Tuesday, November 05, 2013

A Personal Perspective on the Reality of the PCeHR - Emma Hossack

A personal perspective on the reality of the PCeHR –what was promised, what was done, what was delivered.

“We’re doing this based on the hard work already achieved, not trying to build a one-size-fits-all system from scratch.” (Minister’s bold emphasis)

“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.”(Minister’s own bold emphasis)

“the Government has committed $467 million to develop electronic health records into the future.”

Minister Roxon Opening Address to the eHealth Conference, Revolutionising  Australias’s Health Care, Nov 2010.

Sounds good. All over the World eHealth has been recognised as one of the means of enabling governments to maximise their healthcare spend. President Obama called it the “low hanging fruit”, and the then Health Minister Roxon assured Australia that “e-health promises change that will transform Australia’s health care.” Implemented properly there is little doubt that the duplication, errors, and care co-ordination can be significantly improved. So what happened over the last 2 years and 11 months to result in Minister Dutton’s announcement that over a billion dollars has been wasted by the previous government?

The Rudd – Gillard – Rudd government’s National eHealth Strategy and the recommendations of the National Health and Hospital Reform Commission Report had support in the industry. The National eHealth Strategy was clear that there should be no top down, big bang approach. Industry should be given the support of some critical infrastructure, and left alone to get on with their business. The NHHRC said the plan “should not require government involvement with designing, buying or operating IT systems” - this had not worked anywhere internationally. In 2010 when Australia was about to spend $467 Million, there were reports of the UK Health Service National Programme for IT having spent £16 Billion without success.

There were many lessons which Australia could learn from, and there was almost a sense of optimism amongst industry in Australia. There was a sensible plan for a ten year rollout of ehealth. There appeared to be no political milestones. There was emphasis placed on the governance. There was pretty good funding. Despite concern over the grant of several million without tender to 3 of the “First Wave” sites, industry was slightly mollified by the explanation that there would be transparency of what occurred in this First Wave so that the lessons could be shared and industry spared some of the inevitable pain of change. Many in the medical software industry believed that the government was aiming for sustainable growth in the sector, good for innovation and productivity of an industry which Austrade lists as a key growth sector.

Almost three years down the track and with over a Billion dollars spent, industry optimism has been replaced by cynicism and disappointment. Australia has a very expensive piece of infrastructure which is not achieving its stated purpose. Roxon’s promise of mothers having their sick children’s medication histories at their fingertips appears ludicrous. The experience of patients, doctors, allied health care and the army of others involved in health services has not improved. In fact in some cases it is worse. Promising so much, and delivering so little. Ignoring international learnings and recklessly throwing millions of dollars at getting “numbers” of people registered without any interest in meaningful clinical outcomes. There were significant doubts as to whether there was in fact a level playing field. Even some of the keenest “eHealth heroes” have walked away. A huge loss for eHealth, the medical software industry and Australia.

Over the last 3 years we have had a government which pledged to do one thing but did the opposite, competed with industry, failed to collaborate and fostered a culture of secrecy. We continued to hear how successful the PCeHR was despite first-hand experience of its deficiencies. eHealth was misunderstood by the people who were charged with its implementation. The motherhood statements in grand Hotel Ballrooms about how all the “waves’ would provide critical lessons for the ehealth reform have all unravelled.

The reason I am pleased about Minister Dutton’s review is that it openly recognises the failure of the project and has 10 sensible terms of reference which acknowledge the important role the private sector should play. Some of us in the industry were starting to feel as though we lived in a parallel universe. The industry does not want much. If the government could simply do as little as possible and as much as necessary, we would be a lot better off. Fund national infrastructure like a workable National Authentication system, reward success, incentivise meaningful use. None of these are new ideas. They are all a part of the Strategy and Report which the previous Government said it followed. The “ massive data repository” which the government was not going to build, has been built. Whilst it may not be fit for the purpose which successive Health Ministers ascribed to it, it could be beneficially used as a national reporting database. It was never meant to do all the co-ordination and specialised tasks that are done by so many smart medical software systems. We all know that a one size fits all will not suit the diverse needs of the Australian health system.

I am glad that the review is only 6 weeks long. The industry deserves certainty and a clear direction. This whole project needs some sunshine to enable the eHealth reform to get back on track. The original road map is there and the medical software industry has the capacity to make it work. The above is an entirely personal view. In a fortnight the medical software industry members will be meeting to conduct live polling to consider the terms of reference and identify key areas in which they can contribute to the process of the Review Panel.

Emma Hossack is CEO of Extensia and the Secretary of the Medical Software Industry Association. The view above are, however, her personal views alone.




Dr Ian Colclough said...

The Minister's comments seem to suggest there is an expectation that some tweaking and patching will fix the problem. Unless and until a select committee of expert individuals are brought together with the necessary breadth and depth of expertise to holistically examine the 'problem' and develop a practical, pragmatic, affordable way forward little of value will be achieved.

I agree wholeheartedly with your comments Emma. While I am not overly optimistic we will see much of a change for the better coming from this 6 week review I earnestly hope I will be proved wrong.

Paul Fitzgerald said...

Well said, Emma.

Tom Bowden said...

Congratulations Emma, this is a very well written and thoughtful piece and I hope that it is broadcast far and wide.

While no-one can argue that successful e-Health solutions are easy to design and implement, it is very disappointing that this one could have been quite so flawed.

I think there probably is a bit of flotsam washing up from the wreckage that we can use to build huts on the beach and start again. However, lets not kid ourselves, we are still very much at the beginning of the journey some fifteen years on.

We must begin by providing clinicians with systems that improve their ability to deliver day to day care.

Anonymous said...

While ever politics is involved "critical evaluation" will be shallows words without substance in any assessment. The whole lessons learnt and tipping point selling point by NeHTA Executives never materialised. The building blocks of eHealth are still incomplete or non-functional. Go back to basics finish off the building blocks then let procurers and end users decide who is providing value for money.

I expect we will still be dissappointed by lack of eHealth progress in 12 months time but maybe tax payers money won't be wasted in such large tranches as part of political stupidity.

Terry Hannan said...

David, these are wonderful 'bland' comments but offer no solutions to what we should do in e-health. What is going to make Senator Dutton's approach different from any other 'political' one? If the decision makers do not understand the problems we are trying to solve then any plans will be additional expensive failures. As the former Liberal health Minister stated "you people have it all wrong. It is not about the patients it is about the money and getting re-elected!" Well their pragmatism has worked. Terry Hannan

Anonymous said...

There may be a slump in registration numbers and usage. It is hard to sell a product that is under review and described as a waste of money.
Time perhaps for the registration fairies to take some annual leave?

Anonymous said...

David - Essential reading in The Conversation of 6 Nov 2013 thanks to Dr David Gance.

Unfixable: time to ditch personally controlled e-health record scheme

Anonymous said...

I do not qualify registrations as users in this context. Rego's have been gained by sending out spruikers and hawkers to shopping malls competing with people dressed up as Koalas and promoting world peace. All you need to do is provide your name, address, phone number and in return you get a fully branded show bag full of "merchandise" that was part of a $10M change management program designed by the geniuses at McKinsey and PwC.

Anybody who has promoted a website, and looked at traffic numbers would rate the PCEHR as a "dead cat bounce".

Anybody who has put their own money up to promote a new product or website and received this sort of response would have declared 'game over' and moved onto the next thing.

The armies of people who were involved in this project need to hang their heads in shame and humiliation. Labor and it's sycophantic cronies completely misread the ecosystem, sidelined the key players and played with the taxpayer funny money, egged on by Deloitte and co to spend up big while the money was there, because 'we would never get another chance'.

Now the Liberals have to clean up the mess that has been left behind.

A disgrace.

Anonymous said...

The US just spent $400M+ on a healthcare website that doesn't work, and needs to be redeveloped. That pales the PCEHR problems.

The US Meaningful Use structure has higher physician involvement, largely due to the aligned incentives/ strategy, but low patient intake, vs. Australia which has higher patient involvement but less so with physicians.
Would be interesting to get the best of both strategies.

Anonymous said...

A flicker of sense in this debate - thanks.