On Friday we
had an intervention in the PCEHR conversation by the Health Minister.
Pulling E-Health Together, Not Tearing it Apart
Article
by Minister for Health and Ageing Nicola Roxon and published on 6 Minutes.
16
September 2011
This
week we took eHealth to the Federal Parliament, demonstrating to politicians
how records will make a real difference to patient care in the hospitals, GP
surgeries and pharmacies in their electorates.
The
same demonstration will soon travel to different parts of the country, helping
clinicians, consumers and others in the health system understand how connecting
the patient
journey will make a real difference.
What
we were able to show to politicians is that this is not a technology system –
it is a health system. It will improve care for patients, reduce medication
errors and avoid unnecessary tests.
The
display also demonstrates how eHealth is real, and no longer a vague plan for
the future. We now have over a million healthcare identifiers downloaded to be
used, lead implementation sites underway, secure messaging being used and
patient consultations being undertaken through videoconferencing.
And
from next July, Australians will be able to register for an eHealth record.
Yesterday
we released the finalised
plans for the service which will be built by our infrastructure
partners. These were released following long and detailed consultation with
clinicians, health consumers and ICT industry professionals across the country.
Now
that we’re getting on with the job, it is important that people who want
eHealth to be delivered get behind the program. I am buoyed by the enthusiasm
that there is for eHealth across the spectrum of professional groups and the
community.
Over
the past decade of inaction it was easy for everyone to agree – because since
nothing was being done, no decisions had to be made.
But
now that the Gillard Government is actually getting on with the job – it
creates the environment in which differing interest groups want to get their
hands on the steering wheel. That’s obviously impossible.
For
instance, we’ve seen the AMA saying we’re not listening to doctors. This
couldn’t be further from the truth. They should try telling that to the College
of GPs that has endorsed the plan, the leaders of the program include former
Presidents of the AMA and RACGP, and the over 50 clinical leads
that are closely engaged in the program.
The
truth is that while the AMA haven’t won every single discussion about how the
records will work, we agree on most of the design of the system. We’ll never be
able to agree on every single detail because the Government has to take all the
right advice and make decisions that are in the overall interest of the
community and patients, not one professional group.
What
the AMA needs to consider is whether they will be a partner to deliver eHealth,
or whether they will act in opposition and miss this once in a generation
opportunity.
By
working for the collective good, everyone can help us deliver a solution to
benefit patients and clinicians. The alternative option is to try and tear
apart consensus on this program and leave a legacy of mountains of paper in
hospitals and GP surgeries – unconnected and stuck in a luddite time warp.
It
would be a waste to miss this opportunity to transform our health system.
For
our part, we will continue to push ahead with this program in a way that
engages our hard working clinicians, but unapologetically also making sure that
this is a system that has patients at its heart.
The press
release is found here:
The
original publication in 6minutes.com.au is found here:
There was
a report of the intervention here:
Minister urges AMA not to reject PCEHR
- By Michael Woodhead on 16 September 2011
Health
minister Nicola Roxon has rejected AMA claims that the government has failed to
listen to doctors in the design and implementation of the PCEHR.
In
an opinion article in today’s 6minutes, the minister says compromise is essential in
a project that involves so many different groups, and she urges the AMA to come
on board as a partner rather than “tear apart consensus” and leave medical
records in a Luddite time warp.
.....
The
Rural Doctors Association of Australia also said it supported the PCEHR program
but was disappointed that no special rebate will be paid to doctors.
“Many
rural doctors are already working long hours and struggle to keep their
practices economically viable. Given this, they may be reluctant to participate
in the PCEHR system without appropriate incentives for the time they will have
to spend creating and updating the electronic records,” said RDAA president Dr
Nola Maxfield.
This
article is found here:
Miss
Roxon was presumably reacting to this release from the AMA.
Medical advice missing from e-health records plan
12 September 2011 - 4:14pm
AMA
President, Dr Steve Hambleton, said today that the AMA was disappointed that
the Government has failed to heed medical advice in finalising its Concept of
Operations for the personally controlled electronic health record (PCEHR).
Dr
Hambleton said the proposals could ‘de-medicalise’ electronic patient health
information.
“Little
has changed from the draft plan despite the sound advice provided by many
medical groups, including the AMA, about what should be included on a patient’s
health record.
“The
Government has caved in to minority consumer groups.
“Under
the proposed arrangements, people will be able to alter their health record
without consultation with their doctor.
“Patients
could entirely remove from their record clinical documents that they had
previously considered worth sharing with healthcare providers.
“This
is a very dangerous precedent that could undermine all the potential benefits
of an electronic health record.”
Dr
Hambleton said that the AMA would prefer the system to be opt-out, not opt-in.
“The
opt-in system has resulted in incredibly complex rules for patients to give
their doctors access to their PCEHR,” Dr Hambleton said.
“And
there are still concerns around medico-legal liability associated with the
electronic health record.
“The
AMA is a huge supporter of e-health and the benefits it can bring to the health
system, but we cannot support aspects of the system that do not improve on what
we have now and which potentially create risks to patient health.
“We
will have a system that doctors and other health practitioners are keen to
embrace but won’t be able to because their patients haven't yet given them
access to their records.
“Australia
has the opportunity to be a world leader in electronic health but it won’t
happen with the very complex health record announced today,” Dr Hambleton said.
The
release is here:
We
have also had the Rural Doctors Association of Australia react.
Patient controlled e-health records: Better support needed to ensure rural uptake
The Rural Doctors Association of Australia
(RDAA) has warned that rural practices will need adequate support to ensure the
success of a Patient Controlled Electronic Health Records (PCEHR) system in the
bush.
RDAA was responding to comments made this week
by the Federal Health Minister, Nicola Roxon, that at this stage no special
rebate will be paid to doctors to cover their time in creating health summaries
for PCEHRs.
RDAA wrote to the Minister earlier this month advising that,
without such a rebate, many rural practices will find it difficult to meet the
challenges associated with implementing a PCEHR system.
“RDAA supports the PCEHR as a means of making important patient
information available to doctors working in different locations and with
different systems” acting RDAA President, Dr Nola Maxfield, said.
“This is particularly relevant for rural patients who are most
likely to be transferred away from their local community in the event of a
medical emergency or serious illness.
“However, we have a number of concerns about the likely uptake of
the PCEHR system in rural and remote areas.
“Many rural doctors are already working long hours and struggle to
keep their practices economically viable. Given this, they may be reluctant to
participate in the PCEHR system without appropriate incentives for the time
they will have to spend creating and updating the electronic records.
Full
release is here:
In
the presence of this response I find two sections from the Minister very
worrying:
First:
“For instance, we’ve seen the AMA
saying we’re not listening to doctors. This couldn’t be further from the truth.
They should try telling that to the College of GPs that has endorsed the plan,
the leaders of the program include former Presidents of the AMA and RACGP, and
the over
50 clinical leads
that are closely engaged in the program.
The truth is that while the AMA
haven’t won every single discussion about how the records will work, we agree
on most of the design of the system. We’ll never be able to agree on every
single detail because the Government has to take all the right advice and make
decisions that are in the overall interest of the community and patients, not
one professional group.”
The
Minister is assuming here she can undertake the implementation of the PCEHR
without at least tacit support from the AMA and the RDAA. She clearly does not
have that support at present and she surely can’t imagine she is on a winner
without such support. What is happening here is she is trying to ‘verbal’ the
AMA etc. to support a plan they know is flawed. That is a looser of an approach
if I have ever seen one!
“What the AMA needs to consider is
whether they will be a partner to deliver eHealth, or whether they will act in
opposition and miss this once in a generation opportunity.
By working for the collective
good, everyone can help us deliver a solution to benefit patients and
clinicians. The alternative option is to try and tear apart consensus on this program
and leave a legacy of mountains of paper in hospitals and GP surgeries –
unconnected and stuck in a luddite time warp.
It would be a waste to miss this
opportunity to transform our health system.
For our part, we will continue to
push ahead with this program in a way that engages our hard working clinicians,
but unapologetically also making sure that this is a system that has patients
at its heart.”
What
the Minister should be considering here is that the PCEHR she has been advised
to try and implement is by no means the best approach to this mythical
‘e-health’ she is conceptualising at a remarkably simplistic level.
I
am perfectly sure both the AMA and the RDAA would be thrilled to work with
Government in implementing a practical workable e-Health Strategy and but sadly
the present ConOps is just not it!
The
bottom line is that the RACGP thinks the PCEHR needs some work according to
their most recent release:
See
here:
“Dr
Bennett pointed out however, that some aspects of the plan still needed to be
worked out.
“As highlighted in
previous College submissions, we would have preferred to have a default option
of the patient’s usual GP being the nominated healthcare provider. However, the
College acknowledges that in some very remote areas without full-time general
practice services, this role is best filled by a healthcare provider other than
a GP.
The RACGP is also concerned
that the current plan doesn’t offer any incentives for GPs and urges the
Government to consider how this additional effort will be acknowledged.
“We would like to
see amendments to the Medicare Benefits Schedule to recognise the additional
workload GPs will undertake in consultations initiating and maintaining the
patient’s shared health summary and other elements of the PCEHR,” Dr Bennett
said.”
Full release here:
-
and the AMA and the RDAA are pretty convinced it is not a goer in its present
form.
Sorry
Minister you have a lemon here of the same sort as a number of other Labor
plans.
I
hope your advisers are brave enough to tell you that without medical profession
support this will be a huge unused white elephant!
David.
3 comments:
"eHealth fiasco has a deep and wasteful history"
Here as of Sep. 2011 you have the Canadian story: http://www.therecord.com/opinion/columns/article/587794--ehealth-fiasco-has-a-deep-and-wasteful-history
Tea leaves are saying 2013 will see this same story in Australia in the lead up to the next C'th election (if they go full term) and the PCEHR will have had enough elapsed time to be proven to be the wasteful "White Elephant" that it is.
There will be no official announcement as such, just the PCEHR deposited into the same wasteful bin the Health Connect legacy is festering in.
Then the big four can ramp up their forecasts for another windfall of a decade long e-health gravy train, with DOHA and COAG spending lots and getting precious little as a result.
BCG 2004 report will be republished in 2014, and they can just change the publication date to save costs and time.
And the e-health merry-go-round can start again with its fallacious platitudes, bureaucratic conceit and empty political promises by the health ministers puppeteered by their bureaucratic mandarins.
David, be sure to link to this post (http://aushealthit.blogspot.com/2007/07/previous-boston-consulting-group-report.html) when you publish your 2014 commentary once the Tea leaves have proven to be all so shamelessly and tragically prophetic.
It's a perfect example of doing the same thing over and over again and expecting a different result.
The Minister is technically correct to say that "secure messaging being used", but then it has been operating for many many years thanks to the secure messaging providers. There is still, however, a long way to go before secure messaging can be used to link the eHealth system together.
First thing missing is NASH which has been due to be delivered for 3 or 4 years. Maybe 2011 will be its year of delivery. Next is ELS, which is bogged down in Standards Australia. Next, the HI Service is supposed to provide some sort of lookup of ELS endpoints, but there is confusion about its use with that of the Human Services Directory. Finally, interconnect arrangements between the secure messaging providers need to be in place.
There are recruiting and registration processes in place for practices involved in the wave sites, so that these will have HPI-Os and appropriate certificates when SMD arrives in their town.
And this is only one of the essential building blocks where we keep having to hurry up and wait.
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