Monday, June 11, 2012

Good Heavens - It Seems The NEHRS Will Be Like The Old Scanned Electronic Record Systems Where Search-ability , Decision Support and Discrete Data Is Out The Window.

The following appeared a while ago - and I missed it for a while.
MAY 2012 | Published by RCPA
Issue #014

Pathology results will miss this year’s eHealth debut

The long-anticipated eHealth initiative will make its debut on July 1 this year, and it’s been a long journey to date. But the journey’s not over yet, especially for pathology which won’t be included in this year’s eHealth rollout. It’s not a case of omitting pathology from eHealth, but more a case of advocates such as the Royal College of Pathologists of Australasia (RCPA) ensuring that pathology results are uploaded and viewed in the safest possible way.
“The RCPA have been working cooperatively with the National E-Health Transition Authority (NeHTA) on this project,” explains Dr Bronwen Ross, Deputy CEO of the RCPA. “However, patient safety is paramount so we have been making sure pathology results will be uploaded into eHealth records in a way that ensures their complexity and context are not lost in the transition.”
The official title of this new eHealth patient record is the National Electronic Health Record System (NEHRS), although older information may refer to it as a Personally Controlled Electronic Health Record (PCEHR). Whatever its name, Professor Michael Legg from the Centre for Health Informatics and eHealth Research at the University of Wollongong says the roll out will be slow with the initial benefits mostly favouring people who are outside of their normal caring group of health practitioners.
“There’s a good example of this in action on the eHealth information website1 which gives the example of Kelvin’s eHealth journey to demonstrate its usefulness in this situation.”
Prof Legg, who is also a Fellow of the Faculty of Science of the RCPA, says eHealth is an important initiative but he also shares Dr Ross’ concerns about the risks of uploading pathology results in a fragmented way.
“If you grab bits of a pathology report and cut and paste it into an eHealth record then it can lose its context, especially if there are differences in the units and reference ranges used by different laboratories.”
Dr Ross says the RCPA is working on standardising certain aspects of pathology reports, but like any major project it will take time.
“Pathology results are not just a group of numbers or a commodity that can be put wherever people like,” she stresses. “There is medical analysis by a pathologist behind them and that’s one of the reasons why they must be represented in context. For example, microbiology is one area where uploading fragmented information can have serious consequences because the reports deal with different organisms and cultures as well as specific recommendations by pathologists.”
Dr Ross says a group of pathology stakeholders have agreed on a model where the results will be uploaded into the eHealth record in a PDF format so the report is viewed in full. This has the added advantage of enabling treating practitioners to view additional information such as who wrote the report as well as the laboratory’s contact details.
More explanation and details are found here:
Further on we also find the target date for result availability is a year after the NEHRS was meant to go live for large pathology providers and a year later for smaller ones.
It seems that while discrete pathology results (as well as those in PIT format) have been provided by a range of secure message providers for years that we are now going to settle for the foreseeable future on a ‘data lump’ format for the NEHRS.
What needs to be quite explicit here is that this problem has been known about for years by NEHTA. It has always been the intent that the new Secure Messaging standards from NEHTA would support proper interoperability.
Here is a title page from an old presentation. (Not surprisingly Google does not now find it!)

Moving to Interoperability in eHealth

12 July 2006
Andy Bond
General Manager Interoperability
----- End Extract.
Page 14 of the presentation makes it clear that not only e-Results but also e-Ordering are to come. Six years later - Oops missed that one and it will now take a few more years.
I will leave it to others to explain why so much has been spent on NEHTA and why this work still isn’t done. It beats me.
That we have not reached agreement on how to provide discrete information to clinical systems is really a very sad outcome - given the how ‘blob’ formats make things like clinical decision support that much harder.
Use of .pdf files is really such a technically poor outcome that one only wonder why more work has not been done to get a better outcome by those involved - RCPA, NEHTA and DoHA.  Why do I get the feeling there is more than technology involved here - turf preservation or politics maybe? Maybe a careful rethink with the interests of clinicians and patients might be a good idea?
Remember that, of course, once second best gets established - how long will it be before a new improved version emerges? Your guess is as good as mine!