Sunday, November 16, 2014

Emerging Issues And Complexities Regarding The Commonwealth’s PCEHR System.

Prompted by the recent discussions in some quarters regarding the holding of laboratory and radiology results in the Federal PCEHR I thought it might be worthwhile to go back to basics and ask a basic elementary question.
The really key and crucial question might be “What was the PCEHR intended to do and achieve?”
This might be best answered by referring to the 2009 report developed by the National Health and Hospital Reform Commission and finalised in April 2009.
The document was entitled:
Person-controlled Electronic Health Records
The key messages were:
1. Health care is knowledge intensive. The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care.
2. Current health information systems are disjointed, which often results in health care professionals operating with incomplete or incorrect patient information. It is estimated that up to 18 per cent of medical errors are a result of inadequate availability of patient information.
3. As technology, work practices and medical knowledge continue to evolve in the coming years, the complexity of health care interactions will become greater, which means the need to document and readily access a patient’s health profile will become more critical.
4. A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.
5. Investment in health IT lags well behind that of other information-centric consumer industries such as the financial and telecommunication industries, which have invested heavily over the last 20-30 years to achieve global connectivity.
6. According to recent research commissioned by the National Electronic Health Transition Authority (NEHTA), 82 per cent of consumers in Australia support the establishment of an electronic health record (EHR).
7. The implementation and widespread use of information technology in the health sector (e-health) is one of the most important enablers of personal health management and quality health care.
8. The overall economic benefit from increased productivity and reduced adverse events that would be achieved with a national individual electronic health record in Australia has been estimated to be between $6.7 billion and $7.9 billion in 2008-09 dollars over 10 years.
9. The protection of privacy and confidentiality is a key factor in winning widespread community acceptance and uptake of electronic health records.
10. Health providers and the IT industry must work together to develop open, nationally-agreed standards for the secure electronic capture and storage of personal health information.
11. The essential role of governments in a new e-health environment is to protect the public’s interest through legislative reform and ensuring people retain control over who has access to their personal health information.
----- End Extract.
Viewed from the vantage point of some five and a half years later it seems what was being proposed in the other 18 pages of the document were a mixture of over-ambition, misunderstanding and naiveté regarding the complexity of the health sector and health information technology.
What strikes one most forcefully in all this is the apparent lack of impact of the PCEHR System and a seemingly wilful lack of keenness to make assessments of the system success, despite the fact such evaluation was planned. While there is information on numbers enrolled and records automatically updated there are no actual usage statistics by consumers or clinicians in terms of clinical records actually access etc.
One question that comes up out of this, as mentioned above,  is around just what the PCEHR was intended to do? On the basis of the extract above what was originally hoped for was:
1. Improved patient engagement in their healthcare.
2. Improved speed and accuracy of the communication of health information.
3. Improved quality and safety of care.
4. Improved co-ordination of care delivery.
5. Savings for the Health Budget.
After 5.5 years, and a $1.0 Billion expenditure, if these were the objectives it would seem the evidence for success, so far, is pretty limited.
Can we form a view yet or is it too early to tell? If the claim is that it is too early to tell then surely there should be clear performance hurdles, and a defined budget, before more is spent? Otherwise we just have a very dark black hole in front of us!
Additionally we need to be clear that the stated objective of a personally controlled record has rather drifted with such a deluge of largely useless information being fed  into the record (MBS of tests and bills etc.) not under any apparent sort of consumer control! Once you have a record all this just seems to arrive. (I wonder did I consent to all this when the PCEHR stated 2.5 years ago - don't remember) Interestingly the PCEHR does not appear to have changed much in the roughly 12 months since I last logged in. The user interface is just as awful as ever.
Was a dog an age ago and still looks to be.


Anonymous said...

Items 1 through 5 are motherhood statements of the highest order enabling the theft of over $1B in taxpayers' monies to vested, self-serving interests without the slightest degree of accountability intended nor achievable!

Exactly what if any of items 1 through 5 have or are defined by SMART metrics?

And if anyone needs a definition of SMART metrics, then they have no right of access to nor authority over taxpayers' funds whatsoever...

This is also the craven BS that should be called out and dismissed out of hand by our elected representatives within Senate Estimates hearings in the interests of representing taxpayers and holding those willing to pilfer taxpayer wealth to full account and the letter of the law!

Bernard Robertson-Dunn said...

I posted most of the following to a mailing list in response to

IMHO, it bears repeating.

There's an old joke:
A child says to its parents. "Should I get into trouble for something I
didn't do?" Parent says, "no, of course not".
"Good" says the child, "I haven't done my homework"

It's not what governments do, its what they don't do.

Governments have a standard process. Write a business case, get it
approved, run the project. The bit they don't do is in-between the
business case and the project. The requirements "gathered" for the
business case are high level and only sufficient to inform the decision
to proceed. Running a project based upon those requirements is
guaranteed (based upon observed behaviours and observations) to fail.

Government managers, procurement specialists, project managers, vendors
all have a vested interest in the spending of money. They want to get
going as soon as possible, that way, the project will get finished sooner.

The idea that they should stop and have a good think about what needs to
be done is foreign to these people. They don't do it and don't realise
it is essential.

Auditors come along and look at such projects and also don't realise
that something is missing.

Its a bit like dark matter. they know something is missing, but they
don't know what it is, Mr Jones.

(bonus points for the 60's cultural reference)

As has been made very clear in recent postings regarding test results and safety, the PCEHR was implemented without thinking through issues of information management. That's the big gap, which is very difficult to fill once the system has been built. Bad and wrong decisions were thoughtlessly made early on.

Bernard Robertson-Dunn said...

Sorry, the first sentence should have read:

"I posted most of the following to a mailing list in response to a report on the Victorian Government's troubled Ultranet project"