Sunday, October 21, 2012

A Colleague Provides An Unsolicited Clinician’s Impression on The NEHRS. Not Really Thrilled!

A physician mate (Terry Hannan) was approached by a more senior colleague after having had a try of the NEHRS. Here is what the colleague wrote (quoted with permission of both).

“Greetings Terry,

I thought that I would write to you out of interest, knowing that you are interested in this sort of thing, now that I have established an eHealth record, having got a bit confused about it all and to detail my experiences.

I had always rather thought that it was a good idea and my application was following the receipt of a pamphlet put out by the Government "The health record that works for you".

Being a more or less retired 71 year old physician, I thought it would be good to get my data into it. Although I need no eHealth record as things stand as I can account very well for all my health facts to any doctor while travelling, but noting that in due course old age our infirmity will get one in the end, like the colo-rectal surgeon, I should set it up and I could provide a better than average medical record for the system.

Now my troubles began. In spite of having better than average computer skills, and much better than average for a 71 year old, I could not get any really meaningful data into this record.

The setting up was cumbersome, having to set up an Australian Government number and then linking it to other accounts, in my case the Centrelink account, finding that I now have two separate Australian Government Numbers to add to the confusion, but in due course, after becoming duly passworded against that number, I had to go through the security set up, cumbersome, but perhaps necessary. It was a bit tricky to set up and use, and in using it, I found that it was not case sensitive, but absolutely strict as to what one put in as an answer. For instance if one put in the name of the street in which line was raised, one had to get the whole lot correct, and in retrospect I wish I had used simpler criteria. For instance, If one put in Bluegum Street, one could not satisfy the security by just typing in "bluegum".

But the real problem came in trying to input data.

I could get in my medications and allergies and next of kin and contact details without any great stress, but when it came to the important stuff, like putting in my medical history, I could find absolutely no way of doing it. There was no editing function so the whole things remains a waste of time for me as things stand. I could get no other medical data from any of those doctors whom I have seen, presumably because they are not on the system, but i will find out.

I could access and add data to my "personal notes", but that is mort really any use as I know all that stuff and health professionals cannot access it anyhow. The more important shared details zone would not let me into it to add details.

Quite separately, it gives a list of PBS Pharmaceutical supply dates, but one can get no details as to what was supplied, which is a pity.

On checking access to Medicare benefits services, one can get detail of who provide the basic service by going into a complicated sub-menu, but the initial presentation on the list mentions only dates, not the service supplier, which means it very difficult and time consuming to actually discover who did what when. This surely could be easily redesigned as the data is all there.

Anyhow, to date is it is all a waste of time and effort for me until the situation is jigged up.

Can you tell the powers that be that a 71year old physician wants to be a serious user but cannot be.

Best wishes,



I think this really says it all. The system as it presently exists is really not suitable for even a computer literate clinician who is in a target demographic (The over 60’s).

Pretty sad and yet another reflection of the way all this was designed and rushed without real consumer or clinician input.

What is described here is the ‘lived experience’ (as the Government likes to call it) of all who have tried the system. It is tedious, clunky and simply not fit for purpose - whatever that was - at present.

You really wonder how long it will take for reality to dawn. Somehow I suspect the description of one wag might come true. “NEHRS: Never Ending Health Record Scandal”.

Right now there does not seem to be any understanding of a need for change.



Anonymous said...

Yet another independent person states that:

"when it came to the important stuff, like putting in my medical history, I could find absolutely no way of doing it"

This is a classic use-case scenario, which of course they have obviously not walked through before tossing out this half baked system on an unsuspecting public.

By simply going through a set of scenarios like this with real end users you can provide really useable systems. Unfortunately the evidence here shows that they have not done this. Methinks they have taken something that they were using elsewhere and dropped it on an unsuspecting public.

This generic rubbish just isn't going to fly! No matter how much money you throw at the GPs. We need some real software developers in there, not incapables like these guys. Who recommended this thing and on what basis?

A million dollars a day Andrew? Really?

Anonymous said...

Why change when they already know what the outcome will be? Want to know the future of the NEHRS? It will predictably end up in the same dust bin and refuse site that the remnants of Health Connect are festering in, and the next go around will see even more budget and more bureaucrats thrown at the same problem and wasted in an even greater manner than historically achieved, because they've learnt so many valuable lessons from the previous failed attempts that they're certain of success and getting it right the next go around!

Trust us Health Minister with no contextual "clue" and no memory of past failures, nor accountable for any historical tax payer funded and bureaucratically administered "rorts"!

You're in safe, reliable, self-serving hands.

We need another Bastille Day for Bureaucrats.

Anonymous said...

I'll bake the cake for the Bastille day event!

Anonymous said...

Specifications marked final and then withdrawn due to technical flaws! NASH now looking like it has gone back to the drawing board, (how many new and existing jobs and projects will be sacrificed to fix it?) a standards plan and tiger team approach that reads like the mis-managed disaster it is. The PCEHR architecture and build not exactly delivering the solution being sort.. The list goes on, just who is running the architure and engineering groups? They obviouslly cannot have the backing or respect of the senior team and are unable to project their will across the small work plan to ensure architure assurance and quality, either way the diligence being applied is less than acceptable. I am sure whoever it is was a good engineer in their day but it would appear there is a real lack of strong technical leadership and the ability to foster teams and the checks and balances needed by the Minister, folks in DOHA and the Jurisdictions, the CEO and others charges with delivering these promises. This is clearly small teams doing what seems right but lack the oversight to bring it all together resulting in poor requirements management and fragmented technical outcomes. I leave out the clinical drivers as I do not believe they have any

Anonymous said...

I understand knitting needles are also required - I will bring them!

Anonymous said...

From today's mini-budget:

"The Government will cease funding for the Telehealth Support Initiative .. this measure will generate savings of $183.9 million over five years, which will be reinvested in the related expense measure titled National e‑Health Program‑continuation."

Great. So we stop funding the thing that has evidence behind it and keep funding the thing that has no evidence behind it.

I love this bit about the PCEHR ..

"The Government will provide $233.7 million over three years to implement the National e‑Health Program.

This funding will ensure that from 1 July 2012, Australians will have the option of registering for a Personally Controlled Electronic Health Record (PCEHR) to support more informed clinical assessments and decision‑making, improve continuity of care and introduce efficiencies in health care service delivery. Patients who choose to participate will be able to securely access, and permit their health care providers to access, their health information."

Something happens between the first few and the final sentences ... how does one get from these goals via this means?

Bernard Robertson-Dunn said...

Anon quoted:

"Patients who choose to participate will be able to securely access, and permit their health care providers to access, their health information."

But what patients will not be able to do is control who can and who has seen their health information.

From the Senate Estimate transcripts it would appear that the audit trail is being made "more user friendly".

They (The senators and DoHA) just don't get it. The PCEHR controls access at the institution level, not the user level. And even if there was control at the user level, the system cannot control who sees the information.

System access control is an IT problem and what has been implemented is a poor IT solution. Controlling who sees a patients record is a health information problem and is very difficult, if not impossible, to solve, especially in emergency departments, teaching hospitals and where specialists ask each other for second opinions.

The Senators should be asking a lot of questions about the audit trail. Not is it "user friendly", but what will it tell patients about who has seen their health information. Will it tell them the individual who has accessed the record? Will it tell them who was in the room when the record was on the screen?

The purpose of the PCEHR is to facilitate easy access to health information but this easy access is a two edged sword. That's just one reason why it's a Wicked Problem.

All the evidence points to a lack of understanding of the eHealth problem. If you don't understand the problem it is extremely unlikely you will solve it.