Monday, December 13, 2010

Will Someone Tell NEHTA and DoHA They Are Dreaming Please!

I think it is important we all grasp just how silly this PCEHR Project is looking in terms of any reality of a sensible delivery timetable.

As an example here is what is to be delivered by end June 2012.

It is the only stage 1 that a timeframe (for capability delivery) is stated to by DoHA / NEHTA so this is all we can judge the realist of the plans from. Here is what Release 1 is to deliver.

Release 1, End June 2012

PCEHR Core Infrastructure

- Consumer Portal

- Provider Portal

- Indexing and Search Service

Strengthen Consumer Participation

- Personal Health Diary approach agreed

- Portal for Consumers to access their own health information, manage who has visibility of their PCEHR and view an access audit trail

Better Assessment and Treatment Selection

- Pathology report summary information available via PCEHR indexed GP summaries

- Radiology report summary information available via PCEHR-indexed GP summaries

Safer Medication Management

- PBS information indexed by PCEHR

- Prescription exchange service provider information indexed by PCEHR

Improved Continuity of Care

- Discharge summaries electronically sent from hospital to GP

- Discharge Summary indexed by PCEHR

- PCEHR Referrals from GP to Specialists indexed by PCEHR

Enhanced Coordination of Care

- PCEHR populated with initial static health summary view using readily available information (e.g. MBS, Immunisation, GP Systems)

- PCEHR information is available for download to local GP system upon request

Just reading this list makes me tired! In this context it is worth noting that the “Clinical processes for maintenance of richer health summary records agreed” phase does not even happen until the next phase.

Now I know the people at NEHTA and DoHA are very smart cookies but the chances of getting the sort of standardised information flows implied here between hospitals, GPs, Specialists, pathology and radiology in 18 months - given we have wanted most of this to happen for a good part of a decade - is just fanciful. A properly planned and funded 4-5 year program maybe -but not 18 months.

Remember according to the BEACH survey we hardly even have GPs fully automated - let alone specialists. This is the current situation as reported in the Australian a few days ago.

“Eighty-five per cent are using desktop systems to print out prescriptions, while 72 per cent are receiving pathology test results online and 54 per cent are also ordering pathology tests online.

While the data -- from the Bettering the Evaluation and Care of Health (BEACH) survey of GPs -- confirms previously noted trends, the big shift to electronic medical record systems is a surprise.

Sixty-four per cent of GPs are now totally reliant on clinical record systems, with 30 per cent still hedging their bets via duplicate sets of electronic and paper records.”

See here for details

If these clinical people are to be information providers ( and just what is in it for them is by no means clear right now - other than a lot of grief) there is a fair way to go with adoption etc!

If we are going to attempt this, and my lack of confidence in the whole approach is well known, then at least start with realistic and not utterly absurd expectations.

Unless more sensible expectations are set a lot of people are going to look pretty silly - and the fallacy of a delivering a live Health Identifier Service, that is still hardly used, will be repeated. One suspects this might be the case given the heading is that this is a ‘Capability Release Plan' and it may be that they will be able to mock all this up for demonstration in 18 months time - but that actual real world availability and delivery might happen years later.

We shall see!



Keith Heale said...

David, where did you get this "Capability Release Plan"? I've looked for it on both NEHTA's website and DOHA's, but failed to find it. Is its circulation restricted?

I have to agree that the timetable is wildly optimistic. It's tragic, because building unrealistic expectations doesn't help the cause of advancing ehealth. What drives intelligent people to even agree to this sort of folly?

Some of the items just leave me speechless: take "Pathology report summary information available via PCEHR indexed GP summaries". Do the authors of this "plan" not think that there might be just one or two technical and legal obstacles to get over before this can begin to be implemented? And if all the obstacles are overcome is each summary to be hand-crafted by the GP, or is it (as is far more likely) automatically extracted from the practice clinical system? And if the latter, have they not read that a useful summary is a result of intelligent synthesis, not mindless extraction of data?

Surely there is better work than this happening!

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


"What drives intelligent people to even agree to this sort of folly?" Can I suggest stupidity and greed.

"Surely there is better work than this happening!" Who knows - they won't tell us as the public.

I got this information from 'a concerned citizen' It is also seemingly secret.


Anonymous said...

Here's another good example of just plain ridiculous timeline pressures-In the Wave 2 PCEHR grants program announced on, Grants applications opened 14 Dec, grant applications must be submitted by 23Dec, and all clarification questions asked within 3 days of the opening announcement (closes COB 17Dec). That's not much time to pull together complex regional collaborations, even for regions who knew it was coming.

Anonymous said...

"Here's another good example of just plain ridiculous timeline pressures"

What is even funnier is that according to the grant guidelines Phase 1 is working with DoHA & NeHTA to develop an implementation plan and then Phase 2, the actual project, is for 18 months and needs to be completed by end June 2012. Adding 18 months plus 6 weeks means the successful applicants must have started mid November - 5 weeks before the submission date let alone how long it takes (over the festive season) for the evaluation of applications! Glad they can make time go backwards?