The following appeared today - Australia Day no less!.
Long road ahead for e-health records
- by: Karen Dearne
- From: Australian IT
- January 26, 2012
The Health department spent $142 million on e-health activities in the last financial year – around one-third of a total $424m spent on health IT projects over the past 10 years.
Spending more than doubled during 2010-11, up from $60m a year earlier, reflecting a ramping up of work on the Gillard government’s $500m personally controlled e-health record program to meet its July 1 launch.
But documents released today show that while individuals may be able to register for a PCEHR from that date, national usage of the system is not planned in the foreseeable future.
“The first release of the PCEHR system (will) deliver the core functionality required to establish a PCEHR system that can grow over time,” the Health department says.
“Once the design of the national system has been completed, an assessment of the 12 e-health (lead implementation) sites will be undertaken and a transition plan developed for integration to the national PCEHR system.
“This will allow early adoption for individuals participating in the (lead) sites from July 2012, including the capability to target about 500,000 people enrolled in those sites.”
Work on interfacing with GP desktop systems has stopped at most trial sites after the National e-Health Transition Authority discovered software vendors had been given specifications that are incompatible with those used for the national infrastructure build; NEHTA is yet to provide further information about the problems
According to the department, 23 new technical specifications were required to support the PCEHR system, with only four complete and fully tested.
“The remainder will be completed and tested by the end of December 2011,” it says in documents published yesterday.
Lots more details here:
All this does is confirm what most observers have known for ages!
All the answers to many, many questions are here:
Here is the response from DoHA to a Senate Estimates Question to confirm (with a few slippery words) the OZ headline.
Senate Community Affairs Committee
ANSWERS TO ESTIMATES QUESTIONS ON NOTICE
HEALTH AND AGEING PORTFOLIO
Supplementary Budget Estimates 2011-2012, 19 October 2011
Question: E11-490
OUTCOME 10: Health System Capacity and Quality
Topic: EHEALTH – PERSONALLY CONTROLLED ELECTRONIC HEALTH RECORD
MILESTONES
Written Question on Notice
Senator Boyce asked:
What will have been achieved by 30 June 2012 with regards to eHealth and the PCEHR in Australia?
Answer:
The first release of the personally controlled electronic health record (PCEHR) system delivers the core functionality required to establish a PCEHR system that can grow over time. The first release will ensure that all individuals seeking care in the Australian healthcare system will have the option to register for a PCEHR from July 2012.
Once the design of the national system has been completed, an assessment of the 12 eHealth sites will be undertaken and a transition plan developed for integration to the national PCEHR system. This will allow early adoption of the PCEHR system for individuals participating in the eHealth sites from July 2012, including the capability to target approximately 500,000 individuals enrolled in those sites.
The Department has also engaged a National Change and Adoption Partner (NCAP) to develop a national change and adoption strategy and delivery plan; to undertake a range of engagement and communications activities across the health sector to encourage uptake of the system by health professionals and consumers. The NCAP is working in collaboration with health care professionals, software vendors, National E-Health Transition Authority and the Department to successfully deliver the PCEHR Program, including training materials and guidelines.
----- End Answer.
The population of Australia is 22, 813,571 at present according to the ABS. So only about 2.2% will, if they are lucky see anything other than a registration screen by July, 2012.
The second part of this report quoted above is found in this answer:
Senate Community Affairs Committee
ANSWERS TO ESTIMATES QUESTIONS ON NOTICE
HEALTH AND AGEING PORTFOLIO
Supplementary Budget Estimates 2011-2012, 19 October 2011
Question: E11-474
OUTCOME 10: Health System Capacity and Quality
Topic: EHEALTH – AMA AND LACK OF SUPPORT
Written Questions on Notice
Senator Boyce asked:
a) The AMA has made it very clear they cannot support the proposed system as it does not, in their view, improve on what we have now and that, as presently designed, could create serious risks to patient health. Surely this must be of great concern to NEHTA when a body such as the AMA believes this to be the case, so how does NEHTA respond to such concerns?
b) How can NEHTA possible answers such concerns when so many of the key technical standards of the PCEHR have not been completed or adequately tested?
Answer:
a) The Department of Health and Ageing and the National E-Health Transition Authority (NEHTA) have ongoing consultation with Australian Medical Association to ensure that the feedback of their members is taken into account in the development of the personally controlled electronic health records (PCEHR) system.
b) To support the PCEHR system 23 technical standards are required. Four are complete and have been fully tested, the remainder will be completed and tested by the end of December 2011. Review processes for the standards include ‘tiger teams’ which bring together clinicians, software developers, standards representatives and informaticians to review and improve the specifications.
Each stage of the development process for the PCEHR technical specifications require clinical governance and safety processes to be followed. NEHTA’s Clinical Safety Unit (CSU) is fully embedded into all areas of NEHTA's product development and oversees clinical governance at NEHTA. The CSU is supplemented through NEHTA’s Clinical Leads.
The CSU addresses safety by working across the work programs in NEHTA to provide certainty to medical software developers, end-users and policy makers. It is a legitimate expectation of Vendors that products developed by NEHTA are safe and have Clinical Utility.
Any clinical safety findings as a result of reviews of specifications and standards are included in the overall review outcomes and mitigations are recommended for inclusion as part of any proposed drafting changes in the specifications, or in the form of implementation guidance to mitigate the risks.
----- End Answer.
Every one now knows this is just untrue. The Tiger Teams have by no means finished the work and testing has meant that many Wave sites have been discovered to be in need of a pause for a month or two while someone works out what Standards and made up Specifications are to be used.
By their own words the entire thing is just a total shambles that will deliver less than 3% at best of what was trumpeted only 18 months ago.
See the Australian article for an amazing breakdown of what has been spent on e-Health, since 2011, by the Commonwealth.
In passing has anyone else heard of job losses in the much touted but very quiet Clinical Safety Unit recently?
David.
The current state of the eHealth system in general is one that is expected from a decade long development with no real KPIs or SLAs in place. As is typical of a lot if similar projects, this is a Camel (a mouse engineered by a committee). With large amounts of money at stake, almost a $billion so far, and at least half that promised again, there will be VERY little internal pressure to fess up and declare "it's a mess". I am glad I stumbled upon this blog, having an interest in eHealth whilst holding something of a cynical attitude as to whether any government can actually supply a working result. I am also glad to see the discussion(s) here are back on planet. I try and try to explain that the current lofty goal for eHealth is to select a workable data interchange format and methods of checking the reliability of the data. I mention it here
ReplyDeleteehealth.addinall.org
under business intelligence and ontologies. For many years I have felt that XML, which is the data encapsulated transport for HL7v3 started out as a good idea, then became big fat and complex. From the IT point of view, XML, CORBA, SOAP and large footprint, high complexity applications are almost dead. And good riddance. You can tell with a glance the projects hanging onto these types of architectures.
If we have spent so much money with little or no outcome, then it is time we throw what we have, sit down, and ACTUALLY specify what we want to achieve, both from a patients POV, needs and wants of the clinician and constraints, boundaries and opportunities presented by modern information technology.
I would argue that HL7v3 be halted in time and we design (using the solid parts of v3) HL7v4 based on a JSON data model. JSON ( JavaScript Object Notation) is a lightweight data-interchange format. It is easy for humans to read and write. It is easy for machines to parse and generate. It is based on a subset of the JavaScript Programming Language, Standard ECMA-262 3rd Edition - December 1999. JSON is a text format that is completely language independent but uses conventions that are familiar to programmers of the C-family of languages, including C, C++, C#, Java, JavaScript, Perl, Python, PL/SQL and many others. These properties make JSON an ideal data-interchange language. And the point made here, that the clinician is hidden away from what is in the spaghetti that is HL7 XML, can be resolved by using a simpler architecture. I rather doubt this will happen, given the contracts already in place, the money spent, and the ego involved, but it SHOULD happen.
I'll follow this blog with some interest.
Mark Addinall.
Mark, your suggestions are FAR too sensible....it'll never work, more's the pity!
ReplyDeletecheers,
Paul.
Thanks Paul :-)
ReplyDeleteShame eh?
Cheers,
Mark.
Mark,
ReplyDeleteThe serialisation format of the data is mostly not important. That is, whether it is XML or JSON. It is the data itself that is important.
That health data is complex is underlying problem. The experts are still having problems trying to come up with a basis for representing the data.
Reducing the problems to XML vs JSON is not helpful.