tag:blogger.com,1999:blog-23447705.post3936272475543066917..comments2024-03-28T17:49:03.998+11:00Comments on Australian Health Information Technology: Now Here Is An Approach That Might Actually Make A Difference! Fascinating Stuff.Dr David G More MB PhDhttp://www.blogger.com/profile/06902724829795199526noreply@blogger.comBlogger35125tag:blogger.com,1999:blog-23447705.post-86166732284502678042012-02-28T10:48:40.464+11:002012-02-28T10:48:40.464+11:00So, now the PCEHR is "to big to fail" - ...So, now the PCEHR is "to big to fail" - oh dear, what fills me with dread. It already has failed!!! It's currently nailed to the perch.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-57620268080244781192012-02-28T10:27:43.181+11:002012-02-28T10:27:43.181+11:00According to Nicola Roxon last week the PCEHR was ...According to Nicola Roxon last week the PCEHR was another Kevin Rudd whim made with no proper cabinet consideration.<br /><br />It is apparent she is now trying to distance herself from the impending fallout she sees ahead and perhaps open the way for Tanya Plibersek to call a halt to the project. <br /><br />Sensible Minister’s know that either way the PCEHR will be a painful carbuncle for Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-22855533690947211122012-02-28T09:37:03.981+11:002012-02-28T09:37:03.981+11:00With $760 million already spent according to Karen...With $760 million already spent according to Karen Dearne in The Australian today it is no longer possible for the PCEHR project to "whither and die."<br /><br />Why not? <br /><br />You may well ask. Because there are now so many senior bureaucrats too deeply involved in supporting this project in Federal, State and Territory jurisdictions that it now has a life of its own and no one Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-47081202298963519092012-02-28T09:21:29.839+11:002012-02-28T09:21:29.839+11:00Today’s Australian details the extent of the highj...Today’s Australian details the extent of the highjack “Labor's Personally Controlled Electronic Health Record system blows out to $760m” when put in the context that nothing of note has yet been delivered.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-62832437164953211712012-02-27T19:12:22.911+11:002012-02-27T19:12:22.911+11:00"In summary – the eHealth Agenda has been hij..."In summary – the eHealth Agenda has been hijacked." ..... is precisely what I warned on this blog was going to happen. If I looked back I think I'd find it was about 24 to 30 months ago. And if you don't mind me saying so I think it is now all too late to do much about it ... except let it happen until it withers and dies.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-52548168955539471902012-02-27T16:37:49.342+11:002012-02-27T16:37:49.342+11:00Dr David More wrote: "Keith, I posted this bl...Dr David More wrote: "Keith, I posted this blog to point out there are alternative approaches to e-Health."<br /><br />David, I have no quibble with your post. Some of the comments failed to recognize the fundamental differences, and it was some of these that I was trying to clarify, and make explicit.<br /><br /> "The fixation on the PCEHR as the only way forward is a key part of Keith Healenoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-85435116850492173612012-02-27T15:16:41.136+11:002012-02-27T15:16:41.136+11:002/27/2012 09:51:00 AM said: “In my view, the main ...2/27/2012 09:51:00 AM said: “In my view, the main thing wrong with the PCEHR is that it is simply the wrong project. There are many ehealth services which need to be progressed and which would make a difference. Universal secure messaging …. Universal electronic prescription service …. having these services in place would have immediate benefits …. There has never been a solid business case for Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-76612312076791637712012-02-27T12:04:24.167+11:002012-02-27T12:04:24.167+11:00Keith, I posted this blog to point out there are a...Keith, I posted this blog to point out there are alternative approaches to e-Health. The fixation on the PCEHR as the only way forward is a key part of my problem with what is happening at present.<br /><br />David.Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-54656284478094103022012-02-27T09:51:19.630+11:002012-02-27T09:51:19.630+11:00This discussion started with "what are the di...This discussion started with "what are the differences between this (TPP) system and the PCEHR?", but then drifted to "what's wrong with the PCEHR?". A brief comment on each of these questions follows.<br /><br />First, the Clinical Record Viewer in use at Scarborough Hospital, UK, works only with patients of GP practices using TPP's SystmOne software (which is about Keith Healenoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-47629759092302296472012-02-27T08:34:20.881+11:002012-02-27T08:34:20.881+11:00"I too deplore Anonymous contributions too. B..."I too deplore Anonymous contributions too. But that's the rules of the game at the moment."<br /><br />Pretty sad that - but I do understand. The sadness is that this reflects the corruption of our free and open market in e-Health towards an awful form of money driven domination by NEHTA and Government.<br /><br />The number of smart people who talk to me off the record - in fear Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-49486933896220214142012-02-27T08:28:09.837+11:002012-02-27T08:28:09.837+11:00"I think this is why a few very sensible peop..."I think this is why a few very sensible people have been advocating a more incremental, modular, less ambitious approach."<br /><br />I have been advocating that since 2009.<br /><br />David.Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-20905617163445859302012-02-27T08:25:51.708+11:002012-02-27T08:25:51.708+11:00Look, first let me say I do love my exclamation ma...Look, first let me say I do love my exclamation marks - they make me heppy and stop me saying ruder things! Ignore them if you like.<br /><br />Second, there was a workable practical plan for e-health developed in 2008 and instead we have wound up with a much riskier and less well thought out "shock and awe" approach - which I judge to be wrong.<br /><br />Third my submission to the Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-71870292620770506202012-02-26T22:58:30.176+11:002012-02-26T22:58:30.176+11:00This a catch 22 scenario. You want evidence base t...This a catch 22 scenario. You want evidence base to demonstrate it will work before going ahead to build it. Yes, you have said repeatedly that there is not such system anywhere in the world therefore, quid pro quo, there is no evidence base. So you cannot prove it will or will not work until you have build it and put it to the test. Either it will work or it will not work.<br /><br />I think Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-69280576037582858602012-02-26T22:49:21.360+11:002012-02-26T22:49:21.360+11:00I asked..
"Where do you get the idea that pa...I asked..<br /><br />"Where do you get the idea that patients can edit the material?"<br /><br />You replied<br /><br />"They can delete records and do whatever they like with any data they enter.<br /><br />Enough said."<br /><br />That's not enough. Patients cannot edit records added by other clinicians. They can only hide them. You casually say "doctors won't Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-38196133069327126072012-02-26T19:42:19.055+11:002012-02-26T19:42:19.055+11:00Sorry.
Spending 1/2 a billion dollars should have...Sorry.<br /><br />Spending 1/2 a billion dollars should have an evidence base before you start. Why does that not exist?<br /><br />The evidence for other approaches does exist.<br /><br />Are we in an era of blind faith based policy or evidence based policy?<br /><br />You can keep typing all you like - this is something I have been saying for at least 18 months - I did not just make it up to Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-40652703599603453622012-02-26T19:22:20.168+11:002012-02-26T19:22:20.168+11:00It's a classic political ploy to ask for more ...It's a classic political ploy to ask for more evidence. Prove it will work. Which cannot of course be done - it's delaying tactics, not an argument. <br /><br />If you want commentary from those who are involved, however tangentially, you will need to accept that they don't come with names.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-12100314702526490052012-02-26T19:17:12.534+11:002012-02-26T19:17:12.534+11:00Funny how no one will use their name.
My view is ...Funny how no one will use their name.<br /><br />My view is this is a rubbish plan and when someone actually provides some actual evidence I am wrong I am happy to listen.<br /><br />To date all the evidence (KP etc) supports my view and on one has amy evidence to support the PCEHR. If it exists - link to it!<br /><br />David.Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-90607783092661243742012-02-26T18:31:02.627+11:002012-02-26T18:31:02.627+11:00There's more than one person in the thread Dav...There's more than one person in the thread David, which isn't immediately evident as it's all posted as anonymous. <br /><br />I disagree with your assessment. Nevertheless, you are entitled to your opinion.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-50311562310827013852012-02-26T18:13:08.692+11:002012-02-26T18:13:08.692+11:00Sorry,
I am tired of this.
The planned architect...Sorry,<br /><br />I am tired of this.<br /><br />The planned architecture is rubbish in my view and lots of the other points you admit are problems and there are 4 months to go. The thing is a mess and $500M has possibly been wasted.<br /><br />The Clinical, Privacy and Vendor organisations think is it pretty awful. But you want to steam ahead. Just why is that I wonder?<br /><br />David.Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-3988936921584145322012-02-26T18:06:58.932+11:002012-02-26T18:06:58.932+11:00> possibly compromised by Government
uh? What ...> possibly compromised by Government<br /><br />uh? What do you have in mind here? What in the ConOps gives you ground for thinking that the government can compromise the record?<br /><br />After the last week where we have learned what politicians are really like I am in "don't trust and extreme verification mode!"<br /><br />You can be sure they will work out a way to 'Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-76711571488226609122012-02-26T18:06:25.625+11:002012-02-26T18:06:25.625+11:00- No incentives for use.
Can be changed later - l...- No incentives for use.<br /><br />Can be changed later - likely to reduce takeup but not cause failure.<br /><br />- Doctor mistrust.<br /><br />Can be a problem. But probably also something that many doctors are taking a "wait and see" approach to. <br /><br />- Utterly wrong architecture.<br /><br />Wrong in what sense? If this is true then it would be something that was hard to Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-79812676397069126862012-02-26T18:02:50.809+11:002012-02-26T18:02:50.809+11:00"Where do you get the idea that patients can ..."Where do you get the idea that patients can edit the material? It's digitally signed by the provider, and they can't do that. What is added is what is read, and the digital signature can always be verified."<br /><br />They can delete records and do whatever they like with any data they enter.<br /><br />Enough said.<br /><br />David.Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-37063533091587906872012-02-26T17:59:27.148+11:002012-02-26T17:59:27.148+11:00Issues that will have it fail:
- No incentives fo...Issues that will have it fail:<br /><br />- No incentives for use.<br /><br />- Doctor mistrust.<br /><br />- Utterly wrong architecture.<br /><br />- Lousy management of project overall.<br /><br />- Health IT Vendor Community estrangement.<br /><br />- Lack of Governance Framework that is even 1/2 reasonable.<br /><br />- No working identification management.<br /><br />- Lousy expectation Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-45349798960923884232012-02-26T17:57:39.997+11:002012-02-26T17:57:39.997+11:00> possibly compromised by Government
uh? What ...> possibly compromised by Government<br /><br />uh? What do you have in mind here? What in the ConOps gives you ground for thinking that the government can compromise the record? <br /><br />And the GP is only the GP. they can maintain a health summary, but there's loads of interesting data for chronically sick people (you know, the ones that actually consume the bulk of the money) that Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-72248936584310672202012-02-26T17:55:33.490+11:002012-02-26T17:55:33.490+11:00> we go an mess the purity of that idea up by
...> we go an mess the purity of that idea up by <br />> allowing patients to edit and censor and <br />> others to add other material<br /><br />Where do you get the idea that patients can edit the material? It's digitally signed by the provider, and they can't do that. What is added is what is read, and the digital signature can always be verified. <br /><br />They can censor, yesAnonymousnoreply@blogger.com