This quote was taken from David More’s Australian Health IT blog, referring to the Personally Controlled eHealth Record (PCEHR)
“Think of it as a railway, put down the sleepers and the tracks, and lo! the train has something to travel upon.” Link to the full comment
This was my response:
Let’s look at that simplistic statement.
Sleepers and tracks are a known technology and let’s assume the rail gauge is standard. However there are many other issues to do with where the tracks go and how the tracks fit into the greater picture.
1. Where do the tracks start and finish?
2. Is the network to be a star, point to point, circular or mixed topology?
3. What route do the tracks take, a) recognising there are limits as to gradients b) in order to situate stations where passengers can join the trains
4. Are the tracks to support goods or passenger traffic, or a mixture? This determines the load carrying capacity.
5. What speed will the trains be required to achieve – this determines the banking angle required
6. Will the network be a mixture of stopping and express trains? This determines if two sets of tracks need to be provided.
7. What bridges are required a) because of the landscape b) because different rails lines may need to cross c) because of road crossings?
8. Will level crossings be allowed and where will they be situated?
9. What temperature ranges do the tracks have to work within (this determines the length of rail sections, to allow for expansion joints)
10. Where do marshalling yards go?
11. How are trains managed on the tracks (i.e. what signalling systems are to be used)
12. Is power to the locomotives to be provide via an overhead system, third rail or are the locomotives to be diesel powered?
13. How are the tracks to be maintained?
14. What roads will need to be built to permit maintenance access?
15. How are emergencies to be managed? This determines how much and where emergency equipment needs to be placed.
16. Who owns the track network, who is legally responsible for its use and who is liable for negligence?
I cobbled this list together in a few minutes, although it does help that I’m an engineer.
If all these questions arise from the relatively simple task of laying some steel rails and concrete/wood sleepers, can you imagine the number and extent of the questions that arise from something far more complex like health information and how it is accessed by a wide and diverse set of users?
And I think we can only imagine what they are because, AFAIK, they have never been asked or answered. And therein is the biggest concern regarding the PCEHR – a lack of thought. It’s certainly not a good thing.
And just having tracks, literally, gets you nowhere. It’s the trains and carriages that deliver transport outcomes.