For a long while I have been writing about a range of aspects of the conceptual basis of the PCEHR, bit in doing this I have always had the nagging feeling I have not quite got to the absolute core of just what is wrong.
Before getting to the current level of clarity I had expressed concerns about the issues of creating and operating parallel and tenuously linked systems, about the problems of medico-legal accountability as well as about all the issues of information integrity and currency that the PCEHR proposal throws up.
All this was separate from the range of governance, privacy and security issues the PCEHR proposal raised and these were again separate from all the issues around the lack of an evidence base to support the approach being proposed. It is clear none exists to support the specific proposal and that the evidence to support so called ‘untethered’ Personal Health Records (PHRs) is equally tenuous.
See here:
http://aushealthit.blogspot.com/2011/07/reaction-roundup-and-analysis-of-demise.html
And here:
http://aushealthit.blogspot.com/2011/07/fascinating-information-on-adoption-of.html
Additionally, of course we also have the practical issues of capability and practicality of delivering even a small log on screen for consumers to enrol in their PCEHR with any meaningful content behind it.
Yesterday I was involved in a quite animated discussion with some members of the College of Health Informatics (who I won’t name to avoid any possible embarrassment on their part - but who I thank for helping me reach a new level of understanding).
The discussion was triggered by a request by NEHTA to review some specifications of the PCEHR Health Summary and Event Summary.
In a moment of great insight someone asked “just who is this specification for”? Is it for the clinician or the consumer?
The group quickly grasped just how important and fundamental the question was and also that it is obviously a quite fundamental problem. As I have written previously there is a vast difference between systems designed to be used by professionals and those designed to be used by consumers. (Think of the difference between IRESS and Quicken or the differences between PhotoShop and Microsoft Paint).
A system designed for use by clinical professionals is an utterly different beast to the system that might be designed to help a consumer keep track of their basic health information and the health story. As a consumer a set of laboratory results will most likely be a confusing jumble of numbers where as to a clinician they trigger a lot of knowledge and interpretive experience. Equally a MRI scan can provide an interesting image to a consumer and a level of valuable insight to the clinician.
The bottom line is that creating a system to be used by consumers and clinicians is just a fundamental nonsense. Any system targeting both groups will satisfy neither, inevitably. Anyone with even a basic understanding of system design and implementation will agree with me on this!
There I feel better and now know the whole thing is just a flawed concept that is doomed to fail. The docs won’t use it and the patients will be confused and alarmed by it. What a raving success it is we have coming our way!
Just what NEHTA and DoHA need to do to get this back on the rails is a whole different question - and one they better start working on right now!
David.
