Saturday, July 14, 2012

It Really Looks Like The Right and Left Hands Of E-Health Have Not Co-Ordinated The Story. They Have No Explicit Plan And Are All Over The Place.

The following very long piece appeared in the Saturday Health Section of the Australian yesterday.

Sideshow obstructs e-health traffic

THERE is a truck trundling across Australia that should be pulled over and its owners charged with false and misleading advertising.
It's the Model Healthcare Community Roadshow, and it claims the Gillard government's $1 billion personally controlled e-health record guarantees "your health e-info travels with you".
Although that is indeed the aim of modern electronic health systems, the PCEHR is a repository containing a static, point-in-time medical summary uploaded by your GP, and possibly a few "event summaries" from other practitioners.
It's unclear how a hospital will upload a discharge summary after surgery or a visit to an emergency department, just as it's uncertain how specialists will contribute their summaries.
That's so as each person's record is supposed to be "curated" by a single, nominated provider, usually their GP.
It's also unclear how long it will take to update individual records. It's certainly not in real time.
Doctors have made very plain their concern they will be unable to rely on the PCEHR as accurate, up-to-date and complete.
The last point is certainly tricky as it's impossible to ascertain that every healthcare provider you encounter has the capacity or the will to contribute to your record. It's a voluntary system for providers as well as patients.
Take, for example, an emergency admission following a sudden collapse. You're fortunate enough to land in a hospital with good internal e-health systems and a specialist who is already communicating electronically with their colleagues and local doctors through secure messaging systems.
How will the PCEHR help in this situation? It won't.
When you arrive in emergency the receiving doctors will be able to access only a brief health summary from your most recent GP visit, perhaps six months or a year ago.
What about the "X-rays, pathology, scans" proudly emblazoned on the truck's side, implying they too can be uploaded to your record? They can't.
Efforts to provide access to diagnostic imaging through the PCEHR are yet to begin. Work on creating the technical standards and processes for handling diagnostic images, reports and requests is scheduled to start sometime next year.
Worse, it appears the initial versions will provide images in the PDF format only. That's better than nothing but unlikely to please medical professionals already exploring new worlds of computer-assisted technologies as well as those doing 3-D modelling of surgery plans for patients.
And what about pathology? Again the best doctors can expect is a summary of test results, in static form. That means doctors won't be able to dynamically monitor variations.
Instead, they will need to open each result separately, perhaps print out the report, and then work out the changes and trends themselves, much as they do at present.
Pathologists warn that the summary nature of PCEHR information poses particular challenges, as pathology results need to be interpreted in the context of other test results, both normal and abnormal, with a normal result just as important as an abnormal one.
Any omission of results from the record may inadvertently lead to wrong conclusions and wrong diagnoses, thereby compromising patient care.
Lots more here:
The second half of the article then goes on to explain how systems which are in-place, proven and working are being harmed and replaced by the push from a presently worse than useless system ‘from the Government’.
One colleague had the following reaction.
“It's a pretty powerful and very provocative article. I'm sure it will be widely circulated electronically in addition to all the hard copy readers. It could have the effect of dramatically slowing down the e-Health momentum OR it could act as a real wake-up call to the Minister to exercise real leadership and employ some common sense thinking about how best to fix the PCEHR fiasco.”
My feeling is that no one is taking any account of the harm the PCEHR Program is doing to our current e-Health providers and worse that the messaging about e-Health is now hopelessly confused. We have the wandering truck promising the earth while down on Planet Earth it is well known this is all going to take years to make any difference - and the Minister and other senior people are all saying just that.
Again we have an excessive simplification of a debate which is not all that simple. Simply saying ‘e-Health’ is good and opposing ‘e-Health’ is bad misses the point that there is good evidence based e-health and what is going on with the PCEHR which is the extravagant opposite in every sense. I strongly support the former and oppose the latter - despite what you might read elsewhere.
What is missing in all this is the Government actually levelling with stakeholders and providing a real plan of what is foreshadowed over the next few years and the business case and evidence to support that plan.
Dream on David I guess.