Jon Patrick wrote: > As a tax-payer I have always had a problem with the arguments for the > need for an EHR. I have never heard any case that convinced me that it > would make a difference. That is different to my ability to read between > the lines and draw on my IT competency to construct justifications. > Unfortunately politicians or the public can't draw on the same > background. I think the medical profession doesn't explain clearly nor > simply enough the case. > For me what is missing is a plain English description of what would be > different for me the patient with my health care, not what would be > different for the physician. For example case studies that showed how a > person's care plan materially changed and saved their life because > information was available which would otherwise not be. Then you need to > argue that such cases happen often enough to warrant the public's > engagement. You assume that the public/politicians understand how you > work but they only understand you give them pills or cut them open and > sew them up.
Just a point of clarification. I think that when most people on this list refer to "an EHR" to mean an electronic health record operating in the context of a single practice or clinic. The term "EMR" is also used elsewhere to mean that, although in a hospital context it oftem means a hospital-specific record which may be shared amongst a group of hspitals - for example, the NSW Health "EMR" is a single hospital clinical information system intended to be accessible from all 200-odd NSW public hospitals - see http://www.health.nsw.gov.au/health_pr/emr/ However, "EHR" is also used, more elsewhere, to mean "shared EHR" or "community EHR", in which all health providers, regardless of the health sector in which they work, have access to the record. The NSW Health Health-e-link project (see http://www.healthelink.nsw.gov.au/ ) is an example of this. The justification for the practice/clinic/hospital-specific EHR/EMR is not so difficult, because the alternative is paper-based records, with no back-ups, no automation (eg script printing or investigation ordering), no possibility for decision support or aggregate analysis etc. The theoretical benefits are pretty self-evident, although in practice they are often not realised, and this is what needs to be empirically assessed rather more often. The case for a shared or community EHR is a bit trickier, though. It seems like a good idea, but there are so many issues of semantic interoperability, authorisation and access control and trust. Young doctors taught to always look and verify things for themselves and never to trust what it says in the hospital medical record. That conditioning stays with them for the rest of their lives. It may be modified by trust relationships within a practice or with well-known colleagues, but who will is going to trust a shared EHR containing information put there by someone else whom you don't know which says Mrs Bloggs has "no known allergies" before prescribing her penicillin? You are always going to ask her, yet again. Same for medical history and current medications. Objective data, such as path and other investigations results may be more readily trusted. Proponents of shared EHRs always mention the unconscious or confused/demented patient scenario, where you can't ask, and in EDs and other acute settings, and sometimes in general practice, clues from a shared EHR will be helpful in such circumstances. But I have never seen a proper study which verifies this i.e. a study which compares the efficiency and outcomes of care delivered to patients, especially confused or unconscious ones) with and without the benefit of a shared EHR. A rather tricky study to design and implement! But your general point about the lack of political and public general understanding of how the health system actually works (as opposed to how it is portrayed in TV series) , and thus what role IT might have in it, is completely correct. > One of the problems with IT is that it is unseen for the most part. > Other medical machines and paraphernalia can be seen, touched, etc, > hence it is self-evident they do something useful. IT has to be > justified by understanding work practices and how they improve case > outcomes by argument and clear exemplars. Perhaps less so in the GP setting, where the patient can clearly see their doc tapping and clicking away at their computer - and often the patients can see the screen as well (and all that drug company advertising which is seeking to control the mind of their trusty medical attendant...). > It seems to me that some of the profession (e.g. GPCG members) have > moved from a knowledge intensive strategy (the historical nature of > medicine) to a more data intensive strategy wanting much more content > about the patient, and more timeliness of that data. An appreciation > that this change matters for sufficient enough patients in terms of > their health outcomes has yet to permeate the rest of society ( and > maybe some of your profession). > > I am spurred to write to this list on this matter as I have just > received an old draft of a political party's health policy and it > suffers exactly from the complaints I make above. If their advisors > can't write a decent convincing case what chance do the pollies have of > engaging positively in Health IT. Yes. I must say that the slim prospect of a Rudd govt in Canberra provides some hope for greater academic and public-sector investment in health IT R&D, whereas as has been noted, the current government will never do anything which might possibly interfere in "the market", even in the face of partial market failure to deliver better health IT systems. Well, they will never intervene unless there are votes or party funds or chum loyalty involved, and none of those apply to health IT, do they? Tim C > Dr. Ken Harvey wrote: >> John Mackenzie wrote: >> >>> No. It's time to start a political campaign to gain >>> funding for a professional software development >>> company to produce an open source EHR. >> >> Given the forthcoming Federal election this concept could be timely. >> >> However, in order to be electorally (and politically) appealing it >> would need a one page outline on the expected benefits, why past >> history has failed to deliver adequately; why this proposal is more >> likely to succeed and how much it will cost. >> >> Perhaps people might like to jot down ideas under these headings (or >> others). >> >> Cheers >> Ken > > ------------------------------------------------------------------------ > > _______________________________________________ > Gpcg_talk mailing list > [email protected] > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
