Hearing that the World Health Organisation has just declared processed meat bad, red meat ‘probably bad’ and veggies good I was reminded of the mantra that seems to come endlessly from the Department of Health, NEHTA and more recently from the Consumer Health Forum that ‘e-health is good’ and that, by extension even more […]
Hearing that the World Health Organisation has just declared processed meat bad, red meat ‘probably bad’ and veggies good I was reminded of the mantra that seems to come endlessly from the Department of Health, NEHTA and more recently from the Consumer Health Forum that ‘e-health is good’ and that, by extension even more ‘e-health is extremely good’!
This is a classic example of what I have come to term ‘magical thinking’. The line of logic goes that if only we could increase usage and adoption of e-health, then what will follow, inevitably, will be safer, better, cheaper and more consumer-friendly. In other words, pretty much all the ills of the health system will be solved. That is, of course, all politicians need to hear to ignorantly press on.
Sadly nothing could be further from truth. What is going on here, to my mind, is that we have an ill-informed technically illiterate lobby wanting, for its own reasons, to have continuing expenditure on the folly of the Personally Controlled Electronic Health Record (PCEHR) so that they can all stay in work and keep drinking from the financial teat of the DoH.
Since this folly began in 2010, well over a billion dollars have been spent, yet only 10% or so of the population have taken up the offer of a health record, while clinicians have largely rejected the PCEHR as a clinical tool. More importantly, there has yet to be any evaluation of how well the system has delivered its intended outcomes, or if indeed such evidence actually does exist, it has seemingly assumed the status of a state secret.
Moreover, we are seeing continuing the development of plans from the DoH to improve the PCEHR (in ways which are a second state secret) and, because of frustration with the low rate of adoption by clinicians, plans for financial incentives for use of the PCEHR.
It is also planned that patients be conscription into the system unless they are smart enough to opt-out.
In parallel with this frenzy of activity, we have ever increasing evidence that e-health is not all good. We have recent NEJM commentaries identifying clinician frustration with electronic records, we have experts increasingly understanding the potentials for harm in the design and use of these systems, and we have broadening recognition that trusting one’s most intimate personal details to potentially leaky computer systems may not, for some at least, be a very good idea.
The bottom line is very straightforward. Whenever you have the political chattering class asserting anything as an ‘unalloyed good’ be very, very sceptical. e-health is a collection of tools and techniques which when applied in an evidence-based way to some aspects of the health system may result in considerable improvements in safety, quality and efficience.
However, achieving these outcomes is neither certain, uncomplicated or in any way risk-free. Additionally, such outcomes are only possible where there is deep collaboration and understanding between clinicians, administrators and technologists.
The systematic way in which the DoH and NEHTA have ignored considered input from genuine experts, failed to consider overseas failures and totally failed to appreciate the complexity and subtlety of the task they are about has doomed them in my view.
Sadly, even with the new structures proposed with the NEHTA replacement – the Australian Commission for eHealth (ACeH) – I see little evidence that much has been learned. Australia has been on an e-health adventure since well before 1990 and while much has been delivered by private vendors for individual practitioners, to date all national and many state initiatives have grossly over-promised and under-delivered.
What is most frustrating is that we do have a range of experts and clinicians in this country who could do a great deal better that what we are presently seeing but they are being systematically and deliberately ignored.
It really is pretty sad, as a real positive difference can be made, but not with the present cast and crew!
Even more disturbingly, in a speech to the National Press Club on Oct 28 Health Minister Sussan Ley presented a fantastical view of the public having total access to all their electronic records. Just how that will ever be managed, made safe and delivered really defies belief! The apparent magic seems to be pretty strong, given the plan seems to be to incentivise GPs to use and provide information to the system while the public connect with their Fitbit. Just who will deliver this public access system, and who will pay for it is left up in the air…Telstra Health maybe?
