we have to assume Dr Haikerwal did not prepare this information. Hence it is quite disconcerting that NEHTA has prepared it for him and if so it reflects some very deep problems at the core of NEHTA to have allowed a presentation like this to see the light of day. Thirdly, I am also concerned that if NEHTA's clinical lead cannot discern that there is something wrong here I have to ask why is he the Clinical Lead?
I agree - the “PEHR Explanation” slides are vague and confusing leaving a great deal to be desired. Maybe they are the ‘gist’ of the messages that is planned to be targeted at the consumer about why they need a PEHR, who will look after it and how it will help improve your health. It’s all a bit odd. Perhaps dr Haikerwal didn’t get to see them until the last moment. Urgency and pressure to get the message out there may have just been too much.
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