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, August 21, 2015

Has The PCEHR Just Become Obsolete? - This Looks Like An Interesting Approach For the 21st Century.

This appeared a little while ago;

Zobreus Launches the Patient-Oriented Electronic Medical Record Free app gathers medical records and securely stores them on mobile devices

SILICON VALLEY, Calif., Aug. 11, 2015 /PRNewswire/ -- Fresh of a successful Kickstarter campaign and multi-user beta, Zobreus Medical Corporation announces that it has launched the Patient-Oriented Electronic Medical (POEM) Record™ v1.0 in the Apple App Store. The POEM Record™ allows patients to manage and control all of their healthcare data in a structured, mobile electronic medical record (EMR) so that the information is easily accessible to them and their doctors as needed.
"We're responding to the large, unmet need from health consumers who definitively want full, unfettered access to, and control over, their health records," says co-founder and CEO L. Okey Onyejekwe Jr., a practicing physician. "Instead of sifting through stacks of physical documents and sending repeated requests while waiting for weeks, consumers can now painlessly gain control over their medical information." Zobreus is working with a number of hospitals and provider networks to further simplify the records-retrieval process using its proprietary technologies that eliminate additional costs, time, and software integration for clinics.
"What's also unique about the POEM Record™ is that it is built to not only serve as a patient health record, but also as a full-featured EMR that we doctors can use to process our notes and engage with patients from within the same application," says Onyejekwe.
Setup is simple. Patients register directly through the app, or at www.poemrecord.com, and grant Zobreus authorization to retrieve their medical records on their behalf. The company then processes the records into the clean, user-friendly, and aesthetically-pleasing POEM Record™ application.
Given the sensitive nature of health data, security is a central focus of the company. "We use end-to-end encryption to keep your data secure on your device, during transmission, and on our servers," says co-founder and CTO, Patrick Ohiomoba.
Zobreus offers a free, basic tier that allows patients to manage one set of medical records. Subscription tiers are available that unlock additional features such as Care Circles™ and user forums, and that enable additional records updates. The company is running an "early-bird" promotion that allows initial subscribers to receive their paid subscription at half-off for the life of the subscription. Additionally, users who register now will have full access to all premium features for 6 months at no cost, after which users can keep their records even if they chose not to subscribe.
The app is currently available on iPad devices, with iPhone and Android versions currently in development. Users of other devices can nonetheless register on www.poemrecord.com, submit records requests, and lock in the same early-bird benefits.
SOURCE Zobreus Medical Corporation
Here is the link to the release
The website is really worth a browse to see what might be shaped here.
David.

This Is An Important Warning For Those Who Might Trust A Dodgy Health App.

This appeared a few days ago:

Melanoma App Vendor Barred from Making Deceptive Health Claims

AUG 14, 2015 7:42am ET
Under a settlement with the Federal Trade Commission, a melanoma-detection app vendor has been barred from making further deceptive health claims about his products available for sale online in the Apple and Google app stores.
According to FTC, Avrom Lasarow is now “prohibited from making any misleading or unsubstantiated claims about the health benefits or efficacy of any product or service, including that a device detects or diagnoses melanoma.” Earlier this year, FTC charged U.K.-based Lasarow and his company—L Health Ltd.—with false advertising regarding the Mole Detective family of apps and their ability to detect melanoma or the risk of melanoma.
As part of the settlement, a $58,623.42 judgment was made against Lasarow which has been suspended based on his inability to pay the fine. However, FTC states that if he is later found to have misrepresented his finances, the full amount will become due immediately.
The FTC’s February 2015 complaint alleged that the Mole Detective apps instructed users to photograph a mole with a smartphone camera and that the apps could determine the mole’s melanoma risk, even assessing such risk in early stages.
More here:
There is a lesson here for all health app users. Make sure your app is properly validated and safe and if in doubt ask your GP!
David.

Thursday, August 20, 2015

2016 Budget -Parliament Back And It Just Seems To Go From Bad To Worse On Non-Economic Matters.

August 20 Edition
Budget Night was May 12, 2015. We now await economic and  activity data reporting to see how successful it was. Interestingly there are some early indications the small-business stimuli might be working. Certainly JB HiFi and Harvey Norman seem to have been doing well recently.
Parliament has come back on 10th August - so we can expect things to warm up at from now! Sadly the economy has not been a hot topic - Same Sex Marriage and The Union Royal Commission dominated all last week!
Well at least Spring is just around the corner - you can tell as the birds are waking up earlier each day and the daily top temps seem to be slowly rising!
This article gives the background:

Good government needn't be a punchline, Tony Abbott

Date August 14, 2015 - 9:29PM

Peter Hartcher

Sydney Morning Herald political and international editor

The leadership of the most successful conservative government in the Western world had a close-up look at the Abbott government a year and a half ago. 
The Prime Minister of New Zealand, John Key, and half a dozen of his ministers came to Sydney for a joint cabinet meeting with his Australian counterparts. It was a friendly exercise, full of shared interests and personal warmth.
The Australian prime minister’s office is a crucible of crisis, waging a full-time operation just to keep Abbott in his job for even a single term. 
Abbott greeted Key publicly "not just as a brother, but as soul mate. I do welcome him as someone, not just as a friend, but in very significant ways already a political mentor".

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Since this article was published we seem to be having an astonishing amount of leaking against the Government by its own Cabinet. To the uninformed eye, right now, there is a sense of policy chaos which makes the mess in e-Health seem relatively trivial!
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Here is some other of the recent other news and analysis.

General Budget Issues.

Tax rates must fall, says Treasurer Joe Hockey

David Crowe

Australia is suffering an “unsustainable risk” from high personal taxes that must be brought down to encourage growth and boost jobs, Joe Hockey will declare today in a move to set a reform agenda for the next election.
Putting tax relief on the table if the Coalition holds power, the Treasurer will warn that personal income taxes are so high they threaten to discourage workers and weaken the economy. Mr Hockey will also sharpen the debate on the GST by insisting state revenue be “aligned” to the spending needed on government ser­vices, an argument that underpins calls for a rise in the consumption tax from 10 per cent to 15 per cent.
“We cannot afford to have a tax burden that stifles growth and costs jobs,” Mr Hockey writes in The Australian today, singling out the $185 billion income tax take.
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Easy tax reform: axe capital gains discounts

Date August 11, 2015 - 12:00AM

Peter Martin

It appears that capital gains and negative gearing tax concessions are on the nose with everyone except the Prime Minister.
How on earth did we come to be lumbered with a tax rule so bad it is disliked by the Treasury, the Reserve Bank, the Business Council, the Council of Social Service, the Organisation for Economic Co-operation and Development, and both of Tony Abbott's most trusted business advisers?
And why on earth is Abbott still clinging to it?
The  story of how we came to be saddled with a system that taxes wages at twice the rate of profits made from trading real estate is an epic tale of revenge, incompetence, bloody-mindedness and gullibility. Along the way it has forced Treasurer Joe Hockey to set income tax rates higher than he should and fed an explosion in house prices by supercharging negative gearing.
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Why Joe Hockey may have delivered his last budget

11:00pm, Aug 13, 2015
Rob Burgess Economics commentator
ANALYSIS: This question is increasingly being asked – will the government dare hand down a third budget before going to the polls?
While other big stories have tended to squeeze out economic debate in recent weeks – the demise of speaker Bronwyn Bishop, the marriage equality debate and on Thursday more stories of terror and counter-terror relating to Islamic State – the data has been telling an alarming story.
The slump in wages growth is the big one. From fairly consistent growth of around four per cent, private sector wage growth has fallen to 2.2 per cent in the latest ABS data.
When public sector wage increases (2.5 per cent) are factored in, the overall pay increase is 2.3 per cent, which is just a whisker ahead of the latest annual trimmed-mean inflation reading of 2.2 per cent. The ‘trimmed mean’ smooths out sudden spikes or slumps in prices that are expected to be short term, with petrol prices being the best recent example.
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Joe Hockey sees jobs, growth on track after 2015 budget

David Uren

David Crowe

Joe Hockey has good reason to be pleased with the performance of the economy since his second budget was delivered three months ago. Retail sales are going well, consumers are happy and businesses say trading conditions are the best they’ve been since the brief bounceback after the global financial crisis.
The buoyant economic performance, particularly in NSW and Victoria, is being achieved despite tumbling prices for Australia’s exports and evidence that large swaths of the Chinese economy are in a recession that its government is battling to contain.
Although China’s problems are rippling through Asia, they have not yet disturbed the buoyant climate in Sydney and Melbourne. There are echoes of the Asian financial crisis of the late 1990s when Australia was expected to be sucked into the regional vortex of recession, but instead lifted its growth rate above 4 per cent.
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Australia’s growth path assured, says Joe Hockey

David Uren

David Crowe

Joe Hockey believes the economy has developed a “prosperity moment­um” that will deliver the government’s budget targets and maintain growth through to the next election and beyond.
In an exclusive interview with The Weekend Australian, the Treas­urer said he was confident the economy would not be blown off-course by events in China, saying his talks with Beijing’s leading economic officials had convinced him they would do “whatever it takes” to keep growth going.
Mr Hockey said the house price boom, government spending on infrastructure, small-business tax cuts and the fall in the Australian exchange rate were all helping to deliver economic growth.
“I’m still confident about our forecasts from the May budget and I remain more bullish about the region and the global economy than others,” he said.
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Competition is the key to a brave new Australia

Date August 15, 2015 - 7:56AM

Ross Gittins

The Sydney Morning Herald's Economics Editor

Under its newish secretary, John Fraser, Treasury has a new slogan. It is proud to be "fiscally conservative, market-oriented and reform-driven". So just what reform does Treasury advocate?
Well, in a speech last week Fraser spelt it out. But first he noted that the key element of market-oriented reform is that it almost always involves heightening competition. He illustrated the point by summarising what happened during the golden age of micro-economic reform in the 1980s and '90s.
Competitive pressures drive innovation and investment.  
John Fraser, Treasury Secretary
When business speaks of the need for Australian firms to be more competitive, it usually means  the government should do something that makes it easier for firms to compete with their foreign rivals.
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Health Budget Issues.

Changes to commonwealth health cost share ‘to hurt states’

Sean Parnell

The commonwealth contribution to the cost of running public hospitals hit a “historical low point” in the last year of the federal Labor government but the incoming Coalition jeopardised an agreed plan to help share the states’ financial burden.
While federation talks are considering a number of long-term structural reforms to the health system, an analysis prepared for the states warns that the Abbott government’s funding changes will impact on patients in the short term.
The states will use the analysis at a meeting of health ministers in Darwin today to urge federal Health Minister Sussan Ley to back a more immediate examination of funding issues and not rely on federation talks to solve the problem.
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Spending cuts imperil the health of all

Date August 10, 2015 - 9:00PM

Michael Thorn

Public health activists despair of the prospects of an adequate strategy to tackle chronic disease, described as "Australia's greatest health challenge" by the government's Reform of the Federation White Paper. And it is probably our own fault.
That's not to say the odds aren't stacked against us, the Abbott government having almost entirely dismantled Australia's national preventive health system.
It terminated the $370 million National Partnership Agreement on Preventive Health which funded various programs, including the successful public health campaign behind Ararat's transformation from being one of Australia's fattest towns. (The exposure of the Assistant Minister for Health's chief of staff's conflicts of interest saved front-of-pack food labelling from a similar fate.)
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Push for health reforms to fight chronic illness

Sean Parnell

Policy experts, health insurers, academics, professional colleges and consumer groups have called for urgent health funding ­reforms to better support people with chronic illness and ensure best use of limited budgets.
Amid ongoing federation talks and the Abbott government’s consideration of further Medicare reforms, the George Institute for Global Health Australia has used a roundtable meeting of more than 30 key stakeholders to reach consensus on the areas with most pressing need.
The stakeholders want funding reforms to aim for “high-­quality, effective and efficient healthcare” — not simply pumping more money into an often criticised system — with an ­immediate focus on those with chronic and complex conditions, along with people who are disadvantaged.
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Poor mental health dragging our economy down

Date August 11, 2015 - 9:00PM

Ross Gittins

Ross Gittins tries to dispel some of the common myths surrounding mental illness with help from the OECD report, Sick on the Job.
Don't take this as implying that I condone the misuse of taxpayers' money, but the almighty to-do over politicians' "entitlements" reminds me that small things annoy small minds.
If you think the odd unnecessary $5000 helicopter ride constitutes the worst of the wastage of our money – or that it makes much difference to the $430 billion the federal government spends each year – you haven't done enough thinking.
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Govt urged to radically expand PIP payments

Paul Smith12 August, 2015
A revamp of the Practice Incentives Program that would see practices handed lump sum payments to manage chronic disease patients is being touted by Australia's largest health groups.
In a paper released on Wednesday, the George Institute for Global Health says there is an urgent need for new funding models.
While the paper — Investing in Healthier Lives — floats the idea of pay for performance depending on patient outcomes, its main focus is the rollout of so-called capitation payments.
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Medical Research Fund Issues.

Greens to support Medical Research Future Fund in parliament

Jared Owens

Greens senators are likely to support the Abbott government’s Medical Research Future Fund in parliament today, following last-minute haggling between the government and party leader Richard Di Natale.
The Greens were concerned that National Health and Medical Research Council funds might be “gouged”, with funding to the sector increasingly shifted to the MRFF for no real benefit.
However, a senior Greens source said, Senator Di Natale had held “productive conversations” with the government and was “reasonably happy” with the outcome.
“There are still a couple of issues they’re dicing back and forwards but on balance we’re likely to support it,” the source said.
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Medical Research Future Fund Bill Passes

The successful passage of the Government’s legislation to establish the Medical Research Future Fund will significantly strengthen Australia’s standing as one of the global leaders in the field of medical research.
Page last updated: 12 August 2015
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Coalition's $20bn medical research future fund cleared by Senate

Twenty amendments made to legislation – including rules over how money would be spent – means House of Representatives must now reconsider it
Australian Associated Press
The Abbott government’s $20bn medical research future fund has cleared the Senate despite concerns about the potential for its funding decisions to be politicised.
The government says the fund will be the largest of its kind in the world, firming Australia’s position as a leader on medical research.
It made 20 amendments to its legislation, including stronger controls over how the money would be distributed, meaning it must go back to the House of Representatives for approval.
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Medical Research Future Fund finally gets Senate approval

Jared Owens

The Medical Research Future Fund — a signature initiative of the Coalition’s first budget that Treasurer Joe Hockey hoped would help find cures for cancer and dementia — has finally passed the Senate, despite the government’s dumping the GP co-payment that had been ­designed to bankroll it.
The MRFF now will be funded through reduced health spending and about $1 billion left over from the Health and Hospitals Fund designed by the Rudd government to upgrade health infrastructure, until its balance reaches $20bn in 2020.
It will be managed by the ­Future Fund and any interest it generates will be distributed to medical research, beginning with $10 million this year and a further $390m in the next three years.
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Concerns about how grants will be allocated from Medical Research Future Fund

Michael Edwards reported this story on Thursday, August 13, 2015 08:26:22
MICHAEL BRISSENDEN: Doctors are welcoming the establishment of Australia's medical research fund but concerns persist about how the grants will be allocated.
The Government says the multi-billion-dollar-program will strengthen Australia's standing as a global leader in research.
The fund is the largest of its type in the world.
Labor is concerned, though, that the grants process will be open to political interference.
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Medical fund changes a 'stuff up': Labor

AAP
The federal government has been accused of stuffing-up draft laws for its much-vaunted Medical Research Future Fund.
Parliament's lower house on Thursday rejected a government amendment passed in the Senate on how research funding would be dispersed, because constitutional rules mean the upper house can't make laws appropriating revenue.
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Concern over control of medical research fund

Alice Klein13 August, 2015
Legislation establishing the Medical Research Future Fund has passed the Senate, with most financial backing to come from hospital funds in the wake of the abandoned GP co-payment.
The fund will initially receive $1 billion from the uncommitted balance of the Health and Hospitals Fund, while future contributions will come from 2014/15 budget cuts to the health portfolio until the balance reaches $20 billion.
Following the Medical Research Future Fund Bill's successful passage through the Senate on Wednesday, Federal Health Minister Sussan Ley said the fund would support research that enabled game-changing medical innovations and improve the health of Australians.
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Pharmacy Issues.

Loophole closure deadline

11 August, 2015 Chris Brooker 
An investigation into PBS dispensing by non-approved pharmacies will only have remit to investigate breaches that have occurred since December 2014.
A Department of Health spokesperson has confirmed to Pharmacy News that the planned investigation would only cover cases since a legislative loophole was closed late last year.
The Department is also encouraging pharmacists to report colleagues that may be breaching regulations.
“From 1 December 2014, the Minister for Health introduced a new condition of approval in the National Health (Pharmaceutical Benefits) (Conditions of approval for approved pharmacists) Determination 2007 (Conditions of Approval),” the spokesperson said.
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Pharmacy consolidation on the agenda

11 August, 2015 Chris Brooker 
Pharmacies will increasingly be consolidated into large retail groups as the profession adapts to changing professional structures, former Pharmacy Guild of Australia (Qld) president Terry White believes.
Mr White (pictured), founder of the Terry White Chemists group, says it is clear the industry was experiencing the start of significant consolidation.
“The future of pharmacy lies in what we as an industry can do for the health of the
nation,” Mr White said. “A national solution requires a national approach and as we move towards that point it has become clear that more and more pharmacies will need the support of a national retail brand with the right retail infrastructure to move forward.”
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It is going to be very interesting to see what happens to the polls and consumer confidence over the next 2-3 months. With the pollies back will be interesting to see what makes the big news economically.  We are seeing reasonable consumer confidence now so I hope the pollies coming back does not kill it! There has to be a risk after last week.

There is some policy reform work that has been being discussed in the last few days but I fear it will all disappear without trace!
 
Enjoy.
David.

Wednesday, August 19, 2015

The CSIRO Is Working To Make Some Useful Contributions To Electronic Healthcare.

This appeared a few days ago.

Healthcare’s technology revolution means a boost for jobs in IT

August 7, 2015 2.16pm AEST
Eye testing in remote areas of Australia with the images stored and set via satellite to city-based specialists. CSIRO, CC BY-NC
Author David Hansen CEO, Australian e-Health Research Centre at CSIRO
We tend to think about our healthcare sector as a leader in the development and use of advanced medical technology and biotechnology, such as expensive imaging machines or devices that we implant into patients.
But in many aspects of conducting the business of healthcare, our healthcare system is still in a pre-digital era. For example, healthcare may be the last sector where significant amounts of communication are still done via fax and regular post.
This is not to say that significant changes are not happening. Radiology is increasingly using digital technology but the interpretation of these images is still manual. Electronic health and medical records are also being introduced widely but there is little communication between collectors.
The digital revolution in healthcare that is currently slowly unfolding will use data and technology to improve the healthcare of patients. It will also increase safety and quality, and improve efficiency in the health care system.

The eyes have it… remotely

One example of how technology can be used to deliver better healthcare is a recent trial by CSIRO and our partners that provided screening for eye diseases among people in remote parts of Western Australia and Queensland.
Using the nbn’s satellite broadband service, we screened more than 1,200 people in their communities for diseases such as diabetic retinopathy. This disease often causes irreversible blindness, and it affects the Indigenous population at nearly four times the rate of the non-Indigenous population.
Local health workers were trained at capturing high-resolution images of a patient’s retina with a low-cost retinal camera. These images were stored then uploaded over the NBN satellite to ophthalmologists in Brisbane and Perth.
The screening program identified 68 patients who were at high risk of going blind, including those with macular edema. In the most case these patients received treatment locally. However, some patients needed transfer to major hospitals for immediate treatment.
Once patients were identified as being at risk of significant eye disease, they were provided with care plans that involved local follow up consultations and regular screening the tele-eye care screening program.
For diabetic patients this included advice on controlling their diabetes, which improves their overall health as well as reducing the risk of blindness.

We have the technology

Overall, the trial showed the effectiveness of providing a “store and forward” tele-ophthalmology service using satellite broadband. These types of services have previously been held back by unreliable broadband services and the lack of digital systems in our health services to interact with them.
Reliable broadband connectivity together with increased use of digital systems by health services means that these methods of health service delivery can now become the normal way healthcare is provided.
But for these tele-enabled models of care to really take off, patient data must be shared between providers. At the moment, different healthcare providers – GPs, specialist doctors and emergency departments at local hospitals – all separately collect information about the same patients.
This means that the services that a patient receives are generally uncoordinated. With the increase in chronic diseases, such as diabetes and eye-disease, coordinated care will lead to better health outcomes.
For providers to share data requires their computer systems to be able to send and receive data, and make sure that the data is added to the correct patient’s electronic record.
This is where the type of algorithms that power search engines such as Google – semantic web and information retrieval technologies – can be tailored for healthcare systems. Shared properly, the data can be used to make sure that patients receive appropriate services.
Sharing this data will also mean that there is a bigger volume of data about a patient with each healthcare provider. This will require computers to do more to analyse the data and alert patients, clinicians and health care providers when there should be follow up action.
The full article is here and is freely distributable from the Conversation.
Good news for once - after all the other nonsense we have seen this week!
David.

Tuesday, August 18, 2015

Is This Madness Or Arrogant Hubris? I Have No Idea! Either Way Someone Has Really Lost the Plot!

This appeared last week:

MyEHR to National eHealth Record Transition Impact Evaluation

Created on Tuesday, 11 August 2015
At the COAG Health Council meeting in Darwin on 7 August 2015, Health Ministers received a presentation on an evaluation of NT’s My eHealth Record service undertaken by the National eHealth Transition Authority.
My eHealth Record has been operating in the Territory for ten years and as such, provides a unique opportunity to analyse the operation of an eHealth record in the Australian context. Like the national personally controlled electronic health record (or PCEHR) system, My eHealth Record captures summaries of information from healthcare events in an electronic record that is under the control of the healthcare consumer and is able to be accessed by providers that they later visit.
For the first time in Australia, we have strong evidence of the benefits of eHealth records in bridging the gaps in information that occur as patients move between different healthcare providers in the public and private sectors. The evaluation provides a clear case in support of the national PCEHR system.
The evaluation showed that eHealth records reduced the time clinicians took to find information, and supported improved clinical decision-making and continuity of care for patients. The evaluation also provides insights into how an eHealth record evolves and is taken up by the community and by healthcare providers. These are valuable learnings for the national PCEHR system.
Here is the link to the release
Now the evaluation shows the NT system is working well. So what is NEHTA’s plan?
They have a transition project to move away from the working and useful system - that has taken 10 years to really work to the unproven PCEHR.
Here is the slide from the presentation!

M2N Transition Impact Evaluation project

  • The MyEHR-to-National (‘M2N’) Transition Project is transitioning the existing MyEHR Service over to the National eHealth Record System (PCEHR)
  • At the request of the M2N Project Steering Committee, NEHTA is conducting an evaluation of the impact of the transition
  • A pre-and post-implementation evaluation approach is being used
  • Phase 1 has been completed prior to transition; it comprised qualitative analysis of n=94 in-depth interviews, and quantitative analysis of close to 15 million system transactions covering 10 years
  • This presentation is an overview of phase 1 results
(Slide 5)
The reasons for doing this are found in the first paragraph :

Implications for the M2N transition

Transitioning to the national eHealth record system offers a number of advantages, e.g.
·         Cross jurisdictional data exchange
·         Additional functionality, with atomised data
However, there were some issues raised that require consideration:
·         Anxiety about the transition, including re-registration
·         Concerns about effect on clinical workflow, e.g. arising from policy differences relating to identifying individuals and accessing records
·         PCEHR system not yet having equivalent breadth and depth of content
These issues are capable of being mitigated by current change management activities
(Slide 45)
So we have a working system that is being migrated to a vastly more expensive unproven non-working system. We also see the benefits seem trivial at best!
I wonder just what geniuses dreamt this up - especially before the PCEHR is proven to be successful.
Surely you leave the working system in place until the PCEHR catches up - if ever - and then plan a migration?
The present plan seems like utter madness to me!
David.