Monday, October 1, 2012

I Think We Need To Work Out Just What We Mean By E-Health. The Confusion Is A Major Distraction.

This blog post has been triggered as a result of a discussion with a colleague and the NEHRS / PCEHR.
The comments that triggered my thinking is this:
Me: “Glad your glass is 1/2 full. Same as the likelihood of the EU getting its debt under control in my view - but there you go!
If you can provide one bit of evidence that the approach planned with the PCEHR will actually work I will consider a switch...10,000 users in 3 months etc. does not reflect a great future to me.
 Right now a billion dollars and a lot of people praying. But, as they say, 'Hope is not a strategy'.
Correspondent: “I can only agree about the state of the land – don't misunderstand - it’s just that I don't tend to think PCEHR when I talk e-health – PCEHR is just not part of the operational e-health mix.
I was just saying that e-health (in its full and traditional and broad reading) is now a growing part of the health system discussion – which is for the good. Problem is that PCEHR has made everyone stop looking at what is happening in e–health and instead just focus on it. But you know that!”
I wonder if we should more often simply  talk about 'true' e-health whilst also still holding those delivering PCEHR to account for what they have said they were going to do?”
This is why I think being clear we are talking about? We need to do a little better than talking about ‘real’ or ‘true’ e-Health in one breath and then suggest the NEHRS is not really part of the greater concept.
The reason it that any real progress requires at least some level of political understanding and consent, and if we are loose with terminology the political class may not be able to properly understand those things that are worthy of support and those that should not be supported of funded.
It is also important, to me and many others, that distinction is drawn between those thinking the NEHRS is a conceptually and operationally flawed program and drawing from this some idea that these people are somehow opposed to e-Health. This is of course arrant nonsense.
To me a useful way of distinguishing between ‘good’ and ‘bad’ e-Health is probably to assess the evidence for whatever the proposed initiative is. On this sort of basis electronic records, standards, secure messaging, coding, information exchange, analytics and so on are on the good side and politically driven, industry distorting, mega programs are probably bad.
Essentially I want to see those things that are likely to really improve clinical care be supported and those things that are extravagant, wasteful and evidence of benefit free curtailed. To me the NEHRS is a sideshow that is distracting from the main game.
We want the politicians to support and fund the good - so we need to be clear what we are on about.
What do others think?