Peter Fleming gave a talk at the Australian Healthcare Summit a few weeks ago.
You can download a copy of the slides from here:
A couple of the slides in the Health Identifier Service really ‘bell the cat’ on what the real timetables NEHTA has in mind for the HI Service.
Before discussing the slides it is important to keep in mind that the HI Service allegedly went live on July 1, 2010 (at a cost of approximately $90M) and that the funding for NEHTA is only thus far approved until June 30, 2012.
For the PCEHR funding to continue this means there will need to be an allocation in early May 2012 (Budget time) so the time to make a decision is shortening by the day - now close to 13 months.
What happens to both NEHTA and the PCEHR program seems to be linked, in the mind of the Minister for Health at least, to demonstrated outcomes and benefits from the PCEHR program before that date - otherwise the funding is apparently not going to be continuing.
What an astonishing mess that would be. Maybe all this is also going to become a 'change management strategy' as the HealthConnect program realised just how big and costly all this can be!
Let us no look at two slides from the presentation.
Slide 1. Adoption curve for HI in General Practice
Click image to enlarge
This shows the Adoption curve for HI in General Practice. The timeframes talked about extend to 2013 and beyond with only 30% of the population having an HI in use at the end of 2012.
Slide 2. Adoption curve for HI in Acute Care
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This slide shows the Adoption curve for HI in Acute care. Here hospital adoption is not really in full swing until 2015.
Allowing that some slippage is virtually inevitable how long is it going to be before all those patients who sign up for a PCEHR are going to have access to any useful content and how will anyone be able to tell if there is something useful or not without signing up?
Of course we still have no clear idea of just what digital identity credentials will be available for and used by patients to access the planned PCEHR portal and how secure that is going to be. Equally how far the National Authentication System for Health (NASH) is along has not been mentioned since the outcome of the Tender (won by IBM) was declared on March 1, 2011.
The HI Service is clearly not going to reach major levels of adoption until 2013 at the earliest, if that, so just how this fits with any real PCEHR capabilities, besides some cute mock-ups and story boards, being available July 1, 2012 is hard to know.
The time to confess this is a badly planned implementation fiasco and come clean with some realistic plans has well and truly arrived.
On a related topic there is at least one area in the Concept of Operations document that is a little economical with the truth.
On Page 108 we read (On the National E-Health Strategy):
“The Strategy identified a national Individual Electronic Health Record (IEHR) System as a high priority. The Strategy envisaged the IEHR as:
A secure, private electronic record of an individual’s key health history and care information. The record would provide a consolidated and summarised record of an individual’s health information for consumers to access and for use as a mechanism for improving care coordination between care provider teams. [AHMC2008]
Since the Strategy was originally developed, the term ‘PCEHR’ is now preferred as it better aligns with the recommendations from the National Health and Hospitals Reform Commission which recommended that a national approach to electronic health records should be driven by ‘the principle of striving to achieve a person-centred health system.’ [NHRR2009].
In 2010, the Government has invested 466.7 million in the first release of a PCEHR System.”
----- End Quote:
What the Strategy actually said was:
“R-2 Foster and accelerate the delivery of high priority E-Health solutions by vendors and care provider organisations in a nationally aligned manner.
R-2.1 Establish a national fund to encourage investment in the development and deployment of high priority, standards compliant and scalable E-health solutions.
R-2.2 Establish a national compliance function to test and certify that E-Health solutions comply with national E-Health standards, rules and protocols.
R-2.3 Adopt a nationally coordinated approach to the development of consumer and care provider health information portals and an electronic prescriptions service.
R-2.4 Adopt an incremental and distributed approach to development of national individual electronic health records (IEHRs).”
So the IEHR was a much lower priority and the concept was also based on a much more traditional and basic Shared EHR with consumer access as a peripheral component. Doing more to support providers was the priority and this has just been ignored.
Also, the IEHR and the PCEHR were and are very different ideas and that point is quietly just slipped over as well!
We really have reached the time for some frankness and transparency on a range of these things!