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Thursday, March 29, 2012

It Looks Like One Of the Key PCEHR Targets Will Be Hard To Hit. The PCEHR Is Just A Very Poorly Conceived Idea.

It has been a long standing claim that the PCEHR was to initially be an initiative to focus on those in most need which was said to be those with chronic disease, the elderly, aboriginal populations and mothers and babies.
It must be rather annoying then for the designers of the PCEHR to realise they have seriously missed the mark. For the PCEHR to be valuable and widely used it needs clients who will value what it has to offer. If you don’t know how to sensibly use a computer and you don’t know the risks associated with incorrect use then much of that benefit might be lost.
In this context we see this report of NEHTA’s attendance at a recent hearing.

NEHTA to front Senate cyber safety hearing

NEHTA is taking steps to reassure government and health industry stakeholders that it is comprehensively addressing a range of ehealth privacy and security concerns.
Industry groups including AusCERT have questioned the efficacy of the ehealth agency’s standards and technologies for protecting the Personally Controlled Electronic Health Record (PCEHR).
Two senior NEHTA executives will today front a Senate Committee hearing into cyber safety, which chief executive Peter Fleming described as part of the organisation’s ongoing engagement with government on the issue. Dr Mukesh Haikerwal, NEHTA clinical lead, and David Bunker NEHTA’s head of architecture, will make presentations at the inquiry.
Mr Fleming said NEHTA was working hard to meet the July 1 deadline when consumers will be able to register for the PCEHR. “We’ve been working flat out with DoHA, the jurisdictions and the states to deliver on the 1st of July promise and deliver a good quality system,” he said.
More here:
There is coverage also found here

Concerns raised over e-health records for elderly

NEHTA conceded that the system may not be "senior friendly"
The suitability and accessibility of the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) system for the elderly has been brought into question by a Senate committee investigating cyber safety for senior Australians.
The committee voiced concerns to the National E-Health Transition Authority (NEHTA) — the body charged with the rollout of the PCEHR — around just how “senior-friendly” and easy to use the system would be for the demographic.
“We are working with the relevant stakeholders to ensure it is a system that will meet their needs and provide them with a level of confidence that their personal information is safe and secure,” NEHTA head of architecture, David Bunker, said.
 “I wouldn’t single it out as being elderly friendly. I think we need to accept that there is a range of sophistication, maturity and literacy around the use of technology and the system, to be safe, secure and easy to use, has to allow for that.
“I think the best way to address that is to say in terms on developing education materials, there is support for those things and the nature of that material has to be directed to a varying level of computer literacy.
More here:
There is also recognition that ‘senior citizens’ need help they presently are not getting.

ACMA calls for improved senior citizen cyber safety education

Face-to-face programs preferred over online sessions, according to ACMA research
Improving cyber safety education of senior citizens through more targeted programs would greatly improve their confidence and get more elderly Australians online, according to an Australian Communications and Media Authority (ACMA) submission to a Senate committee investigating cyber safety for senior Australians.
Speaking at the Senate hearing in Sydney, ACMA digital economy division general manager, Andrea Wright, said that most cyber safety programs are aimed at young people and the Authority is trying to change this.
During Safer Internet Day in 2012, for example, ACMA targeted grandparents with face-to-face presentations across Australia.
 “We provided a list of questions to seniors that they might ask their grandchildren so they could get online and learn how to use social networking sites,” Wright said.
More here:
The bottom line here is that for the PCEHR to be a success it needs to be fully usable and properly understood by its target demographic. Sadly that little detail just seems to have gone through to the keeper as they say.
The simple fact is that the PCEHR is a wrongly directed and ill-conceived investment in a bad idea. Investment in providers systems and provider messaging was what was needed first and only with this really working do you move to access to live systems for those who want to and can use such access.
This is just another reason we will see such limited penetration in the target demographic along with a lack of useful functionality and so on!
David.

Wednesday, March 28, 2012

There Are Some Very Interesting Straws In the Wind Regarding E-Health’s Future in Australia. A Pause Is Actually Happening!

I was having a close read of an interview given by Ms Jane Halton PSM - Secretary of the Department of Health and Ageing and it really confirms what we heard from the Minister a day or so later.

No ehealth Big Bang: Halton

Australia won’t see an ehealth big bang once the deadline for the introduction of the personally controlled electronic healthcare record passes on July 1. “Our strategy is about demonstrating capability,” said health department secretary Jane Halton, in an exclusive interview with eHealthspace.org.
According to Ms Halton, the focus immediately post July 1 will be on the existing Wave 1 and 2 sites, which were paused earlier this year due to a software specification issue.
Ms Halton said the question of whether more trial sites will be added to the Wave program is “an active debate.” She also said the health department needed to see what movement there is among the general and health communities in terms of ehealth adoption before committing more resources to further roll-outs.
The Wave sites have already enrolled close to 1.4 million people into the PCEHR, said Ms Halton.
“What we want to see is a measured and orderly approach, and if you look at what’s happened overseas you actually have quite slow adoption to begin with,” she said.
The slow roll-out, she added, will enable people to see how the system works, and to figure out if there are better or more effective ways of doing things.
Full interview (with video) is found here:
Taking these comments, along with the Minister’s, it is absolutely clear we are actually going to have a Pause in the PCEHR Program for what looks like a combination of budgetary as well as technical problems.
The Minister’s speech is here if by some mischance you missed it.
So what is now happening?
1. Work is continuing at the Wave sites to figure out what works and what doesn’t. In reality this is the Pause ‘we had to have'.
2. No firm plans to extend nationally exist. Additionally funding from now on may be a little slower in coming.
3. The system will now be rolled out over years - with people being able to register and then do largely nothing until later. (This rather reminds me of the NBN. You are out of luck until they come past your house).
4. There are a huge number of unanswered questions around the future for NEHTA in its present form (staff levels, management, mandate etc.), the various applications that have been built and also just how present private initiatives will be eventually integrated.
We have started down a new and at presently undefined path. Clarity will be needed and soon.
David.

Join The Dots - We Are Not In Kansas Anymore. The Game Has Totally Changed!

We will look back on yesterday’s speech from the Federal Health Minister as a watershed I suspect.
The reactions to date have been quite interesting.
We have the RACGP pretty happy.

RACGP welcomes recognition of GPs’ vital role in PCEHR roll-out

28 March 2012

The Royal Australian College of General Practitioners (RACGP) warmly welcomes the government’s announcement today that funding will be available to recognise GPs who act as nominated healthcare providers when the Personally Controlled Electronic Health Records (PCEHR) roll out from 1 July 2012.
RACGP President, Professor Claire Jackson, said she was very pleased with this outcome and thanked the Hon Tanya Plibersek MP, Minister of Health, for listening to the profession on this critical issue.
“While some of the details still need to be further discussed, I am delighted that MBS consultation items will be available to GPs if they are adding a shared health summary to the patient's PCEHR, which involves taking a patient’s medical history as part of a consultation.
“The PCEHR has the potential to transform Australia’s health system and to make it work better, safer and more efficiently.
More here:
and the AMA rather less than impressed.

PCEHR and the MBS – more work for and no reward for GPs

AMA President, Dr Steve Hambleton, said today that the Health Minister’s announcement about Medicare rebates for preparing shared health summaries for the personally controlled electronic health record (PCEHR) raises more questions than answers.
Dr Hambleton said it is still unclear whether Medicare rebates will be available for this new clinical service that GPs are being asked to provide for their patients.
“The Government has acknowledged that preparing shared health summaries with patients will require considerable extra work for GPs, but there is no clarity that the longer consultation items will apply to cover this extra work,” Dr Hambleton said.
“For example, if preparing a shared health summary as part of a standard 20 minute (Level B) consultation stretches it out to 30 minutes, will the longer Level C item apply?
“Similarly, if the more complex Level C consultation stretches out to more than 40 minutes, will the Level D item apply?
“Will the Government be providing specific new Medicare rebates for this extra work?
“There is absolutely no clarity from today’s announcement that GPs will be properly funded and supported by the Government to assist patients obtain the benefits promised by the PCEHR.
More here:
Payments aside it is important to note 2 things.
First the Minister gives a major e-Health speech and does not mention NEHTA or the PCEHR except by inference.
Second - on ABC Radio’s AM this morning - we have the Treasurer saying programs will be cut or scaled back all over to get to a budget surplus.
The proof of the pudding will indeed be in the eating - and the funding of e-Health going forward in the May Budget will tell us all we need to know.
I suspect we at a similar moment to the time under the Howard Government when Minister Abbott suddenly changed the HealthConnect Program into “a change management strategy” some decade ago.
The more things change the more they stay the same as they say!
We need a new plan and a new forward direction outlined - and soon. It is clear the old one has now changed big time.
David.