This appeared last week:
ACT begins search for $70m digital health records platform
Gets ready to junk legacy systems.
ACT Health is waiting on the arrival of the territory’s new digital health records platform to begin decommissioning as many of its existing clinical systems as possible.
The agency responsible for the health needs of a 400,000-strong population made the declaration in a market approach this week for a provider to deliver the solution.
The solution, which was funded to the tune of $70 million in this year’s budget, will introduce a single health record for every person engaging with the ACT’s public healthcare system.
A central tenet of the ACT government's plan to deliver a “future-focused” public health system, the digital health record will capture all clinical interactions with patients in one central repository.
This includes core, specialty and ancillary patient information, patient administration and management and “sophisticated” analytics and reporting capabilities.
But this is expected to lead to many existing clinical systems within the territory’s “highly fragmented” IT environment being withdrawn over the next four years.
“Currently the territory’s ICT environment is highly fragmented with more than 250 different systems supporting the delivery and management of health care services,” tender documents state.
“The territory will be seeking to decommission as many existing clinical systems as possible, as soon as possible.
“However, it is recognised that it will be necessary to retain some existing clinical systems particularly in early phases of implementation of the digital health record.”
ACT Health said the e-health record would be introduced using a phased approach, the first of which – to take place over the next two years – will cover the design, build and deployment of the solution to the territory’s three primary hospitals.
More here:
From what is said here I am not sure the proponents quite get the complexity or the change management challenge of giving the boot to 250 different systems over just a few years.
Equally moving to a single repository for all clinical and apparently administration as well sounds like something of a challenge.
This will be a project to watch over the next few years….
David.
10 comments:
Will they embrace the NSW solution? or the QLD solution? or the RCH / RMH VIC solution? or the NT solution? and what will be their rationale for rejecting them and opting to follow a different pathway? Could they perhaps conclude that the ACTs needs are oh-so different?
Roll-up, roll-up and place your bets. What odds should the bookies be offering?
They are playing "Pin the tail on the donkey".
Must be about due for a MyHR meltdown of some sort. All those unresolved “bugs” all those known vulnerabilities
Why don’t they just use the PCEHR system?
What was supposed to be the PCEHR was never built. There is no identification of individuals using the system (NASH never happened), there are no conformant repositories that would have automatically provided at least some of a patient's history, there is no interoperability, as originally required as an essential infrastructure component.
Myhr is a simplistic document store, owned and operated by the government, which requires institutions to upload documents which may or may not be downloaded to other systems where the myhr privacy legislation no longer applies.
The constraints in the PCEHR - it is not a complete record of a patient's health status, it is not intended to replace existing clinical tools or be used for communications purposes - still exist.
It was never clear what the PCEHR was supposed to do, and more importantly how it was supposed to do it. The purpose and operations of myhr are even less obvious given what was eventually implemented.
The government claims as a success that over 90% of Australians are registered for a myhr. Another way of looking at the system is to say that it was necessary to abolish the need for explicit consent and forcibly enroll as many people as possible (using the principles of behavioural economics).
The Department of Health created a Behavioural Economics & Research Team (BERT)
https://www1.health.gov.au/internet/main/publishing.nsf/Content/behavioural-economics-research
which quite probably had something to do with justifying the move to opt out. The team only seems to have had one published success. There is no mention of it in the current organisational chart.
Behavioural Economics is alive and well and a team works in the Prime Minister and Cabinet's office.
https://behaviouraleconomics.pmc.gov.au/
They claim over 30 projects. There is an impact report (available from here https://behaviouraleconomics.pmc.gov.au/about) which makes reference to the lonely Health project.
The lead author of the health BERT project still works with Health but in a different role. None of the others named in the report seem to woth at or for Health.
ADHA has an interview with a UK specialist in December 2017
https://www.digitalhealth.gov.au/about-the-agency/digital-health-space/q-and-a-with-david-halpern
"David Halpern is a British psychologist who has specialised in recent years in advising governments on how the findings of behavioural science can be formulated as policy “nudges”. We recently had the pleasure of hosting him for a presentation and workshop on how these ideas could be of value in digital health.
BTW, Digital Health had dropped off the organisational chart in Jan 2018 but it's back now as "Digital Health & Services Australia" under Health Financing.
The final sentence is of interest:
"Australia was the first country to host the annual Behavioural Exchange conference (BX), and will be the first to host it for a second time in June 2018.
Given this background, it will be interesting to see what you do around digital health!"
Why don’t they just use the PCEHR system?
Why not indeed. The MyHR is certainly marketed as a clinical communication tool and patient information portal. The states and territories forced this system on us why are we now having to fund further small systems to do the same presumes job
Australia is not the only country having trouble getting eHR acceptance, in spite of bribery. The USA has spent over US$40B on an eHR incentive program. And that's only on incentives. One wonders just how much has been spent in total - software, running/maintenance/support/usage costs.
Have a look at this blog
http://www.zmetro.com/?p=7464
The first slide is taken from an official report available from this page:
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html
or a direct link (see last graphic for the summary page):
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/October2018_SummaryReport.pdf
It seems many of the states are planning to implement statewide Electronic Medical/Health Record systems. ACT, WA and NSW Health departments are all seeking expressions or interest or tenders. Queensland Health is midway through an EMR procurement. ACT Health call theirs a 'digital health record' - a confusing name when there is already a national 'digital health record.' ?
Data data everywhere, and not a drop to drink...
It looks very much as though the Government, through its Agency the ADHA, has completely lost control of its Digital Health Strategy.
「理念なき行動は凶器であり、行動なき理念は無価値である
Loosely translated
Action without philosophy is a weapon, and philosophy without action is worthless
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