Thursday, February 02, 2012

There Was A Webinar On The Specification Problems With the PCEHR Today. Some Interesting Things Emerged.

The webinar ran between 8:30 and about 9:30. If things follow the usual pattern there will be audio and slides available from this link in due course.
I will let people listen for themselves if they want to understand all the details.
At a high level I came away with the following impressions from the reports I have heard.
1. The key issue is around 5 CDA Implementation Guides for such clinical documents as clinical letters, referrals and so on which are faulty and need to be revised and made ‘error free’.
2. There are some major issues between NEHTA and DoHA which are causing all sorts of problems and it is felt that unless things are got back on track fast there is an existential threat to the whole program.
3. Those who were building to the (old) specifications are pretty grumpy.
4. Astonishingly the CDA specifications were not tested via a ‘CDA Validation Program’ to ensure it was correct. Pretty basic stuff. The suggestion was made was that this was all due to the haste to meet various political deadlines
5. The documentation that shows what has been done to attest to the clinical safety of the specification releases is just not available. It has been developed but no one can know what is says. Struth!
6. There is a lot of unhappiness about the way the press knew what was going on with the problems before those actually involved in the program. NEHTA's media management really messed this up it would seem!
I leave it to readers to assess the chances of anything good coming from this program anytime soon!


Anonymous said...

A clarification is required: the latest versions of the CDA implementation guides in question have been removed from to have minor errors fixed, and to have all the derived "implementation collateral" brought up to date (schemas, generated code, CCA tests, etc).

The earlier versions of the same CDA IGs are still available at, and it is the projects based on this that have been paused. The key issue is that there were multiple released versions of the specifications, not interoperable with each other.

Anonymous said...

3. Those who were building to the (old) specifications are pretty grumpy.

They may be grumpy, that is understandable. We have to assume however they were being paid for all of their time and effort and therefore in no way financially disadvantaged simply because their client was at fault.

We all encounter stupid clients from time to time and it is annoying and frustrating - the key to survival is to ensure all the costs of the stupidity are borne by the client.

Anonymous said...

Unfortunately the Feb 1 7:01PM analysis is a bit simplistic. Getting remunerated at a below market rate for your time to work on development that your customers -- from who you extract profit (ie revenue that amounts to more than your time is worth) -- are not asking for leaves you very much out of pocket and distracted from core business.

Also there is a massive power imbalance in the negotiation between government and the small businesses that are the Australian eHealth can't just fire this particular client as they have PIP trump cards up their sleeve and appear quite willing to trash private enterprise in the pursuit of their uninformed view of what Australia needs. The fact that they pinch pennies when paying the really important players in ehealth yet throw many times more money over their shoulders to impotent divisions, fund toxic ex-NEHTA and ex-Division staffers to startup in competition to the existing market participants just makes the whole process more unpalatable.

Anonymous said...

All this is exactly why you do not throw $467M at standards that don't exist, so cannot be possibly proven as they are yet to be born via a "Tiger Team"

These people are obviously not spending their own hard earned money and have no experience whatsoever in the domain they are supposedly managing.

This should be a national scandal, it is a disgrace. In the process they are smothering people and organisations that have actually been delivering solid results on a shoestring budget. The Nehta Hollow men know they had the money and have been very smug and arrogant, and the pitchforks are being sharpened... There will be little sympathy for them in the eHealth community.

Anonymous said...

If incompatibility between versions of the CDA standard presents a risk at this stage, what plans and procedures are in place to ensure safe backwards compatibility when (not if) the standard is next updated?

Oee would hope that those plans and procedures have been tested...

Anonymous said...

Us developers are grumpy not just because the specs have changed. It is also because we will again being squeezed on our time frames. We are expected to deliver something yesterday on which we have not even a stable spec until the day after tomorrow, if it is delivered on time.

Anonymous said...

I cant understand why the implementations area in NEHTA allowed specifications to be released into vendor hands without co-existence testing, they are supposed to know the market configuration surely? Or is that PCeHR and DOHA's role - confused.