Adventures under the cone of silence

We love it when we are perusing what are normally quite boring or opaque documents about health IT and we suddenly stumble across a hidden gem, like the mention in a recent tender for ACT Health that there were file types in a clinical information system that “frankly seem made up”, or in a Hansard transcript of the Senate inquiry into the Medicare number breach in which the RACGP's Rob Hosking used the infamous cone of silence from TV show Get Smart as a metaphor for making security so tight that nothing works anymore.

We couldn't make that hearing last Friday but the transcript makes for interesting reading and Computerworld covered it nicely in two stories, including a report on Dr Hosking's Maxwell Smartism. Reading the Hansard, we must admit we were a bit bemused by one witness who seemed to be recommending that because the My Health Record and the Department of Human Service's HPOS system can't be made 150 per cent secure they should be decommissioned and we should all carry our health information around on a smart card like they do in Germany.

Whatever the benefits of this approach, it is not the one that Australia has taken or conceivably will ever take. Alternatives to the PCEHR were discussed at length in 2010 and 2011 and no one is seriously considering reversing course now, particularly as we head into opt-out next year. Our friend Ian Colclough argued in an opinion piece this week – one of our most popular stories – that if he were the health minister, he'd ask the Australian Digital Health Agency to go back to the drawing board. However, it is Greg Hunt who is health minister for the time being, and he's gung-ho on opt-out.

Our other most popular stories were about the eMeds roll-out by eHealth NSW, which despite its immense size, complexity and cost, seems to be going very well indeed. There are a number of notable examples of successful implementations of electronic medications management systems in our region – Peninsula Health and Austin Health in Victoria, St Vincent's Hospital in Sydney and Southern DHB in New Zealand spring to mind – but the vast scope of the NSW roll-out is like nothing we have seen here before.

So far, it all seems to be on track. NSW is implementing both Cerner's EMM module and MedChart from DXC, having piloted them at four hospitals over the last few years before the ball started really rolling this year. The 1000-bed RPA in Sydney went live this week and eHealth NSW plans to include 178 hospitals in total, with fellow behemoths Liverpool and Westmead representing two more big challenges down the track.

We'll watch with interest how they go. Electronic medications management is perhaps the most obvious area where health IT can make not just a big difference to efficiency and cost but to patient safety as well. While EMRs may be a massive pain to many clinicians, we've never heard of any who'd revert to paper having used EMM. Similarly, we reckon that once GPs are aware of a new service that allows them to make to make a referral for a home medicines review (HMR) and receive the report back from the accredited pharmacist, all within their desktop software just the way they like it, they'll take a real interest.

Perhaps the My Health Record will help when it comes to medications too. This anecdote from Brisbane GP and AMA Council of General Practice representative Richard Kidd at the Medicare inquiry shows that it seems to already be happening:

“The My Health record is on the crest of becoming a really important system for us to use for the safety of our patients,” Dr Kidd said. “I have already had the experience, in an earlier form of the My Health Record, of one of my patients' lives being saved, because the hospital was able to access the information that was in that electronic record and not give a diabetic in a coma the usual antibiotic that would be used in that situation for sepsis. This person had a severe anaphylactic allergy to that antibiotic and, if it had been given, would have been killed. That's just a single example of how important My Health Record is.”

This brings us to our poll question for this week: Do you think the My Health Record is finally showing clinical utility? Sign up for our weekend edition to vote or leave your comments below.

Our poll last week asked: Is FHIR the most important health IT development in the last decade? A slim majority said yes: 53% to 47%.

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