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Tuesday, September 27, 2016

Here Is A Call For Progress In A Domain The ADHA Should Put At The Top Of Their List.

This appeared during the last week:

RACGP calls time on faxes and letters

22 September 2016
THE RACGP is calling time on the era of the fax machine and the letter, officially telling the government and other health services to catch up and integrate with the electronic communication systems of general practices.
The shift should happen within three years, the college says in a new position statement, citing cases where a lack of timely communication between general practice and other health services have put patient safety at risk.
In one well-known case, a South Australian coroner found that a specialist's "archaic" practice of sending a letter by ordinary post contributed to the warfarin-related death of an elderly Adelaide woman.
The statement says general practice has led the way in moving towards electronic clinical and administrative systems, but that the rest of the healthcare sector has been slow to move away from paper.
More here:
Here is the position paper:

RACGP position statement: The use of secure electronic communication within the health care system

September 2016

1.  Position

Secure electronic communication should be the preferred and default method of communication of all health services and government agencies communicating with general practice regarding patients. The systems should communicate via or integrate with general practices' electronic clinical and administrative systems. These electronic communications should be usable by and satisfactory to general practitioners and general practice staff. The RACGP advocates that services communicating with general practice work towards implementing two-way secure electronic communication within the next three years. The implementation and evolution of the National Health Services Directory now makes this achievable.
This position is consistent with the Australian Government Digital Transformation Office agenda. This agenda is focused on creating a user centered digital approach to ensure all government services are easy to use and communication can be completed entirely electronically.
Slow communication between hospitals and general practice via ordinary mail has been identified as one of the contributory factors resulting in a patient’s death. This position statement addresses safety issues where the lack of timely communication between healthcare services and general practice can result in medical errors that can cause severe injury or unexpected death.

2.  Background

The provision of modern day healthcare often involves patients interacting with multiple healthcare professionals or organisations in different physical locations. The provision of high quality, effective and safe healthcare depends on efficient communication between all parties involved in a patient’s care. Secure electronic communication is currently one of the most efficient methods of communication.
General practice has been an early adopter of electronic clinical, administrative and communication systems. This has enabled general practice to increase the quality, safety and efficiency of care provided. A national priority now exists for the rest of the healthcare sector to move away from paper based healthcare communication systems towards electronic systems.
The majority of health services and government agencies communicating with general practice do not currently use electronic communication systems which are compatible with those existing in general practice. As a result, general practices are often required to manually transfer information from their clinical or administrative systems into paper based or online forms. This information is then sent to the relevant agency via an online upload, by post, fax, or via standard and unsecured email. Information leaving general practice through these methods requires significant manual processing.
Hardcopy or image formats of letters, reports and requests received by general practice from other health services must be manually scanned and added to the patient’s clinical record. Most organisations fail to consider the implications and costs for General Practice’s to manage information transfers safely, reliably and efficiently. The inefficiencies of current processes creates a heavy burden on GPs, diverting their time away from providing essential medical care for patients.
Documents received by general practice provide the most clinical value when they can be searched and interrogated by general practice clinical software. Faxed reports which are scanned into clinical records and saved as an image are not easily searchable. Standard and unsecured email is not considered suitable for routine communication between healthcare providers and patients due to inadequate privacy and security features, and because the content of these messages has to be copied and manually ’transferred. Information manually obtained from web portals presents similar issues.

3.  The principles of electronic communication

The RACGP supports the following principles for electronic communication between general practice and other healthcare agencies:
·         all electronic communications templates and systems should where required use existing data and information from general practice clinical information systems to pre-populate documents and forms
·         all communications should be
o     created and sent from within the general practice’s electronic clinical software system and
o     automatically received into the local patient electronic health record via the clinical software system inbox
·         all electronic communications to external healthcare providers and agencies should be sent securely using secure messaging to align with to best practice data privacy handling principles protect re patient privacy and confidentiality.

4.  Conclusion

GPs are often the “information managers” for patients and rely on other healthcare organisations to reliably provide additional details regarding diagnosis, treatments, management plans and outcomes. The adoption of secure electronic communications should be a priority for the entire healthcare sector to ensure improved efficiencies and provision of safe quality care.
The original release is found here:
Regular readers will recall the poll of a week or so ago which pointed out that the ADHA needed to have a much broader agenda than the myHR. It was one of the most emphatic polls that had been conducted on the site.
Here are the results again.
AusHealthIT Poll Number 336  – Results – 18th September, 2016.
Here are the results of the poll.

Do You See The myHR As The Highest Priority For The ADHA Or Are There Other Issues (e.g. Secure Messaging)That Need To Be Addressed First?

Other Issues Need Addressing 98% (132)

The myHR Is The Highest Priority 1% (1)

I Have No Idea 1% (2)

Total votes: 135

What amazing unanimity again. It seems most think the myHR is a fair way down the priority list!
----- End Extract.
Seems the ADHA needs to simply get on with this and make sure all the barriers and issues are resolved ASAP. A list to address might include security, privacy, end-point location, ease of use etc. etc.


Anonymous said...

Here we go again - the RACGP beats the drum - BUT is anyone asking why have we not progressed on this front in the last decade. What specifically was wrong with the approach that NEHTA was using? Why did it fail? What did the RACGP NOT DO? What should the RACGP DO NOW? The RACGP has made a statement but so what - words, words, words but is there strategy? Is there a commitment? and what of the vendors required to deliver the solution? It won't happen without them.

Anonymous said...

Nothing will happen until the government gets out of trying to create software, mostly by paying overseas companies silly amounts of money. They need to govern by insisting that existing standards are complied with well. The level of concern about quality in the current software market is just scary. I hate to think what terrible things have happened because information was lost or not presented well.

The level of interest in quality is quite concerning, It should be the place where quality is everything, after all peoples lives do depend on it!

Anonymous said...

ADHA’s dilemma is one of confused internal conflict. It wants to see one national health record for every person in Australia but it doesn’t have the skills to architect one let alone develop.

It wants to set standards in all aspects of healthIT which all vendors should adopt and adhere to but it doesn’t have the knowledge, insight or experience across all the various health sectors to set those standards.

It also doesn’t have the wisdom to understand that many, many vendors have invested huge sums over many years in software development which their customers happily pay good money to use, so it doesn’t make sense to expect any vendor to change direction and embrace some untried, unproven, controversial government dictum.

September 28, 2016 5:30 PM says government should get out of trying to create software. It needs to govern by insisting that existing standards are complied with well. All valid and correct, however the problem here is very complex – the government doesn’t know how to do that and it doesn’t know how to let market forces reign supreme whilst ensuring its objectives are achieved and the major consulting forms don’t know either. Catch 22.

Bernard Robertson-Dunn said...

ADHA’s dilemma is one of confused internal conflict. It wants to see one national health record for every person in Australia but it doesn’t have a god reason for doing so.

Summary health records can be useful in some cases. I have never seen an argument that says a national summary health record system, accessible, and controlled, by patients has much clinical value.

IMHO, the federal government should be looking at getting the states to co-operate and work towards common (or at least, compatible) systems that permits the appropriate interchange of health data.

ADHA should be a facilitator of outcomes, not a developer or operator of systems.

And most importantly, ADHA and the federal government should have no role in collecting and/or storing personal health data.