Wednesday, May 17, 2017

The Medical Republic and Jeremy Knibbs Are On A Roll As Far As The myHR Is Concerned.

This appeared late last week:
12 May 2017

MyHR might now be ‘the mother of all red tape’

Posted by Jeremy Knibbs
In the ABC satire Utopia, the head of department asks a consultant to do an “independent review” of a recent project. The consultant asks: “What do you want the findings to be?”
The government-commissioned report by the Siggins Miller consultancy on the My Health Record trials is life imitating art. Here are 10 reasons why this report feels a lot like it is what the Department of Health wanted it to be.

1. A compulsory MyHR?

So far, not one key stakeholder has bought into the MyHR in a meaningful manner, except, of course, for the government itself. Not patients, not healthcare professionals, not key service providers such as software vendors or private pathology.
So, after $1.5 billion and counting, what is the government’s answer to this dilemma? Make it compulsory? Sorry.
What if the system and the concept are (or always have been) fundamentally flawed? There are lots of reasons to suggest that the MyHR idea, certainly in its original grand form, has had its time.
Several technologies are reinventing the concept of a flexible electronic health record from the ground up. More agile, more accurate and timely patient record systems have started via private providers, and they look like they will do a lot of the job the MyHR was originally designed to do.
Yet here we are considering making the system compulsory and tying all points of data in our health system to it. Without understanding its utlity in our rapidly evolving digital ecosystem  better such a move risks creating ‘the mother of all red tape’. We are at the point of bribing doctors to use it via ePIP, and they still don’t engage in it meaningfully.
Do we really think the standover regulatory path will make it work? We’ve had to pay GP-patient management software vendors to write to it, because they didn’t see any use in it.
The major private pathology providers won’t touch it because they see no benefit. Patients don’t care about it, which is why we’ve decided we need to opt them in, understanding full well that their apathy will work in our favour once it’s opt out.
The argument from the DoH seems to go that the reason no one is engaging so far is because the system needs a critical mass of data. Maybe. But if no one is engaging – patients, doctors and service providers – wouldn’t you be a bit cautious about simply ‘enforcing’ the use of the system?
Read the other 9 points here:
I have to say it is really good to see that there are others who have scepticism regarding the myHR.
I look forward to continued analysis that highlights just how many warts there are on this awful myHR program!


Trevor3130 said...

Re "Co-design is a fancy way of saying, when you are designing and implementing a complex system, do it with the people who have to use the system."
Fine, but in the end, when they have a system that's good who gets the kudos? GPs may have invested their own time, without payment, and would be lucky to get mentioned in a footnote.
GPs look at "co-design" every working day. Do they see perfection in the systems they have helped knock into an acceptable shape? What are the drawbacks and irritations that GPs experience when they log on & go about their consultations?
"Co-design" is a can of worms, a concept without foundation in the real life of medical practice. To be still talking about it, this far down the track, is evidence of tragic failure.
But, it must have worked in successful systems for other industries. How?

Anonymous said...

Trevor a good example is the ViSTA work from the VA in the US. The referenced article is well worth a read and demonstrates how Government entities are to some extent are unable to help but smoother such approaches. We saw if with the PCEHR, consultations and standards where paid lips service, the customers needs were not balanced with the owners needs hence why we have a system that works for neither and a long way to go. I don't think we even have an agreed franework from which we can setting on a language to know when agreements are meet and divergences are understood. Something even school kids have in the playground.

Bernard Robertson-Dunn said...

The only problem I have with co-design is that it should be done after answering the question:

Would a secondary health data system that is expensive, government owned, difficult if not impossible to keep the data accurate and reliable, has enormous privacy risks, ever be of use to anyone beyond a few unusual people for which there are better solutions?

After five years, we are pretty sure that the question is valid, we just haven't seen any evidence that Yes is the correct and/or defensible answer.

Especially when we know that there are other, better solutions to the real problem of how to improve clinical data flows between healthcare providers and between healthcare providers and patients; recognising that they are two very different problems, neither of which require government to see or own the data.

Trevor3130 said...

Scot Silverstein on "Texting while driving".

Bernard Robertson-Dunn said...

Trevor, That link deserves a better tagline:

"Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records"

and a quote from the original article, with the same headline

"The sound of medicine is not the click of a mouse. It is the human voice."

A question:
Has anyone, ever, seen any information from the Department of Health, NEHTA or ADHA on the costs, risks and unintended consequences of the MyHR so that people can get the full picture and make up their own mind?

This blog is one of the few places that identifies, explores and discusses these issues. Unfortunately it's too much like screaming into the vacuum.