Tuesday, October 11, 2011
Draft Article on Australian E-Health in 2012 - For Comment.
I am developing a new article to appear very late in the year. Here is a draft. Comments welcome!
By the time you are reading this the Festive Season will be well and truly underway and we will be able to consider what we might hope for in the New Year in E-Health.
Unquestionably the major item on the agenda for next year is the commencement of the Personally Controlled Electronic Health Record (PCEHR) which is planned to commence on July 1, 2012.
Before focussing on the PCEHR is it important to point out there is other work going on in the E-Health domain with both WA and Qld moving on finalising procurement of new systems (as of writing in mid-October, 2011) and the other States continuing with implementation of their hospital system infrastructure. The National E-Health Transition Authority (NEHTA) is also pushing on with their agenda and we can only hope in 2012 some value for patients and clinicians finally emerges for all the funds invested.
Additionally it is also worth noting both the new Commonwealth Telehealth Initiative and a range of private sector projects will be making some progress towards their objectives.
Moving to the PCEHR - which is clearly the elephant in room - I thought that there are two questions that are worthwhile considering.
The first is what needs to go right for the PCEHR System to be considered a practical and political success? Here is my list of what is needed.
1. Consumers - especially those with chronic illnesses and other reasons - need to register for and use the system in reasonable numbers. This will require that patients are confident their private health information will be safe from abuse and disclosure. It will be vital that public trust in the system is well managed, especially in the initial start-up phase.
2. Clinicians need to choose to undertake the work of preparing and transmitting the proposed health summaries to the PCEHR System and also decide to refer to the system when wishing to find out more about patients they are seeing.
3. GP and specialist software providers need to undertake the work necessary to integrate access to the PCEHR seamlessly into their practice systems.
4. Hospitals and service providers (pathology and radiology etc.) need to choose to make their information accessible to the PCEHR system or operate their own compliant information repositories.
5. The two key infrastructure programs (the Health Identifier Service and the National Authentication Service for Health (NASH)) need to be available and properly integrated into all the clinical workflows that need them.
6. The enabling legislation for the PCEHR System needs to get through the Commonwealth Parliament in a workable form including a robust governance framework and well considered security.
7. The technical aspects of the PCEHR System need to be properly delivered and the performance and reliability of the system needs to be satisfactory.
8. There needs to be a guarantee of continuing funding and support for the PCEHR System into the future. As of now the funding runs out on the day the system is planned to go live and there needs to be some clear announcement of future funding and support in the reasonably near future.
9. The risk of the entire project being simply scrapped by an incoming Coalition government before the system has had time to prove itself is not realised needs to be considered and planned for. I would be surprised if any serious evaluation of the Program could be done by the time of the next Federal Election so the project is at some risk until the outcome of that is resolved.
10. There need to be no major or publicly damaging breaches of sensitive personal information - especially in the first year or two.
11. It needs to have becomes clear to the public and profession that the PCEHR System is both useful and valuable and is making a positive difference to the care being provided to patients.
12. There need to be working secure and reliable clinical information communications in place between all the relevant parties in the health System.
13. The Standards required for the system to be implemented need to be decided and available for live implementation.
Right now it would be difficult to not form a view that the whole program carries very substantial risk and that it might have been quite sensible to proceed rather more slowly and in an initially geographically confined area until the concept, utility of the approach and rate of user adoption is better understood.
The second is to address is the issue of just what is meant by real success?
This question is pretty easy to answer. Health Minister Roxon has said many times ““Electronic health records have the potential to save lives, time and money and make the health system more efficient.” A recent example of her view on this can be found here:
Without being too cynical I fear the ‘practical and political’ success and ‘real’ success may not be as closely related as we might like!
It seems to me, therefore, the real criteria are the ones on which we should judge the PCEHR initiative, i.e. making a real and tangible difference. I hope that the consulting evaluation partner hired by DoHA have a plan to get back to us all in year or two after the system is implemented to confirm that indeed this is the case! I won’t hold my breath given the number of times I have seen such evaluations not quite see the light of day. I hope I am wrong in this case.
From an E-Health perspective it is clear that 2012 will be a very interesting year one way or another!
Thanks for any suggestions!
Posted by Dr David More MB PhD FACHI at Tuesday, October 11, 2011