HIC2015: PCEHR not perfect but in for the long haul – Ley

The national PCEHR – soon to be renamed the My Health Record – does not need to be perfect right now but it does need to become functional, practical and beneficial, according to federal Health Minister Sussan Ley.

Ms Ley told the Health Informatics Conference (HIC 2015) in Brisbane today that the PCEHR will not deliver its full benefits – including mooted savings of $2.5 billion per year within a decade – for some years even with better take-up by patients and clinicians, as envisioned under the proposed move to an opt-out system.

“We need to acknowledge that the benefits will flow sometime after we have broad use by patients and providers,” Ms Ley said.

“We need to be honest about the path ahead. My Health Record won’t deliver its full benefits for some years. It will take time, even with a better take-up rate by patients and clinicians, to build up the clinical data held in each person’s record.”

While the system has its problems and uptake has been poor due to a combination of complexity and poor communication, it does not need to be perfect right now, she said.

“In fact innovation and consumer choice will ensure that what we think consumers want now will be superseded very quickly, not to mention changes that will occur in clinical practice and service delivery over the next decade.

“What we need is for My Health Record to be functional, practical and beneficial. Let’s get some experience before we build longer term plans.”

Ms Ley said she believed it would be consumers who would drive the uptake of digital technologies and digital usage in in healthcare, and it was important for providers, developers and governments to recognise this.

“What government can do is empower and facilitate consumer-led change,” she said. “This needs to be seen as a consumer health system, and not just an IT system.

“Now is the time to make a determined and collective effort to make the digital world an accepted and widely used part of our health environment.”

The government plans to run trials starting in April next of opt-out models in four different sites, which Ms Ley said she hoped to announce shortly.

It also plans to take steps to raise awareness and provide access to education and training materials for doctors and other healthcare providers “so that they are able to reach a level where they can confidently use the system for their patients”, she said.

“We will also give them a bit of encouragement. The eligibility requirements for the Practice Incentives Program for GPs are being reviewed, and changes will require doctors to actually use the system to continue receiving the incentives, and not just have access to it.

“They may, for example, be required to upload shared health summaries for a proportion of their patients, and we will be consulting with peak bodies on these changes.”

In terms of the new Primary Health Networks (PHNs), Ms Ley said the government would not be prescriptive but would like to see real health benefits emerging from the use of eHealth, which is one of the six key planks of PHNs.

"[The PHNs'] framework of operations is that they need to report to government about how in their various areas of operation they are helping improve health outcomes,” she said.

“We have given them key tasks and eHealth is one of them. Ultimately though, what they will be doing is saying health has been improved in our population in this way by this much, and what government should be doing is not micromanaging a contract but giving them the resources and the ability to get on with it, and I'd like to see them being paid on that outcome.

“Yes, we've said use eHealth … it won't be perfect but use what is there. Remember they are very well resourced – there is $900 million over three years for the networks across Australia – so we look forward to some good ideas from them.”

Posted in Australian eHealth

Comments   

# Terry Hannan 2015-08-05 13:47
Here are comments on this report from our Federal Health Minister as reported in Pulse+IT
The national PCEHR – soon to be renamed the My Health Record – does not need to be perfect right now but it does need to become functional, practical and beneficial, according to federal Health Minister Sussan Ley.[Where in the planning are the guides and knowledge to make the system become “functional, practical and beneficial”? The data already demonstrates the model is poorly functional, is impractical and there are no measures of benefits.]
[Opt-out is important however even a successful opt-out alternative this does NOT going anyway close to improving the important functionality of “information management” in health care as defined by the WHO and others such as Coiera. (1, 2)
“We need to acknowledge that the benefits will flow sometime after we have broad use by patients and providers,” Ms Ley said.[To date even the governments statistics show that the model [(PCEHR or other) are NOT facilitating broad use. So what is going to change this around?]
While the system has its problems and uptake has been poor due to a combination of complexity and poor communication, it does not need to be perfect right now, she said.[Is this a feeble excuse for existing poor design and implementation and how does the government believe “perfection” will be approached?]
“In fact innovation and consumer choice will ensure that what we think consumers want now will be superseded very quickly, not to mention changes that will occur in clinical practice and service delivery over the next decade.[The referencing “clinical practice and service” highlights one of the major defects in the current eHealth model and was documented by Lucien Leape in 2005.(3) He points out that one of the major impediments to successful eHealth implementations is “the culture of medicine”. This reflects the MAJOR eHealth success criterion described by Mamlin and Biondich i.e. the system must be CLINICALLY USEFUL and feedback to providers and caregivers in real time is critical. If the system is NOT CLINICALLY USEFUL it will not be used.](4)
Ms Ley said she believed it would be consumers who would drive the uptake of digital technologies and digital usage in in healthcare, and it was important for providers, developers and governments to recognise this.[See my earlier comments re “clinicians” using the existing definition of “Clinicians” i.e. doctors. The future “clinicians” will include ALL involved in care INCLUDING the patients as per Eric Topol in “The Patient Will See You Now”.(5)
“Now is the time to make a determined and collective effort to make the digital world an accepted and widely used part of our health environment.”[T he digital world IS an accepted part of the health environment however it is the FUNCTIONALITY of this digital revolution that is emerging as a problem with not infrequent patient harm.(6)]
“They may, for example, be required to upload shared health summaries for a proportion of their patients, and we will be consulting with peak bodies on these changes.”[Alrea dy we have seen that THIS use of summaries under the PCEHR model does not work thus emphasising the poor design functionality.]

1. Leao BF. Terms of Reference for Designing the Requirements of the Health Information System of the Maputo Central Hospital and Preparation of the Tender Specifications. Geneva: World Health Organization. 2007.
2. Coiera E. Why e-health is so hard. Med J Aust. 2013;198(4):178 -9. Epub 2013/03/05.
3. Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA. 2005;293(19):23 84-90. Epub 2005/05/19.
4. Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C, et al. Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2006:529-33. Epub 2007/01/24.
5. Topol E. The Patient Will See You Now. First ed: Basic Books; 2015.
6. Silverstein S. Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties. Drexel University Philadelphia201 2 [cited 2013 24 January]; Available from: http://www.ischool.drexel.edu/faculty/ssilverstein/cases/.
# MHP 2015-08-05 17:49
PCEHR is not perfect is stating the obvious. GPs have known that for some time. what they are seeing is tinkering at the edges with a name change, messing around with some organizational changes and some new talking heads. Otherwise, it's business as usual. The top-down model continues to flesh out the three humped camel they call a race horse while the key end users, General Practice, are rarely consulted. Until the Minister is prepared to really listen and consult with this group there will b e no buy in. There is no point throwing money at hospitals public or private or aged care facilities in an effort to make a bad product look good, that's simply throwing tax payer's money away. Neither will putting a gun to the head of GPs to accept a dud be any good as it will still be a costly dud! If the Minister wants buy in, she needs to consult with GPs, listen and implement a ground up model based upon their advice and input. But leave the bureaucrats and petty functionaries out of it.
# Steve Saunders 2015-08-05 22:54
Terry
Can you please stop throwing the baby out with the bath water. You and your colleagues are constantly against everything. I was the bid manager and project manager of the St Vincent's eHealth site.We were the first to recruit consumers, the first hospital to connect to the PCEHR, the first to send shared health summaries to the PCEHR and the first to send discharge summaries to the PCEHR. What's your alternative to health information sharing Terry? What's your panacea for the health system? Stop being on the outside of the tent pissing in and start contributing constructively to the debate. The PCEHR offers the best opportunity for information sharing across the care chain. The challenges are huge. But what's the alternative? It's time to put up of shut up Terry, I have listened to your rantings for decades and it's become tiresome. If you care about the health system start doing so with your actions and your deeds, stop whinging about everything (assuming anyone apart for me is listening) start contributing constructively to the debate. I am so sick of listening to your endless nay saying. Your are supposedly a leader, so start leading, Steve
Thanks and regards
Steve Saunders
# Terry Hannan 2015-08-06 11:35
Steve, at least someone is reading mine and other “colleagues” commentaries on this topic. It is also nice to receive a response as there is often no feedback to my outputs.
I would like to recommend your use of the Dr DEL Key on the keyboard if after all this time you feel I am adding nothing of value. Now here is hopefully some constructive feedback from myself.
I am in complete agreement with the idea of a national, unified standardised and interoperable eHealth system. In fact I have written in several places (e.g. on my former AustEMRS site). My thoughts were in favour of the original Rudd-Roxon model for health care. Under our Federation the principles underlying such a model were high jacked by the States with a statement I had used in the past “we know how to run health better than the Federal government”.
With respect to the latter statement we continue to see State-based eHealth models, including the institutions in which eHealth should be an essential component, not working.

I would now like to comment on your PCEHR project at St Vincent’s Hospital. Yes, what you have achieved is significant. Despite this technological achievement have you been able to measure and demonstrate that “it has improved the care processes” in terms of costs quality and outcomes? If yes, then I would welcome any documentation or verification of these achievements.

In many of my dissertations I regularly document the core fundamentals for the success of local, regional and national eHealth systems. These fundamentals have not been defined by me but world leaders in this field. They have become the foundation for eHealth systems around the world regardless of whether the countries are developed or of Low and Middle Income status.
From the core fundamentals for eHealth success at a local level and nationally I believe (and I stand to be corrected) there are two fundamentals that we are all having difficulty satisfying.
The first is collaboration. The Federal government bodies appear to not enlist those who “have done it before” have the knowledge to facilitate a national eHealth structure and implementation that would be a significant advancement on the current $1billion plus system that we have created.
The most critical fundamental that is not being met is that the systems must be clinically useful otherwise they will not be used. Referring to the DoH and NEHTA usage data from the PCEHR the acceptance of the system is poor. Humans are very clever at rejecting new technologies that do not work. It is a socio-technical phenomenon with implementations of this type. Steve, I will state that the intensity of your feedback has more positives than negatives and I thank you for the response.
Some links on successful projects.
1. Bangladesh: www. health.bmz.de/g ood-practices
2. Philippines: http://ma4health.hsaccess.org/partners
3. Africa:
a. http://www.isfteh.org/files/media/southafrica_ehealth_strategy_2012-2016.pdf
b. https://www.youtube.com/watch?v=Fvc__rmS7lk
# Steve Saunders 2015-08-06 12:33
Thanks for responding Terry. Setting aside funding arrangements and political interference, the challenge for PCEHR uptake and use is the need to create critical mass and, particularly in the early stages, the alignment of stakeholder participation. Completing the care chain for a patient is also a major challenge not least because of low technology uptake by private specialists and allied health providers. I regret having too much wine last night and as a result the intensity of my feedback. While I do tire of the constant negativity of the health informatics community, it was no excuse for some of my comments. I hope you will accept my unqualified apology. Steve
# Jane Connolly 2015-08-06 14:41
Responding to MHP. There is a usability program in place that provides advice to the Department. Both GP Colleges ACRRM and RACGP are represented. You can also provide independant feedback here http://www.nehta.gov.au/using-the-ehealth-record-system/usability-improvements
# Dr Paul Martin 2015-08-10 17:24
I believe I am your typical rural procedural GP (O&G, anaesthetics, general surgery - practical/pragm atic) A typical discharge summary of a patient of mine from a city hospital today with say pneumonia or heart failure will send me four A4 pages of ink on it in which the word pneumonia or heart failure will appear once somewhere amid a sea of irrelevant ink perhaps on the third page. Where does this go --> shredder, why because I will never want to look it or waste so much time ever again. When I next see the patient I type pneumonia or heart failure into their past history and that's it.
My message to you gurus is this - if it (what ever the documentation comes to be like) isn't of simple quick and relevant to me, not the patient, for my necessary knowledge and record keeping then I will never engage myself with its use. Far simpler, quicker, and more immediately relevant for me to talk to the patient in front of me, and to bother myself to do so even if they are a patient I've never met before. If every item in the electronic record has three or four pages of demographic junk info in it to relay two or three meaningful words, this system will never come into use, least not in my practice. Will I bother to even engage myself with this (and never look at it, except to process it) even if the govt (Ms Ley) pays me to.........
emphatically no.
# Terry Hannan 2015-08-10 18:50
Paul, this area of communication has been a focus for me since the 1980s. I would like to share some ideas with you that support your points of view and how the documentation may be improved. I would also like your 'peer' review feedback. My email is terry.hannan@dhhs.tas.gov.au
# Helen Robertson 2015-08-12 01:24
Further to Paul's comments on the problems of discharge summaries from large hospitals to rural GPs: I find the copious use of acronyms and abbreviations which are so obscure or specialised as to render some discharge summaries incomprehensibl e a major nuisance (and a source of danger to the patient); I suspect it would also get in the way of allowing computers to search the notes for diagnoses in stead of the clinician wading through the whole thing, which as Paul says, just isn't going to happen.
# Simon Winterm 2015-08-21 08:25
My primary concern with the PCEHR is that it will only ever be an incomplete health record, to the extent that the information will not be trusted, hence not used. An alternative model to aggregating data is to leave the data where it is, i.e. maintain multiple existing sources of truth. The data can then be viewed natively and in context. The primary technical challenges then become unique patient identification and indexing.

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