The question was:
Should A New Revised National E-Health Strategy Recommend An Integrated and Simplified E-Health Governance Framework With All National E-Health Activities Under One Roof?
For Sure 49% (18)
Probably 16% (6)
Possibly 0% (0)
No Way 30% (11)
I Have No Idea 5% (2)
Total votes: 37
Looks like about 65% feel we need an improved Governance Framework for Australian E-Health.
Again, many thanks to those that voted!
David.
20 comments:
I think the correct conclusion is that "30% of responders disagree with me that putting all eHealth under one roof would be an improvement." Perhaps they thought about where that one roof would be likely to be.
Previous Anonymous:
Exactly!
The one roof should in no way exist let alone housing the sorry incompetent souls most likely to be deposited there by self-serving mandarins and consulting clingers-on.
David,
Your apparent blind faith in national and state bureaucrats and the questionable ministers of both stripes appointed to govern their (in)effectiveness seems paradoxical with the targeted criticisms of their incompetence and ineffectiveness published daily on this blog.
Doing the same thing and expecting a different outcome results in what exactly?
Throw the sorry lot out and dismantle the remaining one or many roofs.
"David,
Your apparent blind faith in national and state bureaucrats and the questionable ministers of both stripes appointed to govern their (in)effectiveness seems paradoxical with the targeted criticisms of their incompetence and ineffectiveness published daily on this blog.
Doing the same thing and expecting a different outcome results in what exactly?
Throw the sorry lot out and dismantle the remaining one or many roofs."
-----
Totally agree..my view is that we have been catastrophically let down! I have zero / zilch faith in the lot of them!
David
So David, how do you square that with your posts that "about 65% feel we need an improved Governance Framework for Australian E-Health" in the context of "Should A New Revised National E-Health Strategy Recommend An Integrated and Simplified E-Health Governance Framework With All National E-Health Activities Under One Roof?."
I'm struggling with how to read that other than that you think the new eHealth strategy should recommend centralising all eHealth activities under NeHTA, and that you would see that as an improvement. It doesn't really chime with the general theme of this blog.
In no way do I want control centralised in NEHTA. I want a new structure which absorbs DoHA e-health, NEHTA and the relevant parts of Medicare led by people who are committed to clinical safety and quality and see e-Health as an important enabler - not an end in itself.
David.
In other word David - 4/18/2013 09:01:00 AM - wants to shuffle the deckchairs across to another ship, dare I say Titanic, which will have the effect of giving nearly all the existing bureaucrats another job and a new life where they will continue doing what they have always been doing delivering nothing much of value.
Think again.
OK..what would you all like to see?
David.
For me, less focus on tearing down what's already been done, and more constructive thought on how to use it. The reality is that it's done, and that there isn't going to be the money to replace it for 5 years or more. By continuing to stand outside and declare it bad, you're condemning yourself to marginalisation.
I'd like to see the politicians appoint a bunch of people give them a mission and accountability, and then stop interfering with the process for political reasons.
I'd also like to see pigs fly.
David asked:
"OK..what would you all like to see?"
I suggest taking note of Dr Karin Garrety's comment:
“A better approach would have been to ask, what is it that would help people do their work better - and then to build something up from what people would find useful to help them to deliver health care.”
The focus of the PCEHR is on the whole Australian community. There is little value in a system that has all Australians registered and not much health information in it. The costs of securing all that personal data and having the patient control access is much to high for the returns.
IMHO, the aim of the system should be turned on its head.
The system should be there to achieve high value outcomes - probably those that support health professionals where access to comprehensive, detailed, longitudinal and accurate health information on individuals will enable them to do a better job. I say probably because I am not an expert in health care - there may be other high value outcomes, if there are, then these should drive the system.
The personally controlled aspect should be removed. Control should be vested in health professionals who need the system and who would be falling over themselves to use it.
At the moment the PCEHR has large costs and delivers little or negative value. If the concentration and focus is on achieving value then many difficulties disappear and support for the system is enhanced, mostly by those who really appreciate the value.
I have no idea if the system as implemented can be re-engineered to primarily support a much smaller user base of health professionals rather than the average person in the street. The issues are probably around access control and data ownership - issues that are deeply buried in the fundamentals of the system and which are often not easy to change.
It might be possible to overlay new interfaces and functionality on top of what's there and keep, but turn off, the public interfaces. A different mechanism for the patient to see and comment on their data (is there such a capability with current, non PCEHR systems?) could be provided, facilitated by health professionals. They would also act as mediators, advisers and translators between the data and the patient.
In summary, put health information first. Who most values it? What are their needs? How can you best support them? Build them an Information System that delivers to these requirements.
Patients don't need health information. Health professionals need health information. They need high quality health information in order to do their job - to help make or keep patients healthy.
Researchers and the government need information on the nation's health and on the health system. Their needs are secondary, they shouldn't drive the system, which may well be what has happened and why it is so poorly utilised.
I wholeheartedly agree with you Bernard. You have made a number of very valuable points stemming from Dr Karin Garrety's comment which is the essential starting point:
“A better approach would have been to ask, what is it that would help people do their work better - and then to build something up from what people would find useful to help them to deliver health care.”
Your conclusion nails the the problem - "Patients don't need health information. Health professionals need health information. They need high quality health information in order to do their job - to help make or keep patients healthy."
Finally, the personally controlled aspect serves to undermine and complicate the EHR issues. The PCEHR is a concept designed to be all things to all people - consumers, carers, health professionals. The nature of the health system is such that it is not practicable to have a system which is all things to all people. As you say, and as I have advocated for a very long time, remove the personally controlled aspect. Put control in the hands of health professionals who need to use the system. Make it reliable, make it safe, make it accurate, make it secure and easy to navigate and accept and retrieve clinical information and health professionals will fall over themselves to use it.
The benefits to the consumer (their patients) will be enormous.
I was one of the ones that does not want to see central control of eHealth. We have seen the folly of trying to do this for the last 10 years and I don't want to repeat that.
Central input to standards is just as bad, if not worse. No one person, selected by the clueless public service, can drive this. What we need is real vendors with a real IT department to engage in the consensus standards process and for the government to simply say that if you are doing eHealth you WILL comply with the standards in existance.
We have seen the mess that HL7 have created with the V3 process, which was heavily attended by government representatives rather than IT people who actually do real health IT. Nehta are a perfect example of how bad ideas can be bankrolled if you have millions of taxpayer $$ to fill the trough with.
eHealth will thrive and prosper if we let it free from the chains that have been placed around it. All government has to do if actually mandate standards compliance with existing standards. I can't buy a Car that does not comply, but I can run over thousands of patients with software that thumbs its nose at the most basic quality controls and standards compliance. Why is it so?
I disagree, I believe that the clear message from both other jurisdictions and from the ongoing increase in health care costs is that treating health as something that your clinician does to you is the wrong long term approach.
The clear direction in the future is increasing patient involvement in their health care, with that empowerment also leading to them understanding the impacts their behaviour has, and taking more responsibility for in-home care. Some of the leading hospital systems in the USA are heavily investing in this, and are a long way ahead of Australian practice.
As a patient, having access to my health information is a boon. I would not willingly go backwards to a world where my records were purely the preserve of my clinicians, I simply do not trust the system to work seamlessly without my involvement - when it comes to my health care I believe that I am the one that cares the most, and therefore the one who is most likely to have a focus on following through.
I understand the viewpoint that many here have that health is for health professionals, and I can see how people could hold that view. But I disagree with it.
However, first of all we need clinicians to have the data, good data, unlike we have now. When clinicians have good data and can exchange it its a small step to give patients access to that data. To give patients access first, to data that is not very good is no a solution. If the PCEHR proves anything it is that we need better, higher quality data in standard formats. Building on top of bad data leads into the weeds.
We've been waiting for good quality data in standard formats for 20 years. Until people start trying to use that data there is no driver for anyone to actually put it into standard formats, nor to fix the quality.
Too many people consistently say that we can't do anything until everything is perfect, but the reality is that (as others on this site have noted) you can do a lot with text mining or even with interchange of information in PDF formats.
A large part of the pressure to change comes from your patients seeing the data and asking questions, which is part of the reason some clinical groups are resistant to patients seeing it.
"we need better, higher quality data in standard formats"
yes, this is true. If we do nothing but work on this for 20 years, it will still be true, though perhaps the bang for the buck will tail off gradually.
The important thing, though, is that specifying better quality data formats isn't the same as specifying better quality data. The pcEHR has tended to fall back to trying to specify better quality data formats because attempts to specify better quality data have been resisted by so many stakeholders (it's the real costly part).
Until clinicians start adopting better quality data standards, we're stuck. (There are some working on it - yay - but the bulk of practicing clinicians aren't interested, perhaps partly due to the fact that there aren't any benefits from doing so, which ensures that there never will be)
Personally CON-TROLLED?
Personally I feel 'Conned' and 'Trolled'.
"The pcEHR has tended to fall back to trying to specify better quality data formats"
The problem is the quality of the implementations of the current data formats and lack of incentive to fix those problems rather than a problem with the standards. We don't need new standards, just quality implementations and attention to detail. Given that V2 is not going away any time soon there are very good reasons to do this no matter what new standard lights your FHIR.
Andrew, I certainly agree that the core problem is the quality of the implementations and the lack of interest in the users in doing something better (and buying something better).
But what's the solution? Your's appears to be mandating improved quality standards - but I don't really believe in that. It really sounds just too much like your pet hate, which is the government dictating solutions to implementers. If the users won't tolerate better solutions, mandating their use won't work either - they'll just ignore them.
I suppose I sound pessimistic, but I think that the solution will grow organically.
Hi Graham,
well in the medical world that is not health IT related there are quality standards mandated all over the place. Australian Standards are enforced for Cars and building materials etc etc. I am sure none of that is perfect, but an IT vendor can do an atrocious HL7 implementation and there is no one who even cares currently.
We have to have a huge list of proven standards compliance for all sorts of things in a day surgery, but our software can be implemented with zilch compliance and there are no rules being broken. This is silly. Perhaps regulators are fraid to regulate what they don't understand? We need smarter regulators perhaps?
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