Wednesday, April 17, 2013

Is There A Real Trend Here With DoHA Slowly Stepping Away From The NEHRS /PCEHR? Not Really Given The Somewhat Covert Purpose.

A kind and diligent observer of all things PCEHR sent me this a day or so ago as a summary of Departmental comments.
2 Dec. 2010: NEHTA is now "Managing Agent" for DoHA's program
The change in NEHTA's governance became very obvious after Dec. 2010.
7 April 2011: PCEHR is for Chronic Disease and Aged Care
The scope of the PCEHR is wound back to small segments of the population!
 23 June 2011: Actual PCEHR deliverables for 1 July 2012
(Deputy Secretary Rosemary Huxtable)
The PCEHR deliverables are severely wound back to "citizens can register for the PCEHR" ...
On 1 July 2012, DoHA delivers exactly what RH outlines (on slide 15) one year before!
26 March 2012: No "Big Bang" with the PCEHR
The go-live scope of the PCEHR is further wound back to a "soft opening"... which is exactly what happened in July 2012.
20 March 2013: So what about the Future of the PCEHR?
Halton's speech says exactly nothing about the future of the PCEHR, apart from obvious operational growth...
On a review of this collection of public utterances from DoHA  it is hard to disagree that the specific future plans have become pretty vague and diffuse - with a very interesting twist that what became obvious about 6 months ago and is now being made apparent. This is a ‘big data’ system for the Government to mine for their own purposes - not a clinically focussed system.
This is confirmed in the latest speech where there is a clear sense in the first 15 minutes that all the PCEHR is planned to be is a great big feed for the analytics efforts of the Department to manage the health system rather than actually trying to provide clinical benefit.
There is also a sense that we are going to see a multiple set of repositories separate to the NEHRS / PCEHR. The first would seem to be the National Prescribing and Dispensing Repository.
The implications of this are really quite interesting. Is it covered by the PCEHR Legislation and protections? What consent is required for these pharmacy records to be uploaded and so on?
The last 10-12 minutes were on Telehealth and were said to be an integral part of the National E-Health Strategy. While it is mentioned I think this is just a distraction from the failing part of what is going on which was not in the National Strategy at all!
All the speeches are useful but this last one lays bare the why DoHA is doing this. It is to create data for them to mine. Had it been designed to clinical care we would have seen something quite different.


Anonymous said...

Astute observations. Can DOHA be more overt in its covert operations?

Paul Fitzgerald said...

If all they wanted was to mine the data, they could have spent their billion dollars with me and I would have given them a tool to do just that. Then I would have taken the other 990 Million and retired to the Bahamas!
Nothing to build, no interfacing, no need for consultants......just a simple tool to do the job.

Anonymous said...

National Prescribe and Dispense Repository is also government owned and also integrates with the PCEHR. Patients have control over what data is uploaded and data mining is not really possibly through the thousand layers of security. Focus is entirely on clinical benefit.

Anonymous said...

Yes, it's government owned. That shouldn't be a problem - so is the PBS.

The question is - What will the NPDR do that will help improve the way doctors, pharmacists and hospitals work and communicate with each other and their patients?
Nothing as far as I can see. Why not?

Because the NPDR is just another dumping ground. It is not an interactive two-way system. It is just another bucket of data to be trawled through.

Unlike Medisecure and eRx, which are interactive with each other (interoperable) and also with their constituent clients - doctors and pharmacists.

DOHA and NEHTA should be harnessing the industries skills at that level by working more closely with the script exchange vendors - not by telling them what to do (which has historically been the case for years) but by asking them - how to do it and getting them to do it.

K said...

so, the fact that NPDR will make the patient's prescriptions available to the patient and the care providers is "nothing"?

Dr David More MB PhD FACHI said...

@4/18/2013 10:01:00 AM.

You are at a level that is too low. I want to keep all that is working and doing good things by fixing the way it is managed and led. Right now it is all over the place like a dog's breakfast.


Anonymous said...

"K: so, the fact that NPDR will make the patient's prescriptions available to the patient and the care providers is "nothing"?"

Yes I can hardly wait to see my tablets on my tablet. Even better if it can remind me when I need to take them, and then I can hit a button to say 'I did, I did'. And then my tablet can tell me when I need to get a new prescription from my doctor, or if there has been a recall of the medication - stop taking it now!! I can print out or email a list of my current medication profile, including last doses taken, and if I have ceased anything and why. How useful would that be if I am going in to hospital for medication reconciliation?

Anonymous said...

You wish. The NPDR won't do any of that for you - or will it?

K said...

Right. Lots of useful things to come in the end. It'll take time, but the outcomes aren't *nothing*. Interesting to me that part of the PCEHR problem is actually the debate between two views of medicine - the patriarchal doctor-knows-best model, where the patient is just a body to be treated, and the patient-takes-charge model, where the doctor provides expert services to help the patient achieve their needs.

The comments on this blog definitely reflect that the doctor-takes-charge model is still the majority model for clinicians today, and the pcEHR is revisionist in that sense. The problem is that the sum of what has been tried - the technical, the policy, the political, and the clinical - is all too much, and it's a real prospect that the good parts will get thrown out with the whole - and we'll be back where we were.

At least some people will be happy (like the local vendors, for instance, who didn't really want big change, just linear development - low risk, ok returns).

Dr David More MB PhD FACHI said...


I am not sure I agree. The clinician / patient relationship (and communication between the two) is just ignored in all this.

It is just rubbish to see patients control a professional clinical record as it is rubbish to have the clinician control the patient self entered record.

No one has actually figured out just who the PCEHR is for (doc or patient - it can't fully and properly suit both!) - and until that is clear the design is designed to fail.