Fascinating Information on Adoption of PHRs in the US. The Usage Is Hardly Huge!

The following appeared a little while ago.

Google Health Dies, But PHR Market Still Growing

Personal health records will see a 33% gain in revenue through 2015 as doctors push patients to use health IT systems, finds Frost & Sullivan study.

By Nicole Lewis, InformationWeek

July 01, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/231000876

As the demise of Google Health brings into sharper focus the challenges of establishing an online personal health record (PHR) business model, a study by Frost & Sullivan reveals that the PHR market generated revenue of $312.2 million in 2010 and estimates that revenue will reach $414.8 million in 2015, representing a compound annual growth rate (CAGR) of 5.8%. Further, the report predicts that from 2010 to 2015 the PHR market will realize a 33% increase in revenue.

Released Wednesday, the report, The U.S. Personal Health Records Market: Understanding Technical and Strategic Imperatives around Consumer-Focused Health IT, also states that the use of PHRs among Americans was estimated to be around 7% of the population in 2010, but this number will rise due to increased use of electronic health records (EHRs) and other health IT by providers that will lead to greater awareness of their value.

"PHRs as a component of EHRs will drive the market," said Jessica Ryan Ohlin, Frost & Sullivan's analyst and the report's author. Ohlin explained that the growth of digitized medical records means health data can automatically be collected, consolidated, and fed into PHR platforms giving patients the opportunity to request from their medical providers or payers more of their medical records online.

Other trends in the market that will shift consumers toward further PHR use include structural changes in healthcare, including new collaborative care models; the increasing use of mobile health apps that help consumers overcome security fears as they become more comfortable with the idea of tracking and monitoring their personal health through technological means; and the growing number of older Americans and people with chronic diseases who, along with their caregivers, want to access, manipulate, and monitor their personal health information electronically.

"People will increasingly see the benefits of why they should be using a PHR. Just as moms are interested in having copies of their child's immunization records and caregivers want to have access to their parent's or loved one's information so that they can make decisions on behalf of and with their loved one, people will want all that data to reside in a Web-accessible online portal, which is going to be the way that this all goes," Ohlin said.

Link to full article is in text.

What I found interesting here is that total adoption is only 7% of the population even though Microsoft and Google have been in the market for a number of years - and that it will only rise 33% (or 2-3% overall) by 2015. Widespread adoption seems like it is a long way off!

It also seems clear from the report that it is content that is of use to the consumer, as well as functionality that makes obtaining and accessing services easier, are the drivers of adoption.

Another issue that is related to this aspect is the nature of just what will be made available and even more importantly just what they will be able to glean from that information.

I am told present plans are for the PCEHR to provide a Summary Clinical Record (the clinical basics) and information from Medicare. This is to include:

* immunization records

* organ donor records

* MBS claims including costs

* PBS claims including costs

Just what the ordinary punter will be able to make of a listing of MBS claim codes and costs I guess we will have to just wait and see on this - but I suspect won’t find the list riveting reading.

As additional clinical material is added it seems to me the risk of misunderstanding etc. of what is being presented will rise and so will the time spent by clinicians explaining what a or b actually means in this patient’s context. There is, of course, a risk that in some patients considerable anxiety and worry could be triggered unless explanations are easily available from a trusted source.

Frankly, just pushing information out the a PCEHR without some professional mediation seems like a pretty bad idea. People who want to know are more than entitled to know all, but discovery should be in a supported environment where the unexpected is able to be safely handled.

David.

Astonishing Silliness From DoHA! Can't Even Run A Government WebSite Properly!

As of 6:15pm 12, July 2011 if you want to access the PCEHR Submissions you get the following.

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/404ref.htm

It is really hard to understand why the link to the PCEHR Submissions should just vanish - other than either their not being happy that there were some who were not content the PCEHR - as planned - made any sense or just pure incompetence.

The link that used to work was (as of this morning):

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/PCEHRSubmissionsReceived

Really just nonsense!

David.

There Is Something A Little Odd About the Legislative Discussion Paper for the PCEHR.

In the last few days we have had the release of some consultation documents on possible legislation for the PCEHR.

The documents can be accessed from this link:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehrlegals-document

As I have read this there is one amazing oddity that has popped up.

First we know that Medicare Australia issues HPI-I to all the health practitioners it registers. (HPI-I and Individual Identifiers for Providers -as opposed to Organisational Identifiers HPI-O)

See here:

http://www.medicareaustralia.gov.au/provider/health-identifier/index.jsp

Second here is the list of provider types that can obtain an HPI-I

These include

› Chiropractic

› Dental

› Medical

› Nursing and Midwifery

› Optometry

› Osteopathy

› Pharmacy

› Physiotherapy

› Podiatry

› Psychology

See here:

http://www.ahpra.gov.au/

In the legal discussion paper we read:

Page 23

Nominated healthcare providers

Section 4.2 of the draft Concept of Operations describes clinical documents that will provide information that can be indexed by the PCEHR system and accessed through the consolidated view10 of a patient’s PCEHR.

Most of the clinical documents described are already part of the healthcare information created in the current healthcare system, such as discharge summaries, referrals, specialist letters, and pathology or imaging reports. However, healthcare providers are proposed to have a key role in creating documents specifically for the PCEHR such as shared health summaries and event summaries. The shared health summary would contain key pieces of information about an individual’s health status, such as allergies and adverse reactions, medicines, medical history and immunisations. The event summary would contain similar information in relation to a healthcare episode and would be created when something significant happens that is important to the individual’s ongoing care.

The draft Concept of Operations proposes at 3.2.5 that an individual will be able to nominate a healthcare provider organisation, or individual healthcare provider, to be responsible for establishing and maintaining the individual’s shared health summary. An individual could only nominate one healthcare provider organisation at a time to manage their shared health summary, however it would not be essential to have a nominated healthcare provider in order to have a PCEHR.

The legislation would not describe criteria or specific functions for the role of the nominated provider, however it would provide a framework for rules and standards to which a nominated provider must comply in managing a shared health summary. These rules and standards may also relate to the authorship of other documents on the PCEHR system, such as event summaries.

----- End Extract.

Nowhere can I find any suggestion that the nominated provider has to be a medical doctor. Why on earth would this not be explicitly stated or is it intended that nurses or dentists etc. can assume the role? This section seems to leave the choice of provider type wide open.

A search of the whole document does not clarify the point as far as I can see.

If that is the case we can be and it will be a wide choice of healthcare provider types then this entire project will be still born.

Of course it may be that the reason for this is that the powers that be don’t want GPs in the role - as they may have to pay them - and so this is a cost saving measure. How silly would that be?

Now I know the doctors are a pain in the neck as far as the Health Department is concerned but really this seems to be going just a little far. No doctor is going to be relying on health summaries developed by other than other doctors - I promise!

David.

Weekly Australian Health IT Links – 11 July, 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

Well the Carbon Tax details are out and most are either ignoring it or working out what it means for them. Some of the more perspicacious are also trying to work out what difference it will actually make to the atmosphere and whether we will be making a contribution to reducing anthropogenic global warming (which I have to say up front is something that I accept to be real and needing a really significant global policy response).

Part of the overall outcome will, inevitably, be determined by the quality of the plan and the quality of the implementation that follows. This brings me to e-Health.

This appeared a few days ago

Nicola Roxon gives in to states on health

• Sue Dunlevy and Matthew Franklin
• From: The Australian
• July 07, 2011 12:00AM

LABOR has caved in to premiers on national health reforms, junking a plan to guarantee public hospital elective surgery patients private hospital treatment if they are forced to wait beyond recommended periods.

Federal Health Minister Nicola Roxon has also watered down the previous blanket guarantee of a maximum wait of four hours for treatment in hospital emergency departments, agreeing that the target will now be rolled out on a hospital-by-hospital basis and will apply to only 90 per cent of patients.

Ms Roxon announced the backdowns yesterday just hours after Julia Gillard postponed a Council of Australian Governments meeting that had been scheduled for next week to thrash out the disputes with the states over the health reform package.

More here:

http://www.theaustralian.com.au/national-affairs/nicola-roxon-gives-in-to-states-on-health/story-fn59niix-1226089357048

This is only the last of a series of changes and modifications we have seen with the implementation of the Government’s plans for health reforms.

It also seems we are now starting to see a variety of changes being developed for a new version of the PCEHR plans.

The reason for this brief comment is just to make the point that the present Government seems to have a rather poor record of implementing what is announced (e.g. BER, Pink Bats, Health Reform, Off Shore Refugee Processing and so on) and with that record we can pretty safely assume both the Carbon Tax and the PCEHR will probably not happen in the way they are announced.

Stand by for all sorts of heat and noise with the Carbon Tax and hopefully some sanity to emerge with overall direction of the PCEHR. The latter would be really good!

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http://www.telecoms.com/30321/e-prescription-vendors-need-to-up-their-game/

E-prescription vendors need to up their game

July 5, 2011 Written by Pamela Weaver

While e-prescription systems can cut the costs and inaccuracies often associated with their paper counterparts, uptake of the technology has been low. A new report from analysts Ovum indicates that, despite the technology’s capacity to fundamentally change the healthcare systems of Europe and America, vendors of the software need to “up their game and improve the design of their systems” if widespread adoption by hospitals and surgeries is to be reached.

The report, entitled ePrescribing brings fundamental change to the Healthcare and Life Sciences Ecosystem, states that a major cause of resistance to e-prescription adoption is that healthcare practices, particularly those in the private sector, believe that current IT solutions “are not sophisticated enough to integrate well with other IT systems.” Report author Andrew Brosnan says that the software’s inability to “mesh seamlessly” with other IT infrastructure is “of great concern to prescribers.” Brosnan also points to high up-front costs and patient confidentiality fears as two further key reasons behind slow up-take, particularly in the US.

-----

http://www.voxy.co.nz/business/vendors-e-prescription-software-should-improve-their-game-tackle-low-adoption/5/94049

Vendors of e-prescription software should improve their game to tackle low adoption

Tuesday, 5 July, 2011 - 11:45

Vendors of electronic prescribing software need to up their game and improve the design of their systems, if widespread adoption by hospitals and surgeries is to be reached, according to Ovum.

In a new report*, the independent technology analyst finds that while e-prescribing systems, which cut costs and inaccuracies associated with paper prescriptions, are bringing fundamental changes to the healthcare sector in the US and Europe, uptake has been low.

The report states that a major cause of resistance to adoption is that healthcare practices, especially those in the private sector, believe that the IT solutions currently available are not sophisticated enough to integrate well with other IT systems.

-----

http://www.smartoffice.com.au/Technology/Software/U5X7U4G3?page=1

Healthcare E-Prescriptions Stunted By Software Vendors

By Matthew Lentini | Tuesday | 2011-07-05

Electronic prescription could grow right across the Australian healthcare market but the software vendors need to improve their offerings if e-prescription is going to take off, according to new Ovum research.

E-prescription systems integrate healthcare patients' prescriptions and the dispensing of medicine in an IT solution that cuts the costs and inaccuracies of the paper system, also giving the perks of patient medicinal history and reducing potential fraud through the streamlined, online system.

The report found that while these types of e-prescription systems slowly grow in the European healthcare sector, the Australian healthcare industry sees current software offerings as being not sophisticated enough to integrate with existing IT systems.

-----

http://www.zdnet.com.au/299m-dedicated-for-e-health-training-339318093.htm

$29.9m dedicated for e-health training

By Suzanne Tindal, ZDNet.com.au on July 7th, 2011

McKinsey and Company has lucked out again, winning another deal for the implementation of the Federal Government's plan for personally controlled electronic health records.

Health Minister Nicola Roxon today said that the government has appointed a consortium headed by McKinsey and Co to lead the national change and adoption process for the records scheme, which the government has committed to have up and running by July 2012.

Other members of the consortium include PricewaterhouseCoopers, Hill and Knowlton, Workstar, Event Planet, Ocean Informatics, Alfred Health, Salmat and the Australian General Practice Network (AGPN).

-----

http://www.6minutes.com.au/news/gps-exhibit-computer-anxiety

GPs exhibit ‘computer anxiety’

• By Gemma Collins on 5 July 2011

Some GPs are still battling with “computer anxiety” with nearly one in five not using computers for any clinical tasks, Australian research suggests.

A survey of nearly 500 GPs across the country found 17% were not using computers for any clinical functions, including writing prescriptions, preparing referral letters for patients, storing pathology results or for diagnosing.

Using data from a national telephone survey, researchers at Queensland University found the majority of GPs did have a computer in their practice, according to the study published in Health Information Management Journal (Vol 40 No 2 2011).

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http://www.telecoms.com/30273/e-health-case-study-telstra/

E-Health Case Study: Telstra

Australia

Australia’s incumbent fixed and mobile operator, Telstra, is targeting the health sector with services to be deployed in the next year or two. Its strategy has been formulated by a cross-company team that aims to deepen the operator’s involvement in the health sector and incorporate all of its core telecommunications products, in particular expanding on the existing customer relationships owned by Telstra Enterprise & Government and Telstra Business.

As the dominant player, Telstra is an early mover in the slowly developing Australian e-health market. But its competitors are increasingly aligning with the same strategic partners to offer services and the operator faces competition not only from other telecommunications companies but also from IT suppliers.

-----

http://www.medicalobserver.com.au/news/longterm-telehealth-funding-may-fall-short

Long-term telehealth funding may fall short

7th Jul 2011

Andrew Bracey

START-UP grants and incentive payments for GPs engaging in new telehealth consults may not be enough to sustain the services in the long term, the AMA is warning.

From the beginning of this month, a suite of new MBS rebates will see GPs outside inner-metropolitan areas paid to sit with patients while they consult a specialist via webcam.

The item numbers attract a 35% loading on top of rebates for standard time-based consultations, a $40 incentive payment plus another $20 incentive if the consultation is bulk-billed. One-off $6000 payments to cover equipment costs are on offer.

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http://www.theaustralian.com.au/news/health-science/high-tech-boost-for-diabetics-in-perth/story-e6frg8y6-1226090870966

High-tech boost for diabetic children

• From: AAP
• July 08, 2011 4:59PM

TREATING diabetes in children is about to go high-tech.

Doctors are hoping to revolutionise how children with type 1 diabetes receive their regular insulin doses using a special sensor inserted under the skin and transmitting data to a mobile phone.

Early trials of the device are being carried out at the Princess Margaret Hospital in Perth amid hopes it will simplify how diabetics receive their crucial insulin doses.

People with type 1 diabetes currently have to measure their blood sugar levels up to 10 times a day by carrying out finger prick tests.

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http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/PCEHRSubmissionsReceived

Submissions received on the PCEHR Draft Concept of Operations – Relating to the introduction of a PCEHR system.

This page lists received submissions that comply with the submission terms of use.

Submissions closed on 7 June 2011. Review this consultation's context

Submissions will be progressively published to the yourHealth website over the next few weeks.

------

http://www.brisbanetimes.com.au/business/isoft-board-faces-a-few-hard-questions-20110704-1gz4j.html

iSoft board faces a few hard questions

Scott Rochfort

July 5, 2011

CBD

Shareholders in iSoft might have a few extra questions at a meeting next week that may not entirely relate to the $180 million takeover offer from Computer Sciences Corporation.

While shareholders are expected to accept the 17¢ a share bid, questions linger over the share price movements at iSoft in the week before the takeover was announced to the market in early April.

In the two days before iSoft shares were placed into a halt (prior to the CSC announcement), they rose from 3.6¢ to 5.2¢ on heavy volume - a rise of more than 40 per cent and just days after shares in the company hit a record low.

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http://www.theaustralian.com.au/business/companies/csc-confident-its-full-and-fair-offer-for-isoft-will-be-successful/story-fn91v9q3-1226089297783

CSC confident its 'full and fair' offer for iSoft will be successful

• Michael Bennet
• From: The Australian
• July 07, 2011 12:00AM

COMPUTER Sciences Corporation says its $188 million offer for beleaguered iSoft Group is "full and fair" and has pledged support to the company's staff in a last-ditch plea to win the support of beleaguered shareholders.

In the US IT giant's first Australian interview since lobbing its offer in early April, corporate vice-president Randy Phillips also outlined plans to turn around the ailing IT health company.

But first, CSC must win approval from at least 70 per cent of iSoft's shareholders, outside of majority holder Oceania Capital Partners, for the scheme of arrangement in Sydney on July 15.

OCP, formerly Allco Equity Partners, has pledged its 24 per cent to the 17c a share offer -- a 227 per cent premium to iSoft's price before the bid.

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http://www.zdnet.com.au/electrotherapy-to-replace-depression-drugs-339318085.htm

Electrotherapy to replace depression drugs?

By Larry Dignan, ZDNet US on July 7th, 2011

Electrical signals appear to increase blood flow to the brain and alleviate depression symptoms, according to a recent clinical trial.

The trial, detailed by NeuroSigma, which specialises in "neuromodulation", found that external Trigeminal Nerve Stimulation boosts blood flow in areas of the brain focused on mood regulation.

NeuroSigma has licensed the technology from UCLA, and is looking to commercialise it. The Phase 1 clinical trial found that patients had reductions in depression severity over eight weeks. However, that first trial included four patients, who saw a 44 per cent reduction in their depression severity score. A Phase II double-blind trial is expected to be completed in late 2011.

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http://www.theaustralian.com.au/news/nation/nine-out-of-10-concerned-about-identity-theft/story-e6frg6nf-1226086723907

Nine out of 10 concerned about identity theft

• From: AAP
• July 04, 2011 12:00AM

NEARLY one in six Australians have been a victim, or known somebody who has been a victim, of identity theft or misuse in the past six months.

An independent online survey of 1200 people also revealed nine out of 10 people were concerned or very concerned about identity theft and misuse.

"It's clear from these results that there is real concern in the Australian community about identity theft and misuse," federal Attorney-General Robert McClelland said yesterday, adding that as people undertook more transactions online, the risk of identity theft increased.

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http://www.theage.com.au/digital-life/computers/blogs/gadgets-on-the-go/aussie-appetite-for-bandwidth-grows-20110707-1h3e6.html

Aussie appetite for bandwidth grows

July 7, 2011 - 10:08AM

We're demanding fatter pipes and sucking down more data than ever.

More than 8.1 million Australian households were connected to the internet in December 2010, up 11 per cent on the year before according to the Australian Communications and Media Authority. Those households pulled down an average 6.26 GB per month, which doesn’t sound like a lot but it’s a 30 per cent jump on the year before.

As our appetite for downloads grows, it’s little surprise that we’re upgrading to faster internet services. Last year 46 per cent of household internet connections offered an advertised maximum download speed of 8 Mbps or more, compared to only 30 per cent the year before. Of course those figures are a little rubbery, as it counts all homes on ADSL1+ or ADSL2+ even though many of them would actually get far less than 8 Mbps. Akamai’s 2010 Q4 report figures perhaps paint a more realistic picture. Akamai found the average Australian connection speed was 3 Mbps, up 35 per cent on the year before. The report found half of Australian households connected to the internet at speeds above 2 Mbps.

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http://www.smh.com.au/technology/technology-news/new-mobiles-study-doubts-cancer-risks-20110702-1gvyo.html

New mobiles study doubts cancer risks

Kristen Hallam

July 3, 2011

MOBILE phones may not increase the risk of brain cancer, a study has found, just a month after the World Health Organisation said using the devices may cause tumours.

Studies from several countries have failed to show an increase in brain tumours, up to 20 years after mobile phones were introduced and 10 years after the technology became widespread, the International Commission on Non-Ionizing Radiation Protection's committee on epidemiology wrote in the journal Environmental Health Perspectives.

The findings of the committee, which included scientists from Australia, challenge those of an International Agency for Research on Cancer review.

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http://www.theaustralian.com.au/australian-it/confusion-on-child-pornography-site-blocking-scheme/story-e6frgakx-1226087523741

Confusion on child pornography site blocking scheme

• Andrew Colley
• From: The Australian
• July 05, 2011 12:00AM

AUSTRALIAN internet service providers have expressed fears that the federal government's voluntary online child pornography blocking scheme could become a mandatory system by stealth.

The voluntary filtering scheme will for the first time authorise the Australian Federal Police to use section 313 notices under the Telecommunications Act to direct ISPs to block an Interpol-vetted list of child abuse sites on the internet.

Traditionally, carriers have viewed following instructions contained in 313 notices issued by law enforcement agencies as an obligation and company officers can face contempt of court orders for refusing to follow them.

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http://www.smh.com.au/technology/technology-news/telstra-optus-net-filters-trivial-to-bypass-20110705-1h02i.html

Telstra, Optus net filters 'trivial' to bypass

Ben Grubb

July 5, 2011

An internet filter designed to block access to child pornography, which is being imposed on Optus and Telstra customers, is "trivial" to bypass, say civil libertarians.

But the Internet Industry Association (IIA), which helped design the filtering scheme for ISPs such as Telstra and Optus, said that just because it could be bypassed did not mean it should not be implemented.

The list of URLs that Telstra began to block at the start of this month and which Optus plans to begin blocking at the end of July is maintained by the International Criminal Police Organisation (Interpol). It aims only to prevent access to sites hosting child pornography.

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Enjoy!

David.

AusHealthIT Poll Number 78 – Results – 11 July, 2011.

The question was:

How Would You Score NEHTA's Efforts in Delivering Implementable E-Health Standards For Australia?

The answers were as follows:

10/10

- 3 (8%)

8/10

- 4 (10%)

6/10

- 3 (8%)

4/10

- 3 (8%)

2/10

- 9 (24%)

0/10

- 15 (40%)

A reasonably clear poll. 73% of readers gave NEHTA a less than passing grade.

Votes : 37

Again, many thanks to those that voted!

David.

I Am Pretty Sure The Basic Rules Of Change Management Are Being Ignored with the PCEHR.

The following press release appeared a few days ago.

More Progress in e-health Consultation and Engagement

7 July 2011

Two important milestones in the development of Australia’s e-health system have been met with the key appointment of the National Change and Adoption Partner and the release of the Personally Controlled Electronic Health Record System: Legislation issues paper.

“E-health records will drive safer, more efficient and better quality healthcare for Australians. It is one of the important elements of national health reform,” Minister Roxon said.

“Patients will no longer have to remember every immunisation, every medical test, and every prescription as they move from doctor to doctor.

A consortium headed by McKinsey and Company has been selected to lead the national change and adoption process as Australia moves to introduce Personally Controlled Electronic Health Records (PCEHR) next year.

“The National Change and Adoption Partner will help educate and support the training and information needs of the health workforce who will use the system,” Minister Roxon said.

“The consortium will plan, design and develop training, guidance and tools in collaboration with clinicians and software providers. It will also provide change management support for clinicians including at the 12 lead implementation sites.

“From 1 July 2012, Australians will be able to choose to have a personal eHealth record, giving individuals a level of control over their health information never previously available.

“For doctors, nurses, pharmacists and other health professionals, PCEHRs will help transform Australia’s health system, improving the security of patient information and allowing for better clinical assessments and more efficient, effective treatment.”

“The Commonwealth is investing up to $29.9 million for this important contract for e health implementation.

.....

The Change and Adoption Partner consortium led by McKinsey and Company also includes PricewaterhouseCoopers, Hill & Knowlton, Workstar, Event Planet, Ocean Informatics, Alfred Health, Salmat and the Australian General Practice Network (AGPN).

Submissions made on the Personally Controlled Electronic Health Record System: Legislation issues paper will inform the drafting of legislation around the PCEHR system. Draft legislation will later be released for a further round of public consultation before introduction in Parliament later this year.

The legislation issues paper may be viewed, and submissions made, at www.yourhealth.gov.au, for a period of four weeks until 5pm Wednesday 3 August 2011.

The release is found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr138.htm

Press coverage is found here:

Team McKinsey bags major e-health deal

• Fran Foo
• From: Australian IT
• July 07, 2011 5:24PM

A MCKINSEY and Co-led consortium has been given the thumbs up by the Gillard government to run a key component of the $467 million personally controlled e-health record project.

The news comes as Health Minister Nicola Roxon today called for input into the proposed PCEHR legislation.

As national change and adoption partner for the project, McKinsey will lead a cohort that includes PricewaterhouseCoopers, Workstar, Event Planet, Ocean Informatics, Alfred Health, Salmat, the Australian General Practice Network and public relations agency Hill & Knowlton.

Ms Roxon said the government was investing up to $29.9m in the change management aspect of the project.

"The national change and adoption partner will help educate and support the training and information needs of the health workforce who will use the system," Ms Roxon said in a statement.

She said the consortium was charged with planning, designing and developing training, guidance and tools in collaboration with clinicians and software providers to support the PCEHR rollout.

The group will provide change management support for clinicians that will also cover 12 lead implementation sites.

"From July 1, 2012, Australians will be able to choose to have a personal e-health record, giving individuals a level of control over their health information never previously available.

"For doctors, nurses, pharmacists and other health professionals, PCEHRs will help transform Australia's health system, improving the security of patient information and allowing for better clinical assessments and more efficient, effective treatment," she said.

More here:

http://www.theaustralian.com.au/australian-it/government/team-mckinsey-bags-major-e-health-deal/story-fn4htb9o-1226090028555

And here:

$29.9m dedicated for e-health training

By Suzanne Tindal, ZDNet.com.au on July 7th, 2011

McKinsey and Company has lucked out again, winning another deal for the implementation of the Federal Government's plan for personally controlled electronic health records.

Health Minister Nicola Roxon today said that the government has appointed a consortium headed by McKinsey and Co to lead the national change and adoption process for the records scheme, which the government has committed to have up and running by July 2012.

Other members of the consortium include PricewaterhouseCoopers, Hill and Knowlton, Workstar, Event Planet, Ocean Informatics, Alfred Health, Salmat and the Australian General Practice Network (AGPN).

"The National Change and Adoption Partner will help educate and support the training and information needs of the health workforce who will use the system," Roxon said in a statement. "The consortium will plan, design and develop training, guidance and tools in collaboration with clinicians and software providers. It will also provide change management support for clinicians, including at the 12 lead implementation sites."

Roxon said that up to $29.9 million would be spent on the contract.

More here:

http://www.zdnet.com.au/299m-dedicated-for-e-health-training-339318093.htm

Just so we know what we are talking about - here is the work program requested in the Tender.

Change and Adoption Work Program

1

2

2.1

2.2

2.3

2.4

2.5

The Change and Adoption Work Program comprises five major work components:

Component 1 – National Change and Adoption Strategy;

Component 2 – Strategic Stakeholder Engagement Program;

Component 3 – Marketing and Communications Program;

Component 4 – National Change Program; and

Component 5 – Local and Regional Change Program.

National Change and Adoption Strategy: This is the work required to develop and maintain an overarching strategy for the Change and Adoption Program. This work will include strategies and implementation planning for stakeholder engagement, marketing, national eHealth change programs, eHealth Site change programs, workplace change programs and the integration of the Benefits Realisation and Evaluation Framework. This work will be the first deliverable that the National Change & Adoption Partner will produce and will be informed by the eHealth Site learnings, national and international research and experience, industry best practice, and will be performed in consultation with DoHA and NEHTA. The National Change and Adoption Strategy will be a key PCEHR Program document and will contribute to the PCEHR system business case for Government funding, post June 2012.

Strategic Stakeholder Engagement Program: This is the work necessary to continue to plan and execute strategic stakeholder engagement for policy and business design consultation, concept validation and requirements verification from a national perspective. The strategic stakeholder engagement work performed by the National Change and Adoption Partner, will build on the planning and stakeholder engagement activities completed by DoHA, NEHTA and eHealth Sites, conducted during the first year of the PCEHR Program. This program will need to align with DoHA’s overall engagement program and will need to take into account the wider eHealth environment and the National Health and Hospitals Reform Agenda. This work will include engaging with a widening spectrum of stakeholders including: Australian Government agencies, state and territory governments, healthcare providers, software vendors and consumers, including early target areas (those suffering from chronic and complex conditions, older Australians, Aboriginals and Torres Strait Islander peoples, mothers and their newborn children), under the guidance and direction of DoHA The Change and Adoption Partner will also participate in a Communications Working Group, which will coordinate all stakeholder engagement and marketing communications for the PCEHR Program.

Marketing and Communications Program: This is the work associated with planning, design, alignment and implementation of national marketing and communication campaigns in a way that maximises stakeholder participation and engagement with the PCEHR Program and which delivers the outcomes outlined in Table 1, defined within the Benefits Realisation and Evaluation Framework (delivered in quarter 2 of 2011 by the Benefits and Evaluation Partner). This work will be led by DoHA, co-ordinated with NEHTA and supported by the National Change and Adoption Partner.

National Change Program: This is the work necessary to develop a National Change Program which will be overarching, integrated and will result in an evidence-informed change management plan for the PCEHR system. This work will be co-ordinated by the National Change and Adoption Partner and will be informed by the Benefits and Evaluation Partner, DoHA, NEHTA, eHealth sites “lessons learned”, external bodies such as the National Workforce Agency, clinical training and registration organisations and other key stakeholders. It will result in the development of tools and national training projects for clinicians, administration staff and the public so that the rollout of the PCEHR system occurs effectively and safely, to deliver the outcomes stated in Table 1. In particular, it will involve co-ordinating the change programs deployed at a local clinical or workplace level across Australia, incorporating activities such as education, technical, data support and on the job training. This program will also link to other national health reform initiatives such as the Practice Incentives Program, GP After Hours, chronic disease management services, telehealth incentives and GP super clinics.

Local and Regional Change Program: This is the work which will be initiated by the eHealth Sites and will be carried out by local change companies or agents. These local agents will be required to integrate and align with the National Change and Adoption Strategy, developed by the National Change and Adoption Partner. This work will be co-ordinated by NEHTA and the results and effectiveness of this program will need to be reported on by NEHTA and provided to the National Change and Adoption Partner.

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So what we have here is a team to deliver a program to foster change and adoption leading up to the June 30, 2012 deadline. The contract has options for 2 years extension but no guarantee that will happen.

On the basis of the partners involved it seems there are planning, marketing, educational and consumer interaction tasks being requested.

Change management 101 makes it clear that in a complex domain like planning and implementing a PCEHR what is needed is:

1. Clarity as to what the desired future state is and an agreed plan involving all the stakeholders to move to that future state.

2. Clarity as to what the benefits and problems that will be faced by each stakeholder group (consumers, clinicians, service providers etc.)

3. Clarity as to the incentives and support that will be provided to assist in the desired transition.

Wikipedia gives a nice summary of some of the critical success factors:

“Successful change management is more likely to occur if the following are included:

1. Benefits management and realization to define measurable stakeholder aims, create a business case for their achievement (which should be continuously updated), and monitor assumptions, risks, dependencies, costs, return on investment, dis-benefits and cultural issues affecting the progress of the associated work.
2. Effective Communications that informs various stakeholders of the reasons for the change (why?), the benefits of successful implementation (what is in it for us, and you) as well as the details of the change (when? where? who is involved? how much will it cost? etc.).
3. Devise an effective education, training and/or skills upgrading scheme for the organization.
4. Counter resistance from the employees of companies and align them to overall strategic direction of the organization.
5. Provide personal counselling (if required) to alleviate any change related fears.
6. Monitoring of the implementation and fine-tuning as required.”

---- End Extract.

Found here:

http://en.wikipedia.org/wiki/Change_management

Given that there is no established evidence based benefits case for the PCEHR, that to date there are no planned incentives for adoption and that many clinical organisations struggle to see much utility in the program the risk that this whole change and adoption exercise will be a waste of $29.9 million spent over a little under a year must be pretty high.

It is quite amusing that DoHA wants an evidence informed change management program to work on the evidence free PCEHR program!

One wonders if McKinsey and Co might just have the honesty and intestinal fortitude to say to the Government that this exercise is just too rushed and too unclear in the desired end state for a worthwhile change management initiative to have any realistic chance of success. One can dream I guess!

David.