E-Health is harder than it should be

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Looking back at 2014 it seems to be clear that as far as eHealth is concerned it has been largely a wasted year as far as the national initiatives such as the Personally Controlled Electronic Health Record (PCEHR), writes Dr David More.

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It seems to me there is at least some small hope things might just be a little different in 2015.
Despite all the propaganda that tends to be encountered from government and its agents the goal of eHealth, or what might be better termed Health Information Technology Deployment and Use, is to safely and securely provide relevant health information to those who need it for decision making in the care of and support of patients. This can be via the provision of record keeping systems for patient information as well as a range of information communication and sharing systems which make available health information where it is needed with security, integrity and privacy.
In 2010, for reasons best known to herself, Ms Nicola Roxon, the then Health Minister, set out to create a national centralised system of patient records, which was to operate in parallel with the record keeping systems that were being used by doctors in their practices. The benefit of such a national system was to have a patient’s record available wherever and whenever needed, via the internet. The system began operation in June 2012, and when the government changed in late 2013, one of the first acts of the incoming Health Minister (Peter Dutton) was to commission a review of what had by then become a $1Billion program.
The Review was completed in December 2013 and released publically in May 2014. At the time of writing (late January, 2015) there has yet to be a government response to the Review which, among other things, recommended that there be a radical shake up in the leadership and governance of the sector, a change in the law to have an electronic patient record created for every citizen unless they specifically opted out, rename the system MyHR, oblige doctors to upload clinical documents to the system and the disbanding of the National EHealth Transition Authority (NEHTA).
You can read the summary of all the (38) recommendations of the review here:
http://aushealthit.blogspot.com.au/2014/05/summary-of-recommendations-of-pcehr.html
These were all intended to happen by 1 January 2015 - but clearly most of the recommendations have not yet been actioned and, as far as I am aware, there is no time line for action.
The situation has now been further complicated by the governmental re-shuffle just before Christmas 2014 when Ms Sussan Ley became Federal Health Minister and found herself deeply embroiled in the public debates around the sustainability of Medicare and Co-Payments, with little time to worry about eHealth!
There has been a hiatus in strategic direction for eHealth in Australia since the change of Government (Sept. 2012) and this has not been without consequences. Among these has been, with an abiding and single minded focus on the PCEHR / MyHR, a total lack of government decision making in other important and related matters and deep frustration on the part of private providers of services in the sector who have had, essentially, no idea what is coming next as well as a series of demands for system changes in their systems to suit the needs of the MyHR with little, if any, financial compensation.
Having now seen two-and-a-half years of operation of the MyHR system it is pretty plain to most observers that the system is an expensive failure despite all the claims of government. What is now needed, in my view, is a five point action plan to be implemented. The action points are:
Action One
We need an updated National eHealth Strategy that consults all stakeholders properly and provides the governance, leadership, strategies, technical standards and managerial pathways to actually achieve the goals needed by those working in the health sector and their patients.
This Strategy needs to consider and review both the PCEHR Review and the input of all other relevant stakeholders. Both private and public sector need to be fully involved.
We then need the Strategy to be properly implemented, funded and led - as did not happen with the 2008 version.
Action Two
We need to recognise that there are two distinct clients for eHealth systems and services and that their needs are not by any means the same - meaning that different systems are required for each. The professional clients (doctors, nurses, allied health etc.) need systems that enhance their clinical capabilities, improve record keeping and facilitate their secure sharing of clinical information to improve patient care and safety.
The consumers need systems to allow them to record their own information while at the same time having access to, ideally, the live clinical systems so they can better engage with and understand and contribute to their care. It is obvious the present PCEHR/MyHR does neither of these things well. Radical change is needed - at least.
Action Three
We need to recognise we don’t need a single monolithic system but that we need an eHealth ecosystem where health information flows efficiently, accurately, securely and privately between appropriately credentialed actors within the health system and to and from consumers.
Before anything more is done or spent there needs to be an in-depth peer-reviewed evaluation of what eHealth in all its guises has achieved in Australia and what has been achieved in the rest of the world that might be applicable to Australia. This research should inform what comes next and be a major input to the strategy mentioned in Action One.
Action Five
We need to understand that nowhere in the world has a transition to eHealth been easy, uncomplicated, pain free or without missteps. As we increasingly realise, getting this right is a very considerable and some might suggest near impossible challenge that takes lots of time, lots of money and dedication, as well as quality leadership and governance for success. eHealth is not something for generalist bureaucrats and technicians to have repeated goes at and repeatedly fail at!
Crucial to fixing the government created mess we are now in is that the actions listed above are treated as an indivisible action plan and that the Minister is fully involved and supportive. The bureaucracy also needs to understand that they have a very imperfect grasp of what is needed and to listen much more closely to experts and other stakeholders and get out of the way as appropriate!
I can see no other realistic way to provide direction and give stability and certainty to all involved in eHealth so that they can move forward, invest and innovate with confidence. To just wander on as we are presently doing is just not an option.
It is clear that there needs to be major change so the government stops being part of the problem and becomes part of the solution and this change really needs to happen soon!

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“We need to recognise that there are two distinct clients for eHealth systems and services and that their needs are not by any means the same - meaning that different systems are required for each.”

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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.