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."

Sunday, January 15, 2017

Is It Right To Grossly Oversimplify Communication To The Public About The myHR?

This appeared last week:

Personal health records now available online

12 Jan 2017, 10:25 a.m.
Following a Federal Government trial in Western Sydney, local hospitals are now uploading around 570 discharge summaries to My Health Record each month.
What this means is that GPs can easily access information about their patients after a stay in hospital and our clinicians can access important health information about patients that their GPs have uploaded.
As a resident of the Nepean Blue Mountains regions, which also includes Hawkesbury residents, can access their personal health record online and even set access restrictions and add information about allergies, medication and other important health information.
“In the event of a medical emergency, residents will know that their health information is stored safely and securely and can be accessed immediately by emergency doctors if required,” a spokesperson said.
“Pharmacies are also uploading to My Health Record so we can easily see what medications a patient is on – this helps doctors treat you safely if you need emergency care and are unable to communicate.”
More here:
Talk about painting a totally positive picture.
We all know that no amount of enthusiasm can cover up the fact that only few doctors or patients have actually accessed their myHR and we also know that very few patient records have a clinician curated Shared Health Summary that can be relied on to some extent.
To me this reporting should be explaining the way the patient can access their record (if they accepted one (by not opting out)  – apparently 1.9% of individuals declined the offer of having a record – and by explaining just what content they can expect to find and how it may, or may not, make a difference to their care.
They should also be told that the discharge summaries may or may not be complete, will almost certainly have been created by the most junior member of the clinical team, will probably not have been reviewed by senior doctors and will not have been reviewed by the patient for embarrassing content before being posted.
For some reason my most recent discharge summary was posted by a clinical pharmacist with no attempt to obtain consent from me. I wonder why this is seen as reasonable?
As far as drug information is concerned it is all dependent on the individual local pharmacist who may or may not upload information.
At the very least there should be a link in the article to some more detailed myHR information.
This really should be being managed with rather more openness and transparency as far as I am concerned but I accept others may think it is not needed. Comments welcome.
David.

AusHealthIT Poll Number 352 – Results – 16th January, 2017.

Here are the results of the poll. 

Is The ADHA Correct In Assuming That 'National Digital Health' Is A 'Good Thing' And All We Need To Do Is Work Out How To Do It Correctly And Get On With It?

Yes 21% (22)

No 58% (62)

ADHA Does Not Assume Digital Health Is A Good Thing 0% (0)

I Have No Idea 21% (22)

Total votes: 106

An interesting outcome with a good majority thinking this is a more complex issue than Digital Health simply needing to be done properly. Some more fundamental rethinking seems to be called for. Comments welcome!

A good turnout of votes for so early in year.

Again, many, many thanks to all those that voted!

David.

Wednesday, January 11, 2017

Does This Qualify For The Term Fake News Do You Think?

This popped up a little while ago.

New digital health chief to get $522,000 a year to fix troubled My Health Record system

Daniel Burdon
Published: January 11, 2017 - 11:08AM
The head of the Turnbull government's six-month-old Australian Digital Health Agency will be paid a tidy $522,000 annual salary package after beating more than 100 other applicants to take the role fixing the plagued My Health Record system.
The chief executive's pay comes with the difficult task of overseeing the $156 million agency and its remit to digitise the nation's health systems, including fixing the delayed national roll-out of My Health Record.
Despite a number of teething problems, about 4.4 million Australians have signed up so far, as the government moves towards an "opt-out" system rather than the previous "opt-in" system.
The government's creation of an agency dedicated to improving digital health systems was been widely supported, although some stakeholders have been sceptical of how much the agency will achieve given past problems.
Health Minister Sussan Ley has previously described the use of digital technologies in health as "a game changer".
Vastly more of the article is found here:
First off, just forget about the pay, as I for one would not be prepared to even consider the job, as framed, for four times the salary.
The real issue is just how wrong the article is, and this is found in the first few paragraphs.
First most of general practice, pathology, radiology and a good amount of other health service delivery entities are already digitised and communicating with many of their peers digitally as well. The job is not to digitise the nation’s health system – that is largely done!
Second the myHR is already ‘rolled out’ technically. All that is needed is the go-ahead to compel the rest of the populace to enrol and – much harder – actually use it. The reason we see few, if any usage stats it that the little if any actual clinical use of the system. So that job, supported by the rapidly developed evaluation reports, is largely done!
The actual job seems to be to run a limited scope consultation process which will come up with an evidence-free strategic endorsement of all things ‘digital health’ and especially the myHR, and support continuing funding for all the bureaucrats who have now been employed to mostly continue on with what NEHTA was doing. The Strategy  has to be at least partly evidence-free as there is no actual evidence that confirms the myHR is a ‘good thing’  that anyone has yet seen. (If you have some worthwhile evidence let me and ADHA know!). Of course the Strategy will need to address other issues like SMD, NASH, SNOMED etc. but myHR is the main thrust, wrongly IMVHO!
So, in essence, the job is really to compulsorily foist a largely unrepaired, unwanted, unnecessary and useless system on an unsuspecting public and have them thank you for wasting all their tax money on it!
Now that is what I call a hard job!
David.

Monday, January 09, 2017

News Alert: Sussan Ley Has Stood Aside While An Enquiry Is Conducted!

Martin Parkinson is said to have been asked to conduct the enquiry.

Link is here for details:

http://www.abc.net.au/news/2017-01-09/sussan-ley-stands-aside-over-travel-expenses/8169410

Do you reckon there is any chance the Acting Health Minister (Arthur Sinodinos) might just have a close look at the myHR and give it the flick?

Just hope so!

David.


Sunday, January 08, 2017

Sussan Ley - Federal Health Minister - Admits To Errors Of Judgement! What About The myHR? She Needs To Go So It Can Be Abandoned.

This appeared today.

Health Minister Sussan Ley apologises for Gold Coast trip, agrees to repay expenses

Matthew Knott
Published: January 8, 2017 - 4:39PM
Embattled Health Minister Sussan Ley has admitted she made an "error of judgment" by charging taxpayers for a trip to the Gold Coast in which she bought a $795,000 apartment and will repay the cost of the trip.
Ms Ley's decision followed a conversation with Prime Minister Malcolm Turnbull in which he said she had not met the standards he expects of ministers. 
Ms Ley has come under pressure to provide a full explanation of the trip or resign from the ministry since it was revealed on Friday.
Ms Ley originally said the apartment purchase was "not planned nor anticipated", a claim that has been questioned given subsequent revelations that her partner owns a business located near the unit.
In a statement released on Sunday afternoon Ms Ley said the apartment auction was not the reason for her trip to the Gold Coast but she understood the purchase had "changed the context of the travel undertaken".
…..
More to come
Here is the link:
If she has trouble with less than $1.0m house investment how can the manage the investments in the myHR?
Passed on without comment. (Other than I reckon she should go! My call is not related the Gold Coast home unit nonsense - which is just maybe a little off at worst - but the continuing total incompetence in digital health - which I do care about!)
David.

It Seems To Me There Is Something Somewhat Dishonest At The Core Of the ADHA Consultation On Digital Health.

A day or so ago we were all reminded to get going and respond to the ADHA Consultation. I have reproduced the whole thing so you can respond to the request.

How do you see the future of digital health? Your health. Your say. Survey and written submissions.

Created on Friday, 06 January 2017
The Australian Digital Health Agency wants to hear from you. Whether you’re a patient, a member of the public, a healthcare provider, scientist or researcher, entrepreneur or technology innovator. Tell us what is important to you so that what we do is shaped around what you need.
There’s nothing more important than our health and the health of those we care about. Putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them can help Australians live healthier, happier and more productive lives.
How should Australia take advantage of the opportunities that new technologies offer to improve health and care? What do Australians want and expect from a modern healthcare system?

Survey and written submissions

Our survey provides you or your organisation the opportunity to have your say about the future of digital health in Australia.
Alternatively, you are also welcome to send us a written submission. To provide us a written submission, email your feedback directly to yoursay@digitalhealth.gov.au.
Reminder: Submissions will be collected until Tuesday 31 January 2017, 5pm AEDT.
Have any further questions? Please contact us on 1300 901 001 or yoursay@digitalhealth.gov.au.
Here is the link:
Now in the post-truth / false news era it rests with all of us to wind up our falsity checking meter to the maximum and keep on at that level of scepticism.
In that vein it the second paragraph that stands out.
“There’s nothing more important than our health and the health of those we care about. Putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them can help Australians live healthier, happier and more productive lives.”
I am sure all who read here will be well aware of the risk of making ‘sweeping generalisations’, and that somehow glossing over detail a false impression can be created. When this impression leads to government expenditure on a grand scale then we all have a problem.
So stepping back, obviously, appropriately used data and information is crucial for the proper operation of the health system in most aspects from research to patient care etc. Think everything from research management systems to patient management and scheduling systems. Trying to do without these systems would clearly be a waste of time and money – if not impossible – think the management of major clinical trials to the optimisation of patient flow in a major hospital – all basic stuff that, if it did not work, no one would pay for and use it!
Equally there are a zillion technologies that are vital from MRI Scanners and drug discovery to the various monitoring systems that track our patient’s progress. The evidence that these technologies do / have make a positive difference is well documented.
But the ADHA is not interested, as far as I know, with all this. Their interest is in patient specific information and how it is shared and communicated by digital systems and this is where we hit a problem with evidence as well as all the other issues of safety, privacy and so on.
There is no doubt that a well-designed GP System can improve the quality and safety of what the GP does with and individual patient and make it easier to follow a patient’s clinical journey and treatment. There is good evidence to this as well as much evidence that current systems are by no means perfect and still need more work.
This makes the point very recently:

Engineering technology resilience through informatics safety science

Enrico Coiera, Farah Magrabi, Jan Talmon
DOI: http://dx.doi.org/10.1093/jamia/ocw162 First published online: 31 December 2016
With every year that passes, our relationship to information technology becomes more complex, and our dependence deeper. Technology is our great ally, promising greater efficiency and productivity. It also promises greater safety for our patients. However, this relationship with technology can sometimes be a brittle one. We can quickly cross a safety gap from a comfortable place where everything works well, to one where the limits of technology introduce new risks. Whether it is through a computer network failure, applying a system software patch, or a user accidentally clicking on the wrong patient name, it is surprisingly easy to move from safe to unsafe. As the footprint of technology across our health services has grown, so to by extrapolation, has the associated risk of technology harms to patients.1 It is the potential abruptness of this transition to increased risk of harm, this lack of graceful degradation in performance, and the silence accompanying degradation, that remain unsolved challenges to the effective use of information technology in healthcare.
-----
The link in the text gives access to the lucky few paid subscribers only for some reason.
What we lack is evidence that national systems such as the myHR are really offering both benefit and value for money.
What the consultation process should be doing is surfacing and making available this evidence and not be trying to run a consultation on the value of motherhood!
Surely part of the process need to be to explain what works and what doesn’t and why and to then propose what is planned for comment – based on evidence not vague feelings and assumptions.
I will nod off now for another week and, God willing, will be back up and rolling from next week.
David.

AusHealthIT Poll Number 351 – Results – 8th January, 2017.

Here are the results of the poll.

Given The Rather Poor Progress, Few Benefits And Huge Cost Of Australian National EHR Programs, Over The Last 20 Years, Should They Just Be Abandoned?

Yes 98% (158)

No 2% (4)

I Have No Idea 0% (0)

Total votes: 162

Well that was very clear cut with 98% saying we should just stop this myHR program and so work out something more useful to do.

A good turnout of votes.

Again, many, many thanks to all those that voted!

David.