Driving the eHealth bus with no GPS

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Our regular eHealth columnist David More outlines why he believes it looks like the Federal Government has no real viable plan to reset the national eHealth program for the future.

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With the appointment of Ms Sussan Ley to replace Mr Peter Dutton as Federal Health Minister - and the even more recent replacement of Mr Abbott by Mr Turnbull as Prime Minister - there was some expectation that effective remedies for eHealth woes and better health information usage would emerge.
The hope was that we might see a reset and adoption of a new evidence-based direction for eHealth.
We have arrived in our present eHealth situation via almost 25 years of effort which has been sadly, not really based on actual evidence.
The worst offender in this regard has been the Personally Controlled E-Health Record system (PCEHR). Started in 2010 under Labor and launched in 2012, three years later it still sees such desultory adoption and use that the current Government wants to force a PCEHR on all citizens who don’t choose to ‘opt-out’, with all the risks to privacy, consent and security this entails, in order to improve uptake.
The work to date, by both sides of politics, has been based on the rather dubious assumptions that electronic health is good for us, and that great benefits are available for the Health budget.
It should be stressed that the PCEHR is not the only electronic health record system in operation in Australia; in fact, it is one of the least useful. Hospitals, GPs, specialists, laboratories etc, all have their own systems, tailored for their needs and appropriately partitioned as to content and requirements of the health professional user.
The publicly available documentation states quite clearly that “the PCEHR system is intended to complement and not replace existing clinical information systems”, and that “the PCEHR is not a replacement for normal sharing of information between an individual and their healthcare provider”.
I do not dispute the potential benefits achievable through the use of eHealth record systems, however the PCEHR will never deliver any of them.
Sadly, at the time of writing in November 2015, increasing evidence has emerged that there may not be as much change on the PCEHR front as one could desire.
The evidence comes in three strands.
First, and probably most important, we had a press release from the Federal Minister for Health, Ms Sussan Ley, on October 9, 2015, entitled “Developing a 21st century electronic health record system”. This release outlined the composition of a new steering committee charged with establishing the Australian Commission for eHealth, intended to take forward both the present national eHealth infrastructure and PCEHR system which will (depending on the passage of legislation) be renamed My Health Record.
The release claims that “A functioning national electronic medical records system is essential to ensure doctors, nurses, pharmacists and other healthcare providers across the country have instant access to the information needed to treat patients safely and efficiently, without having to gamble on unknowns in their medical history.”
Sadly, I’m not aware of any evidence that the proposed My Health Record will actually provide a working example of the system intended, or deliver the benefits claimed (some $2.5 billion per annum apparently).
Equally it is difficult to believe that a task force mostly made up of the leaders of the failed implementation of the PCEHR is suddenly going to develop the insight to deliver a much better working system at this attempt. Surely a very substantial injection of new expertise and experience is needed, and this has simply not happened. No real reset here.
You can read the full press release from this link: www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley122.htm
The bottom line here is that we are going ahead, spending money and not really thinking hard about why the PCEHR system has been so unloved to date.
Second, we had the announcement in early October of the criteria for selection of the sub-sets of population who are to be used as the test populations for a switch of the My Health Record to an opt-out system, rather than the opt-in approach.
For those test populations, this means an individual health record will be created by the Federal Government for everyone in the area, and populated with available information from the MBS and PBS. A public education campaign will advise local people how they can take steps to notify Government that they do not wish a record created, before the trial starts.
The criteria for sample population areas for opt-out trials have been agreed by State and Territory Health Chief Executive Officers:

• Site population of approximately 250,000-500,000.


• Clearly defined geographical area so there is no confusion as to whether people are included or not. · Ability to confine communications, including electronic media, to the site.


• Demonstrated existing eHealth capabilities and utilisation of eHealth services across local health services including General Practice, pharmacy, aged care services, and at least one hospital.


• Higher than average PCEHR uptake by providers.


• Strong clinical networks with a demonstrated commitment to the success of the trial - Primary Health Network/s, Local Hospital Network/s and any other relevant local health organisations within the trial site area.


• Positive community engagement with, and local government commitment to, previous non-eHealth trials.


• Not currently involved in, or minimal involvement with, other State, Territory and/or Commonwealth run trial activities (for example the NDIS).


• Include a range of population groups (i.e. Aboriginal and Torres Strait Islander, CALD backgrounds. · At least one of the opt-out trial sites to include rural and/or remote areas.

You can read a more detailed discussion of the plans from the link: www.ehealth.gov.au/internet/ehealth/publishing.nsf/Content/trials
So in summary they want to trial the opt-out process where there is good support and some considerable opt-in to PCEHR use.
Might it not also be a good idea to trial in one or two regions where this is not the case, to get a good understanding of possible risks and issues?
To be utterly frank, I have no idea how the the very young and very old, the socially isolated, technology-illiterate, and those suffering mental illnesses and cognitive impairments are going respond to all this.
At this point, it is hard to see the trials up and running by the time you read this in early 2016 - and then running for long enough to allow a proper evaluation considering the broader scheme, along with all the “wrinkles” ironed out before mid-2017, never mind next year, as planned. Two years may even be too optimistic a timeframe.
Finally, we had the following from a speech given by the Health department’s Chief Information Officer in late September.
A report of the speech given by Mr Madden to CEDA states: “ ‘But progress remains slow. While the (Royle) review recommended opt-out be introduced from the beginning of this year, legislation allowing for the regional trials and eventual national transition was only introduced to the Parliament last month. Nonetheless, although it ‘needs some tweaking’ and usability changes, ‘the good news for our government is they’re not up for a really big system build’, said Madden. ‘The system exists, it’s been there for three years.’ And it’s been improved from where it began. Whereas the prospective customer needed to endure clicking through 17 screens to prove their identity when it was first created, the system is now down to two.”
Mr Madden’s claims regarding benefits of the system are also - to my eye, and putting it gently - pure fantasy.
To quote again: “It is expected that putting records online could save the Commonwealth $2.5 billion per year within a decade by reducing inefficiencies, with an additional $1.6 billion in annual savings also delivered to the states, according to the Government.”
Here is the link to the relevant article: www.themandarin.com.au/54581-my-health-towards-national-opt-out-ehealth-system/?pgnc=1
Overall, all this reveals an utterly clueless collection of bureaucrats, steaming on in an attempt to implement
an evidence-free program, in the absence of a coherent National E-Health Strategy and before any appropriate governance mechanisms are in place to look after the interests of a very broad range of stakeholders.
This is all going to end very expensively, and very badly, I predict.
 
 

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Dr David More
Health IT Consultant
Dr David More is a Health IT consultant with more than 20 years’ experience in the e-Health area. His blog can be found at aushealthit.blogspot.com and covers all matters e-Health. He may be contacted via the links provided on the blog.