Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, December 03, 2010

Finally the Department of Health Releases a Description of the PCEHR. Does It Make Sense?

The 6 page document can be downloaded from here.

http://moreassoc.com.au/downloads/DoHA%20Fact%20Sheet%20No%201.pdf

The file is a .pdf and about 2.5 megs.

It seems to be the basic idea of all this is that their PCEHR will have a basic record for the absolute clinical basics and pull everything else in from current systems. It is very much like the US Health Information Exchange approach as best I can tell.

A grand vision that will take ages to implement! Note it will be easy to have people register to have something that won’t deliver for years into the future!

David.

Thursday, December 02, 2010

How Did We Go Getting Answers From the E-Health Summit? You Be The Judge.

A couple of weeks ago I published a blog asking the questions I had hoped the Summit might answer.

The full post is here:

http://aushealthit.blogspot.com/2010/11/few-answers-we-would-like-from-e-health.html

Here is what I wrote then (in italics) and how close I feel we got to clear answers in plan type

The key questions I want to see addressed are:

1. Just what exactly is meant by a Personally Controlled Electronic Health Record (PCEHR)?

I really did not get the feeling there was clarity among the speakers on this.

2. Exactly how is the PCEHR intended to operate?

We saw a five minute concept video.

There is a link to the video here:

http://www.thomson-webcast.net/au/dispatching/?event_id=e93ab89e7d50e535fd440f8850306913&portal_id=fa33b0f8ca2d2fedb15d66aaaede71f1&presentation_id=d3b54f477972365a695515a9c399b303

This is well worth a look as it is the most detailed information available so far on just what is presently envisaged. The presentation is about 1 minute in (and is also available from the 11 am Tuesday link found here:

http://www.ehealthconference.gov.au/agenda.asp

I have to say what is shown here on this link seems a bit more evolved but very similar to the DoHA effort.

http://www.axolotl.com/products/product-demos.html

3. What is the literature evidence that supports the adoption of this - rather than a more conventional - approach to the progressive implementation of e-Health?

None was offered that I saw.

4. Where has a PCEHR similar to the proposal been successfully implemented?

The concept of consumer control of an EHR which clinicians are to use is not really implemented anywhere I am aware of.

5. Where is the information to be held in the PCEHR to be sourced from and how will the quality of the information be assured? Will providers be paid for providing information?

The information is intended to be sourced from securely connected operational systems and the PCEHR will provide a presentation service and the security / authentication etc. Just why health professionals would provide information was not made clear.

6. What support is the Government planning for provider EHRs and Secure Clinical Messaging?

It was not clear if any further support - beyond standards setting and NEHTA’s assistance - was contemplated

7. What will be the medico-legal status of information held in PCEHRs and what will be the consequences if clinicians mistakenly act on erroneous information? Will they be indemnified?

This was not really addressed as far as I can tell.

8. What is the evidence base that supports the other Government e-Health proposals (teleconsultation and the like) as the optimal expenditure of the available funds?

It was not clear that this area has been addressed by DoHA.

9. How do the PCERH and the other proposals fit with the National E-Health Strategy which has been endorsed by Health Ministers and has yet to be implemented?

This is not at all clear and was not really explained in what I heard.

10. When are the issues of absent leadership and failing governance in the e-Health domain going to be addressed?

The Health Minister indicated that DoHA would be driving the PCEHR project. NEHTA is to be a delivery manager of private sector contracts in a range of areas to support the as yet fully defined initiative.

The separate e-Health managing entity suggested by the National E-Health Strategy and the AMA is yet to be agreed.

The full speech from the Health Minister is now available on the web and is worth a browse for the details (which sadly it does not seem to provide).

See here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/sp-yr10-nr-nrsp30112010.htm?OpenDocument&yr=2010&mth=11

You can read Senator Conroy’s speech here:

http://www.minister.dbcde.gov.au/media/speeches/2010/013

There is some fun analysis of what he said here:

Conroy's NBN health hustle

Rob Burgess

Published 7:35 AM, 2 Dec 2010

Stephen Conroy is Australia's greatest hustler. And the NBN is a giant hustle that the newly dubbed 'Minister Assisting the Prime Minister on Digital Productivity' knows will utterly snooker the opposition at the next election.

Senator Conroy was out pulling his usual trick in Melbourne yesterday, singing the praises of the NBN at the 'e-health Conference 2010: Revolutionising Australia’s Health Care'.

The trick works like this – tell the punters about the amazing health services the NBN will make possible, but studiously avoid the two main criticisms levelled at the NBN by Shadow Communications Minister Malcolm Turnbull and his pool-room buddies:

1) Aren't these services mostly possible using existing technology?

2) Can't the market mostly provide the infrastructure to deliver these services?

Beyond the public eye, Conroy has good answers to both (and I will address them in a separate article), but his speech to the conference yesterday, as usual, did not include them.

More here:

http://www.businessspectator.com.au/bs.nsf/Article/Stephen-Conroy-NBN-broadband-internet-Turnbull-pd20101202-BQRRC?OpenDocument&src=sph

All in all as a commenter said on a recent blog this was really a conference that was organised for the ‘wrong’ audience.

What is contained in the discussion paper which is to be delivered early in the new year now becomes crucial to see if this is a real project or folly!

David.

Wednesday, December 01, 2010

Wrap Up of the E-Health Summit. Was it Worthwhile?

Well the e-Health Summit has just wrapped up. This morning we had two formal presentations and a demonstration of telehealth working quite reasonably despite the fact we have not actually built the NBN yet! (Not that the NBN - when it comes - won’t make a pretty big improvement).

First - Senator Conroy gave us an e-Health focussed discussion of how important the NBN is. No real news there except for a grant of some funds to trial telehealth.

Second Mr Shane Solomon, Head of Healthcare, KPMG Australia gave a really useful presentation on the near two decade journey the Hong Kong Health Authority has undertaken to a presently pretty impressive - but still evolving - e-Health system.

It was fun to hear Shane point out that much of the progress happened by fiat of the CEO of the Health Authority. He decides and the HK Health System does! Might not quite work here.

His examples of what you can do once you have EHR systems in place in terms of use of information to assist care delivery and care quality were just excellent.

The presentations and slides will be available, I am assured by DoHA, real soon now.

In the early afternoon there was a forward looking discussion with a group of experts that explored the blue sky that might be possible for 2025.

We are now seeing some press coverage of the proceedings.

Examples are here:

http://www.computerworld.com.au/article/369816/nbn_first_release_sites_trial_telehealth/?eid=-6787&uid=25465

NBN first release sites to trial telehealth

Federal Government provides $4 million in funding to NSW Health to trial high-speed health monitoring

Two of the first mainland release sites under the National Broadband Network (NBN) will receive telehealth monitoring units in coming months, as part of a $4 million trial conducted by NSW Health.

As part of the trial, telehealth monitoring units and videoconferencing systems will be installed in homes and primary healthcare clinics of veterans with chronic diseases and those aged over 65 in the sites of Armidale and Kiama Downs. Under the rollout of the NBN, each of the sites are expected to encompass up to 6000 premises connected to speeds of up to one gigabit per second (Gbps).

The federally funded project was announced by communications minister, Senator Stephen Conroy, this week at an e-health conference hosted by the Department of Health and Ageing and is expected to determine the benefits of greater bandwidth afforded by the NBN for telehealth and other e-health systems.

And here:

http://www.theaustralian.com.au/australian-it/government/private-sector-key-to-e-health-rollout-says-roxon/story-fn4htb9o-1225963698809

Private sector key to e-health rollout, says Roxon

  • Karen Dearne
  • From: Australian IT
  • December 01, 2010 8:36AM

THE National E-Health Transition Authority will be contracted to deliver the $467 million patient e-health record system with private sector help, Health Minister Nicola Roxon has confirmed.

"We will be asking NEHTA to ensure the national infrastructure is delivered to a high quality standard and in a timely manner and to set the standards for how the system will work," she told the E-Health Conference in Melbourne yesterday.

"But we want the best available expertise so there will be an open approach to the market for key elements of the program."

Ms Roxon said the government was not looking to run the whole system.

"Our job is to contract partners to build the infrastructure and the linkages, and to set the standards and regulations," she said.

"It will not be our job to deliver all of the technological advances – that’s what we’re looking for from the innovators in industry."

And here:

http://www.theaustralian.com.au/national-affairs/ama-attacks-e-health-record-plan/story-fn59niix-1225963522922

AMA attacks e-health record plan

THE Gillard government's $466 million e-health record "won't work" , the Australian Medical Association says.

The AMA says it could be dangerous if patients were able to hide information about abortions or their use of anti-depressants.

AMA vice-president Steve Hambleton told an e-health conference doctors would not trust the new record if it did not contain all relevant patient information, and there was a risk of serious medical mishaps if information was kept secret.

And he says only doctors should alter information in the e-health record, which will be offered to patients from July 1, 2012.

"It should only be able to be changed by doctors who understand the implication of what is recorded, and this can certainly be done in consultation with the patient," he said.

----- End Quotes.

Summary impressions.

1. We have been warned this is a long term - decade + - process - so funding that runs out in 18 months is not smart. The costs are also much larger than presently admitted and this was raised repeatedly on the second day.

2. I think all I have seen from the conference misunderstands the level of complexity and the barriers that will be faced. Attempting to have something working and useful in 19 months is fanciful in my view.

3. I think the program governance plans are inadequate as presently framed. It is hard to believe the community will be keen on the present ill-defined plans. The AMA is right to demand a single Government Entity to run all this - as recommended in the National E-Health Strategy.

4. I believe the Department developing a central infrastructure and expecting the rest of the Health Sector to just ‘hop on board’ and pay their own costs is nonsense.

5. Until more information on the plans from DoHA / NEHTA is properly formulated, documented and widely discussed and reviewed all the optimism expressed by attendees is pretty premature.

6. The PCEHR concept is very likely to be opposed by the AMA in the way it is presently being talked about and if that is the case it is a ‘dead duck’. Refinement to make the plan acceptable to most of the doctors is an urgent issue!

7. At the last panel discussion it was clear that the key barrier to success of the PCEHR will be utility to both clinicians and consumers. At present none of the plans have addressed these issues in any realistic or sensible way.

8. The Department chattering on about sustainability and how the private sector will need to contribute to make this work mis-understands just who is hoping to benefit and it is not the providers!

9. Amazingly the Deputy Secretary closed saying they were starting serious planning and consultation on the PCEHR next year. Runway is looking a bit short!

Sorry we have had a lot of noise but little light! I fear the PCEHR might just need a major rejig to be made even half of what is naively hoped for by its proponents.

David.

Tuesday, November 30, 2010

E-Health Summit - End Day 1.

After the Workshops we had 2 presentations.

First we had:

Dr Ivan Lund Pedersen

National Program Manager, Connected Digital Health, Denmark.

Dr Pedersen has been the National Program Manager at Connected Digital Health in Denmark, (SDSD) in Denmark since 2007.

SDSD is the Danish counterpart to NETHA in Australia and Infoway in Canada,

At SDSD Dr Pedersen has been the chairman of steering committees in several of the major programs, for example the Common Medicine Record (FMK), the National Patient Index (NPI) and the Infrastructure for videobased translation.

From 1 January 2011, Dr Pedersen will be working with innovation and clinical customer relations in the new government organisation called National e-health agency.

From 2002 to 2007, he was head of the development and implementation of Electronic Healthcare Record at the hospitals in Region Sjaelland. The biggest achievement in that period was the development and implementation of OPUS Medicine which is a web-based medication module. It took two years to develop and is now running on its 7th year, with two yearly updates. It is now ready to integrate with the patients shared medications record.

-----

This presentation made it clear this is a very long term project - that has gone pretty well for 15 years and is still evolving - and that consultation and incentives are vital and that Denmark is still learning - despite the hype.

Second we had a summary of the two workshop sessions conducted earlier in the afternoon.

This session was led by Adam Powick who was the lead developer of the 2008 Deloittes National E-Health Strategy.

Lack of rigor and care at this point on our e-health evolution will be a disaster seems to be the message. A lot of good people have put sound views and they really need to be integrated into the overall picture. We need to think hard to make this a success!

Bottom line of all this was that we need to develop a major discussion document on what the outcomes were from these two days - that then this needs careful discussion and scrutiny.

My view this should have happened before the Summit but better late then never!

Enjoy your evening!

David


Minister Roxon Has a Few E-Health Announcements to Kick off the Summit.

We had two announcements besides the speech given to open proceedings. These were:

Next Step for Telehealth Services for Patients

The Australian Government’s investment in better connecting patients to specialist services through technology took a step forward on 30 November, with the release of a discussion paper seeking views on the most effective delivery for the scheme.

30 November 2010

The Gillard Government’s investment in better connecting patients to specialist services through technology took a step forward today, with the release of a discussion paper seeking views on the most effective delivery for the scheme.

Over $352 million will support online specialist consultations for Australians in rural, remote and outer metropolitan locations.

“Telehealth will cut down the tyranny of distance and bring specialist services to the patient’s doorstep through the use of online videolink technology,” said Ms Roxon.

“That will cut down patients’ travel time and is part of the Government’s investment in delivering specialist services closer to home.

“From 1st July 2011, this telehealth initiative will provide around 495,000 services over four years, as well as training and incentives for specialists, GPs and other health professionals to participate in delivering online services.

“For example a patient in a regional area who is being treated for high blood pressure and whose GP wants a specialist’s opinion may be forced to travel a long distance to see a cardiologist – now they would be able to get the service delivered locally.

…..

A copy of the discussion paper can be found at www.mbsonline.gov.au and submissions close on 27 January 2010.

More here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr188.htm

The paper is pretty short (5 pages) and really is just seeking suggestions as to what would work best. It is a fair bit of money so I hope they get some really good ideas!

And this one

Mobile Phone Applications Could Help Revolutionise Health Care in Australia

Accessing a patient’s record may be as easy as using a mobile phone application as the Government’s investment in e-Health revolutionises health care in Australia.

30 November 2010

Accessing a patient’s record may be as easy as using a mobile phone application as the Government’s investment in e-Health revolutionises health care in Australia.

A demonstration iPhone app has been developed to show how Doctors could access a patient’s record easily with e-Health records including x ray results and allergies, making diagnosis quicker and safer.

“The mobile application is an example of how we want to make it easier for patients so that wherever they are in the country, doctors and nurses can see their medical history.

“Allowing doctors instant access to a patient’s health record will mean that any conditions such as allergies can be quickly discovered and that can save lives.

“It will cut down on medication errors which account for 190,000 admissions to hospital each year.

“In years to come, the Government’s e-Health investment will be considered as one of the great technological advances in medicine and like the invention of the stethoscope, the x-ray and the vaccine will be part of routine healthcare.

“e-Health will have great benefits, take for example the case of a young mother whose two children suffer from asthma.

“She would have their medication history at her fingertips which means that if the children were to be hospitalised with an attack, the emergency department teams won’t be working blind – they will be able to know the history and current drug treatments.

“The iPhone app is in the concept stage, but is a good example of how we can harness technology to help health professionals deliver better patient outcomes.

More here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr189.htm

It is good the team get that once you have a mobile browser and a portal all sorts of things are possible. Doh!

Keep up the visionary work!

David.

An Apparent Conceptual Overview of the PCEHR. Lunch Report from E-Health Summit

The e-Health Conference has now heard from many speakers including the Federal Minister for Health. (See link below for program and list).

It is fair to say that most of what has been said would come as no surprise to readers here.

My key observations are:

1. Most speakers were not at all clear just what was being talked about in any precise sense - with most equating the PCEHR with a bit of a cross between a Shared Summary EHR and a Personal Health Record.

2. Both the AMA and the Consumer Health Forum really get how complex this will be.

3. Everyone recognised that Mid 2012 as a date with the PCEHR would be available to be signed up to was a pretty huge ask!

4. A lot of the early discussion felt like it was suggesting the PCEHR was basically an 'aide memoir' for patients!

5. The linkage between what was described and the intended benefits was tenuous at best to me.

As far as the Ministers / DoHA view is concerned the following seems to be what they are talking about with respect to the PCEHR - derived from a 5 minute animated conceptual model shown about 11am.

1. There will be a central infrastructure that will be have an indexing service (to locate relevant records using the Health Identifier Service)

2. There will also be a central authentication / permission service that will decide what information is to be accessed.

3. There seemed to be the core concept of a centrally held summary record that was to be augmented by information acquired from remote clinical systems (referrals, discharge summaries, results etc.). It is this central Summary that Professor Coiera pointed out was pretty problematic yesterday.

The Minister made it pretty clear that DoHA was into standards setting, governance and piloting and the delivery of ‘linkages’ not actual systems (however that is to play out)

4. It is not totally clear just what information flow are patient / consumer controlled and what flows are healthcare provider controlled.

5. There is an underpinning assumption that all providers will make information they hold available for indexing and access and use. This assumption strikes me as extremely problematic.

6. Overall what seems to be under discussion is a model very similar to the US Health Information Exchange Model - available commercially and view the US DHHS Connect program (and based on the IHE methodologies to some degree)

The Minister repeatedly referred to the PCEHR as a shared effort between private and public sector but it is not at all clear what incentives / rewards are available for involvement. There was a lot of discussion about governance but just how the private sector (which includes GPs) are to be involved is still being evolved it seems.

All in all an interesting morning where 1-2% more clarity may have emerged. The session on Denmark and its approach at around 4:30pm looks interesting as does the summary of the day which follows.

Go to the webcasts tab to watch from here:

http://www.ehealthconference.gov.au/index.asp

It worked pretty well this morning.

David.

Monday, November 29, 2010

It Seems Some Serious Thinkers Are Pretty Concerned about the Current NEHTA / DoHA Strategy and Direction.

The following Commentary appeared in the Medical Journal of Australia today.

For Debate

Do we need a national electronic summary care record?

Enrico Coiera

eMJA Rapid Online Publication

Abstract

  • Electronic referrals and discharge summaries can improve the quality and timeliness of clinical communication.
  • The electronic summary care record (SCR) extends the concept of digital health summaries to create a perpetually updated and centrally stored summary of care, extracting key data from local systems after each encounter.
  • The only major SCR evaluation to date, in England, found that rates of usage were low, and any impact on care was difficult to quantify.
  • The SCR is seen by some as a first step to building a national distributed shared electronic health record (SEHR). However, the SCR may be a problematic diversion, creating a need for centralised databases, while the SEHR can function by sharing locally stored records, letters and discharge summaries.
  • Uncertainty about the quality and provenance of SCR data raises concerns about patient safety, as key data may be absent and old data may persist, partly because of a lack of ownership of the summary.
  • A national e-health strategy should emphasise the true stepping stones to a distributed and shared electronic record, including encouraging the uptake and meaningful use of electronic clinical records, clinical messaging, electronic discharge summaries and letters, and services such as decision support and e-prescribing, all of which have good evidence to support them.

The full article is available (free) here:

http://mja.com.au/public/issues/194_02_170111/coi10895_fm.html

It is well worth a click through to read the full article.

There is also coverage here:

Electronic summary care record a waste of GP time: expert

29th Nov 2010

Andrew Bracey

A SENIOR e-health expert has questioned Australia’s push to develop an electronic summary care record (SCR), saying it lacks evidence and will create more work for GPs.

In an article published today in the MJA online, Professor Enrico Coiera, director of the Centre for Health Informatics at the University of NSW, called on authorities to instead focus on developing technology to better share existing health records nationally.

“Right now, we should keep our eye on the main game, which is to develop a way of sharing our existing health records nationally and connect up the different silos of clinical data,” Professor Coiera wrote.

“Making clinical data ‘liquid’ enough to move across the system is our primary challenge. We need to ensure that every clinical service has its own electronic records, and that these records are meaningfully used.”

Professor Coiera said there remained little evidence supporting the worth of an SCR, saying its purpose and impact on clinical care remained unknown.

Full article here:

http://www.medicalobserver.com.au/news/electronic-summary-care-record-a-waste-of-gp-time-expert

Additional coverage is here:

E-health records "unjustified"

By Gemma Collins

Nicola Roxon’s plans for a $467 million personally-controlled e-health record (PCEHR) system are “simply unjustified” and could cause major problems for Australia’s healthcare, a health IT expert has warned.

Professor Enrico Coiera, Director of the Centre for Health Informatics at the University of NSW, makes the scathing attack in the MJA (online 29 Nov) as he says that the negative response to the UK’s summary care record (SCR) should make Australia “pause and think again” before rolling out a similar system.

The government’s PCEHR systems are due to be rolled out by July 2012 but Professor Coiera says the national record system in England has only been used in 4% of GP consultations in England and has generated additional workload for doctors.

More here:

http://6minutes.com.au/articles/z1/view.asp?id=525995

What Professor Coiera is saying here overall is that the direction of the 2008 National E-Health Strategy is a far preferable way to proceed than the silliness and wooliness of the NEHTA IEHR / DoHA PCEHR proposals. Both these proposals lack the evidence base to justify the proposed investment and these funds would be conclusively better spent on the projects mentioned in point six of the abstract.

The issues raised by Prof. Coiera are very serious and have not been properly addressed to date. Until they are there are much better things to do with the e-Health dollar!

Nice to have some heavyweight support for what I have been saying for a good while now! Maybe the Summit tomorrow could give some thought as to whether the present plan from the Federal Government is actually the right one?

David.

There is Sneakiness Afoot Here! Publications Swapped To Confuse Us All!

The following link is the correct one for the Peter Fleming presentation on Friday.

http://www.nehta.gov.au/component/docman/doc_download/1175-achsm-breakfast-seminar-26-november-2010-melbourne-petrer-fleming

The earlier link in the previous blog was correct - until in their excitement to get down the presentation with blanks in the achievements area they mistyped the URL (note the petrer not peter)

Here is the earlier link (which now requires a log on).

http://www.nehta.gov.au/component/docman/doc_download/1174-ashsm-breakfast-seminar-26-november-2010-melbourne-peter-fleming

This link gave you a presentation that was 4 pages longer!

Oh well I guess that is the way it goes.

David.