Quote Of The Year

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."

Tuesday, July 06, 2010

Now Here Is An Issue or Two NEHTA and DoHA will Really Need to Address.

And now from the real world we find out about the quality of data in Shared EHRs in the UK where there have been efforts and incentives in place for years to improve the problem!

GPs confident their data is fit to share

24 Jun 2010
Four out of five GPs believe the quality of their practice data is fit for sharing, according to a survey on the future of general practice IT.
More than 500 GPs took part in a survey by doctors’ magazine Pulse which looked at GPs use of IT systems now and their views on access to information out-of-hours.
The survey found that 82% of GPs thought the quality of the data held in their practice’s clinical system was of sufficient quality to share with other healthcare. Only 7% thought their data quality was not fit for sharing and 11% said they were unsure.
The survey also found that 56% of respondents had received electronic records through the GP2GP transfer project. Just under one in three GPs (30%) thought that the quality of the records was good enough to ensure seamless delivery of a high quality service but 25% said that the quality of the records was not good enough.
GP data quality was described as one of the ‘wicked problems’ delaying implementation of the Summary Care Record in the independent evaluation of the SCR LINK published two weeks ago with researchers finding that SCRs did sometimes contain incomplete or inaccurate data.
More here:
Put another way one in six GPs were not sure their records were up to scratch. Not really great news given the efforts over five + years to get the data quality up. A survey asking similar questions now in Australia is needed I reckon the see how much work we have ahead to lift the Australian GP (and specialist) game.
And if that issue is not enough, here is at least some thinking on another contentious issue.
The other issue is consent management so that only what should be shared is shared!
I found this very all interesting.

Govt., vendors show off consent-management tools

Posted: June 30, 2010 - 12:15 pm ET
There are at least seven computerized consent-management software systems either operational or under development that let patients segment their sensitive healthcare information and control and audit who sees or uses their electronic health records.
Today's existing messaging standards are sufficient for allowing patients to communicate their privacy preferences to these systems, according to government and private-sector developers of privacy-protection software systems who testified and demonstrated their wares Monday in Washington at a daylong, HHS-sponsored hearing.
The most sophisticated of these consent management systems let patients exert unprecedented levels of so-called "granular" control over their medical information.
The missing link to wide deployment of these systems, many of the developers said, is not the technology but the lack of a uniform national policy on what level of control patients should enjoy as providers continue to adopt EHR systems and regional and state organizations seek to link them in a proposed national health information network.
The hearing was held before the Privacy & Security Tiger Team, a new work group of the federally chartered Health IT Policy Committee. The committee and its companion Health IT Standards Committee were created pursuant to the American Recovery and Reinvestment Act of 2009 to advise the Office of the National Coordinator for Health Information Technology at HHS on health IT issues.
Links to the written presentations of participants and a webcast of the hearing is available at the Tiger Team Web page.
Three of the seven systems featured during the hearing were open-source or public-domain software projects. Two were government-sponsored initiatives.
Lots more here:
It seems on both sides of the Atlantic people are battling with these complex issues.
No one can accuse me of not warning all that will listen that this whole shared patient record business has a zillion wrinkles which might come back and bite you! Care, learning from others and careful planning are vital if you are to have a hope in hell of succeeding!


Anonymous said...

Practitioners may be critical of other practitioner recording but the sharing of less than complete data because patients choose to cherry pick the data to be shared is a far more important issue.

In OZ, if patients & health providers want to be subsidised & remunerated via government sourced taxpayer dollars, that government should require and stipulate that patient E-health records be complete, not edited to suit personal preferences.

Unless this principle is adopted, health providers like me will NOT trust E-health data and require validation by questioning & testing just as we do now.

In my view that means if a patient does not want to participate in comprehensive E-health, they can opt out but they cannot opt back in for a lengthy period or subsidy withheld.

Perhaps practitioners need a flag in distributed records for which they are responsible that indicates the record as distributed is complete or incomplete.

I imagine indemnity insurers may require such a flag system or similar effect!

What do other forum respondents think. Is this the majority view?

Anonymous said...

"What do other forum respondents think."

You do make it sound so easy. Conceptually and philosophically I am tending towards agreeing with your premise but pragmatically that is more the end state goal and a long way off it is.

To attempt, to drive or implement policies, rules and procedures which cement your premise into place too early is to ensure your approach will fail before it even gets the slightest traction thus slipping away into the chasm of nothingness into which most such philosophically based projects have disappeared.

Impending reforms in primary care will create a turbulent environment for all. Gnashing of teeth by doctors will be particularly evident as the primary care health reforms take hold.

There is much that does and should happen beyond the medical practitioners domain and those activities need to be embraced and positioned more definitively within the realm of primary care. For that to happen doctors must open their minds to the possibility that their doctor-centric view of primary care is no longer the holistic view they once so ardently promoted.

The world has moved on. Information technology and the possibilities it brings with it have opened new horizons. So the doctor-centric world is now being steadily transformed into the more appropriate patient-centric world; one which will enable better ways of delivering primary care through improvements in coordinated team-work, collaboration between multiple health care personnel, advances in chronic disease management and more streamlined approaches to navigating the highly complex health care system. This suggests the primary care model must be expanded to recognize and accept that the less privileged, the disadvantaged, the mentally ill and the homeless should all be embraced, in one way or another as resources permit, by and within a broader definition of primary care than has been the case in years now past.

Anonymous said...

I agree with "This suggests the primary care model must be expanded to recognize and accept that .... ".

This raises many issues including:
1. What structure, governance and responsibilities should be given to the 'organisation' chartered with delivering the grand patient-centric, all-embracing model of primary health care?

2. The money. Surely the Federal Government won't take over a lot of those areas you (Thursday, July 08, 2010 9:27:00 AM) suggested in your expanded definition of Primary Care.

This means some form of Federal & State shared responsibilities and funding will be required.

3. If 2 holds true the 1 cannot be Federal-centric.

Now, as I read it the Federal Government plans to fund 100% of Primary Care (within its definition of what that means) and the States will probably end up managing the space which will most likely differ from state to state making it too hard to manage centrally.

And it is the 'definition' that is most important right from the outset. Yes, we'll take that bit thanks and fund it. No, no we don't want that bit, or that bit, or that bit, - you keep them, you fund them.

So how all encompassing the world of primary care becomes will be determined by THE DEFINITION OF PRIMARY CARE and that in turn will be determined by what the Federal Government wants to control and wants to fund. The States can have the left-overs.