Tuesday, August 28, 2012

Currently Reporting On the NEHRS Is Not Painting A Good Picture. Transparency On What Is Happening Would Surely Help.

Today we have had two articles on the NEHRS / PCEHR appear.
First we have:

Canberra admits PCEHR delays

THE Gillard government has confirmed that key components of the personally controlled e-health records program missed the crucial June 30 deadline, but says the entire system has now been "implemented".
Some items have yet to be properly tested, which means complete rollout will take a few more months.
The opt-in PCEHR scheme allows consumers to enter personal information, medical history and medication details. They can choose which healthcare organisations can see and edit their record, and view a log of those who have accessed and added information to the record.
One of the biggest benefits of the system is that consumers can share their health information with healthcare professionals from a central online system.
Although the program's national infrastructure partner, Accenture, missed the deadline to provide a working solution for a slew of offerings, the Department of Health and Ageing refused to say if the company would be penalised.
The department declined to respond when asked whether the Accenture contract provided for any damages or penalties -- other than delays in payment -- for missing deadlines.
Lots more here:
Second we have:

Threat to privacy in e-Health records

PATIENTS who want to keep private a visit to a psychiatrist, the use of a mental health medicine or an abortion under the new e-Health online system will have to ensure Medicare and pharmaceutical subsidy data is not linked to the new record.
The only other way to keep the information private would be to pay the full cost of the treatment and refuse Medicare and pharmaceutical subsidies - or use a fake name, a privacy expert said yesterday.
Consumers who set up an e-Health record will be asked if they want to attach their Pharmaceutical Benefits Scheme records and Medicare general patient information such as medication and doctors provider information.
Macquarie University ethics and legal expert Julie Zetler said the "last bastion" of privacy was a health record.
But there were major concerns about how private information would be under the new Personally Controlled e-Health Record (PCEHR) rolled out on July 1.
The information will reveal past or planned abortions, or mental health consultations, and could be viewed by doctors or other health professionals such as nutritionists and complimentary health care providers.
More here:
All this mainstream media commentary on the problems with the NEHRS Program is really only going to be calmed down if we see a great deal more transparency as to what is happening with the overall program and what the ‘real’ plans and probable deliverables are.
No amount of spin from the legions of paid spinners in DoHA and NEHTA will work in my view.
I found this interesting in this context.

Departments splurge $10m on monitoring the media

FEDERAL government departments and agencies are spending more than $10.3 million a year checking what is said about them in the media.
The hefty monitoring bill from external companies would pay for more than 100 full-time staff each earning $100,000 a year.
An analysis by The Australian revealed the Department of Health and Ageing ploughs more than any other department or agency into monitoring -- with a bill of $940,000 for press clippings and transcripts in 2011-12.
Lots more here:
Right now these people are not advising their masters properly as to how to give the program a decent image and obtain / regain consumer and provider trust.


Paul Fitzgerald said...

hopefully they are monitoring this site so may have a view as to the real world reaction to their failings?

Keith said...

What's a mere $10M on monitoring the media when they spend $150M per year on spin doctors?


Winston Smith said...

Shall we attempt to put some relative perspective on this PCEHR National Infrastructure?

Let’s say we apply these approximate facts to get some sense of proportion:

Australia’s Population: 22,620,600 (World Bank – 2011)
Registered PCEHR Patients to-date: 6,830 (PulseIT Aug-21, 2012)

Patronage Percentage: 0.03% (That’s Three Hundredths of 1% for the innumerate amongst us, and there’s plenty no doubt, maybe even a concentration at both NEHTA and DOHA)

Sydney Entertainment Centre has a seating capacity of 13,250. If the Gov’t built this piece of “National Infrastructure” for the benefit of ALL the population and sized to its full capacity (built by 1983 for $42M by the way), would it have been deemed an initial success in any way shape or form if it opened on July 1st and only approx “4” (that’s Four for the innumerate) people have signed up and registered to attend an event held at the entertainment centre within two months?

Have not seen any details or data as yet for what “utility” the PCEHR has achieved to date, in the sense of a real clinician looking up a patient’s record for both theirs and their patient’s benefit. If we did, we could then see what proportion of those 4 people intending to attend the Sydney Entertainment Centre have actually turned up for an entertainment event, and maybe received better healthcare there to-boot.

At this rate, the only thing the PCEHR is competing for is the title for the greatest White Elephant of all time, which the “Millennium Dome” in London currently possesses the unofficial public opinion title for.

The Millennium Dome’s colossal flop prompted Prime Minister Tony Blair to remark, "If I had my time again, I would have listened to those who said governments shouldn’t try to run big visitor attractions."

Let’s also not forget the infamous and notorious NHS E-Health 12B(GBP) debacle was also a grand plan and wet dream of Tony Blair and his grandiose Labor Government!

I hope DOHA finds reading this BLOG entry both informative and confronting after their $10M Media Monitor services pick it up for their reference and consumption (again at Tax Payers expense).

Would it be possible to proportionally dock the wages and salaries of DOHA staff so they themselves can pay for Media Monitor services instead of outright Tax Payers funding their nefarious media surveillance activities?

Cris Kerr said...

Sorry Winston, but I think it's unfair to tar every staff member of a whole dept with the same brush.

Unlike private enterprise, govt employees are highly restricted in what they can and can't do, can and can't say, depending on their salary classification level.

There is a very heavy top down approach ingrained in all govt depts, where initiatives and risk management recommendations are perceived as either 'rocking the boat' or a threat to power positions.

Govt employees are the same as everyone else.

They are Australians who care very deeply about the quality of their work and the quality of their outcomes, but due to their restrictive work environments, have had to very quickly learn to put their heads down, keep them down, and do as they are told.

Anonymous said...

And what is disappointing in all of this is that they are destroying the local medical software companies, whilst filling the coffers of the multinationals that run slush funds and slave labor in India.

It is clear, the taxpayer gets no value, the medical software industry gets no value, and the patient gets bugger all!

Enough is enough!

Anonymous said...

Sorry Winston, but PCEHR has always had a ramp up plan that starts slowly. Your diatribe is about as useful as declaring your new baby a failure because it's not walking yet, even though pretty much everyone can tell you that it's a couple of years before a newborn baby starts walking.

You can't get to 100,000 without going through 6,000.

Anonymous said...

nice to see some at NEHTA are still drinking the Koolaid! I think Winston has a point - 6000 signed up, but how many have actually used the NEHRS in "anger"?

Anonymous said...

Dear 8/29/2012 08:10:00 AM

We are promised that by July next year there will be 250,000 registered PCEHR users from memory - a KPI set by government. (correct me if wrong)

Well done if it gets there, but anyone monitoring the current uptake rate would be hoping there is an exponential spike somewhere down the track, because the current rate is not predicting success.

Maybe the hope is that with working clinical software on the scene in a month or two, GPs will be a forcing function for enrolment? Can't see it myself, especially as there is no enrolment bounty.

Dr David More MB PhD FACHI said...

"We are promised that by July next year there will be 250,000 registered PCEHR users from memory - a KPI set by government. (correct me if wrong)"

I seem to recall 500,000. Still a heck of a lot more than now!


Bernard Robertson-Dunn said...

Be careful with unjustified criticism.

Comments on current usage of an infrastructure can easily be dismissed by those who don't want to listen. It also devalues other, more relevant, criticism.

It is probably more effective to criticise what they have done (or not done) and where they are likely to end up than where they are right now.

My issues with the PCEHR are that there has not been a full analysis and understanding of the information and the information flows in the whole eHealth environment. The issues raised in the media report yesterday support this conclusion:
http://www.news.com.au/national/threat-to-privacy-in-e-health- records/story-fndo4bst-1226459382482

And secondly, there are so many social and other stakeholder problems not yet recognised by NEHTA/DOHA, never mind resolved, that I can't see how it can succeed. Not in the time frame they expect, for the costs they predict, and with the strategy they have made public.

And I also agree with Cris Kerr who said...

Sorry Winston, but I think it's unfair to tar every staff member of a whole dept with the same brush.

IMHO, its a failure of leadership. Nobody has responded to my query about who is responsible for the delivery of the system aspects of the PCEHR.

My conclusion is that there would appear to be no technical leadership, which means it is a failure of senior management to appreciate that a major initiative such as eHealth needs more than project managers and technical specialists.

To summarise, IMHO the PCEHR is likely to not meet its desired outcomes because of what hasn't been done, rather than what has been done.

Anonymous said...

David - it was 500,000 but now that we are in a period of 'deflation' - real estate, share market, etc. surely it's legitimate to progressively deflate expectations by 25 percent a month.

So at the end of 2 months the forecast would be 281,250. At the end of 12 months the target of 15,858 would have been achieved which is probably pretty close to the mark.

Let's round it up to 20,000. But as DOHA will have NEHTA tightly corralled by then they will be able to use that as a reason why the figure isn't higher.

Anonymous said...

Interestingly, there was a spike in registrations following a page 3 article in the Sun Herald a couple of weeks ago headlined "Patients reject eHealth" :)

Anonymous said...

As anyone who has worked inside the public service knows, there are a lot of dedicated hard working people that make things happen in there, particularly in health.

All political parties want to do stuff without getting suckered by the opposition and all in all they are both as bad as each other. Both parties have been at this e-health game over the years as those of us who have been around in the industry will remember that.

The implementation problem lies in between. The slippery pole climbers that dodge and weave on and off projects and really only want to get higher up the technical power/money ladder and lower down the accountability ladder. They like to hang out with their important consulting mates in the belief that they have somewhere to go when the gig is up! Look at the evidence.

Our political leaders and their minders are more often than not frustrated by the behavior of these guys.

So IMHO it ain't the politicians and it ain't the troops!

Cris Kerr said...

Hi Bernard,

This all began with a high level panel review and a completed National Health Reform document that, after prompting, included an ehealth addendum as an afterthought. I believe the review panel included at least one private health insurance executive.

Following that and in response to signals of growth opportunities in private healthcare and subsequently private health insurance in Australia; there has been commercial movement/investment in that market.

These and other signals seem to indicate Australia wants to gear up the ratio of private healthcare (similar to the USA) perhaps because that option is perceived as the only way to gradually reduce big projections for public health costs.

There are other better options that would contribute to improving health outcomes, minimize and rein in public health costs, and also help protect the long-term sustainability of our public health system, but they haven't been given due consideration.

PS I clicked on your link and I agree... begin with the problem/s.

I would add though, that the solution needs to be underpinned by values.

Bernard Robertson-Dunn said...


re: "I would add though, that the solution needs to be underpinned by values"

I'd re-phrase that:

The value of the solution exists in the problem it solves.

or - Value comes from solving the problem. And there is a huge difference between benefit and value. A solution may have benefits, but unless the people with the problem value those benefits, the value is zero.

Of course, when you use the term "values" rather than my term "value", you may be talking about different things.

In which case, "values" are part of the environment in which the problem and solution exist.

Anonymous said...

Anonymous 8/29/2012 08:10:00 AM

It appears Winston Smith made same metaphorically valid points and observations.

Your diatribe is about as useful as declaring your new baby a failure because it's not walking yet, even though pretty much everyone can tell you that it's a couple of years before a newborn baby starts walking.

Spurious argument and even weaker to enlist "everyone" when equating the PCEHR (granted, it is someone's intellectual but intellectually bankrupt baby) with a newborn that may have intrinsic developmental and growth potential given the right nourishment and natural environment to flourish, but the PCEHR is no newborn by any stretch of the imagination.

If we choose to indulge the PCEHR newborn metaphor, then what are the expected "developmental milestones" this conceptual baby is expected to meet and over what time period so we can continually measure and assess normal and expected development?

500,000 patient registrations in 12 months is the only metric I've seen published by DOHA and NEHTA. Which is only an "activity" metric with no relevance or relation to utility or value. "How many records have been referenced in the context of clinical care" would be a more "meaningful" measure.

Given this, then if there's a linear adoption rate we should be seeing 83K registered patients by the 2-month mark to meet the published target, not 6.8K.

Please don't anyone insult anyone's intelligence by arguing the expectation is for an exponential adoption growth rate for registrations as it is highly unlikely and already not the measured expected case.

So my question to the PCEHR supporters and evangelists, is what, when and how will success be measured, and not using newborn and/or infant milestones but more appropriate National Infrastructure "utility" measures, as-in "value" milestones?

Then we can draw a line in the sand to demonstrate and agree whether this PCEHR Baby had a low apgar score, was stillborn or will be severely handicapped with arrested infant development for the rest of its foreseeable Tax Payer funded and subsidised existence?

Or on the other hand, a rollicking bouncing baby with a bright future ahead of it with the sky as the limit for its potential?

Time will only tell, but the early signs are not too promising and I hope no laws need to be changed or will be broken when this PCEHR baby is inevitably euthanized like its Health Connect elder sibling.

Anonymous said...

A soothing lullaby for the PCEHR

When the dough breaks, the cradle will fall
And down will come baby, cradle and all…

Cris Kerr said...

Agreed, Bernard... 'values' should be part of the environment in which the problem and solution co-exist... to guide solution development and to protect against the risk of implementing a 'claytons solution' that instead of solving the problem, contributes to it.

Dear Anonymous (8/29/2012 08:10:00 AM), Growth in sign-ups may be assisted by the recent renewed focus on Aged Care.