Sunday, May 08, 2016
Parliamentarians Reveal Just How Little They Really Understand About E-Health. Magical Thinking In Spades!
Just before the election was called the House of Representatives released the results of an enquiry on Chronic Health Care.
Here is the full title and link:
Report on the Inquiry into Chronic Disease Prevention and Management in Primary Health Care
5 May 2016
The bits that seem relevant to e-Health and myHR seem to be as follows:
4.1 The importance of telehealth and eHealth initiatives, especially to rural, remote and low-mobility chronic disease patients, is a focus for many health care providers and commissioners.
4.2 Programs such as the Royal Flying Doctor Service’s ‘Medical Chests’ program allow patients to access the services they would not normally be able to access easily. The Medical Chests program allows for pharmaceutical dispensing for inflammation, wound care or antibiotics via caches of supplies and specialised telehealth consultations to aid in dispensing these pharmaceuticals in specific circumstances.
4.3 Innovative programs and services using telehealth and eHealth support, such as linking in multidisciplinary teams to rural cancer centres is essential to coordinating the chronic disease management of affected rural and remote populations.
4.4 Simplified video or telephone consultations for disease management, such as ‘home monitoring, coaching, video consultation appointments and home medication management’ is a key benefit that can be realised in the delivery of health care via eHealth initiatives.
4.5 eHealth support in the form of websites that allow for the convenient delivery of relevant information or secure messaging between providers of relevant records or patient information are essential to diversified health care delivery.
4.6 eHealth records, such as the expanding ‘My Health Record’ initiative are also an important component of diversified and supported health care management.
Data Registries and eHealth Records
4.1 Regardless of the expansion of the services and coordination of chronic disease care, without the appropriate data, records and patient information, both for care and evaluation and research needs, the fragmentation of chronic disease management in Australia will continue.
4.2 While primary health care, especially general practice, is a technologically advanced sector of society, the same cannot be said for allied health providers, specialists and surgeons. In 2012 only approximately 37 per cent of specialists and 22 per cent of surgeons relied on computerised patient records.
4.3 Similarly, even though general practice do generally use electronic patient records, there are still multiple proprietary systems used and on the market. It is for this reason that the Australian Government and state and territory governments established the National Electronic Health Transition Authority (NeHTA) in 2005 to help promote eHealth initiatives and create standards for the health care sector to adopt.
4.4 These standards and their application to patient records aid in the connectivity required for multidisciplinary and coordinated care. The Health Network Northern Territory highlighted the importance of eHealth in a diverse community:
Given the large geographical size of the Northern Territory, increased access to eHealth technology will greatly improve the prevention and management of chronic disease. The use of eHealth has been demonstrated internationally to decrease the administration burden of health care service delivery, improve the quality of care, increase efficiencies and encourage patient self- management. Best practice includes an electronic patient record, electronic prescribing and medication administration, telehealth services and secure message services for health professionals.
4.5 The establishment of the Personally Controlled Electronic Health Record (PCEHR) in July 2012, now the My Health Record, has enabled a universal platform for the storage and management of health information about patients in Australia and placed the control of that information with the patient themselves. The review of the PCEHR released in May 2014 establishes a firm foundation for the My Health Record to become the central repository of patient information, for both general health and chronic disease management.
4.7 NeHTA will transition into the Australian Digital Health Agency as of 1 July 2016, continuing its work in the electronic health standards space, as well as taking responsibility for the continued management of the My Health Record.
4.8 Access to the My Health Record is currently limited to the patient and any ‘nominated healthcare provider’ that is granted access by the patient’s consent; however access to the health information stored within can be accessed by certain parties in the case of an emergency.
4.9 The patient data stored within the My Health Record, as well as in the wider electronic patient and other health record systems across Australia, can form the datasets and data registries that many identify as being crucial to coordinated chronic disease care, as well as evidence-based research and policy development.
4.10 The creation of a unified national health dataset, by combining the information from federal government data (Medicare, Pharmaceutical Benefits Scheme (PBS) and aged care) along with private and public hospital data, is an ideal outcome that could help drive health outcomes and reform.
4.11 However, the reality of multiple sources, formats, quality and access to the health care data existing in Australia’s systems places barriers on accessing a centrally consistent dataset or data registry for use in chronic disease prevention or management.
Currently there are multiple datasets of patient information within the health care sector, as well as potentially replicated data held by private health insurers related to their members. The potential to access that de- identified or secure member data, to supplement any consolidated government patient data, is a compelling reason to investigate sharing and
The Committee recommends that the Australian Government examine the feasibility of linking relevant Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data, with applicable hospital patient data, to create a unified patient dataset, or to consider this link when developing the National Minimum Data Set for Healthier Medicare purposes.
Moving into the Future
5.112 Supported by well-funded and coordinated eHealth systems – expansion of the My Health Record to become the central repository of patient data, augmented by practice data and de-identified central government treatment data, that can be used for performance measurement, as well as research and outcomes-based improvement.
5.117 Additionally, the Committee recommends that the Australian Government continue to fund the evolution and expansion of the My Health Record, managed by the Australian Digital Health Agency from 1 July 2016. The importance of patient-managed care information, as well as the resultant data that can be used to measure successes, failures and outcomes, as identified in Chapter 4, is essential to moving the primary health care system into the future.
5.120 The Committee recommends that the Australian Government continue to prioritise funding of the evolution and expansion of the My Health Record to support improvements in the prevention and management of chronic disease, as well as the wellness of all Australians.
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Overall what we see here is:
1. There seems to be a total failure to recognise the myHR is a secondary system and not a primary data source. The GP, Specialist and Diagnostic systems are where the trustworthy information is.
2. The myHR is not well designed to support co-ordinated care as opposed to other much better designed private sector systems to support these requirements.
3. The politicians seem to want to create huge databases of personal health information that they can just troll at whim - while the really don’t understand just how reliable and trustworthy the base information is and how wrong conclusions may be derived. Of course all this ignores the security and privacy implications…
4. Yet again we have just a bucket load of assertions as to benefit on the scantiest, if indeed, any evidence.
The bottom line is that the pollies are victims of the magical thinking of the bureaucrats who think they can produce a wonderful data and information driven future without having a clue just how hard it will be.
Posted by Dr David More MB PhD FACHI at Sunday, May 08, 2016