Amongst the frenetic activity arising from Health Minister Roxon’s promise to have a personally controlled health record (PCEHR) available to all Australians by July 2012, and her more recent announcement of a summit on the subject at the end of November, comes the spawning of a spate of related articles in the media. In particular, I’d like to recommend and briefly comment on three articles in this month’s excellent Pulse IT magazine.
I’ll work backwards from the order the articles appear, and start with the article by Simon James addressing the three pilot implementation projects. Simon raises a number of issues. My take on these projects is that neither the Minister, nor her Department, actually know enough about the nature of this PCEHR thing they wish to create, that they have decided to shine a spotlight on 3 “lead implementation sites”, to get a feel for e-health capability “out there” in the real world. Well this will only be of use if we actually do put a spotlight on each of them, so that unlike a number of HealthConnect trials earlier this century, we can learn lessons of real benefit and pass these on to the broader community. From Simon’s investigations, it seems little or no information is available so far. Questions that spring to my mind include:
- what standards are being used in these advanced ecosystems?
- which projects have trialled the Australian Medicines Terminology? If not, why not?
- who is using Australian Standard AS4700.2 for pathology messaging? If not, why not?
- which of them are associated with those “half-brained” vendors who have already signed up with Medicare Australia to integrate the HI service?
- who is using NEHTA’s HL7 CDA specifications for hospital discharge summaries? If not, why not? If so, how are they working?
- how many installations have trialled SNOMED clinical terminology? What are their experiences to date?
In a tone of cautious optimism, comes the second article by Bridget Kirkham and Dr Geoffrey Sayer , CEO and President respectively of the Medical Software Industry Association. This lays out the immensity of the challenge to build a PCEHR in the Minister’s timeframe, particularly given past history, some of which is graphically presented to reinforce the message. And the message is – yes we can, but only if we set an achievable bar, use the existing “vendor offerings” , and all jump together. I guess it’s the kind of message you’d expect from an organisation representing hungry vendors all eyeing off their rightful share of the $466.7million cake. But they do make some valid observations.
The third, and to my mind most prescient article, titled “E-Health: Lack of ownership is the real impediment”, is by Peter Brown of Cancer Voices Australia. The thrust of Peter’s article is that success can only come from a truly collaborative approach involving all stakeholders, and until and unless e-health is seen as a community collaboration, we will not make much progress. In the article he is not endorsing timetables, nor particular deliverables, but simply getting the ownership right as the first step.
A common thread in all these three articles is trying to heed the lessons of the past. I’m skeptical that will occur. The political pressure; the tight timescales to spend a large bucket of money; the vagueness of the deliverable; the vagueness surrounding hidden costs; the vagueness around perceived benefits; the vagueness of who’s in control; the lack of understanding amongst policy makers, of the complexity and interdependence of organisational, information and technology factors, and also of clinical workflow.
These all lead me to the conclusion that come the First of July 2012, all we will see are some thick tyre marks through a heavy pall of rubber smoke.