Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Thursday, June 03, 2010

Senate Estimates Hearing - June,3 2010 - Preliminary Notes.

The e-Health component ran from about 3.00pm up until about 3:40pm

Questioning began by Senator Boyce at 3.00pm.

Others who asked most questions were Senator Furner and Senator Fierravanti-Wells.

The two main areas of questioning were around the Personally Controlled EHR (PCEHR) and the HI Service.

Personally Controlled EHR

We discovered the following:

A PCERH is a personal health record owned and controlled by the patient.

It will be voluntary to have one.

The PCEHR is apparently planned to be accessible via a portal.

Access will be possible by anyone who has been authorised by the patient and it is planned access via the internet will be possible from home, public libraries.

It was suggested that maybe Google or Microsoft would offer the service and this was denied. (Note: a correspondent has suggested that I may have misheard - and that the question was not really answered directly) The net outcome is I think it is possible but not plan A at the moment - time will tell!

DoHA has not yet worked out how infrastructure for the PCERH will be built.

When asked about the relatively small amount of money, we were told the $467M was consistent with Larger PCEHR Business Case which ran for more years. It was also clear that there was, as yet, no real idea as to how the money would be spent and on what.

It was made clear that e-Health development would be “incremental rather than small steps”. (Whatever is meant by that!)

Comment:

No comments made on where the health information to populate the record would come from and no real discussion on what functionality the portal would provide.

I was left with the distinct impression that the Business Case that was talked about was not the IEHR plan developed by NEHTA.

Health Identifier Service

Use of HI Service Number.

The plan it to allocate the IHI numbers once the legislation is passed and regulations are approved.

It was the plan that provider would be also allocated numbers and they would be major users initially.

It was quite clear there would be little happen for a good while after July 1, even if legislation is passed.

Status

To date no live system had been tested.

Amazingly only 3 software providers had signed ‘Developers Licences’ to access the Medicare HI Service Development system.

No indication was provided on how promotion of the HI Service would be undertaken of funded but Senators mentioned that NEHTA had released an Implementation and Communication Plan.

See here:

http://www.nehta.gov.au/component/docman/doc_download/1012-hi-service-implementation-approach

And here:

http://www.nehta.gov.au/component/docman/doc_download/1011-hi-service-communication-plans

If legislation not passed – impact on scheme was recognised to be substantial and it was agreed that it was being talked about rather optimistically.

Other Matters:

Senator Fierravanti-Wells asked a number of details on NEHTA funding, plans etc (Other questions were also asked on the total cost of e-Health since 1993) so the answers on notice to those will be interesting when they arrive.

Senator Furner asked a good set of questions based on the Booz E-Health Report. All the bureaucrats agreed E-Health was vital and important in saving lives and money. That was good to get on the record!

See here:

http://aushealthit.blogspot.com/2010/05/major-study-confirms-value-from-e.html

Overall:

Not really enough time but some interesting points. We really need more time than this and we need NEHTA to turn up!

David.

14 comments:

Anonymous said...

It is obvious that no one in DOHA has really thought about what this PCEHR thing is. The system described doesn't sound as if it will be useful to the medical profession.

Patient access to medical records may be good in the long term, but it is more important to get that access to the medical profession.

Anonymous said...

Totally, completely, absolutely and utterly out of control. The problem however is how long should bureaucrats like this be permitted to continue being unaccountable, delivering little and spending hundreds and hundreds of millions of dollars to deliver nothing of any benefit to anyone?

It's time 4 Corners or some highly competent investigative journalist did a doco on this disgraceful of saga of perpetual incompetence for pre-election release.

Anonymous said...

The sad thing is that 467 million dollars of well targeted eHealth work could revolutionise the landscape. Giving it to Nehta will just distort the market and lead everyone on another wild goose chase. I think on balance we would be better off without it as it will just delay progress for another 2 years until everyone realises that its gone down another black hole. In uninformed peoples eyes it will appear that Nehta must have a plan, and know what they are doing, but we have pretty good evidence that that's not the case.

Looks like Mr Kevin Magoo strikes again.

Anonymous said...

Ten reasons why a PCEHR won't work:

1. The PCEHR will disenfranchise those who need the most healthcare management – the elderly, most of the chronically ill, indigenous Australians and the poor.
2. Of the remaining population, only a minor proportion will be likely to have a long-term commitment to managing and making available a comprehensive health record (and these may only do it when they get sick!)
3. The infants and children of the families on Point 1 will miss out
4. Patient-managed records are likely to be incomplete and patchy
5. Clinicians will not have confidence in a health record that is maintained by patients (even if it is available).
6. Clinical practices will continue, in any event, to maintain their own comprehensive notes and histories of their patients.
7. Is Microsoft or Google (or a similar PCEHR provider) going to pay vendors to implement/integrate solutions using the Healthvault or similar development platform? If not who will pay
8. Will individuals be willing to pay for a system that has questionable clinical value.
9. What happens to practices that do not use Microsoft based software and development tools?
10. Would you trust Microsoft, Google (or Facebook??) with your health records? Neither would I!

Anonymous said...

Well as someone commented a couple of days ago ehealth is too embarrassing to let it get a fair airing. By moving it to late Thursday it effectively got pushed off the agenda. NEHTA is pretty well accountable to no-one and DOHA is meandering along pretty well devoid of ideas.

Anonymous said...

Its not as if the PCEHR is needed when you have an HI indexing all of your health information ...

Anonymous said...

If I am to own it and control it then I want it to be defined and implemented properly. I don't want any old yahoo googling myspace and twittering at my health status. And I want an iPAD and good broadband coverage so that I can access it whenever and wherever!

Anonymous said...

To "Ten reasons why a PCEHR won't work" - I fear your reasoning is as impeccable as the famous IBM CEO argument many decades ago that the world only needs 4 or 5 computers. Made perfect sense - with respect to the world as it was - but not the world that was to come.

The PCEHR is a game changer for health care service delivery - it is not about making the old ways better, it is about doing things differently. How differently? Lets resume the discussion in this blog in 10 years time.

WIll there be changes in our understanding, evolution in what 'it' is, successes and failures ... sure ... but 'it' is about everyday folks being engaged and active in managing their care ... that change will take a while, and the technology will shape what we do as much as what we do will shape the technology.

The world does not stand still, and sometimes an idea like the PCEHR comes along, seemingly innocuous, and starts to reveal an entire new way of doing things.

I personally cant' wait. Roll on ...

Anonymous said...

And when you hear that Kaiser Permanente has 3 MILLION patients looking up results, making bookings, and ordering prescriptions, the advent of patient controlled or patient centric records cannot be far away.

http://www.ehiprimarycare.com/news/5930/nhs_it_pros_urged_to_%E2%80%98keep_the_faith%E2%80%99

Anonymous said...

Um, not sure we want to emulate Kaiser Permanente? Did you see Michael Moore's movie Sicko?

http://www.sparselysageandtimely.com/blog/?p=3616

In any case, according to Wikipedia, KP's ehr system has cost over $US6 billion - or more than $US500,000 per doctor covered.

http://en.wikipedia.org/wiki/Kaiser_Permanente#HealthConnect

This cost was more than three times what they were expecting at the outset, in 2002-03

http://www.intersystems.com/cache/analysts/449618.pdf

In any event, it appears KP has made some "good" use out of interrograting the patient information it holds - look up US investigations of "patient dumping" by managed healthcare firms, including by KP

Dr David More MB, PhD, FACHI said...

It is important to remember KP's systems manage a whole integrated health system that provides all medical and surgical services to more than 8 million people.

Their system are widely recognised as the best in the world in terms of clinical care provision, preventive care management and clinical research support at present and I would expect some more balanced comments than what seems to me to be some commentary coming from a very negative perspective.

If we had systems of this capacity supporting our health system I strongly suspect we would have a much higher performing health system overall. KP's clinical outcomes and financial performance are genuinely world class.

See here for more information about KP.

http://www.earthtimes.org/articles/show/kaiser-permanente-honored-for-health,1327231.shtml

Kaiser Permanente Honored for Health Information Technology Innovation with CIO 100 Award
OAKLAND, Calif., June 2 /PRNewswire/ -- Kaiser Permanente was recognized by IDG's CIO magazine with a CIO 100 Award for using information technology in innovative ways that provide value. The award was specifically in honor of Kaiser Permanente's first-of-its-kind Mobile Health Vehicle.


David

Anonymous said...

My comment on KP on June 6 12:34 am was really just to illustrate the consumer/patient demand/interest for involvement in e-health (and their own health care) IF you have a good system that makes sense to people and they can see value in it.

KP obviously have a very good system in place for patient use (not withstanding whatever you may think of other aspects of their operation) and it is a good example of what is possible if you decide to make the patient one of the foci of your e-health operation.

And I happen to think that real progress in e-health will be driven by patients(and their families - particularly those caring for elderly relatives) requesting/demanding the same sort utility in their interactions with health care providers that they currently enjoy with banks, travel agents, airlines, and just about every other form of consumer interaction

Anonymous said...

With regard to Kaiser Permanente in this context of electronic health records, as well as David's comment on KP being an integrated HMO, it's very important to understand that they have a number of systems that serve very different needs.

To support clinical decision making, they've deployed EPIC in their hospital and clinic environments. By and large, any physicians working in Kaiser use EPIC as their first source of information. EPIC is deployed as effectively both an EMR and an EHR, in that it provides a view within a single hospital as well as a shared view across multiple hospitals/clinics. It's an old architecture based on MUMPS that requires a heavy client (no portal in sight) although it is deployed over Citrix for access over the web. Definitely not a portal though.

KP's MyHealthManager is a patient's view into a subset of the data in EPIC but mainly focuses on giving patients access to self-management tools, prescription repeats, appointment scheduling and so on. It's only for patients though.

In 2008, KP started a pilot for 160,000 staff to be able to connect their MyHealthManager system to Microsoft Healthvault. They did this because not all services for all members are delivered by KP. Also they didn't want to build all the difficult device integration like glucometers, blood pressure meters, etc. But this was a way to bridge beyond their span of control, letting their members choose to share information.

What's important is that clinicians only used one system, one that was designed and deployed in a way that fits their workflow. There's no way a clinician in KP would use EPIC for ordering, then log into some other shared EHR portal for a summary health record. The EMR/EHR in Kaiser has only one purpose - better clinical decision making at the point of care.

The MyHealthManager has a simple purpose - it's to give KP's members an access point to their services and if they have a condition, it's to help them make changes to their behaviour or lifestyle.

In Australia though, somehow a view seems to exist that these two concepts can be delivered by the same solution:
- That clinicians will disrupt their workflow to log in to a portal with questionable data, a significant chance of incomplete data and data that is difficult to put in context of their particular interaction with that patient at that point in time.
- That patients will want to look at their information in a medical record that simply data, dense with confusing terms and missing information

We need EMR's, EHR's and possibly PHR's. They are not equivalent - they serve totally different purposes and require different information architecture, constructs, terminology, use cases and user experiences.

The silliness of the government and NEHTA's rhetoric (call it a PCEHR or an IEHR) is that such a thing is worthless. EMR's + EHR's + PHR's = something that might make sense.

A central portal that somehow is supposed to magically work for the needs of both patients and clinicians is just a plain fantasy of technocrats and an obscene diversion.

(Incidentally, it's cost something like $1.8billion to implement EPIC, that's after already spending something like $800m on a custom built system, then throwing it out and starting again )

Anonymous said...

No one (except perhaps NEHTA) said they had to be the same system. The patient's view will eventually be an abstracted view of possibly a number of quite disparate systems.

A good example is the ATM or Bank portal, which is the easy to understand consumer view of a complex network of banking systems, some of which may also be very old - re-writing banking systems is not undertaken lightly.