Sunday, February 28, 2016

The US And UK Governments Make It Clear What Is Needed For EHR Adoption. We Were / Are Not Even Close With The mHR.

The following report appeared a little while ago:
February 2016

The adoption and use of digital health and care record systems:

International success factors

A collaboration between NHS England and US Department of Health and Human Services

Here is the link to the report .pdf
The report outlines the following purpose and objectives:
Introduction and purpose
This publication sets out the findings of a collaborative work program undertaken between the US Department of Health and Human Services, NHS England and the Health and Social Care Information Centre; to investigate ‘what good looks like’ in terms of the successful adoption and optimization of digital care records for patients. While technology is evolving, particularly in terms of usability, this report focuses on the steps providers can take to ensure successful adoption and maximize technology utility. It is hoped that this report and its supplemental materials may be used by providers of care services to accelerate the adoption process, educate the workforce, and enable provider replication of best practices in order to mitigate common challenges.
Clearly such a study has some relevance to what is presently going on with the mHR.
The concluding section and what is needed for successful adoption is what matters:

6. Conclusion

The findings from this work program have been synthesised into a set of essential attributes which can be used by organisations to consider when embarking on a digital health transformation program. These are derived from the key learning points addressing cultural aspects, workflow design, and workforce competency and leadership qualities. All of these attributes require significant initial and on-going effort, often with delayed but ultimately positive results.
Our findings were clear in that there were a number of factors which were seen as pre-requisites (must have’s) and others which, although still essential, could not work without the former. For example, core standardised infrastructure was seen as one of the ‘must have’s’, whilst localised workflow design although extremely important, would not be possible without the other.
In piecing together these critical factors, a distinction between them was made; the ‘must do’s’ were labelled Primary Attributes, with the others being labelled as Secondary Attributes, yet all still being essential .
The synthesised findings are set out overleaf, which taken together with the accompanying toolkit comprising materials from both countries, can support both those who are early into their digital journey as well as those who are more advanced on their path to digital care records.

7. Essential attributes of successful adoption

Primary attributes
Need to be in place before the secondary attributes, and remain so throughout the development and continued use of the system.
a.> Ownership and inclusiveness needs to be felt by all staff, with support for patient care as the central focus of the deployment and genuine leadership commitment. This needs clear and regular communication across the whole workforce and transparency and realism around timelines and outcomes. A culture of trust should be developed throughout the development and continued use of the system. Consider the needs of patients, engaging with them as well as clinical and administrative staff. Take time to pause, and get it right.
b.> A solid core standardised and reliable infrastructure is imperative (i.e. networks and databases) which is able to support clinical and reporting requirements. Standardised, secure, uniform interfaces, reports, and templates across the organisation are important to ensure consistency in information aggregation and reporting. Local customisation has proved to be key to successful adoption.
c.> Establish and maintain a strong working relationship with the vendor/ supplier. Work together to establish a fair contract and ensure the product meets organization and/or practice needs, ensures accessible interoperability, and identify opportunities such as participating in user groups to both learn and provide feedback to vendor/supplier to influence and inform future developments.
d.> Interoperability with other systems is imperative. Patient information must be able to flow freely among patients and providers alike, enabling them to securely send, receive, find, and use the right information at the right time.
Secondary attributes
These need to be met through mobilising the primary attributes in order to continue to successful adoption.
a.> System workflow design should be a top priority and follow intuitive care pathways where possible. It should encourage patient engagement with their record and offer efficient, flexible and relevant data input solutions. The ability to customise and adapt the solution to local requirements has been found to overcome barriers to use.
b.> Training should be continuous. A core set of competencies is a must and should include information input, retrieval skills, security, confidentiality and quality management; with some knowledge of project and benefits lifecycles.
c.> Extra skill-sets should be identified and invested in according to clinical level of use. This will help with the retention of local expertise and key roles.
d.> Local expertise and key roles need to be retained, achieving a stable and motivated workforce.
e.> Easy access and effective use of other health IT technology, including mobile technologies, should be an important part of digital strategy. Use of hand held devices, barcodes, RFID, voice recognition etc.
----- End Extract.
From alienation of the private sector, lack of training on to totally ignoring workflow consequences on GPs it is clear you would have to mark the PCEHR a fail on pretty much all criteria.
I reckon we all know why our DoH and NEHTA were not consulted on this - even though one of our academics is cited. Of course the Department / NEHTA just ignored him as best as I can tell!

1 comment:

Anonymous said...

1. alienation of the private sector (the bureaucrats believe they have done a great job engaging with the private sector),

2. lack of training (the bureaucrats believe they have put a huge effort into training doctors and others through their Medicare Local and Primary Health Network programs),

3. totally ignoring workflow consequences on GPs (the bureaucrats believe they have designed and developed a solution which will streamline workflow for GPs, save time and provide quicker access to essential patient information)

4. consequently the bureaucrats believe the PCEHR should be given a high score on all these criteria.

5. the bureaucrats believe they have done everything necessary to achieve success with the PCEHR because the peak bodies CHF, AMA, RACGP, PGA, and others, have made submissions, sat on committees, given encouragement (and some criticism).

With such compelling evidence how can the bureaucrats possibly be wrong?