Sunday, December 04, 2016

If I Wanted To Get There I Would Not Start From Here. This Rather Describes The Problem We Have With The myHR!

The blog I posted last Wednesday has thus far attracted 17 comments – which is getting close to a record!

Tuesday, November 29, 2016

Do You Reckon This Success In New Zealand Might Just Help Reshape Our Digital Health Strategy? A Critical Post I Believe!

Here is the link:
The nub of the message (and problem) is summarised in one sentence:
“Patient portals enable patients to manage aspects of their own healthcare such as booking appointments, requesting repeat prescriptions and messaging clinical staff directly,” says Coleman.
This view has been confirmed by the Royal Children’s Hospital in Melbourne using an Epic Portal.
This is what they now have:

Your RCH medical record at your fingertips!

My RCH Portal connects you with information in the RCH medical record, when and where it suits you.
You can use My RCH Portal to: 
  • add or update information on your child's medical record about medication they are taking, allergies or other health problems you want to flag with your child's doctor 
  • request, confirm or cancel upcoming hospital appointments
  • see your schedule of upcoming appointments
  • see which medications your child has been prescribed and instructions for taking them
  • see test and imaging results 
  • read some of the notes taken by your doctor in appointments
  • view your child's care plans. 
Over time, My RCH Portal will grow to offer even more information and features that benefit you and your child. 
Here is the link:
The portal can be accessed via the web and via mobile phones (Android and iPhone)
To me it is pretty simple what needs to happen with the myHR. If it is to become useful and used it needs a fundamental re-design to offer what can be done in NZ and at RCH and this needs to be at the core of the new ADHA Strategy.
If the ADHA will not face up to the fact that the present myHR is a lemon and will never provide what the public wants and needs then we all need to give up on the National Plan and work to improve things locally and regionally.
This is the one chance for the ADHA to become useful and valuable. Blow it and they will just drift into irrelevance as local solutions are developed.
Even with this re-think and re-design it won’t be easy. Without it, it is plain hopeless.
The great blog from John Halamka says it all.

Where does health care IT hurt? Everywhere.

Over the past few months, I’ve been in England, China, Denmark, New Zealand and Canada.
Each of them is rethinking their health care IT strategy and is not entirely satisfied with past progress.
I’m often asked by senior government officials to help harmonize IT strategy at the country level. That — I can do.
I frequently say that health care IT issues are the same all over the world. Here are a few common observations:
1. Top down never works. In every country I’ve visited (there are 195 in the world right now, and I’ve been to about half), I’ve never found a health care IT program that succeeds by disenfranchising stakeholders and imposing a solution from above. Asking users what they want/need, then working collaboratively to deliver a workflow solution that enables them to practice at the top of their license tends to overcome any resistance to technology implementations.
2. A single EHR for a state, province or country never works. The VA, Kaiser, and Department of Defense are completely vertically integrated which means that payers and providers in all sites of care (inpatient, outpatient, emergency, urgent care, long-term care) are part of the same organization and management structure. A single EHR platform works in those circumstances. However, when a country has private payers, private providers or a mixture of a public payer with private providers, there is not a single command and control structure. There will be heterogeneity in requirements and care processes. A single EHR vendor cannot support all use cases. Similarly, having 50 different EHRs is unlikely to provide the data integration and care coordination needed by a regional group of health care organizations. The right answer is a parsimonious approach — the fewest number of EHRs and technology tools to meet the needs of the region — not one and not 50. In Eastern Massachusetts, we use about six.
Lots more here:
What I am interested in is what those with more technical experience than me believe can be saved from the $2Billion Program (not much I suspect) and what is needed to get us to where we need to be?

1 comment:

john scott said...

David, if we pick up John Halamka's points as a package and then turn to your question, I suggest: you are asking the wrong question.

Point 1: What is our collaboration strategy to enable effective workflow solutions, solutions that reflect preferred care delivery and embraces digital pathways?

Point 2: What is our Health Record Repository strategy? How do these pieces fit into the complex mosaic that is our healthcare system? One question would be: where does the 'openEHR' initiative fit in?

Point 3 Interoperability has to start with the clinicians and be resolved through our collaboration strategy in order for us to have proper specifications for the data and IT requirements. The communications between and among clinicians as well as with patients and carers has to share the same meaning at both ends of the conversation. This cannot be taken for granted.

Point 4: Healthcare is a Service Industry. A Return on Investment calculation requires a more sophisticated set of metrics; money is simply too narrow a base given that there is a potentially huge difference between Output and Outcome in terms of healthcare's impact on the financial situation of an organization and the fiscal situation of a country. Further, we need a more sophisticated conversation about the difference between 'services' and 'infrastructure'. You see some of this in the growing debate about so-called 'Platforms'. The identification, design and development of platforms requires a sophisticated collaboration mechanism--one that is able to think and act in 'network-centric' terms.

Point 5: This could be considered a strategic conversation where 'Both-And' thinking is involved. That is, we think in terms of our repository strategy and our platform strategy. A platform might be a platform for asking questions in the system where there has to be agreement that the question can be posed to those who have access to current and past knowledge. The NZ Parliament did something like this in the late 1980s when it wanted to get some sort of answer in respect of the health effects of unemployment. The worked closely with the College of GPs and the small number of software vendors to pose the question(s) electronically and with patient privacy concerns upheld.

If we are to obtain any value out of the ADHA 'opportunity' then we need to start with a framing that enables the right questions to be asked and high value contributions to be made.

The demands on our healthcare systems will only increase along with the costs. Taking a judicious step back and moving up a level or two to begin our conversation with the above points can make all the difference for all stakeholders. This is not a 'zero-sum' game.