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!

We Are Almost Into A New Year. Time For An E-Health Progress Check.

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!


EA said...

Maybe one aspect to be pursued is whether the documentation supporting the establishment of identifier and authentication services will be open to FOI inquiries. If they are sheltered by Special Purpose Vehicle legislation, they will be closed.

B said...


Most failed ICT projects cite, as a significant reason for their failure, that the project requirements:

a) are not complete, and/or
b) are not clear, and/or
c) are not well understood, and/or
d) keep changing.

I suggest that, in the case of the PCEHR, all apply.

The report in today's Australian:

Panic to meet e-health deadline.

would tend to support this view.

You might want to include in your article an assessment of the stability and completeness of the requirements for the PCEHR. It's a useful predictor of project success - or failure.

Anonymous said...

There are now many elephants in the room impacting the E-Health reform roadmap. PCEHR, National Health Reform, Model National Work and Health Safety Act and others are all context changers with near term dates. Health ICT Strategies and multi year projects are being hit from many sides, and their ability to adapt to change will be tested. Ability to prioritise available budget, and existing budget plans based on historical context will hinder progress.

Anonymous said...

With all these $$$ being spent on Identifiers and Pussy Cat Team standards someone must have done some risk assessments on all these highly risky investments. There is patient risk as well as pride risk and its about time we all saw the risk assessment results

Dr David More MB PhD FACHI said...

As with everything else NEHTA does the TRA (Threat / Risk Assessment) does exist in draft but is secret!

The arrogance of these people is just astonishing in my view.


Anonymous said...

David, there is a much bigger elephant in the room than the PCEHR model, non-existent standards and an unworkable conformance regime; it is the lack of sustainable, long-term commercial model that supports all of the participants in the national PCEHR program (patients, providers, practices and technology providers). DOHA and NEHTA have not begun to think about this and without it, the whole shebang is likely to come to a screeching halt on 1 July. For example, NEHTA's Conformance testing requirements could add, in the worst case, more than $500k per annum to a small softare development company's operating costs. Who will pay for this? GPs? I don't think so. State Health? Nope. This is not sustainable and will put SMEs out of business.

Dr David More MB PhD FACHI said...

Good point - noted and thanks.


Anonymous said...

There is a lot happening in eHealth and your article glosses over everything except the PCEHR. I suggest you retitle it to something more focussed on the PCEHR.

Anonymous said...

Item 4 is misleading. The aim is to make the data available to the users of the PCEHR System of Systems. This can be done in a number of ways, such as implementing a compliant repository, adding it to the national repository or adding it to a 3rd party compliant repository (for instance an area health service repository).

Anonymous said...

As with everything Labor has done, the SME and the end user is of very little importance.

Their penchant for foreign consulting firms and software solutions is a national disgrace.

Like the Telecommunications industry restructure, the Australian eHealth industry has been routed.

It is this centralisation and government control ideology that is ruining small and medium sized business right across the country.

Anonymous said...

hmm. someone missed out on getting their nose in the trough

Anonymous said...

Recent events indicate that eHealth in Australia has reached a crisis situation. There is no turning back the clock. NEHTA cannot fix the problems.

No intelligent person could possibly misunderstand the implications and the seriousness of the current situation. It is abundantly clear that the Government, the department, the Minister, and NEHTA are unable and unwilling to acknowledge the severity of the
problems they are now facing.

Big vendors see this as a golden opportunity to step in, cut through the cloud of confusion and panic, and milk this fiasco for all its worth while one 'Titanic' sinks to the bottom and another is born to replace it. All the while highly skilled and competent small vendors are forced to watch on.