Friday, December 23, 2011

This Really Is An Article That Is Too Important To Ignore. The PCEHR Program As Presently Conceived Is Clearly In Its Death Throes.

The following article appeared today.

Patient safety a mystery at Health

  • by: Karen Dearne
  • From: Australian IT
  • December 23, 2011 6:00AM
THE federal Health department is in the dark about patient safety implications in its introduction of the personally controlled e-health record program.
The department is responsible for the rollout of the Gillard government's half-billion-dollar system, and is now in a rush to have it operational by July 1.
Sharon McCarter, head of the eHealth Systems and Implementation branch, has told The Australian the department does not have any patient safety risk assessments in relation to the huge IT and change management project.
The Australian recently lodged a Freedom of Information request for "any document of any name performing the function of examining risks to patient safety and/or examining the risks from the perspectives of patients".
Clinical risk assessments should contain detailed analysis of all potential software error scenarios, provide a guide to identifying and reporting flaws and address mitigation procedures.
But the FOI request has been declined by Ms McCarter "as the documents do not exist".
"We have undertaken reasonable steps to identify any documents relevant to your request held in the department, including a thorough search of the department's electronic and paper records and the department's contracts listed on AusTender,” she wrote in the rejection letter.
"The department has been unable to identify any document we hold at this time (that is) relevant."
Instead, Ms McCarter said, Nehta was responsible for ensuring patient safety.
"As part of Nehta's role to develop, maintain and assure the PCEHR solution architecture and high-level design of the system, Nehta conducts ongoing clinical safety assessments," she said.
Nehta has previously insisted that its two-year-old clinical safety unit is "fully embedded" into all areas of software product development, despite not having produced any formal reports on IT systems and patient safety.
The authority is exempt from Freedom of Information laws, despite taxpayers funding it through both state and federal taxes.
But Australia’s Information Commissioner, John McMillan, has said that any Nehta documents held by the commonwealth in its capacity as shareholder would be subject to FOI requests.
“Any document in the possession of a government agency or minister, no matter where it came from, that document is subject to the FOI Act,” Professor McMillan told a Senate estimates hearing earlier this year.
Health department secretary Jane Halton is a director of Nehta, and the federal government provides half of its funding.
Liberal Senator Sue Boyce this year called for an overhaul of Nehta's structure, citing its lack of public accountability, and for a pause in the PCEHR rollout.
"The board of Nehta is currently all the secretaries of the jurisdictional Health departments. An independent chair, David Gonski, has been appointed as a nod towards the lack of commercial experience amongst the other directors,” she said.
"I would prefer to see a board similar in structure to the Australian Institute of Health and Welfare, with a mix of stakeholder and government appointees.
"The answer to getting an e-health system ready to 'burst out the front door' will not be easy but it starts with accountability and transparency," Senator Boyce said.
Health would not confirm whether any staff members had seen any patient safety documentation, nor whether there were any concerns about potential adverse events.
A department spokeswoman said the PCEHR system "is being built on the basis that integration to the system will be governed by a range of defined specifications and standards".
But The Australian understands the fast-track "tiger teams" process is in disarray, following delays in finding volunteers and the late release of thousands of pages of both old and new documentation still to be pulled into shape as useable specifications. 
Key specifications were due for completion by November 30, as they are needed by the Accenture consortium for its build of the core PCEHR infrastructure, and by the lead implementation sites.
Reliance on a large number of entirely new and untested specifications will inevitably heighten clinical risk factors.
The Australian asked the department whether its lack of information on safety issues represented inadequate oversight, a poor understanding of the risks and unacceptable project management practice.
The Health spokeswoman replied: "Clinical safety is one of a number of important elements to ensure that the system will be safe to use when it is implemented.
"Nehta has embedded clinical safety assessment throughout their design process and holds the relevant documentation to support those assessments."
However, Nehta has not made that documentation available to software vendors and has previously refused to provide any such information to The Australian.
Lots more here:
I alerted readers to the issue being recognised in the US a month or so ago - see here:
In this article I pointed out there was serious concern in the US about this issue and the impact on their national Health IT Program - and that the issue had been highlighted by the prestigious Institute of Medicine.
The purpose of e-Health is to improve patient safety and to improve the quality of care. Essentially what we are told here is that DoHA and NEHTA simply do not know if their planned systems will actually provide that outcome!
This really is mismanagement, stupidity or worse on a really grand national scale. Just why there is no documentation of the processes and efforts NEHTA / DoHA have employed to address system and patient safety issues available really beggars belief. Maybe we, as patients, are not entitled to know so we won’t worry or some such. Talk about treating the public like mushrooms!
This sort of issue really has to cause a major rethink of the quality of management involved with all this! I really think such material must be seen as signalling systemic problems that must be addressed and fast!
Back off to a Christmas break now!


Anonymous said...

the only way to ensure patient safety is not to use it

Anonymous said...

NEHTA bells, NEHTA bells, NEHTA all the way,
Oh what fun it is to ride in NEHTA’s empty sleigh,
Do they know the way,
Have they got it right,
What is it that we have seen that makes us run in fright.
Oh, jingle bells, jingle bells,
Jingle all the way,
Christmas has at last arrived,
Wrapped up in disarray,
NEHTA you have done it,
This we all do know,
You have made a mess of things,
So it’s time for you to go.

Anonymous said...

Perhaps after Christmas when Santa's little elves have regained their strength and are all rested they might get out their hammers and chisels and snow glue and make a new home for NEHTA in farfarfarawayland.

Anonymous said...

Farfarfarawayland – and with NEHTA tightly ensconced inside perhaps the big farawayland bearess could stand outside huffing, puffing and bluffing with all the hot air she can muster until all the snowglue melts and the house falls down.

David, here’s one coming for you Christmas Cracker Bob Bon ……..

What would NEHTA say?

Hold on. ….. or ………

Anonymous said...

... or ... holton.

Anonymous said...

Dear Lord,

please forgive them for they know not what they do.

Please reincarnate them somewhere else, far, far away.

Anonymous said...

This PCEHR really must be stopped, I for one would like to see the various solution managers (as they are called) Project schedules, I would have a guess the reason Security, Privacy and Clinical Safety are being overlook is that they have not been considered and as such the timelines being worked towards and the activities being undertaken are being done so without these critical steps.
For this the Portfolio Manager must been relinquished of their role and the Solution managers retired to a lesser role under the leadership of trained professional programme and project managers as there is clearly none involved currently
The Head of PCEHR should be shown the door as he has clearly demonstrated that he does not understand this space and relies solely on reading tea leaves and his own self belief that he is some sort of player
There are also clear indications that there has been no orderly implementation of a programme as laid out by Australian National Audit Office for Government Policy Implementation or basic OGC guidelines for portfolio programme and project management. The programme instead lives on pushing promises out to allow for a fingers crossed wishful thinking approach. Looking at the vendor site none of these specifications have been released with any apparent relationship or reason.
The Specification releases and the Standards plan I believe are the dreamed up rubbish of the Head of Architecture (stated in the documents), this is far from a plan and would appear that it has either been badly implemented or worse.
Again the Head of Architecture should be removed as the person in this role is obviously out of their depth and actually causing more harm than good, Architecture should be ensure good practice from the outset and continue working with the planners and managers throughout the projects until the outcomes are delivered.
A Security Framework has been released, however this is not a PCEHR specific framework, and so one must wonder if this was released because it appears to be a well thought through initial piece of work (which I hope to see built on rapidly) rather than being of any implementable assistance to the vendors. I note a Security Policy is due to be released on December 31st (Can't they even plan release dates properly??), However this is an outcome that needs supporting documentation, processes and management in place and I have yet to see any Security Requirements, Governance Framework, Security Management Plan (not necessarily released due to the sensitive nature but at least announced).
Ultimately the CEO will need to be removed by the board as this non-sense should never have been allowed to go on for so long, it does not take a genius to see that the PCEHR programme is disconnected from reality and itself. Good Management would stop the programme, audit it and release an achievable set of outcomes over a realistic timeline which includes clinical safety, security, controlled implementations and testing and contracts that hold the suppliers accountable.
This cannot be the case however, no one could make a mess of what on the world stage is a rather straight forward programme, it does not even include the wave sites, which is another concern for another day