Tuesday, October 01, 2013

E-Health Professionals And Consumer Groups Express Concern Regarding Outcomes Of The Planned PCEHR Review.

The following appeared last week.

Peter Dutton shifts into high gear for e-health overhaul

HEALTH Minister Peter Dutton has moved swiftly to initiate a review of the troubled $1 billion personally controlled e-health record system at the behest of Tony Abbott.
Mr Dutton has received initial briefings on the PCEHR from key stakeholders such as the Department of Health.
The Coalition will undertake a comprehensive assessment of the true status of the PCEHR implementation as outlined in its health policy released in the lead up to the election.
"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 policy says.
"The Coalition will again work with health professions and industry to prioritise implementation following a full assessment of the current situation."
A spokeswoman for Mr Dutton declined to say who was expected to lead the review or how long it would take.
"We all support an electronic health record," she said.
"However, we have grave concerns about the amount of money the previous government spent on e-health for very little outcome to date.
"At a cost of around $1bn, we should have a lot more to show for it."
In opposition, Mr Dutton and others criticised the PCEHR's performance, saying that while more than 650,000 people had registered for an e-health record, only 4000-plus shared health summaries were created.
The summaries are generated by a patient's GP and contain diagnoses, allergies and medications.
The spokeswoman declined to say if Deloitte's refresh of the 2008 national e-health strategy had begun.
Medical Software Industry Association president Jenny O'Neill said her organisation was "very willing to assist the new Health Minister in a review and planning for a sustainable (e-health) future".
"In a recent Q&A program on the ABC, former health minister Tanya Plibersek equated a $1.5bn investment by government as a 'rounding error'," Ms O'Neill said.
"Had her department invested this 'rounding error' in the e-health sector by strengthening the electronic bridges between all the parties, Australia would have achieved major and sustainable transformational change in this timeframe. If all the important infrastructure supporting current data transfer had been strengthened and upgraded with the latest technologies, national security and safety standards would now exist."
She said the PCEHR was "a much advertised national system which is next to empty".
"Each transaction in this national system has to be routed through a national repository," Ms O'Neill said.
"It is like building a fast train system between the cities and towns of Australia and requiring every trip to go via Canberra."
She said taxpayers could not afford rounding errors in e-health.
Lots more here covering the consumers, pharmacy guild and a rather confused CIO of the now DoH.:
It strikes me the comments of the former health minister explain why Labor lost Government - seeing $1B + on the PCEHR as a ‘rounding error’ betokens an attitude to the spending of tax money of extreme profligacy.
Ms O’Neill also catches the point many others miss - the fundamental architectural design error that at, at least in my view, dooms the entire program.
The full article is well worth a careful read as those outside DoH clearly know more about what is needed with the PCEHR than those who designed and are ‘managing’ it.


Bernard Robertson-Dunn said...

David, at the risk of repeating myself (I am anyway), there's a more fundamental question than design of the PCEHR, that goes to purpose:

What would a national eHealth record, that only contained a summary and information that was not guaranteed current (their words), do that local hospital, state or other systems do, or will do, for the health professionals that most Australian patients see on a regular basis?

It may be nice that some of a patient's health information is available on a national or non-local basis, but how often will it be of value or use?

A couple of billion dollars, that could have been used better elsewhere, is a lot to pay for something that's "nice to have".

Anonymous said...

My advice would be to freeze all development both inflight and planned for the PCEHR. It will make an assessment easier if the target is not moving.
I also hear on the grapevine that the new approach whereby the department takes the lead on requirements is turning into a fiasco with NEHTA specification being asked to delivered to dates without requirements and subject to constraint change.
Stuff this up Minister and you will lose the pathology sector forever.
Stop the PCEHR developments, go into maintenance mode, get NEHTA to uplift its current specifications (these FAQ's are getting out of hand). And get itself ready for whatever the refreshed ehealth strategy recommends we do with NEHTA.

For my sins I believe NEHTA has a role, it was a mistake to get side tracked with PCEHR

Bernard Robertson-Dunn said...

Stuff requirements, that's IT project talk. An eHealth system is far more than an IT system.

Those responsible for eHealth in Australia would do well to take note of this:

Australia is one market that also has seen lots of attention on leading adoption of EHR systems but Hector-Taylor again casts doubt on the real value. "Rather than upset anyone by not proposing any changes to workflows or healthcare structure, Australia has simply said it will digitize all patient data," he said. "That simply takes a manual mess and turns it into a digital mess and quite possibly not even a comprehensive digital mess."


eHealth is not about automating current practices, it's about achieving better health outcomes in new, innovative, more effective and efficient ways. The PCEHR does none of that.

Anonymous said...

"In a recent Q&A program on the ABC, former health minister Tanya Plibersek equated a $1.5bn investment by government as a 'rounding error'"

Ms Plibersek with this statement demonstrates her utter contempt for Taxpayers monies and illustrates what a complete Leviathan of a C'th Gov't this nation now suffers under.

Is she able to stretch her intellect and imagination to the opportunity cost this $1.5 Billion “rounding error” represents?

The LNP in maintaining the magnitude of the present Healthcare budget and intrinsic unconscionable waste is only propagating the issue and sustaining the problem.

The PCEHR review will be nothing short of a charade and ruse on the poor unrepresented Australian Taxpayer if this mindset is allowed to fester and continue within the C’th Government!

Anonymous said...

Bernard really 'stuff requirements' you seemed in some posts to be more than 1 dimensional in you analysis of problems. There are still underlying IT outputs that are being done regardless, it is those that should be stopped, research white papers on the web is not what is costing money and damaging health relationships

Terry Hannan said...

David, taking the following statement from your posting, "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", one question needs to be asked and that is “what do we have now?”
Australia is quoted by eminent scholars in e-health around the world as having ~ 95% of GP ‘computerised’.
So what are the implications of a new e-health system in GP (and all medical disciplines) that will have the features of ‘imposition’ at from a Federal level?
You have addressed my question in your comment, “Ms O’Neill also catches the point many others miss - the fundamental architectural design error that at, at least in my view, dooms the entire program”.
We need a fundamental Federal standardised e-health system. We need to REMOVE State-Federal fiefdoms of (we know better than you how to do e-health). We need to KNOW what we are doing (hmm, I am not sure how the previous “clinicians leads will respond to this”).
The system must have the following features which I have posted several times before. COLLABORATION: SCALABILITY: FLEXIBILITY: RAPID FROM DESIGN: USE OF STANDARDS: SUPPORT HIGH QUALITY RESEARCH: WEB-BASED AND SUPPORT INTERMITTENT CONNECTIVITY: LOW COST: preferably free/open source and the most important component is that the system must be CLINICALLY USEFUL: feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL it will not be used.

Anonymous said...

"I can confirm that the Government is not going to build a massive data repository. We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks" (~Nicola Roxon)

Did Hon Nicola Roxon know what she was talking about or was she blatantly lying to the Australian Public?

Granted, currently the PCEHR with its 4K odd health summaries is anything but a massive repository but its purpose and architecture are very much "massive repository" engineered.

How on earth do these political boldfaced liars get away with this?

One can only hope that the lies and deceit which led to our present $1.5B rounding error PCEHR debacle will be highlighted and drawn to the public's attention when the review report is eventually published.

Anonymous said...

More likely none of the Ministers, even Dutton, know what is going on in their Departments. By the time the briefing papers get written and escalated and modified as they pass up the various layers and then to the Minister there is just fluff and spin that doesn't reflect what is really happening. It is a miracle there is a PCEHR system at all, despite the Department of Health and Nehta.
If they have a review of the PCEHR, then it will likely say this:
• the labour govt is to blame
• the libs will try their best to fix it now
• we need to get some basics working, get the discharge summaries in, make it easier for GPs etc
• we need to consult more with the clinicians about what they want (oh yes!)
• we need to focus on some key components that add some real clinical value – probably medications for the elderly?
But in reality nothing will change, just heaps more money for another big consulting company who will do the review. And a steady income for Accenture to keep ‘operating’ the system.
Then we will have yet another silo of information to confuse clinicians – is it complete, is it up to date?

Dr Ian Colclough said...

The Minister needs to retain a two or three independent advisers with lengthy experience in both health and ICT who are not aligned with the peak bodies, the major consulting houses or the vendors. Identifying those needles in the haystack is the hard part.