Wednesday, February 08, 2012

What Questions Does The Senate PCEHR Enquiry Need To Form A View On To Work Out What Comes Next?

Following on from the Public Hearing on Monday I was left considering questions (and the answers to them) that the Senate Committee needs to be clear on before finalising a concluded report on the planned legislation and the other matters being considered.
Before discussing a possible list of questions I have to say that I fear there are two major barriers to the Committee being able to really provide a useful report.
The first is that the Committee (apparently) lacks expert and independent technical / health advisor (or advisors) that it can work with to really test the veracity and implications of what it has been told. There are a range of quite complex issues that are needing to be assessed before the Committee can really reach a view as to what should happen next.
While not wishing to in any way understate the skills of the Committee’s Secretariat many of the issues to be addressed are pretty technical and requiring very specific expertise to address. It is also not clear just how much investigation to locate relevant facts is possible.
Indeed the committee may also need significant input regarding just what is possible and just how any alternative plan should be formulated.
The second is that the report is presently due in just 21 days. This seems like a very short time to be able to review the written and oral evidence - seek advice and clarification where necessary - and then come up with a useful report which will provide a sensible and practical way forward.
Just how difficult the task facing Committee is can be gauged when one considers the following issues / questions that the Committee needs to form a view on, and then provide recommendations.  

Part 1. The PCEHR Bills.

1. Has the right balance between legislation and regulations been achieved?
2. Is the legislated Governance Framework appropriate? What is the appropriate leadership framework for e-Health in Australia?
3. Will the legislation optimise the chances of use of the PCEHR System by the public by facilitating trust, privacy and security?
4. Does the present legislation impose unreasonable obligations on health care providers or consumers in areas like user authentication and user support?

Part 2. The PCEHR Program.

1. What evidence is there that the PCEHR system, as planned, will deliver the expected clinical outcomes?
2. On what attributes of the planned PCEHR system is the business case based that there can be confidence will be delivered?
3. When will the full planned functionality of the PCEHR be available to users?
4. How long is it expected to take for the PCEHR System to reach technical completion?
5. How long is it anticipated to take before 10%, 20%, 50% and 75% of the population have enrolled in the PCEHR Program?
6. Do there need to be Clinician / Provider payments for the present workload planned to be added with the PCEHR?
 7. Is the present design and architecture proposed for the PCEHR the optimum for Australian e-Health?
8. What impacts, positive or negative, is the PCEHR Program having on other e-health plans and initiatives in Australia.
9. Does Australia need a conceptually centralised electronic health records system?
10. How is adequate education and information going to be provided to PCEHR System users?
11. That the proposed PCEHR System and associated infrastructure demonstrably safe from the perspective of the consumer and clinician and will the proposal increase overall patient safety?

Part 3. The Future of NEHTA.

1. What impact(s) for good or evil has NEHTA had on the Australian medical software industry?
2. What are the root causes of the levels of dis-satisfaction aired with NEHTA and how can they be addressed?
3. How can NEHTA be re-cast and / or reframed to provide what Australian e-Health needs while avoiding the problems faced to date? What alternatives might there be to NEHTA?
4. Does NEHTA have enough ‘real’ clinical input to its work programs?
5. Is the public and government receiving ‘value-for-money’ for the funds being invested in NEHTA’s activities?
6. When will the critical dependencies for the PCEHR System (NASH and the like) actually be delivered?
Overall the Committee is faced, I believe, with an almost impossible task. To me there are simply too many unknowns in the answers to the important questions I have suggested above - as well as those I have not thought of - to be able to sensibly recommend a way forward that will be acceptable to the stakeholders.
My feeling is that the outcome really has to be a recommendation for a ‘pause’ and a strategic evidence based enquiry (involving the Auditor General) at much greater depth to formulate the way forward. What is presently underway is really not equipped or able to reach the quality and in-depth outcome that is needed in my humble opinion!
Put at its simplest the problem for the Committee is to determine what is needed to get the forward direction for Australian e-health to be widely agreed among stakeholders so that there can be consensus as to what be done to recover the presently rather fractured situation. This will need to wisdom of more than one Solomon I fear! Only with a consensus forward direction is it likely any useful outcomes will be achieved.


B said...


IMHO, it all comes down to one question:

Is there certainty, agreement and stability regarding what e-Health is and how it is to be delivered?

I suggest that the submissions demonstrate that the answer is: No.

In which case, spending money on implementing any sort of system is almost certainly a bad thing.

I'd also make the observation that getting out of a problem situation takes a higher skill level than getting into it. To put it another way, those who got into this mess are not the ones who can get out.

G said...

Politically, I don't believe the Government can afford to be seen to back-peddle on this given their current situation . Another about face on another big issue could spell the end for them. Instead, I think they will march onwards directly over the dirty great cliff visible to everyone ( except the cordial drinkers in NEHTA).

Anonymous said...

I think there have been some very good reader contributions on this post recently. I read this blog regularly. I agree with many things written – but sometimes feel the occasional personalisation and shrillness distracts from the value and authority of this blog, the blogger and its contents. But most recently I have found entries insightful and valuable, largely confirming my suspicions regarding PCEHR and ehealth generally. The influence of this site and those that read it will only increase if this continues. Hence I would encourage an articulate shared insight of those involved in this industry as an important and powerful force going forward. If this can be facilitated by the blogger and a wider community that can act in such a way – that is a good and significant thing.

Anonymous said...

THank you for your blog but I think you have missed the elephant in the room on this one. The rule is "first do no harm" and it seemed that some of the submissions were flagging serious concerns about patient safety (through potential mis- identification, scope, haste, failure to communicate lessons learned,)yet you do not mention this. Surely this is the number one issue? Patient safety must come first?

Dr David More MB PhD FACHI said...

Agreed, there are just too many points and as you know I have been harping on that point for ages. Will add a point.