Tuesday, September 03, 2013

Now Here Is A Call I Would Really Like To See Actioned After The Election No Matter Who Wins.

This appeared a little while ago.

Can the PCEHR be salvaged – a consumer view.

Aug 27 2013
The Consumers e-Health Alliance is calling on the major parties to revisit the $1 billion national electronic medical information-sharing system and actually deliver the promised benefits.
CeHA convenor Peter Brown says the launch of the $1 billion Personally Controlled Electronic Health Record (PCEHR) “needs to be seen positively for the opportunities it presents.”
But with emerging difficulties identified by medicos, consumers, the local health IT industry and the full range of State and Federal government agencies charged with implementation, CeHA believes it is now important to bring all parties together to tackle the issues.
There is no way an effective e-health system can be established without standardised infrastructure providing quality interchange and secure storage capabilities for people’s confidential medical information.
We need to build on the basic PCEHR infrastructure by incorporating the many practical systems operating across the currently siloed health sector, but this has to be done in a co-ordinated, connected way. Such an approach is increasingly being undertaken elsewhere around the globe.
The original National e-Health Strategy, agreed by all Commonwealth, State and Territory Health Ministers in December 2008, addressed the need for a national governing body with an independent chair and broad stakeholder representation to set priorities, direction and funding.
Crucially, the National e-Health Governing Board would be publicly accountable for ensuring the desired outcomes, with the support of a new National e-Health Entity tasked with managing the work program, overseeing standards development, a privacy and security framework, and systems compliance. it will also co-ordinate the implementation.
It is unfortunate that these governance arrangements were not established from the outset. Obviously the co-ordination and management of such an inherently complex system would be a critical factor in its successful implementation and ongoing operation. That would achieve good quality co-ordination and collaboration of all stakeholders. This accords with the recommendations of the Health Ministers Conference, December 2008.
Instead, responsibility for operating the network has been handed to the federal Department of Health and Ageing.
Clearly, this was not initially envisaged, and the Department is not designed for such a task and has no prior experience in an operation of this size and type. Department secretary Jane Halton correctly pointed out recently that the national e-Health program was larger than the Snowy Mountains scheme. This is true, but the responsibility for that construction job was not given to a Government department.
The PCEHR system is far, far bigger than can be managed in that way. Healthcare not only involves millions of individual citizens and their personal medical records, but many thousands of organisations – public, private, sole practitioners, and some 800,000 employees.
It involves a new communications paradigm on a grand scale that will be strange to nearly every participating consumer and clinician alike; based on an appropriate electronic networking infrastructure.
It needs to be accepted that such an e-health network can only be made workable by having the four key stakeholder groups – clinicians, consumers, the medical software industry and government agencies – present at the same table at all stages of its development and implementation. The operation needs to be melded into a suitable type of network. This complex situation cannot be validly compared with the banks, since a health service is quite different.
CeHA believes consumer organisations can play an important role in articulating and clarifying privacy and confidentiality concerns, advocating for higher quality patient outcomes and more efficient use of scarce health resources through new technologies, and the use of patient data for medical research endeavours. And importantly, greater engagement with the patients themselves.
Good governance can help to de-politicise one’s electronic health record, by focusing on long-term infrastructure that can evolve to meet the needs and aspirations of clinicians and consumers.
Lots more here:
All I can say is that I agree - and that I have been saying the same for the last few years. The unaccountability of DoHA and NEHTA in the e-Health domain is just a travesty.


Anonymous said...

Geez, that PCEHR Dead Horse is sure copping a flogging!

It has, was and always will be, Dead on Arrival...

DOHA and NEHTA's "Millennium Dome" of triumph.

Anonymous said...

Only 5 years too late and at great tax payer expense, everyone jumps on after the horse ( a dead one at that)has bolted.

Where have all the noise makers been all this time.

They are no trying to save face and save relevance me thinks.

Lastly, EHR systems can be compared with banks, they are both transaction event based processes.

Prof. Michael Legg said...

The most recent correspondent misses the point that with banking there is one well understood type of information that is being transacted, namely money and there a limited number of things that are done with it, mostly basic arithmetic.

Health in contrast is a very complex information domain with huge socio-technical issues that we are some way off conquering.  In support of this contention, after more than 20 years of continuous effort, we do not have internationally adopted standards for:

· The grammar used to communicate health care information - despite progress with standards like HL7v2 and CDA

· A health information structural model - despite progress with models like the HL7 Reference Information Model and OpenEHR

· Health terminology - despite progress with SNOMED, LOINC, HUGO and many others

· Knowledge - despite progress with HL7 Arden, Drools and many others

· The man-machine interface

Indeed with the advances of the biological revolution even the core concepts of medicine are being reconsidered now (see attached).  It is also not that we haven’t been trying. The attached 1963 report to the US President pretty much sums it up.

Since we have largely worked out rocket science and we have probably spent more on health informatics in the last 50 years, health informatics must be harder than rocket science!

Grahame Grieve said...

Hi Michael

The way I look at it, the problem with Banking is to take an information-based framework that already exists minus the technology, and add the technology. (accounting is mostly IT done on paper)

Whereas in healthcare, first we need to inject the information basis. The technology is the easy bit.

Bernard Robertson-Dunn said...

If I could add a couple of agreements...

Re Prof. Michael Legg "health informatics must be harder than rocket science!"

It is. Rocket science (and getting to the the moon) is an engineering problem in the domains of physics, chemistry and biology - all of which behave according to well known laws.

Health informatics is about people. They have a habit of not following any particular behaviour patters, certainly not predictable ones.

Re Grahame Grieve "in healthcare, first we need to inject the information basis. The technology is the easy bit."

It's all about the information and how people interact with it.