Saturday, July 7, 2012

A First Look - Well We Can Now See What Roughly A Billion Dollars Buys In A Health Record System. It’s Not Much So Far.

I had a frustrating time 2 days ago trying to convince the NEHRS system I was real. Eventually I decided the phone was the go and had a very kind lady spend 15 mins or so to provide me with a password to get started with setting up my personal health record.
Since I am sure not many have do so as yet here is where you wind up and what you will find so far.
There are all the usual disclaimers, warnings and threats to your first born and you get to a sort of record home page.
The layout is traditional - with demographics at the top and then this menu down the left had side.

Health Record Overview

Clinical Documents
Shared Health Summary
Personal Health Notes
Personal Health Summary
Advance Care Directive Custodian
Your Personal Details
Emergency Contact Details
Medicare Records
Medicare Services Overview
Restricted Settings
Medicare Information Preferences
Notification Settings
Manage Access to this Record
Manage Document Access
Restricted Settings
Audit Log
----- End Extract.
In the real system each of these are links to their own pages.
The record is powered by Orion’s Concerto software using Oracle as the Single Sign On and Security Manager.
Initial Impressions:
1. Clean open screens with lots of explanations meaning there is a lot of navigation (not all that quick) to move around.
2. The log on with a combination of ID, Password and Random Security Question (1 of 5) is slow and annoying but I guess necessary.
3. There is essentially no content of any sort - except what you type in and an non-user friendly audit trail. There were no Medicare records I could see also.
4. Just how records will be managed over time (a potential lifetime indeed) with all that entails is not hinted at here.
5. That this is a consumer and not professional system is emphasised throughout with all the disclaimers about clinicians not needed to read some parts and other parts being fully available.
6. The lack of a condensed consumer information summary screen seems to be a big omission.
7. Flicking between and the record is slow any annoying.
8. Right now the term PC-LES for Largely Empty Shell is spot on!
 The bottom line is that right now it is impossible to see where the money has gone. What we have is a pretty clunky web-based system of a design that was common close to a decade ago. The complexity of what is on offer is very low and right now the system is about as user friendly as a piranha. There is really no point much to using this right now.
Until there is wide-spread co-operation from the profession in the provision of Shared Health Summaries and Event summaries (and the provision of effective, slick and very quick Business to Business (B2B) links between the system and practitioners) this system is a remarkably expensive aide-memoir. Right now a MS Word file on my home computer looks like a pretty good and cheaper option.
If that is to ever really to be adopted and used it will rely on dramatic improvements in usability and information content. I am really not sure I can see that happening any time soon. Time will tell.