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Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, June 16, 2010

A Colourful Pie Chart From NEHTA That is Really a Huge Misleading Fantasy.

The NEHTA CEO is wandering around popping up a slide extolling the benefits that flow from e-Health as prepared by Booz and Company.

The presentation can be downloaded from here:


His slide is headed as follows

Economic value of e-health in 2020


Optimal use of pharmaceuticals (including generics) 2.3% ($200m)

Eliminating duplication of effort 8.1% ($600m)

Improved use of infrastructure 8.2% ($600m)

Enhanced workforce productivity 14.7% ($1.1bn)

Reduction of errors 36% ($2.8bn)

Enhanced adherence to best practices 30.6% ($2.3bn)

Source: Booze & Company Global E-Health Investment Model

The details of where this information can from the presentation referenced here:


On the next slide we have the following:

E-health will improve records management

18% of medical errors occur from inadequate patient information

50% of unnecessary acute episodes from lack of knowledge of patient condition

10% of all GP consults are with a patient the doctor has never seen before

25% of doctors’ time spent collecting data

Does anyone else notice the incoherence in all this? Is the NEHTA work plan really going to deliver the benefits cited above? Just where is the explanation of (and evidence for) how much of these 'so-called' will be altered by NEHTA's efforts and the PCEHRs proposed by Government?

The core issue I see in all this is the use of the term ‘e-health’ without really being clear just what is being talked about.

This list from the Booz Report (Page 12) provides some useful clues as to what is the core of e-health

Core E-Health Applications and Capabilities Defined

Connected care enables the electronic transfer of referral information from one provider to another and supports shared care plans where multiple providers are involved with the case treatment of a patient over time.

Decision support provides clinicians with access to guidelines, reminders, and best practices to improve patient outcomes by helping them to make more informed and cost-effective decisions.

Electronic medical records extend a clinical information system with comprehensive patient records, imaging, specialised clinical tools, and interfaces to the local administrative systems within a healthcare organisation.

Identity and access control provides the security infrastructure needed to maintain patient privacy, effectively identify and authenticate providers and patients, and control access to facilities and health information.

Medication management provides clinicians, patients, and dispensing pharmacies with information regarding a patient’s current and past medications, allergies, and basic medication-related decision support in the quest to eliminate medication errors.

Patient self-management provides patients with a portal view for managing their health records and researching health topics. In addition, the capability can provide secure, private patient communications with clinicians, enabling more effective participation in disease management programs and avoiding unnecessary visits to a clinic.

Quality and performance management provides a comprehensive database supporting intelligent performance reporting, monitoring, and the revision and improvement of care guidelines and best practices. It can also support clinical trials and academic research.

Shared summary care records (also referred to as EHRs) provide clinicians with summarized descriptions of the medical events in a patient’s history that may pertain to the current treatment, along with electronic access to detailed procedure, laboratory, and radiology reports.

----- End Extract.

What is obvious, when you take the suggested list of benefits and the core capabilities, is that the strategic and implementation emphasis has to be on provision of ICT support to providers if the majority of the benefits are to be genuinely harvested.

The big ticket benefits come from helping providers do their job better and more safely and all this discussion on Personally Controlled EHR (PCEHR) should be given much less emphasis until we really have nailed provider and hospital support and the communications between these health sector components.

The NEHTA focus on facilitation of messaging applications is correct as far as it goes, but improved GP and Hospital systems are probably even more (and certainly equally) important. These are where the main paydirt (read benefits) exists.

The issue is, of course, that to do this will actually cost some real money and needs to be properly planned, managed and executed. This is something we have not seen all that often recently!

The PCEHR, and its alleged benefits, is a smokescreen and needs to be named as such by those who should know better.

On a slightly different tack is it good to see how the Booz Study points out just how unbalanced the benefits flows and costs are between each of the different elements of the Health Sector (Providers, Consumers, Payers and Government).



Anonymous said...

This cost benefit stuff gives people like Peter Flemming warm fuzzy confidence they can argue their case for more money to do what they think they should be doing.

Unfortunately it reflects with crystal clear clarity the fact they do not understand the issues, the industry, the culture, the problems or the politics prevailing in the turf which they have chosen as their playground.

The cost benefit stuff is the least relevant of everything despite the fact that just about everyone thinks it has to be at the top of the pile. If we continue in that vein we will all continue to fail time and time again.

Bruce Farnell said...

We tend to see this a lot in Health where issues/concepts are grossly simplified to aid communication of the core message to a wider audience. However, when we get to the next step (a business case perhaps) the discussion focusses on the simplified message without sufficient understanding of the real underlying issues. There have been a lot of them over the years in my work in the the primary health area. PKI and eReferral immediately come to mind. eHealth is the latest - sad really.

After rereading the media release of the Booz and Company report I noted the call for a shift in e-health focus from hospitals to primary care settings. The focus was on GP clinics and supplying relevant information to the clinician at the point of care. This is 100% correct in my view. It's a pity that this is not the major eHealth focus rather than the ill considered PCEHR.

With this in mind there is a lot that could be achieved in enhancing existing systems to improving information presented to GPs without spending buckets of money. For example, a quality based approach to clinical messaging with mandatory accreditation of massage senders and receivers could result in atomised HL7 reports which always work with the clinical software in use. It is not a new problem and is still somewhat hit and miss at the moment with many 'atomised' HL7 messages not populating GP databases correctly. It is hard to know how extensive the problem is and if the problem lies with the sender or the receiving software but currently there is no formal mechanism to fix the problem when it appears. This results in a lost opportunity for GPs to easily see trends without manual data entry - particularly important for Chronic Disease Management. Note: I'm not concerned about how the message is sent - just the format of the content.

I accept that enhancing existing systems lacks the marketing appeal of the PCEHR concept. However, real-world solutions are often like that.

Jane Gilbert said...

In relation to Bruce Farnell's comment there is a facility to verify sender systems HL7 messages, the Australian Healthcare Messaging Laboratory (AHML) www.ahml.com.au, a free web based system which tests conformance of HL7 messages. This allows you to determine where the problem is, sender or receiver. There are also problems with some systems just wrapping a PIT or PDF in HL7, so the receiver can read the result but can't do anything further with the result/report. We can also help with determining problems and providing advice on better use of Standards. Jane.

Bruce Farnell said...

Thanks Jane - I should have mentioned the AHML as part of my rant. It is a key part of the solution from my perspective.