Sunday, September 08, 2013

Well The Election Is Done - What Now For E-Health?

Well we seem to have got a clear result in the House Of Representatives and I have to say what rather looks like an unpredictable set of results in the Senate and the inevitability of some really odd legislated outcomes.
With a high probability that Mr Peter Dutton will be the next senior Health Minister and Dr Andrew Southcott (Opposition Primary Care Spokesperson) looking like a certainty  in his seat their comments are both important.
Before the period immediately prior to the election we have had the following
From 2010 - the previous election period:

Coalition e-health black hole worries AMA

Summary: Australia's peak medical body, the Australian Medical Association (AMA), has expressed concern over the Coalition's seeming lack of e-health policy.
By Josh Taylor |
update Australia's peak medical body, the Australian Medical Association (AMA), has expressed concern over the Coalition's seeming lack of e-health policy.
In a statement, Shadow Health Minister Peter Dutton said that the Coalition was "absolutely" committed to e-health.
"We are committed to e-health into the future. We do strongly support a roll-out of e-health and the funding is there until 2012."
"We don't trust Labor with money; we don't trust them because they have wasted it in every other area," he said. "We will review why Labor has gone nowhere on e-health in three years and whether or not the money is being most efficiently spent."
Updated at 3:00pm, 6 August 2010: comment included from Peter Dutton.
We then had the debate on the PCEHR in 2012 when it was legislated for. Dr Southcott gave a long speech where the Opposition supported the legislation but were not sounding all that convinced.
You can read this here:
We then had a pretty clear set of comments in the heat of the recent campaign.

Labor’s $1 billion E-Health debacle

Date: Mon, 19/08/2013
Spokesperson:  Shadow Minister for Health and Ageing, Federal Member for Dickson, The Hon Peter Dutton MP
Labor’s implementation of an e-health patient record is a $1 billion disappointment.  With nearly $1 billion spent on the program, it has failed to deliver anywhere near what the Labor Government promised.
The e-health program has been shown to be more about politics than about policy and more about spin than about outcomes for patients.
“Australian Doctor has reported that there are only 4,000 e-health records in existence.  At a cost of $1 billion that works out at $250,000 per record,” said Peter Dutton.
“This latest development proves this government is incapable of delivering on e-health.  It speaks volumes about Labor’s incompetence,” he added.
Apart from the very low take up rate, the system itself is deeply flawed.  The Government has been throwing good money after bad, spending money getting Medicare Locals to sign people up to a program that does not yet have basic clinical protocols in place, let alone support from clinicians.
“The Coalition continues to provide in-principle support for e-health, but shares the concern of many in the sector about Labor’s incompetence in managing the process,” said Mr Dutton.
The previous Coalition Government achieved significant improvements in the computerisation of general practice, from 17 per cent to over 94 per cent, by working with the profession and implementing effective policy.
“If elected, the Coalition will assess the true status of the PCEHR implementation and again work with health professionals and the broader sector to provide real results on this important reform for patient care,” Mr Dutton said.
More here:
Very recently we had this:

Tony Abbott eager to overhaul e-health system

  • "DoHA are already and will by: Fran Foo
  • From: The Australian
  • August 27, 2013 12:00AM
TONY Abbott has vowed to work with health professionals to review the troubled $700 million personally controlled e-health record system should the Coalition win on September 7.
One GP called for the PCEHR to be governed by an independent council comprising medical experts. The proposed review does not come as a surprise as the opposition called for a "pause" to the system's rollout more than two years ago...
Both Queensland Liberal senator Sue Boyce and opposition e-health spokesman Andrew Southcott have repeatedly criticised the PCEHR implementation over the years.
While the future of the National E-health Transition Authority - Mr Abbott's baby while he was health minister during the Howard years - under a Coalition government is uncertain, doctors say an e-health overhaul is timely. The opposition's health policy, released last week, says "if elected, the Coalition will undertake a comprehensive assessment of the true status of the PCEHR implementation".
"In government, the Coalition implemented successful incentives to computerise general practice and will continue to provide strong in-principle support for a shared electronic health record for patients.
"The Coalition will again work with health professions and industry to prioritise implementation following a full assessment of the current situation," the policy says.
So in summary we have support for the woolly concept of e-health but considerable scepticism as to how it is being done and whether the money is being spent.
It also seems clear that the Coalition will have a review as well as possibly receive some input from the Deloittes National E-Health Strategy review.
This blog also makes a key point regarding any review.

Assessing the PCEHR implementation will not tell the Liberals what they should be doing instead

The PCEHR has received a little bit of attention in the run-up to the Australian Federal Election – not much and nothing useful.
This is a slightly expanded version of what I posted to Dr David More’s Australian Health IT blog  (There’s a 4k character limit)
Tony Abbott’s statement doesn’t fill me with hope:
“If elected, the Coalition will undertake a comprehensive assessment of the true status of the PCEHR implementation. … The Coalition will again work with health professions and industry to prioritise implementation following a full assessment of the current situation”
Oh goodie. They will assess the status of the PCEHR implementation and then prioritise implementation.
What the heck does that mean?
For a moment let’s pretend the PCEHR is a car. It stops working. It won’t start reliably, when it does it lacks power and doesn’t brake well. You call the NRMA. The service man gives the car a once over and says – “my assessment is that it’s not working”. That’s a lot of help. So you get it towed to a service station for a second opinion. The report says “our assessment is that the engine has blown a gasket, the transmission is stuffed and the brakes are worn out. It will cost twice as much as the car is worth to repair.”
So what do you do? Sell it for scrap and buy a replacement?
You head off to your local car dealer and ask them for advice. You tell them you have a Mazada 1 which is beyond repair and want to price a replacement. The dealer, being a good dealer ask the question “what do you want the car for?” Your reply leaves the dealer stunned. You need the car to tow your four berth caravan when on holiday and your two-horse float every weekend.
The reason your car has worn out is because you have the wrong car. The NRMA man and the service station couldn’t tell you that because they only saw the car. You didn’t tell them what you wanted it to do.
The issue is not the car, it’s your choice of car.
Getting back to the PCEHR, it’s the same situation. They can assess the PCEHR as much as they like, but without a description of what it is supposed to do – in terms of health outcomes, not registrations and health summaries – any assessment is useless. The only question it answers is “we must do something, what can we do?” Unfortunately, doing something is not the same as doing something useful.
Full blog here:
This is a really important point Bernard raises as it is really clear and has really never been well answered - namely what is the PCEHR for and what is it actually intended to do - and of course will it actually do as intended.
It would seem ‘courageous’ for the Coalition to press on without being clear what is hoped for in terms of benefits and outcomes and also an assessment of just how likely these benefits and outcomes are.
What I expect is silence for a number of months - followed by an announcement that the PCEHR will continue - but with no expansion or extension - and that it will be quietly allowed to disappear. Any spare funds will probably diverted to support of more evidenced based and proven to be useful initiatives.
What do you think?


Anonymous said...

Will Abbott redeem himself and direct his appointed new Health Minister to drown his beloved NEHTA puppy, midwifed into existence on his personal Health Ministerial watch?

Will be interesting to see how fast (or slow) decisions are made and the rate of change (if any) visible in this eHealth space now that it is under "New Management"!

Anonymous said...

The Government has changed BUT the management of eHealth remains the same.

Jane Halton, Secretary Department of Health, established NEHTA when Abbott was Health Minister. The only think that has changed is that Tony Abbott is now Prime Minister.

Unless Prime Minister Abbott appoints a new Departmental Secretary for Health nothing will change.

As the saying goes ..... some things change and some thing remain the same.

Anonymous said...

They need to be very careful where they get the advice from and what questions are asked as "Fixing the PCEHR" may not be the appropriate thing to do. The government needs to find ways of encouraging standardization and innovation to progress eHeath. It has surely proven that it can't do it itself and further attempts are doomed to failure. I think government should govern what is in use and enforce standards and insist that government health institutions use standards where they exist (currently often not and poorly when they do).

Governing is very cheap and allows innovation, they just need to ensure doctors and hospitals can support the costs of compliant software, but even then good software should pay for itself and really enforcing compliance with standards is actually the cheap, obvious and effective strategy they should adopt. The government creating standards is a ruddy thing to do.

Trevor3130 said...

From 'Public Hearing—Examination of the Auditor-General’s Report to Parliament No. 4: Queensland Health eHealth Program'
Dr Cleary: For the committee’s information, I was involved in the user group that selected HBCIS some many years ago. HBCIS is a system, as you would probably be aware, which comes as a package. It is an ‘everything you want’ package. At the time, 22 years ago, it was able to deliver the complete requirements of a hospital. Clearly, that has changed and now there are best of breed systems in all of those areas. So the operating environment has changed, but migrating from a package that is all encompassing to one where you want to have best of breed systems is obviously complicated. I think also in accordance with government policy, the approach is going to be completely different. So rather than an in-house solution with in-house support, it will be managed very much like the IEMR product, which is outsourced and hosted. So with Cerner, I would imagine, we would have a similar sort of a model where there will be a web based product which is hosted off site from Queensland Health, but that is going to take some time to construct. As you have indicated, it is an area where the realignment of the various modules is going to need to be undertaken with some diligence to make sure that the transition progresses smoothly. There has been quite an amount of work done on that already. The pathway is fairly clearly identified. It is now really the business model that would be required to support that pathway that would need further consideration.
Just out of curiosity, does anyone know anything about HBCIS? I couldn't find a description of its operating system. Dr Cleary skimmed over "migrating" but I doubt that includes porting actual data across, does it? I mean, he has been in the guts of HBCIS for 22 years, so if it was possible to set it up so patient data could be made available in a replacement system, he'd have done that, right?

Anonymous said...

I think the HBCIS Clinical Admin operating system was PICK using the old McDonnell Douglas software when Richard Jackson was CEO.

Dr David More MB PhD FACHI said...

The last comment is correct as I recall it to. MD were not a wonderful company and the system should have been replaced long before it was!


Trevor3130 said...

I did wonder if it is PICK. Shades of Victoria's "HOMER replacement" project, and where that finished up!
I'll stick my neck out to say that no-one has managed to port clinical data out of a PICK system, and, further, no-one has ported essential clinical data across from *any* legacy system. I reckon I'm pretty safe with that, because if it had been done successfully (ported data) it would have been shouted from the rooftops.
In that report, "Queensland Health has approved a project to implement a single sign-on solution to the nine IEMR sites as part of release 2, with the implementation schedule
to commence in the second quarter of 2014 in line with the IEMR implementation time frames."
That SSO does sound like a real winner in the proposal. ;) Are politicians still falling for it?

Dr David More MB PhD FACHI said...

It was PICK - not sure if it is much used these days - has some real technical limitations for hospital use.


Grahame Grieve said...

"no-one has ported essential clinical data across from *any* legacy system"

Vendors do this as a matter of routine all the time. It's nothing to shout from the rooftop, it's a base requirement for any system replacement - i.e. Nearly every single sale (every sale that isn't made to a brand new hospital or clinic).

Jim Cocks said...

Yes it was PICK running on McDonell Douglas hardware which was Ahmdahl plug compliant. There was an $80m project to "customise" the generic HOMER system to HBCIS and there was a specialised unit established to perform this task. Concurrently smaller hospitals used Burroughs BTOS systems (I kid you not). first implementations were Royal Brisbane and Gold Coast hospitals.

Trevor3130 said...

Ah, yes, Graham, thanks. Don't know how that happened. Maybe I meant to say "ported all data from legacy systems". Back to the sidelines.

Dr David More MB PhD FACHI said...


Grahame is right for most systems but I seem to recall the way data was held in PICK systems this sort of transfer was no mean feat. Other oldies may remember the details but I just have a feeling this is why those systems were kept in use for so long.

I could of course be dead wrong and suffering from early dementia!


Grahame Grieve said...

David, I've never touched a PICK system :-)

Dr David More MB PhD FACHI said...

You are a very lucky person then. One of the most endearing features I recall was that if you had even the most trivial disk failure the next step was a total system reload! The entire system was just one huge pile of data with a zillion - easily corrupted - pointers.


Bernard Robertson-Dunn said...

The Pick OS took a very technical approach to data storage. The goal was to make it very efficient in data access time.

SQL, on the other hand started by modelling the information and left implementation issues to technologists.

SQL is alive and doing very well, thank you. It has more than just survived and has few if any serious competitors. Pick never really got going and will eventually die, having caused all sorts of maintenance and technology issues.

Does this sound familiar? Start with the information and decouple from the technology?

K said...

Bernard, you mean, like the pcEHR does?