A little PCEHR/My Health Record history

Jane Halton has just resigned. She was Secretary of the Federal Department of Health when Tony Abbott was Health Minister.

They set up NEHT which in turn created the PCEHR.

The problem with both Tony Abbott and Jane Halton was their perspective. They both looked at healthcare from a Federal and funding position.

As such, personal healthcare was not their objectives. These were:

  1. a) how to collect data for policy, research and other purposes
  2. b) how reduce healthcare costs.

So, when they created NEHTA, NEHTA’s objectives were to collect as much healthcare data as possible to support the Federal Government’s objectives. Which was why they built a rather dumb database of documents and facilitated access to “repositories”, rather than work out how it could be used to support either patients or healthcare professionals.

They’ve never addressed the second point – reduced healthcare costs. They’ve never even tried to justify how they would do it, other than motherhood statements saying that sharing healthcare data is a good thing.

NEHTA disguised their database as eHealth infrastructure, but the real infrastructure components (NASH and secure messaging) have never been properly built.

What they have built is a big data sucking machine, but they can’t set it working without GPs putting data into it. Hence the bribes. GPs have no interest in making their own lives harder without any gain – other than financial through the ePIP program.

They made a number of mistakes along the way, the most important one being to make it personally controlled. This immediately destroyed its usefulness as a clinical tool. It was done to aid in selling it to the populous but has IMHO, backfired spectacularly – neither patients nor GPs believed the story.

That means, in the end, NEHTA built the wrong solution to the wrong problem.

Then Royle review pointed out all sorts of things wrong with the PCEHR as a solution, without addressing the problem – who is it for and what is its value?

Most of the things wrong have still yet to be resolved but the two things the government did, in support of its objectives above, were

  1. a) to try and make it opt-out.
  2. b) create ADHA

The first point only makes sense in the context of the government’s objectives. It won’t address patient’s and GP’s concerns and issues, in fact it will make them worse.

The direction set by Abbott and Halton is still the guiding star for Health and ADHA.

Unfortunately, ADHA has been set up in the context of My Health Record and under the control of the Health Department. For all the talk about eHealth and Digital Health, the main game is collecting health data and sharing it within government, with research organisations and potentially with commercial operations.

Good luck to them after the census and the mess they’ve made with the trials, i.e. removing the legal requirement for consent to collect patient’s health data. That makes it even harder to argue that patients who have consented to having their health data collected for personal health care have also consented to allowing it to be used for other purposes.

They’ve sorted the legal problems so now they can collect health data without consent. Hospitals are already automating uploading of discharge summaries but GPs are not putting much in. Getting it out and sharing is proving a bit harder.

IMHO. the real issue facing Mr Kelsey, the new CEO of AHDA,  is not will he realise all this, but will he be allowed to to anything about it.

Of course, this is only my opinion, YMMV.

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