Sunday, May 10, 2015

Thus Far We Do Not Really Have Enough Detail To Really Understand What The Government Plans With The PCEHR.

Overnight we have had two reports on the PCEHR and NEHTA for the future.

Australians to benefit from Sussan Ley's ehealth health records revamp

Date May 10, 2015 - 12:00AM

Adam Gartrell

Australians will get easier access to their medical records and be at less risk of treatment and prescription blunders under a revamped e-health system that will cost the Abbott government at least half a billion dollars.
The new myHealth Records system will be announced by Health Minister Sussan Ley on Sunday. It will build upon and replace some elements of a struggling scheme introduced by Labor in 2012, which has already cost taxpayers more than $1 billion.
Tuesday's federal budget will set aside $485 million over the next four years to get the new system up and running but costs will continue beyond that.
The government believes that once the system is fully operational it could save the federal budget in the order of $2.5 billion a year. The states would also benefit from billions of dollars in savings through a reduction in diagnosis, treatment and prescription errors that lead to thousands of hospitalisations every year.
The biggest change to Labor's Personally Controlled Electronic Health Record system will be a transition to an opt-out system.
That means that if a series of initial limited trials go well, all Australians will be given an e-health account and have their records put online, unless they choose to be excluded. Labor's system was opt-in, leading to a disappointingly small take-up rate – only about 2.2 million people, or 10 per cent of the population.
The government will also invest money in streamlining the system to make it more user-friendly so more doctors, nurses, pharmacists and hospitals want to be a part of it. So far, only a few hundred of the country's 1300 hospitals have adopted e-health.
The governing body NEHTA – the National E-Health Transition Authority – will be scrapped and replaced by the "Australian Commission for e-Health". The government says it will be less complicated and bureaucratic.
The full article is here:

Budget 2015: New 'opt out' e-health system to see all Australians given electronic record

By medical reporter Sophie Scott
All Australians will now have an electronic health record as part of a new e-health system, and people will have to opt out if they do not want to take part.
The previous arrangement, commissioned in 2012, was an "opt in" system where patients could choose to join, but it was plagued with problems.
Health Minister Sussan Ley said research showed the best way was to put everyone on the system by default.
If a person did not want to be on the system, they would need to opt out.
"A personally controlled electronic health record is theirs," she said.
"It's not going to be out of their control and we are going to give the community the confidence they need."
A review of the personally controlled electronic health records released in 2014 found significant challenges with the opt-in system and a lack of focus on those who needed the e-health records the most.
It recommended moving to an opt-out system.
Ms Ley said it was important that all Australians sign up to e-health to ensure the system functions well.
More here:
As the title says it is hard to know what this actually means and the questions are legion.
For example:
What is the revamped PCEHR actually for and how can we know if it is actually making a clinical difference?
Where is the evidence supporting the planned investment and will the basis of the investment and the supporting business case be made public?
What are the trials that are planned, what will be the criteria separating success from failure and for how long will they last? For any credible trial there will need to be at least a few months planning, a few months of implementation and then at least a year of operation before evaluation. Anything less will be nonsense and a waste of money and if it is to be done properly then there will a delay for national implementation for at least two years, assuming the trials are successful.
Just what is envisaged to support and encourage GP and other clinician use and just what is the strategy for clinician engagement with their known concern with personal control of the national record?
What is the intent for the information content of the new system - a pile of .pdfs or something more useful?
Has the system been re-designed to have a clear purpose and objectives and is there a written strategy and design that has be properly consulted with all the relevant stakeholders?
Just what are the assumptions that underlie the claimed benefits of the new system and what is the evidence they are credible given global experience that the benefits are hard to realise in virtually all HIE circumstances.
What secondary uses is it intended to deploy the information held in the PCEHR for?
Just what NEHTA functions will continue, what will stop and what will be the fate of the huge document pile produced by them?
What governance framework will be applied to the Australian Commission for e-Health or will the secrecy, incompetence and opacity continue?

Will an Audit of the old PCEHR be undertaken to see what worked and what didn't?

Surely new Legislation will be needed. What will that say? Won't getting this passed delay the trials?

How is the Government going to counter the "This looks like an Australia Card" concerns?
Australians are not all that keen on compulsory systems.

All in all in the next week or so we will need to see some much more detailed announcements and more evidence of fundamental change and very high quality planning or we will be able to be even more certain than ever that this won’t end well!
What do you think is the chance there has been quality and consultative planning around all this?
I wait to be proved wrong given it is the old, failed team who seem to have put this proposal together, but I reckon we will see more good money thrown after bad.

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