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Sunday, August 16, 2015

It Really Is A Pity We Don’t Have Any Real Leadership In E-Health. Some In-Depth Understanding Might Help As Well.

This article appeared earlier today:

Slow progress on e-health causing medication misadventures

Date August 16, 2015 - 12:15AM

Harriet Alexander

Health Reporter

The hospitalisation of thousands of people each year could be prevented if their health providers shared information electronically, but they can't because their software systems do not talk to each other.
About 230,000 people are admitted to Australian hospitals every year as a result of medication misadventures.
The federal government's top advisor on e-health said poor communication between nurses, GPs, emergency staff, pharmacists and other health professionals resulted in thousands of preventable hospitalisations and deaths because patients were doubling up on medication or taking the wrong drugs.
Steve Hambleton has called on the IT companies contracted to work on the billion dollar national health database to make their messaging systems compatible, or the government's $500 million dollar e-health scheme cannot move forward.
Professor Hambleton, who chairs the National E-Health Transition Authority, said the six major e-health companies who have designed internal messaging programs have said it would take them three months to make their systems inter-operable.
"Each individual company has built their own set of users and they're all talking to each other internally but they're not talking to the other systems," Professor Hambleton said.
"They keep telling us they can do it and we go, 'OK, when?'
"We've got the IT, we just have to use it better and use it more and one of the elements is messaging. They're just not doing the work that we require to get the system rolling."
Lots more here:
There are a few issues with all this:
First the clinical messaging providers are hardly involved in the PCEHR and are certainly not being paid the huge sums of money spoken about in the article. Unless I am badly mistaken the key GP system providers are pretty much all able to share a clinical summary securely with the PCEHR - it’s just that to date most GPs don’t seem to want to be bothered to use the government system.
Second clinical messages can be already shared between providers.
Here is the NEHTA announcement from 2013:

Australian eHealth a step closer with successful trial of Secure Message Delivery

Created on Friday, 17 May 2013
The Australian healthcare industry is one step closer to fully adopting technology in health ('eHealth'), with healthcare providers successfully trialling electronic information transfer and sharing.
Five healthcare messaging vendors - Argus Connect, Global Health, Healthlink, LRS Health, and Medical Objects - collaborated with General Practices, the National E-Health Transition Authority (NEHTA) and associated government agencies to develop Secure Message Delivery (SMD) capabilities.
According to NEHTA's Head of Clinical Leadership and Stakeholder Management, Dr Mukesh Haikerwal AO, the success of the Project represents an opportunity for improved effectiveness and better health care.
"The progress that has been achieved by this Project will mean any medical practitioner – be they a public or private GP, specialist or surgeon – will be able to share information over time through online secure messaging.
"We can see that this technology is available, it does work and all healthcare providers will have the ability over time to connect across a wide range of clinical information systems.
It will increase electronic clinical information exchange between healthcare professionals, decrease the use of paper based communication and importantly provide more timely and accurate patient health information."
Here is the link

Maybe if the NEHTA Chair and DoH provided some funds and support to the small businesses involved here (the GP system providers and the secure message providers) and actually knew how to distinguish between problems and solutions around drug side effects, clinical messaging and the ‘billion dollar’ database  systems we might get somewhere.

To suggest all the problems - or even a majority of the problems - with medication errors relates to e-health communication deficiencies is just fanciful. Quality prescribing systems, clinical decision support and so on are way more important than communication between providers - not, of course, that it should be ignored. Medication errors are a multi-headed problem that needs a wide range of improvements to address.
It is also important to realise that the PCEHR is only one pretty poor part of the e-Health ecosystem and right now is more of a problem that a solution.

Additionally the technologies to do what is actually needed to facilitate communications between clinicians and hospitals already exist. What is needed is to provide the rationale and incentives for adoption and use via leadership, persuasion and demonstration of benefit. Blaming the technology providers is a classic ‘blame the victim’ approach.

The key problem is we have a ginormous public e-Health database which no-one feels has a great deal to offer without fundamental changes which is draining huge resources and a small private e-Health sector which brims with capability and just needs a little encouragement and support.

It is a great pity that we don’t have balanced coherent supportive advocacy and leadership that sees the big picture and fosters real clinician friendly progress!

1 comment:

Andrew McIntyre said...

Its really hard to work with these people when they come up with such total rubbish. This sounds like a threat when they say we can spin anything so do what you are told or else.

I have personally told them that the major barrier to connecting messaging systems is the poor quality and standards compliance of the messages. I have also pointed out the huge deficiencies in there Medication terminology. Its these issues and the fact that they have not done a single thing to make reliable communication of medication history possible that are causing the issues.

Because of the messaging providers we actually do have electronic transfer of results, despite the negative influence of NEHTA. To somehow suggest that messaging providers are the problem when you have just wasted $1.5 Billion of taxpayers money goes way to far. Shame on you Steve, you are a hazard to eHealth in this country. This is way over you head.