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."

Tuesday, March 15, 2011

Is There Any Chance the PCEHR Dog Will Hunt? I Think Not. It is Fundamentally Flawed.

Key Point:

Does it make any sense for the Government to be operating a Patient Controlled EHR System in parallel and alongside provider managed patient EHRs with the associated risks of inaccuracy, confusion and lack of currency?

Now read on:

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I thought it would be useful to go back to the official source on the PCEHR.

NEHTA Home - eHealth Implementation - What is a PCEHR?

What is a PCEHR?

A Personally Controlled Electronic Health Record (PCEHR) is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view.

Information in a PCEHR will be able to be accessed by you and your authorised healthcare providers. With this information available to them, healthcare providers will be able to make better decisions about your health and treatment advice. Over time you will be able to contribute to your own information and add to the recorded information stored in your PCEHR.

The PCEHR will not hold all the information held in your doctor's records but will complement it by highlighting key information. In the future, as the PCEHR becomes more widely available, you will be able to access your own health information anytime you need it and from anywhere in Australia.

----- End Extract.

Here is the link to the page (Accessed March 14, 2011)

http://www.nehta.gov.au/ehealth-implementation/what-is-a-pcher

If you read closely you can extract the following points:

1. The PCEHR is “is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view.”

2. The information in the PCEHR is accessible by the patient - and with permission their clinical provider.

3. The record will gradually also become a Personal Health Record (PHR) as the patient will be adding information.

4. The PCEHR does not replace but is in addition to information held in an EHR by the responsible clinicians.

In summary the PCEHR is an additional EHR controlled by the patient which will contain information that the patient my decide to disclose to their carers - or not.

What is needed for this form of Electronic Patient Records to be successful and valuable?

The list I would suggest includes:

1. A compelling reason for use by Clinicians.

It is hard to see this being the case since Clinicians already have their records. Only if there is unique information that the patient highlights as being important is the record even likely to be accessed.

An alternative might be to provide a fee for use to the clinician to compensate for the time and professional effort involved but this does not seem to be on any agenda I have seen.

Expecting clinicians to use and update the PCEHRs for no charge will be about as successful as having lawyers stop charging for their ‘billable hours’!

2. Demonstrable and proven clinical benefit of the approaches adopted.

International experience does not provide much evidence that running parallel systems (clinician and patient controlled systems) will add much value or be widely used.

3. Essentially zero interference with present work practices unless there is a reward associated with any negative impact.

It is difficult to imagine how this can be achieved with parallel systems. The clinician has no reason to trust an external system as opposed to their own records.

Overall the PCEHR looks likely to be an expensive, time wasting, nuisance for the vast majority of clinicians. The chances of significant adoption without major re-design and major financial incentives seems remote.

Yes I know all the arguments about involving patients in their care, co-ordinating care delivery and so on but this macro architecture does not get there I believe.

The ideal of IT system design over the last 20+ years has always been to try for a single ‘source of truth’ for any data element as it is this that makes sure only current and as accurate as possible information is that presented to the user. The NEHTA approach guarantees there are multiple sources which may lack both currency and accuracy. How idiotic is that? Take it from me the CBA does not have multiple sources of information regarding your bank balance - one is plenty!

David.

Monday, March 14, 2011

Weekly Australian Health IT Links – 14 March, 2011.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment:

It has been an interesting week with the State Health IT implementations in NSW and Victoria being challenged in terms of the approaches adopted.

It will be interesting to see just what flows from the two reviews that are going to be undertaken over the next few months.

Sadly we still seem to waiting for any transparency on the part of DoHA or NEHTA as to just what precisely they are planning with the PCEHR. This is really an intolerable situation as the current poll - which closes tomorrow - so vote if possible soon - would strongly indicate!

Lastly, I have to report I have switched to Firefox V4 Release Candidate One and am pretty impressed. The browser really flies and seem pretty stable after 2 days of use.

Grab from here if you want to try it.

http://www.mozilla.com/en-US/firefox/RC/

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http://idm.net.au/article/008290-data-quality-must-deliver-e-health-revolution

Data Quality must deliver for the e-health revolution

03.09.11

“Data standards are fundamental for any data collection environment with multiple data providers and data collectors.” - Heather Richards, Canadian Institute for Health Information (CIHI)The move towards activity-based funding as part of national health reform in Australia will put a spotlight on data quality, as hospitals receive funding based on the number and type of cases they treat. A similar regime is also on the horizon in Canada, where the Canadian Institute for Health Information (CIHI) is charged with ensuring the quality of health care data. We asked CIHI Consultant Heather Richards, to highlight the data quality issues to be faced.

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http://www.theage.com.au/national/thousands-dying-from-preventable-hospital-errors-says-professor-20110307-1bl7e.html

Thousands dying from preventable hospital errors, says professor

Julia Medew

March 8, 2011

THOUSANDS of people are likely to be dying every year as a result of preventable hospital errors, a health economist says.

Doctors and academics yesterday called for more funding of hospital programs to examine adverse events (unintended injuries from medical care) after The Age revealed inadequacies in the voluntary reporting system for such incidents at the Royal Children's Hospital.

The professor of health economics at Monash University, Jeff Richardson, said that if the last major Australian study to estimate the number of deaths due to preventable adverse events was right, 350 patients were dying every two weeks because of the problem.

Professor Richardson said it was astonishing that so little had been done since The Quality in Australian Health Care Study in 1995 estimated about 12,000 Australians were dying each year because of preventable events.

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http://www.theaustralian.com.au/australian-it/painful-but-necessary-transition-for-austin-health/story-e6frgakx-1226017252178

Painful but necessary transition for Austin Health

VICTORIA's Austin Health had a range of ageing computer systems but information access was proving painful.

It sought a means of easily obtaining information from its systems and presenting it to a range of clinical and management staff to drive decision-making.

"We were really trying to get much greater visibility of our data and more consistency in the way it was presented," Austin Health strategy, quality and service redesign executive director Fiona Webster said.

Austin Health had also seen in-patient treatments grow by 10 per cent in the past three years, putting pressure on it to increase efficiency to cope with the demand.

Managing the rapidly increasing amounts of complex data sets, including patient and operational data, created a serious challenge.

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http://www.pharmacynews.com.au/news/nsw-to-follow-south-australia-on-project-stop

NSW to follow South Australia on Project STOP

Victoria could be the last mainland state to adopt Project STOP, after NSW Coalition health spokesperson Jillian Skinner pledged to mandate the pseudoephedrine sales recording system if elected.

Speaking to Pharmacy News, Kos Sclavos president of the Pharmacy Guild of Australia said Ms Skinner wanted to ensure all NSW pharmacists were using the system to prevent drug runners accessing pseudoephedrine to make methamphetamine.

While the Tasmanian Government has also yet to mandate Project STOP, Mr Sclavos warned there would be increased pressure put on Victorian pharmacists, if NSW follows the lead of South Australia, where mandatory online recording of all pseudoephedrine sales will be required from 1 July.

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http://afr.com/p/business/technology/libs_prepare_to_lance_health_boils_KMcIyUvTxvzYkKlkuV8PXJ

Libs prepare to lance e-health boils

Julian Bajkowski

KEY POINTS
  • The NSW opposition has joined Victoria in pledging to block a new clinical records system.
  • It represents a setback for the introduction of a national scheme.

Australia’s two largest electronic clinical records systems could be scrapped by the end of the financial year amid signs that bipartisan support for a national e-health deployment is starting to unravel.

The NSW opposition yesterday promised that, if elected, it would halt the forced deployment of the maligned FirstNet system into the emergency departments of state hospitals after senior doctors labelled it a risk to patients.

The promise is bad news for the US-based Cerner Corporation, whose software is being used to create the controversial systems in NSW.

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http://www.theaustralian.com.au/australian-it/sharpening-delivery-of-healthcare-online/story-e6frgakx-1226017251107

Sharpening delivery of healthcare online

MEDIBANK Health Solutions chief information officer Brett Winn aims to put his passion for technology to good use.

In a 20-year career, he has spent a decade mainly in Asia-Pacific tech chief positions in advertising, media and recruitment before moving to healthcare.

Mr Winn joined web-based health services provider McKesson Asia Pacific as chief information officer before it was acquired by private health insurer Medibank Private.

For the past eight months he has been IT executive general manager for Medibank Health Solutions.

"If you really want to add value to community healthcare, and particularly the healthcare services we provide, this is where you want to be," Mr Winn said.

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http://www.computerworld.com.au/article/379069/e-health_advocacy_groups_decries_government_secrecy/

E-health advocacy groups decries government secrecy

Consumer consultation workshops no resolution for continued vagueness

An e-health consumer advocacy group has joined a growing choir of those dissatisfied with the lack of communication from lead agencies surrounding implementation of the Federal Government's $467 million personally controlled electronic health records (PCEHR) project initiative.

The group, known as the Consumer Centred eHealth Coalition (CCeHC) and formed in 2009, claims to represent e-health consumers in issues of privacy, security and confidentiality related to the e-health project. It counts the Australian Privacy Foundation, the Cyberspace Law and Policy Centre, the Public Interest Advocacy Centre, Civil Liberties Australia and the Queensland Council of Civil Liberties among its members.

The coalition has remained quiet on the issue over the past year, but in a recent post on its website, the group voiced concerns over three community consultation workshops held by the Department of Health and Ageing (DoHA) and e-health managing agency National E-Health Transition Authority (NEHTA), arguing the sessions failed to provide enough detail around the project.

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http://delimiter.com.au/2011/03/08/nehta-doha-deaf-to-consumers-claim-critics/

NEHTA, DoHA deaf to consumers, claim critics

A new e-health lobbying organisation has voiced its frustration at the National e-Health Transition Authority and Department of Health and Ageing for not communicating with consumers well enough.

The Consumer Centred eHealth Coalition (CCeHC) is a group of non-government organisations which maintain an interest in privacy, security and confidentiality issues in the rollout of the Federal Government’s new Australian eHealth system. Its members include the Australian Privacy Foundation, the Council of Social Service of NSW, the UNSW Cyberspace Law and Policy Centre, the Public Interest Advocacy Centre, Civil Liberties Australia and the Queensland Council of Civil Liberties.

Late last week, the CCeHC wrote on its site that despite NEHTA and DOHA holding three workshops to gauge consumer views on the issue, there had not been enough transparency and scrutiny on its $467 million e-Health investment – which will provide the Australian health system with a Personally Controlled Electronic Health Record.

“We are growing frustrated with the NEHTA/DoHA-led consultations process and skeptical about any useful outcomes incorporating consumer feedback,” the group wrote. “We ask for evidence the feedback has influenced a single aspect of the e-health experiment”. NEHTA and DOHA have been invited to respond to the comments.

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Monday, March 07, 2011

NeHTA not a FOIer

When posing the question the other day about what other government related entities, like NBN Co (until amending legislation passes), are outside the scope of the Commonwealth Freedom of Information Act, I was unaware of the exchange below during the course of questioning of officers of the Office of Australian Information Commissioner in Senate Estimates. Their evidence is no one has a reliable list of who's covered and who's outside the Commonwealth act. I suspect that a similar situation applies in the states with respect to state legislation.

The confirmation that the National E-Health Transition Authority (NeHTA) is not covered by the FOI act despite the fact that annual reports on the operation of the act have for years past listed it as subject to the act, again raises the question: what other entities are out there carrying out important public functions with large amounts of public money that should be subject to the highest standards of transparency and accountability, but aren't?

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http://www.theaustralian.com.au/australian-it/government/medicare-misses-out-on-authentication-contract/story-fn4htb9o-1226017333254

Medicare misses out on NASH contract

MEDICARE Australia was beaten on its bid to build the National Authentication Service for Health by its IT services provider, IBM Australia, which last week won a $23.6 million contract for the job.

A Medicare spokesman has confirmed the services delivery agency did tender for the NASH work, but was unsuccessful.

The contract was let by the National E-Health Transition Authority, as part of its $218m Council of Australian Governments-funded program to develop vital e-health infrastructure.

Federal Health Minister Nicola Roxon announced IBM's win last week, saying the NASH would improve the security of electronic communications across the health sector, and underpin the planned patient e-health record program.

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http://www.itnews.com.au/News/250359,nsw-hospitals-rate-firstnet-last-for-patient-care.aspx

NSW hospitals rate FirstNet last for patient care

Paper is easier and faster.

Directors of seven Sydney hospital emergency departments have damned NSW's $100m clinical information system FirstNet, blaming it for declines in the quality of patient care.

NSW Health's deputy-director general Tim Smyth denied the claims.

"We now have one of Australia's largest electronic medical record systems installed and it is part of a 10-year strategy," Smyth told ABC News.

"With all IT system installations, some people find it more difficult to use because they are used to the old system. That is just part of change in the health system."

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http://www.computerworld.com.au/article/378888/nsw_libs_can_firstnet_e-health_system/?eid=-255&uid=25465

NSW Libs to can FirstNet e-health system

FirstNet system has been generating complaints from clinicians ever since the rollout began, NSW Coalition says

The NSW Opposition has committed to canning the State Government’s FirstNet computer system in hospital emergency departments if improvements to the troubled system cannot be made.

According to shadow health minister, Jillian Skinner, the state’s Labor government was ignoring risks to patients caused by the system and as highlighted by medical specialists. "If clinicians are saying this system is putting lives at risk, then we need to halt the roll-out and sit down with frontline health workers and find out how to make it work," Skinner said in a statement.

"The FirstNet system has been generating complaints from clinicians ever since the roll-out began, but Labor has refused to listen to frontline health workers."

Skinner said the NSW government had spent more than $100 million on the FirstNet system designed to improve patient care in emergency departments.

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http://www.zdnet.com.au/nsw-libs-to-halt-hospital-system-roll-out-339310853.htm

NSW Libs to halt hospital system roll-out

By Luke Hopewell, ZDNet.com.au on March 7th, 2011

The New South Wales Opposition today pledged to halt the roll-out of the troubled FirstNet system currently used in hospital emergency departments statewide.

A review found that the Cerner system suffers from design flaws and botched records management, saying that the issues could lead to a doctor administering the wrong treatment due to mismatched charts.

A specialist doctors' group said yesterday the system ought to be scrapped due to the danger to patients, thoughts echoed by the state opposition this afternoon.

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http://www.smh.com.au/technology/technology-news/software-adds-to-wait-say-doctors-20110307-1bl9g.html

Software adds to wait, say doctors

Julie Robotham HEALTH EDITOR

March 8, 2011

PATIENTS are waiting longer in emergency departments because of design flaws in a computer installation, doctors say.

Preliminary survey results by the Australian Medical Association NSW suggest the system, Cerner FirstNet, had slowed down administration in two-thirds of hospitals, delaying treatment, said the association's president, Michael Steiner.

The Herald revealed yesterday a University of Sydney study had identified failings in the software, including some that put patients at risk of wrong treatment.

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http://www.medicalobserver.com.au/news/ed-computer-system-a-risk-to-patients-experts

ED computer system a risk to patients: experts

7th Mar 2011

Andrew Bracey and AAP

A REVIEW has found the computer system that runs emergency departments in hospitals throughout NSW is crippled by design flaws and is compromising patient care.

The review found the FirstNet system allowed treatment details and test results to be assigned inadvertently to the wrong patient, The Sydney Morning Herald reported.

The review by Professor Jon Patrick, director of the University of Sydney's Health Information Technologies Research Laboratory, is based on a technical study of the software and interviews with directors of seven Sydney emergency departments.

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http://www.news.com.au/national/queues-computer-flaws-and-broken-promises-at-state-hospitals/story-e6frfkvr-1226016882534

Queues, computer flaws and broken election promises at state hospitals

  • By staff writers
  • From: news.com.au
  • March 07, 2011 8:05AM

HOSPITALS around the country are struggling to cope, with patients forced to wait for hours in corridors and a $115 million spent on a computer system that assigns treatments to the wrong patient.

In New South Wales, a review of the FirstNet computer system found it is crippled by design flaws and is compromising patient care.

FirstNet allows treatment details and test results to be assigned inadvertently to the wrong patient, The Sydney Morning Herald reports.

Difficulties retrieving patient records could delay treatment, and the system - on which $115 million has been spent - automatically cancelled pathology and radiology requests if the person was transferred from the emergency department without checking whether these were still needed, the review found.

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http://www.zdnet.com.au/qld-health-ibm-bury-the-payroll-hatchet-339310901.htm

Qld Health, IBM bury the payroll hatchet

By Renai LeMay and Luke Hopewell, ZDNet.com.au on March 8th, 2011

Queensland's Health Minister Geoff Wilson yesterday declared a tentative victory in the state health department's battle to tame its troubled payroll system, labelling the platform "stabilised" and noting that further improvements were being made. The department also seems to have buried the hatchet with IBM.

The payroll system went into meltdown in early 2010 after being introduced in March, with a large number of Queensland Health staff receiving little or no pay for some pay periods. The SAP-based platform, built with the assistance of IBM, serves some 78,000 of the department's staff every fortnight, with the total payroll amount being $210 million.

In a statement released yesterday, Wilson described the new system as having been "stabilised" one year on from its go-live date, but said there was further work to be done.

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http://www.smh.com.au/technology/sci-tech/research-solutions-for-a-bionic-eye-may-be-closer-than-they-appear-20110304-1bi2l.html

Research solutions for a bionic eye may be closer than they appear

Conrad Walters

March 5, 2011

RESEARCHERS working on Australia's bionic eye have a new solution in sight.

People with normal vision use light to understand an object's shape, texture and brightness. For the blind, though, it is hard to deliver enough clues to achieve this via a computer sensor - an implantable substitute for vision.

However, a team at Bionic Vision Australia is testing a counter-intuitive approach that seems to help people navigate an obstacle course with few visual clues, said Dr Chris McCarthy, a research engineer with the consortium developing a bionic eye. The creation of a bionic eye was cited as a national goal at the Australia 2020 summit convened by the former prime minister Kevin Rudd.

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http://www.apo.org.au/research/medicare-locals-guidelines-establishment-and-initial-operation-medicare-locals

Medicare Locals: guidelines for the establishment and initial operation of Medicare Locals

Read the full text

DOC Medicare Locals: guidelines for the establishment and initial operation of Medicare Locals

07 March 2011These guidelines provide an overview of the arrangements for the establishment of Medicare Locals. The Commonwealth Government is establishing Medicare Locals to drive improvements in primary health care and ensure that primary health care services are better tailored to meet the needs to local communities. Medicare Locals will be primary health care organisations, established to coordinate primary health care delivery to address local health care needs and service gaps.

These guidelines take into account submissions received on the Medicare Locals Discussion Paper on Governance and Functions released on 29 October 2010 on the yourHealth website and views of other key stakeholders.

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Enjoy!

David.

AusHealthIT Poll Number 61 – Results – 14 March, 2011.

The question was:

Is The NEHTA Applied Secrecy Surrounding the PCEHR Concept of Operations Document Justified and Necessary?

The answers were as follows:

Of Course

- 5 (10%)

Possibly

- 2 (4%)

Neutral

- 1 (2%)

Probably Not

- 5 (10%)

It is Just Absurd

- 33 (71%)

Well that is seems pretty clear with only 14% suggesting it was even remotely OK to be so secretive! NEHTA / DoHA need to do a great deal better clearly!

Votes : 46

Again, many thanks to those that voted!

David.

Sunday, March 13, 2011

We Look Like There Is Still A Way to Go with E-Prescribing Standardisation. This is all Taking A Long While For Some Reason.

Quietly, on Friday afternoon, I published a blog on HL7 V3.0 reporting on the views of some who are concerned with some of the directions being taken by HL7.

The blog is found here:

http://aushealthit.blogspot.com/2011/03/different-view-on-hl7-version-30-there.html

By late Sunday there had been lots of comments - with an especially interesting part of the thread being initiated by Dr Eric Browne.

Here is the thread from that comment on (the rest is on the blog directly)

Eric Browne said...

"My understanding is that there are two private consortia doing e-prescribing and that NEHTA is working - at a glacial pace - on developing a standards package for the domain - and a few others - referrals etc."

Well NEHTA have produced an HL7 V3 CDA specification for electronic transfer of prescriptions (eTP) and have submitted it to Standards Australia to fast track it into an "Australian Technical Specification". I understand that this is to be used as the basis for eTP in Australia, and presumably will be adopted by the two existing private consortia and any newcomers.

However, although this CDA specification introduces a lot of new complex codes, it is actually less prescriptive than the existing HL7 v2 based AS4700.3 standard for exchanging medication information, particularly for supporting safe clinical practice. Let me give one example. I could give many others.

Quality Use of Medicine programs continually push the mantra "Right person, right drug, route dose, right route, right time". I'm not a clinician, but as a patient, I would like to know that the route and dose have been supplied on the prescription. The existing Australian Standard has a whole HL7 segment devoted to recording route of administration. NEHTA's proposed standard has NO specific field to record Route of Administration, and NO terminology to support it. Instead, it has a single free text field that conflates route with dose. Thus, no compliance checking to ensure that route has been supplied would be possible. No compliance checking to ensure that any dose information has been supplied would be possible.

I'm perturbed that from a clinical safety perspective that we might be going backwards in some areas of clinical data standards. This is not a criticism of HL7 v3 per se in this case, but yet again, illustrates the lack of proper governance in e-health in Australia.

Saturday, March 12, 2011 3:45:00 PM

Dr David More MB, PhD, FACHI said...

Eric, thanks for the detailed comment.

It is my understanding that one of the present providers is committed to implement what Standards Australia comes up with and that the other has said they will look at it when the Standard is finalised.

I should say I am aware of others besides Eric with very considerable concerns about just where the HL7 vs CDA situation currently sits - many of who are on the relevant IT-14 Sub Group.

David.

Saturday, March 12, 2011 3:56:00 PM

Anonymous said...

Eric Browne (Saturday, March 12, 2011 3:45:00 PM) said “NEHTA's proposed standard has NO specific field to record Route of Administration, and NO terminology to support it. Instead, it has a single free text field that conflates route with dose.”

That is amazing, indeed quite incredible. It simply is not good enough. I had to check conflate – which means melds or brings together.

From quality control, accreditation, and safety perspectives NeHTA would fail dismally if, what Eric says, is true.

From a medico-legal perspective any doctor, nurse, dentist or anyone else authorised to write prescriptions would be totally liable if a medication error (adverse event) occurred as a consequence of a medication being taken which did not specify precisely the ‘route’ and the ‘dose’.

Much of the rationale behind introducing electronic prescribing and transmission of scripts is to cut down on medication errors. As a doctor I can categorically state that I would never ever prescribe a medication without stating exactly the DOSE (‘n’ mgm, microgram, ml, or whatever) and the ROUTE (Intramuscular, orally, per vagina, in the eye, on the skin, on the affected area, up the nose, in the ear up the rectum, whatever).

It beggars belief to think that NeHTA could even contemplate creating standards which do not include ROUTE and DOSE. So much so that I have to think, despite Eric’s acknowledged expertise in this area, he has to be wrong in his claim that NEHTA has “NO specific field to record Route of Administration, and NO terminology to support it” and simply has a “free text field that conflates route with dose”.

I suggest someone very quickly asks a Medical Defense Organization to provide an opinion on this pronto.

And I suggest too that NeHTA be asked urgently to very clearly clarify its position on this matter.

Saturday, March 12, 2011 6:49:00 PM

Anonymous said...

I think HL7 V2 is a very under-appreciated standard and I would in general agree with the original comments.

V3 messaging appears dead, even from Graham says and CDA is mentioned as "working", but CDA is a Document format and not a messaging specification.

We do require a messaging specification and V2 is rich and flexible in this arena and there are a lot of existing implementations out there, although most are quite flawed however. CDA on its own just cannot do ePrescribing in anything but a token document transfer. HL7V2 medication messaging has all the behaviours needed to actually enable ePrescribing. By definition CDA has no behaviours as it’s a document.

The advantages of CDA are that it is xml and people can use an off the shelf parser and it allows richer structure in the body of the document.

Good HL7V2 parsers are available and V2 can be encoded in xml and the parsing side of the problem is a tiny percentage of the task.

The structuring of the clinical data in HL7V2 is an area that needs improvement, but there are several projects active working on that and in any case you could embed CDA documents in HL7V2 to get the messaging and the structured payload. Either or both approaches are appropriate, but standalone CDA will not solve our problems.

Enhancing V2 structure is a path that could be backward compatible and could be incremental but it seems that very few people have a deep understanding of both V2 and V3 and just choose the most recent technology thinking that V2 is on the way out when in fact, its expanding. Taking the lessons learn in over 12 years of V3 development and applying them to enhancing V2 is a path that is doable, but I fear that it appears to much like a failure for people to support it.

In Australia we really only have V2, so enhancing what we have with compliance testing and actually using the V2 Medication standards we have would seem a very sound choice, but Nehta appear to have a complete block when it comes to looking at working standards and enhancing them. Everything has to be done from the ground up and we end up with over complex V0.9 "standards", that would need years of trials to perfect, time they do not have.

In fact Nehta appear to show no interest in looking at what is working, it’s an arrogance that the country cannot afford. Nothing Nehta have produced so far is out there and working now so the track record is pretty poor and there is high level pressure on Standards Committees to approve the Nehta work, bypassing the normal processes which are there in an attempt to allow proposals to be critically examined. The proposals are all flawed and the new policy is to ignore Nehta work until its proven, which at this stage means ignoring everything they have done.

This Dinosaur has escaped Jurassic Park and it’s time to hit the kill switch before it eats all the people trying to do real work.

Saturday, March 12, 2011 9:03:00 PM

Anonymous said...

Saturday, March 12, 2011 9:03:00 PM thank you for a very lucid account of the HL7 issues and your comments on eprescribing.

Your comments serve to reconfirm the rationale and absolute imperative of funding an industry led eprescribing initiative in parallel with NeHTAs work. It is clear, from what you say, that is the only way we will see any progress in the foreseeable future in this vitally important application.

Sunday, March 13, 2011 11:14:00 AM

Anonymous said...

Saturday, March 12, 2011 9:03:00 PM said "there is high level pressure on Standards Committees to approve the Nehta work, bypassing the normal processes which are there in an attempt to allow proposals to be critically examined."

The Standards Committees should resist such pressures, remain true to their raison d'etre and under no circumstances bypass their normal checking processes. If they did bypass and take short cuts for political expediency or because they are being paid by NeHTA to deliver to an unrealistic timeline they would be doing the nation as a whole a gross disservice and undermining the credibility of Standards Australia.

We have standards for a very good reason. No one should be permitted to corrupt the process under any circumstances.

Sunday, March 13, 2011 1:42:00 PM

Anonymous said...

As the CDA Schema contains specific elements for both Route of Administration Codes and Dose Quantity, it would be very surprising if the NHETA specification (presumably an application layer Data Model) does not map directly to these elements. Whether all of the systems that will use the NEHTA specification currently store these elements in an atomised and (in the case of Routes) coded form is another question.

Sunday, March 13, 2011 2:14:00 PM

Grahame Grieve said...

Hi David

You asked for my opinion on how this will play out. It's too early to say - the outcomes will be driven by external events and not by the quality of the underlying standards. (A familiar story in IT)

Some of the comments on this thread are profoundly ignorant. NEHTA has an extensive consultation process. If ETP does conflate route and dose (which sounds like a bad idea to me), then the decision sure didn't come out of NEHTA, but from the consultation process. (The discharge summary does conflate the two, but I don't think ETP does). Nor is the decision driven by the standards. It's based on requirements analysis.

And I hope that all the anonymous commenters on this blog are also contributing to the NEHTA CMK (http://dcm.nehta.org.au/ckm/). Of course, you have to stand behind your comments with your name there. But the DCM models matter, particularly with regard to things like route/dose conflation.

It's true that there is tension between the consensus based standards process, and project based deadlines. That's true in all contexts, and it's a problem that IT-14 (which met this week) is well aware of. While the standards process shouldn't be compromised, committees do need to figure out how to assist meeting politically set deadlines.

Grahame Grieve

Sunday, March 13, 2011 2:25:00 PM

The first thing to be said is that is far as I can tell Dr Browne is spot on:

From Page 36 of 92 of the ETP Structured Document Template Version 3.1 of 8/12/2010

----- Begin Extract

4.9 Dose Instruction

Identification

Name Dose Instruction

Metadata Type Data Element

Identifier DE-16008

OID 1.2.36.1.2001.1001.101.103.16008

Definition

A description of the dose quantity, frequency, route instruction and cautionary advice that determines how the prescribed therapeutic substance is administered to, or taken by, the subject of care.

Definition Source NEHTA

Synonymous Names

Dosage Instruction

Data Type Text

Usage

This SHOULD include the dose quantity, frequency, route, administration schedule and any additional instructions required to safely describe the appropriate dosage. If appropriate, this MAY also include the site of administration.

Conditions of Use

Conditions of NEHTA

Use Source

Examples

1. One tablet twice a day every 12 hours, before or with the first mouthful of food.

2. Apply thin layer to affected area 3-4 times daily; reassess after 7 days if no response.

----- End Extract

Note both this element and the following Quantity of Medication are simple uncoded text.

Just what would drive going down the uncoded path for this information really eludes me.

Using uncoded text for prescribing seems odd given all the work that has been invested in the Australian Medicines Terminology - or am I missing something?

As a clinician I certainly share the concerns raised in the comments above!

Grahame Grieve mentioned the IT-14 group met last week. I wonder what their views are? I suspect we will know soon enough.

I note, in passing, that the US has moved in the drug naming / terminology area:

Drug-naming standard for EHRs expanded

March 10, 2011 — 11:15am ET | By Janice Simmons - Contributing Editor

The RxNorm standard clinical drug vocabulary produced by the National Library of Medicine (NLM) has added more accurate and complete connections between national drug codes (NDCs)--the product identifiers assigned by American manufacturers and packagers of drugs--and standard nonproprietary names of medications recommended for use in electronic health records (EHRs).

Providing new connections between NDC product codes and RxNorm standard names and identifiers will have many potential uses within an individual patient's EHR, according to the NLM. These include the use of NDCs on medicine bottles to speed up standard data entry or to trigger an alert written in the RxNorm standard to prevent a medication error.

No single source currently contains all the NDCs for all medications marketed nationwide. RxNorm, though, has included NDCs provided by the Food and Drug Administration, the Department of Veterans Affairs, and the Multum and Gold Standard drug information sources for several years.

More here:

http://www.fierceemr.com/story/drug-naming-standard-ehrs-expanded/2011-03-10

It is also worth pointing out this has all been going a long time and really should have been sorted long since. The first version of the ETP documents appeared in late 2009 - now near to 18 months ago.

I look forward to further news on all this. Eric’s comments about the lack of appropriate leadership and governance in all this sure ring true to me!

David.