3 November 2017

First the rugby, now national e-health records

Government Technology

What is it about small countries that are cold, wind beaten, have highlands, and lots of woolly hooved livestock? Both New Zealand and Scotland punch well above their weight in sport, especially rugby. And both do the same in digital health.

If you’d like a few answers to the digital health side of this strange cultural phenomenon Dr Libby Morris, clinical lead on Scotland’s SPIRE program, the pragmatic and so far successful equivalent to our My Health Record saga, might have a few. Dr Morris is the keynote speaker at next week’s annual summit of the Medical Software Industry Association (MSIA) being held in Melbourne.

To offer appropriate contrast, Tim Kelsey, and others from the Australian Digital Health Agency, will be there as well, spruiking the “Australian way”. It will be worthwhile seeing the two countries head-to-head. The approaches of both are a long way apart, and most commentators have Scotland a long way in the lead, despite starting five years after us. 

SPIRE stands for Scottish Primary Care Information Resource. If you’re a GP you’ve got to love the name from the outset – it’s putting primary care at the centre of things up front, where it probably should be. Some would argue that My Health Record is better because it’s patient centric. And that’s where you start to see how Scotland may have got things right and we may have missed the mark somewhat.

Patients don’t care about their EMR and they have no idea why a form of EMR for all citizens might be a good thing. GPs do. Patients and EMRs are the centre of their world. So why not start with them at the centre and work outwards? Scotland seems to have done that. Get the main professionals engaged first and go outwards to their patients and make sure the stakeholders are in the boat before you start rowing ever further out to sea.

Much better still, at no point did the SPIRE program get close to contemplating a “boil the ocean” approach, which is the path we’ve taken with the MyHR.

Someone, somewhere in the dim dark past of the MyHR saga, a political identity almost certainly (possibly Julia Gillard or maybe Tony Abbott) decided they needed a healthcare moonshot.  A poster program to prove a government’s ability to build big for the future.

The MyHR, starting as the PCEHR was that program. It was a great goal. Noble even. But it was always somewhat doomed by its scope, grandiose goals, and by the fact that government was going to be the main driver of its success. It was hexed by being politically led project, not a medically led one.

In Scotland, Dr Morris and her colleagues set about things at just about the other end of the spectrum. They did a lot of consultation with the key healthcare providers and they asked very simple questions. What data do you most need and when, in order to improve things for you and the patient? What will help you – the GP – the most?

Even when they got those answers they went lean on their deliverables. Start small, see where you get, and work on that, was the Scottish approach – which does seem to play to that stereotypical image we have of the Scottish as being cautious spenders. Build from the ground up and from the health practitioner outwards. Don’t waste a cent. Och aye!

By all accounts, this approach, which was also informed to a degree by the disasters of the NHS in England, in trying to roll out an all-singing, all-dancing, all-encompassing EMR for the nation, is working very well. Notably, there is de novo buy-in from general practitioners, something we still haven’t got in Australia. And no, the fact that the RACGP has bought in does not mean GPs are engaged in the My Health Record. They are still uninterested, and this is an ongoing problem.

The MSIA, of course, are at the centre of the EMR world in Australia. Speak to most EMR vendors, such as Dr Frank Pyefinch, the founder of our two largest primary-care patient management systems, and they will be fairly blunt about how much the software vendors have been consulted throughout the MyHR project.

Until quite recently, the ADHA had never actually spoken directly to Dr Pyefinch, and he only agreed to write a link to the MyHR after the ADHA gave up trying to convince him of its utility and paid him. He still saw it largely as a waste of his time. That should have been ringing alarm bells with someone back at home base in the ADHA.

Though seemingly niche, the MSIA meeting is a gathering where you will get real and deep insights into what is going on the world of interoperability and, perhaps most importantly, patient safety. The software vendors are the beating heart of solving the complexity of secure and seamless health communications. It’s a meeting that you sense has, in the past, been underestimated a little by our present day healthcare leaders as a perhaps too technical or geeky. Quite the opposite.

Having said that, clearly interoperability and the success of the MyHR as a big ticket item for the nation is ringing loud in the ears of our current day healthcare leaders because this year’s summit will feature our Federal Health Minister, Greg Hunt, along with ADHA CEO Tim Kelsey, the effervescent digital GP campaigner and ex AMA president Dr Mukesh Hakerwail, Shane Jackson, the president of the Pharmaceutical Society of Australia and a host of other bigwigs. Should be an interesting meet.

If you’re interested in attending you can still get tickets HERE

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David Chan
David Chan
1 year 1 month ago

Surely you jest – the Government , Colleges and smart people consulting the doctors (especially GPs) who have to do the work, implement and use the information to improve their patients’ healthcare and outcomes? What’s more, recognising that the central important driver to success of this program was the primary care provider and not the political spin and patients’ centric consumer line constantly prioritised in virtually every Government health program policy?
You are in the wrong Country or Universe and wrong century.