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- Issue 81: April 2009
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We are in the process of moving all of our articles to the new site.

In the meantime you can find them on the old i2P site.

Does the National Health And Hospital Reform Commission (NHHRC) Know What it is Talking About in e-Health?

Dr David More
From a Medical IT Perspective

Issue 80: March 2009
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Editor's Note: Dr David More is recognised as one of the health informatics industry experts and we are pleased to carry his column in i2P.
For this month we have selected his comments in regard to a report prepared as a discussion paper by NHHRC.
David More queries whether e-health is fully understood by this group, and the fact that they seem intent on producing a different version of a shared patient record to that of NEHTA.
As he says, " I am vitally interested in making a difference to the quality and safety of Health Care in Australia through the use of information technology.
There is no choice.. it has to be made to work!

I have been reflecting for the last couple of days on the NHHRC comments in the e-Health area.
To me what seems to be the core of what they have said, we have:

“Finally, in our Interim Report we argue that creating a robust and integrated primary health care service will require the implementation of a person-controlled electronic personal health record. Across Australia’s range of community- and hospital-based health care settings the sharing of information is limited, fragmented or non-existent. This results in high dissatisfaction from patients, exasperation from clinicians, adverse events and sub-optimal care.

An electronic health record that can be accessed – with the person’s agreement – by all health professionals and across all settings is arguably the single most important enabler of truly person centred care. It is one of the most important systemic opportunities to improve the quality and safety of health care in Australia. We will explore the prerequisites and incentives to allow us to reach this goal in our final report.”
(See Page 8)

As previously noted the full report and broken down sections of the report are available from the NHHRC website.

Close reading of this suggests there is some confusion between two possible ways forward and that the thinking on the various options is, right now, quite muddied.

By “person-controlled electronic personal health record” I assume they are taking about an electronic health record for an individual that that individual has control and ownership of and which the individual decides who – and who not – is permitted access to the record. This seems to me to be describing a form of record as already offered (for free) by Microsoft Vault, Google Health and a host of smaller providers. This seems to be talking about a classic Personal Health Record (PHR).

While such records have now been available for a good few months there does not seem to be any information presently available on their use in Australia

It needs to be noted that the benefits profile and utility of PHRs is still to be clarified – although it makes intuitive sense there are situations where value will be easily demonstrable. What is seriously up for discussion at this time is just how the patient held and controlled record should interact with the clinician held ‘professional’ record.

However they then go on – in the same paragraph - to talk about the sharing of professional information between health care providers in hospitals and practices – somehow envisaging the person is also going to control this information as well. This is all very vague and muddy to me. This really conforms to no model I am aware of – except possibly in some UK practice management systems which can share information between the various clinicians associated with the practice while at the same time providing the patient with a view of the information held in the record on them as an individual. The record is controlled by the clinician but the patient has secure access to the same information.

In the next paragraph we have a description of what I would describe as a traditional Electronic Health Record (EHR) which is used by the clinician to manage and provide clinical care. It is this sort of record which has been evaluated so far in terms of making a positive difference to the quality and safety of patient care.

When the NHHRC says “We will explore the prerequisites and incentives to allow us to reach this goal in our final report.” I think there are a few things that it needs to do first – and given it has only five months until the final report it had better get going.

First it needs to assemble the evidence on what works and what does not work in the e-Health domain and how vital such technology is to health reform in general – taking into account overseas and local experience to date.

A useful source it might start from is found in my submission which can be found here:


Second it might like to consider the work done in the US on defining terms. If they see some value it might help discussions if they use language more precisely.


To the expert eye their words lack clarity and understanding at present.

Third it might then be an idea to define the strategic objectives and priorities the NHHRC has in the health record domain so that appropriate technical, security, privacy and so on architectures can be evolved and reviewed. Ultimately this work will inform what is delivered and what it will cost, as Government will certainly be keen to know!

I am sure NEHTA is keen to know if what the NHHRC is talking about is their IEHR of something different. If it is, it would be good if the NHHRC said so and defined how it envisaged it would work practically – given the dearth of detail so far from NEHTA.

This should then result in some sort of coherent set of suggestions as to what to do in this area.

To do this work the Commission will need some serious help, lots of it and soon!

Alternatively the Commission could review the Deloittes National e-Health Strategy developed a few months ago, conclude it is a useful way forward and endorse it (as Australian Health Ministers already have) as a way forward with any modifications it feels are vital after discussion with the authors and Booz who developed the NHHRC discussion paper on the issue.

The second approach is vastly to be preferred in my view, as it is not at all clear that if the Commission has not developed some clear, well articulated ideas by now, that it will in the next five months. Clarity and coherence of thought will be vital if any of these reforms are to succeed and e-Health will be a key enabler of that success.


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