Tuesday, March 12, 2013

We Look To Be Seeing Very Little Progress In E-Health Standards In Australia. Why Is That I Wonder?

I hoped onto the Standards Australia e-Health web site a few days ago. I was curious to see what had become of all those Tiger Team standards that were to be delivered to urgently. We started to hear about Tiger Teams in 2011 and they were apparently really rolling later that year.
See here:

Sunday, November 27, 2011

The Tiger Teams Are Off And Rolling. To Where Is Really Unclear!

On the 17th November, 2011 there was a daylong meeting of the Tiger Team which is working to specify what is to be the Consolidated View of the PCEHR.
As it happens a kind soul has made available some of the documents that were used / came from this meeting.
First to provide some context.
It is intended that the PCEHR will be accessed via an Orion Systems Home Page for that particular patient.
There will be a space for the usual controls and for a document list at the left of the screen - some patient ID across the top of the screen and the Consolidated View (CV), which will include access to the Shared Health Summary and then a range of Event Summaries (Discharge Summaries, Test Results etc) will be at the right.
From this point on it would seem the design - which is due to be frozen come November, 30 - would still seem to be rather fluid with a large range of design decisions yet to actually be taken.
The focus of the meeting was on presentation of the clinical information in the screen real estate available - there apparently being confidence the data issues around the contents of all the information were already resolved. Time will tell if this is true.
Buckets more here:
(I note in passing what we have from Orion looks nothing like the mock-up that is shown in the picture associated with that blog!)
Moving on to recent standards publications which can be viewed here:
For 2013 we seem to have this:
ATS 90006.1-2013                             Core discharge summary – Structured document template
For 2012 we have:
HB 262 (Rev)-2012                            Guidelines for messaging between diagnostics providers and health service providers
AS 21667-2012                                 Health Indicators Conceptual Framework
AS 2828.1-2012 NEW                        Health records - Part 1: Paper-based health records                 
AS 2828.2(Int)-2012 NEW                 Health records - Part 2: Digitized (scanned) health record system requirements     
MP 120-2012 NEW                           Telehealth: Remote Patient Monitoring - Discussion Paper            
MP 54-2012 NEW                             Survey of standards environment for telehealth devices
AS 4700.2-2012                                Implementation of Health Level Seven (HL7) Version 2.4 - Pathology and diagnostic imaging (diagnostics)
For 2011 we have all these:
HB 308 2011                                     Location of digital signatures in HL7 V2 Messages
AS ISO 27799-2011                           Information security management in health using ISO/IEC 27002   
ATS ISO 25237-2011                          Pseudonymization                                                                  
Essentially we have seen zilch I can detect from the much ballyhooed Tiger Teams that would actually seem to relate directly to the NEHRS and its associated functions etc…
Conceptual frameworks and guidelines seem to feature but not much that clearly seems relevant.
Another miss I would suggest. The NEHRS is hardly documented at the Standards level that I can see.
Could it just be that NEHTA and DoHA are utterly clueless when it comes to working with people who are competent and have some ideas other than those coming from the centre?


Anonymous said...

There are some issues around the Consolidated View of the PCEHR. From the concept of operations it is supposed to be derived from the data in other clinical documents submitted, and to include key data such as current medications and allergies. The 'author' responsible for the consolidated view is who? The System Operator? With data in clinical documents not being semantically interoperable yet, there may be a legal risk for the author who provides an overview interpretation.
What sort of caveat do you put on a consolidated view when the consumer and/or the provider can decide whether or not to include a document in the record? A consolidated view that does not include a key allergy to a medication and the fact that the medication has been stopped is a liability for the patient, the provider and the System Operator.
I don't think we will ever see a consolidated view in the PCEHR. I think we will only ever see the index view - pointing to the documents for which others are liable.

Eric Browne said...

Anonymous of 12 March 2013 10:18 says "I don't think we will ever see a consolidated view in the PCEHR". Well this is already being slated for medications history with the Pharmacy Guild's National Prescribing and Dispensing Repository - see http://wp.erx.com.au/eprescribing/pcehr_npdr/ for a sample screen shot.
With this model, DoHA can presumably wash its hands of responsibility for the oversight of data governance, provenance, etc. since the "consolidation" is occurring outside the PCEHR proper, by a third party information source. As far as I can gather, this model is also totally outside the scope of the eTP specifications developed by NEHTA, currently an ongoing focus of Standards Australia update to AS4700.3, and beyond the scope of the 2011 Privacy Impact Assessment commissioned by NEHTA under their e-Medication Management program. I think it is potentially a very dangerous development. Are we to see more of the ongoing battle between the RACGP/AMA and the Pharmacy Guild, partially refereed by DoHA, and with little or no opportunity for informed input from consumers/patients or individual practitioners?

K said...

"since the "consolidation" is occurring outside the PCEHR proper"

No. NPDR consolidation is done by the NIO using the pcEHR data store.

"this model is also totally outside the scope of the eTP specifications developed by NEHTA"

The question of harmonisation between the NPDR and ETP specifications is being examined.

Anonymous said...

Eric Browne said - As far as I can gather, this model is also totally outside the scope of the eTP specifications developed by NEHTA.

This should not be too surprising. It us clear from the PulseIT article - National medications repository to roll out in May - that NEHTA is deferring to DOHA.

Where does DOHA stand? Perhaps NEHTAs specs are superfluous.

Perhaps the Guild President's recent comment about a review by Deloitte of the National ehealth Strategy provides a clue to an impending change of direction aided and abetted by the Guild's heavy pressure on politicians.

Anonymous said...

That suggests the default will be the eRx developed Barwon Medview NPDR being readied for national rollout - a turbo charged pre election ehealth booster.

Anonymous said...

With MMR Global sniffing around over patent infringements it is timely to ask who owns the IP to the NPDR?

Is it NEHTA, eRx, the Government or the Guild?

Anonymous said...

Standards and the specifications NeHTA produce are no longer relevant. We have our in house teams and designs, these will become the standards for the simple reason that you will not be able to participate in the e-health game if you can't interact with our systems. Government incentives will ensure we are all in agreement