Everything ageing is new again

The first sitting week of the new Australian parliament got off to a roaring start on Monday, with some very fresh faces looking very pleased with themselves and a pretty good vibe that this parliament might be a little more constructive than the small target promised before the election.

Most pleasing was the fast-tracking of legislation to reform the Aged Care Act, which was one of four big issues canvassed by the new government this week. The legislation had of course been written before the election but the previous government’s legislative incompetence meant it was gathering dust on the shelf. Two bills got their second reading yesterday and the reforms are set to sail through pretty quickly.

The government has wisely realised that one of its main election promises, that a registered nurse needs to be on site 24/7, is going to be very tough for rural and regional aged care facilities to ensure within the timeframe, so it’s likely they’ll be given a waver. But otherwise, it’s all happening, and not a moment too soon.

Aged care providers will have increased reporting requirements for things as disperse as nutrition, care hours, information sharing with aged care recipients and their families, controlling polypharmacy, reducing psychotropic prescribing and the cap on management fees for at-home care, meaning they are going to have to finally take digital tools seriously. We hear that some of the software vendors also need to get their backsides into gear in building functionality for the new requirements. That being said, interest and good will about reforming aged care is high and the new government cannot drop the ball. We doubt they will, but it will be a hard slog.

Speaking of which, we reported this week on a speech that the Australian Digital Health Agency’s CEO Amanda Cattermole gave at ITAC, the aged care IT conference recently held in Sydney. Ms Cattermole appeared to be incredibly positive about progress in digitising health and aged care and reeled off a host of statistics showing that use of digital tools like the My Health Record had improved.

The stats for My Health Record use and views sounded impressive – although as Ms Cattermole admitted, they were coming off a low base – but those for aged care were not so good. As we’ve reported in the past, only about 10 per cent of aged care facilities are even registered for the system and less than three per cent are actually using it. There’s no doubt that the agency has put a bit more emphasis on the sector this year, but it still comes as a jolt to read a primary health network newsletter just this month scouting for feedback and ideas on how to engage the sector in registering for it.

Apparently, some money is being made available by PHNs to provide a My Health Record registration support officer in a two-month pilot to help develop guides and training materials for aged care providers to navigate the registration process. Ms Cattermole is welcome to her positivity but bloody hell, it has been 10 years and here we are, back at the beginning.

Putting that palaver aside, another big topic on a global scale this week was the appearance of Oracle’s executive vice president for industries, Mike Sicilia, in front of a US Congressional hearing into how the gargantuan US Department of Veterans Affairs electronic health record modernisation project is going. (Not too well, but that comes as no surprise to anyone.) But with a price tag for the Cerner system project heading towards $US20 billion, the Congressional oversight committee is noticeably concerned on a bipartisan level about the project. Putting the cost aside, we think they should probably be a bit more concerned about the new owners of the technology.

Mr Sicilia released a statement to the committee that said all the right things about Oracle’s commitment to a best in class, mission critical solution, and while the statement was reasonably free of jargon, there were a few concerns. Oracle has set up a “war room” led by senior Oracle engineers and developers to conduct “a top-to- bottom analysis of the entire EHR system” (they might have done that before buying the thing) and bringing their admittedly formidable resources to the task.

Oracle also plans to move the Cerner application to “a modern, hyperscale cloud data center within the next six to nine months, which will deliver better performance and stability for the end-user,” Mr Sicilia said. This is where the doubts set in.

Then we hear: “In my recent meetings with many of the Committee members and other Congressional stakeholders your frustration with the current situation with the VA’s EHR system was clear. I have spent the last six weeks reviewing the issues and working through engineering plans, and I have concluded that there is nothing here that can’t be addressed in reasonably short order.”

This is where we take a very deep breath. And then, referring to the EHR’s usability: “Let’s be clear, modern applications should not require training or the training should be minimal.”

This is where we uncork the bottle. If Oracle thinks this is going to be easy, they are in for a very rude awakening. Every step they have taken since buying Cerner has been worrisome, including the plan to change the name of the company to Oracle Health. Even more worrisome for us in Australia, where Cerner holds almost 90 per cent of the market through its dominant position in NSW, Queensland and Victoria, we hear that Oracle is simply not interested in existing Cerner customers outside of the US.

That might be why rumours persist that NSW is very seriously thinking of swapping its entire system over to a new vendor under its Single Digital Patient Record program. This program was supposed to bring disparate systems, including EMRs and pathology systems, together through a single view, but we are hearing that serious thought is going into ripping out Cerner altogether, with a trial of a new system at the non-Cerner Hunter New England site testing the concept.

We asked eHealth NSW about it, and received this response: “NSW Health is currently undertaking the final stages of a comprehensive procurement process with short-listed suppliers for the Single Digital Patient Record program. The procurement process is ongoing and NSW Health will provide an update once completed.”

We’ll keep looking into it. In the meantime, let’s go back to our story on another troubled project in the $2 billion+My Health Record system for our poll question this week.

Are you convinced by the ADHA CEO’s positive outlook on MyHR?

Vote here or leave your comments below.

Last week, we asked: Does MBS-funded telehealth policy need a complete reset under the new government? Big time, our readers said: 93 per cent were in the affirmative.

We also asked what you think should or should not be done about it. Here’s what you said.

Comments  

0 # Kate McDonald 2022-08-05 17:59
Are you convinced by the ADHA CEO’s positive outlook on MyHR? Not many were, we’re afraid. 16 per cent said yes, but 84 per cent said no.

We also asked why you voted yes or no. Here’s what you said:

- Poor functionality, poor interface with CIS, medicines section unclear

- Uncurated ,no useful summaries, it’s just a document repository not a proper secondary record

- Many RACFS don’t have access ,many don’t even have wifi expensive and not useful

- Until access is seamless for clinicians and providers from inside their existing systems, uptake will be limited. From a consumer perspective it is okay but hardly a modern, well designed system fully integrated with other MyGov services.

- I use it a lot, but so, so very hard to get colleagues to use it, and where I am in South Australia, as a paediatrician, the decision of SA Health not to upload results for pathology and radiology for the under 18s and to stop uploading discharge summaries for children has made it somewhat disappointing if not useless.

- Heard it all before. Donald Acheson’s quote of forty years comes to mind: “The EMR is exactly where it was 25 years ago - just around the corner.”

- Lots of reasons. Governments including the new Federal Government realise that it is time to "drive" forward with interoperabilit y and standards.

- Nothing has changed over the past ten years. NEHTA/ADHA didn't understand the problems of Digital Health and still don't, never mind why My Health Record is a heap of rubbish.

- Too time consuming for doctors

- The data in it is not complete/reliab le enough for ED and Urgent Care Doctors to depend upon it. It is good to see it may have some peripheral uses.... But the cost... and the opportunity cost....

- Back to the future with any greater insights

- ADHA vision

- We are just starting to get critical mass with useful information available for clinicians.

- The technologies in place are and will be replaced by newer and better models.....when people realise that true patient centred healthcare will bring with it greater individualisati on of the data collected, they will be less likely to have it government controlled. This was always the vision from the beginning that was high-jacked by a bureaucracy.

- We don't need any health record as the technology is moving faster.

- Maintaining it is very difficult and if there is incomplete data in the record then it can lead to diagnosis which may harm patients. It better to stop funding ADHA and close all offices

- past performance.

- The messaging from ADHA about the MHR is mostly spin and carefully selected statistics that don't show how little the MHR is used and useful. Your article noted "Ms Cattermole said while the numbers were coming off a low base, the increase in views and uploads was significant." The first part is correct but not the second . Use of the MHR is still insignificant. There were 170.1 million GP visits in 2020-21, and the MHR was only used 1.3m times in 2021-22 by a GP looking at a document that was uploaded by another organisation. That is 0.8% of the time. There is a big difference between a statistically significant change and significant impact. ADHA promotes the former when it should be more open about the latter.

- It is not about usage it is about value and benefits and there are very few. Also data accuracy is poor

- Health in consumers hands growing focus

- My Health Record does not even show my recent tetanus vaccine shot

- I think it's only temporary.

- Does the MyHR currently cater for the Aged Care sector needs?

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