This appeared last week:
17 August 2020
GP study looks at impact of education and My Health Record
The CHIME GP study is a project to help GPs use the latest evidence around prescribing, pathology and radiology ordering to improve patient outcomes using My Health Record.
CHIME (Clinical and Healthcare Improvement through My Health Record Usage and Education in General Practice) looks at potential change in GP behaviour both before and after education around de-prescribing and rational use of pathology and diagnostic imaging ordering.
The education also incorporates use of My Health Record (MHR) in an everyday clinical setting to assist GPs in avoiding duplicate or unnecessary tests, preventing the pitfalls of polypharmacy, and improving delivery of patient-centred care.
CHIME-GP is a CPD Accredited Activity* (formerly 40 category 1 points) and recognises your time with a $200 (ex GST) payment.
More here:
http://medicalrepublic.com.au/gp-study-looks-at-impact-of-education-and-my-health-record/33160
Here is more information:
CHIME-GP Study
Background Information
Welcome to the CHIME-GP Study (Clinical and Healthcare Improvement through My Health Record usage and Education in General Practice). Below is some background information about the study, along with links to participant information and consent forms.
This research is being funded by the Australian Digital Health Agency (ADHA). ADHA has contracted Medcast Pty Ltd to deliver the educational intervention to GPs. Medcast has subcontracted the University of Wollongong (UOW) to conduct an evaluation of the intervention.
The main purpose of this research study is to see if GPs can use My Health Record (MHR) effectively to improve how they care for patients. As part of the study, the doctors will receive online training on improving the way they order tests and prescribe medications.
The study will have 3 arms. When GP participants sign up, researchers will randomly allocate GPs into one of the following arms:
- Rational prescribing
- Pathology
- Diagnostic Imaging
Information Sheets
For details regarding your participation in this study, please review the information sheets via the links below.
PenCS Topbar Terms & Conditions
Consent Forms
To enrol in the study, you or your practice manager need to complete and return both of the following consent forms. Please return completed forms to the UOW research team per the instructions provided on the forms.
Enquiries
If you have any queries relating to consent forms and ethics, please contact the UOW research team – Alyssa Horgan amunkman@uow.edu.au
If you have any queries relating to the educational intervention, please contact the Medcast team at chime-gp@medcast.com.au.
Enrol
Enrol now to be eligible for a $200 (ex GST) payment.
Here is the link:
https://medcast.com.au/chime-gp-study/chime/
What is interesting about this study is that it runs for 12 months. The PENCS software monitors clinical ordering activity for 6 months – there is some on-line education in the areas above for a few hours and then monitoring occurs for another six months to see if there is ‘improvement’.
The data collected will be:
· Age and sex of patients;
· Consultation rates at a practitioner level;
· Baseline and post-intervention rates of prescribing, pathology and imaging ordering at a practitioner level; and
· MHR access rates at a practitioner level.
Just what the MHR does in all this and how the effect of MHR use versus the effect of the education is hard to follow. Given the education is only on one of the three target areas is becomes more so.
I have a PhD is clinical research and frankly just what is actually going on and what might be able to be concluded from this eludes me.
Can anyone explain?
David.
Note: The use of CHIME is a bit too cute.
CHIME
The College of Healthcare Information Management Executives (CHIME) is the professional organization for Chief Information Officers and other senior healthcare IT leaders. CHIME enables its members and business partners to collaborate, exchange ideas, develop professionally and advocate the effective use of information management to improve the health and care throughout the communities they serve.
See here:
https://chimecentral.org/about/
D.
27 comments:
clutching at straws. MYHR is supposed to be for patients (hence the My), not for GPs who have the data (and more) anyway. Sounds rather like the study into ED use, which has never seen the light of day - or peer review.
The purpose of the My Health Record has never been documented with precision and clarity; vague, unsubstantiated claims about a multitude of benefits, devoid of deep analytical critical thinking, have been embraced to justify its development. To give credibility to such claims a lot of peak professional and consumer bodies also lacking in critical analysis have been enticed to add their voices and support.
From the Auditor-General Report No.13 2019–20, Performance Audit
"The rationale for the My Health Record system was based on the intended benefits of a single point of access to health information at the point of care. The Minister for Health stated in August 2018 that:
Health information is spread across a vast number of different locations and systems. In many healthcare situations, quick access to key health information about an individual is not always possible.
Limited access to health information at the point of care can result in a greater risk to patient safety, less than optimal health outcomes, avoidable adverse events, increased costs of care and time wasted in collecting or finding information, unnecessary or duplicated investigations, additional pressure on the health workforce, and reduced participation by individuals in their own healthcare management.19
Footnote 19: My Health Records Amendment (Strengthening Privacy) Bill 2018, Explanatory Memorandum, p. 1."
For those of us who have followed myhr since it was proposed know that it is not "a single point of access to health information at the point of care"
It was intended to be but isn't. The government's own website makes it clear that there will be no historical data in the record when it is activated. Furthermore, there is no way such data can be incorporated, only summary data and test data.
As it isn't what is claimed, there is no way it can deliver the supposed benefits.
Read the publicly available details of myhr and you will quickly come to the realisation that it is obviously a fraud.
Just an academic paper, churned out by the hundreds every year. Academia like online media content throws some good nuggets occasionally but you have to wade through a lot of cheap productions to find it.
I am sure this paper met someone quota for something
Was the architecture encompassing a "single point of access" conceptualized around "one centralised database" or a number of "specialised databases"?
The single point of access was supposed to be achieved by creating a virtual record by accessing existing data sources (they were called conformant repositories). This required solving the interoperability problem. It was a critical infrastructure components but wasn't solved and is still outstanding.
The central database in the original design was only there for a few extra, optional documents such as summaries. That is all that was implemented. All the data in existing databases is still there - inaccessible by myhr. Hence the lack of historical data in a myhr.
"Conformant repositories". How many different conformant repositories were envisaged?
What was the specific function / purpose of each repository?
Should each repository be (have been) developed in parallel or would that be (have been) too huge a task, and if so would developing one repository at a time and proving its efficacy be (have been) a better approach?
@Ian 9:11am
You might be interested in what the Concept of Operations (ConOp) says about the PCEHR:
(The PCEHR) "is a distributed system of service providers working in concert and not a single government store of personal information."
Except it isn't.
To repeat - the PCEHR (and hence the myhr) is not what it was intended to be, nor what it is claimed to be.
Re your questions:
The ConOp did not specify a limit to the number of conformant repositories.
The ConOp says:
"infrastructure services will be used to facilitate access via a service coordination layer to a range of PCEHR-conformant repositories. This includes a national repositories service and the capability to link to other independent conformant repositories, such as repositories offered by the Department of Human Services Medicare program, Diagnostic Service Providers, regional operators, State/Territory public health system(s) and other parties."
These repositories were supposed to be indexed by the PCEHR:
"6.4.3 Index Service
Purpose
If the individual chooses to participate, the index will associate an individual with a range of his/her clinical documents already stored within the PCEHR conformant repositories.
The index stores metadata (i.e. data that serves to provide contextual information about other data) about each clinical document; the actual content of the clinical document is stored within a PCEHR-conformant repository."
i.e. a virtual record that gets much of its information (including historical data) from existing sources.
It is also worth noting some of the other specifications (i.e. promises)
"4.3.6 Prescribing and Dispensing information
The PCEHR System will enable the collection of Prescribing and Dispensing information.
Participating prescribers and dispensers who have access to the PCEHR System will be able to upload a copy of Prescription and Dispensing information to the PCEHR System. This information is a copy of information that is also sent to the Prescription Exchange Service (PES).
Prescriptions and dispense records will be provided as a level 2 or 3 clinical document conformant with the NEHTA Electronic Transmission of Prescription Specifications [NEHTA2010f] and forthcoming Australian standards. eHealth Site Notes: The FRED IT Group Medview eHealth site will be informing the development and implementation of the sharing of Prescribing and Dispensing information.
Scope Notes: The PCEHR System will include the capability to index a conformant repository containing Prescribing and Dispensing information from July 1 2012. NEHTA will work with the FRED IT Group Medview eHealth site to develop a transition plan."
Not surprisingly the ConOp is no longer available on the ADHA website. A copy is available here:
https://www.privacy.org.au/Campaigns/MyHR/docs/PCEHR_110912_Concept_of_Operations.pdf
It might be argued that the ConOp as originally developed does not represent what was actually delivered, which is a reasonable claim, especially as it is so obviously not what was delivered.
However, the ConOp does say:
"The Concept of Operations will be periodically updated as the development of the PCEHR System progresses."
Ironically when the Department of Health made a submission to the Senate inquiry into the opt-out process, they had to refer to the above link. It could be that the ADHA is not keen to have the ConOp circulating freely. You might think it was some sort of conspiricy; I couldn't possibly comment.
The one thing that has been consistent throughout this whole sorry saga is the unkept promises.
To the experienced eye in large scale system development and deployment of a highly complex system involving vast numbers of disparate users and information sources and an untold number of messy workflows and political scenarios to be accommodated the approach adopted was bound to fail.
Too big, too fast, too many, too broad, too ambitious, too vague, too complex, too costly.
"To the experienced eye in large scale system development and deployment of a highly complex system involving vast numbers of disparate users and information sources and an untold number of messy workflows and political scenarios to be accommodated the approach adopted was bound to fail."
That's the modern, IT way.
The engineering approach it to a) realise there are huge uncertainties and b) adopt an approach of test and learn. i.e proofs of concept, prototypes, pilots, small scale adoption, etc.
Governments don't like this sort of approach, not with IT anyway. They believe the magic offered by consultants and vendors.
Yes indeed Bernard "That's the modern IT way". Fast track, high level conceptual design and work out solutions to problems as they arise along the way!
The traditional way, emoying a strictly formalised engineering design approach to development of an SEHR to replace the MHR has the greatest likelihood of success. There is $5M available to undertake that challenge. The biggest obstacle is enrolling the 'right' people.
I sense that ‘engineering’ a better future and a way out is Beyound ADHA current cohort. What you will find is they try and change the conversation, you see it with Bettina trying to pivot using telehealth, but like the GOP not mentioning the impacts of COVID-19.
@5:45 PM They can change the conversation anyway they like; upside down, inside out and back to front, it matters not.
If they aren't involved in the challenge at 5:06PM they aren't involved in the conversation that counts.
@5:06PM "The biggest obstacle is enrolling the right people." Now that's a real challenge. How many are needed? What experience, what skill sets, where might they come from, what would they do, are some questions which immediately spring to mind. Yep, that's a challenge for sure.
@5:45 PM ".... Bettina trying to pivot using Telehealth ..."
She is not alone The new 'theme' (the latest fad) is that Telehealth will provide the ubiquitous infrastructure which will support all the integration and interoperability solutions that the health system has been seeking for a very kong time. Telehealth - panacea extraordinaire - why did it take so long? What would we do without Bettina and others to show us the way?
It is all about learnings dear citizens, all about learnings. Pulse IT are suggesting we will see an announcement for the new CEO. The pendulum has swing that is for certain. Grey is the new colour of clinical innovation. Guess a few acting roles will become surplus to requirement as is always the case.
Looks as though it's going to be a bureaucrat. If so that's a resounding vote of no-confidence from the world of Digital Heath. MyHR is so toxic they couldn't attract anyone from outside the Canberra bubble.
Whoever it is is in for an interesting time as they try and breath some form of life into a $2 billion corpse. Or maybe they are being brought on board to bury it. This would explain the lack of interest from those who actually want to make progress in healthcare.
The news release will tell a lot about the government's intentions, probably for what it doesn't say rather than what it does.
I'm not too bothered by whether the appointment is a 'bureaucrat', an industry 'expert', or an 'academic'. In theory, and perhaps in practice, the CEO answers to the Board. Therefore the first question to consider is - 'How has the Board performed'? The second is - 'Who will have the authority, power, courage and freedom, to ask the hard questions and pursue the difficult answers unrelentingly. The CEO needs a unique combination of objectivity, insight, experience and advice, in order to redress the wrongs and succeed.
@11:24am
'Who will have the authority, power, courage and freedom, to ask the hard questions and pursue the difficult answers unrelentingly. The CEO needs a unique combination of objectivity, insight, experience and advice, in order to redress the wrongs and succeed.
It would be nice for once to have someone who can understand the answers and recognise when they (and we) are being conned.
@11:42 AM "someone who can understand the answers". It involves an awful lot more than that.
It involves an awful lot more than that.
It would be a good start.
Looks to me like the new CEO has been known for a year. If you look at one candidates movements the last year it smacks of MOG. Lines up with Timmy disappearing with tail between legs and Bettina stepping up to support the cause.
No problem with that, just remember this now marks the end of an era. There will be no standards, no specifications, no conformance, no market engagement.
Agree with Paul. ADHA has been a great pawn.
Appointing a pawn as CEO from the health bureaucracy is the first step.
The next is to begin transferring some ADHA staff back into various government departmental cemeteries, such as Services Australia or Dept of Health. Finally Board Directors step down after the Last Rites have been said as the coffin slides into the furnace at the Crematorium of Terminated Projects.
Time to appoint an Undertaker, failing that an Executioner.
Oh well. Another week. Still no announcement of a CEO for ADHA. Why am I not surprised?
Won’t spoiled the surprise then
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