At Last: A Solution to Plibersek Uncertainty Principle

by Charles Wright on August 23, 2012

We imagine the world’s top cryptographers will have been consulted to dissect and analyse the third-generation (or possibly fourth-generation) explanation offered last night by Health Minister Tanya Plibersek  of what she meant four months ago now, when she detailed “additional support” for clinicians creating or adding to a shared health summary.

Readers may recall that the first-generation explanation, issued by a ministerial spokesman, appeared to state categorically that “a GP making what would normally be a level B consultation would be entitled to claim a level C if the extra work involved in creating a shared health summary made the consultation longer than 20 minutes”.

That was widely assumed to mean GPs could in some circumstances actually be paid to gather and upload their information to a patient’s PCEHR.

Regrettably, this temporary, and completely illusory clarity was subsequenty superseded by a second-generation explanation, or a revised revision, delivered by the minister on ABC Radio.

In this re-explanation, Minister Plibersek expressed some astonishment that anyone could possibly imagine that the “additional support” she was so pleased originally to be announcing was actually additional support in the sense that it was (a) additional and (b) support and that (c) “The idea that [doctors] would during a longer consultation be paid extra for recording that information in a computer program that many of them are already using is probably not the best use of extra health funds.”

In other words, what the minister explained on the national air waves was this: When she announced that MBS numbers would be available, what she meant was that they would not be available.

What with the ensuing spectacle of highly-intelligent officials of the AMA and the RACGP wandering around with heavily bookmarked and underlined copies of the Oxford English Dictionary and The New York Times Dictionary of Misunderstood, Misused and Mispronounced Words, a bold and completely new explanation was shortly forthcoming from the RACGP.

It was about this time that this blog identified the phenomenon of the Plibersek Uncertainty Principle, as the RACGP produced a variety of scenarios aimed at clarifying for their members the precise circumstances, including tide tables and lunar progressions, under which it might theoretically be possible to extract public funding for the uploading of data.

In the circumstances, you can possibly understand why there is still just the tiniest residual doubt at eHealth Central about the assertion by officials of the AMA and the RACGP that “absolute clarity” has been delivered on the matter with Minister Plibersek’s address at the AMA’s annual parliamentary dinner in Canberra.

According to the MO, the minister announced “ehealth billing would now be time-based instead [of being based on complexity] and that the e-health PIP would be extended until May 2013”.

The new explanatory notes specify the time spent by a GP reviewing a patient’s history on an e-health record or preparing an event summary or shared health summary “may be counted towards the total consultation time”.

“When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time,” the notes say.

MBS rebates will still not be available for creating or updating a shared health summary as a stand-alone service.

What might be required it seems to us, is a ministerial explanation of what Ms Plibersek actually meant when she proclaimed that “The idea that [doctors] would during a longer consultation be paid extra for recording that information in a computer program that many of them are already using is probably not the best use of extra health funds.” We suggest that the word “not” now appears to be surplus to requirements.


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Reporter’s glitch blamed on ehealth … yet again

by Charles Wright on July 30, 2012

One of the things that can completely ruin your day when you’re in the business of breaking news is the sheer tyranny of time. While sometimes something that happened a few months ago can still be news – if the events were significant enough and nobody knew about them until you broke the story – too often that lack of immediacy not only  lessens the impact, it also renders the event meaningless.

That, regrettably, seems to be the case with Mark Metherell’s piece in the Sydney Morning Herald and The Age this morning headlined “Patient ID glitches dog ehealth system”.

On the face of it, Metherell’s story was pretty troubling: “Glitches in patient identity details for the new e-health system have been found in about one-third of cases nationally, according to a report the Federal Health Department refuses to release.”

It’s the second paragraph where the “news” starts to fall apart: “The secret report shows patient identity information held by state public hospitals frequently fails to match the data that Medicare holds on the same individuals. Differences in the spelling of names or other variations can pose a significant obstacle, as the system requires an exact match before individuals can get e-health access.”

For one thing, since admissions to state public hospitals don’t make up anywhere near one third of national health cases – we’d be a terribly ill population if they did – it cannot be true that mismatches in IHI numbers are running at about 30 per cent nationally, even if mismatches in state hospital records were at that level. And my inquiries suggest that that they are not.

The story appears to have been based on a report which IBM did as part of NEHTA’s DaCS (Data Cleaning Service) Program, which was launched in 2010 to assist state health departments for the Health Identifiers Service and PCEHR.

That program analysed patient data quality, IHI (Individual Health Identifiers) matching and integration with the HI Service, as well as making recommendations on data quality and cleansing initiatives for ehealth adoption. As everybody involved expected, given that public hospitals have not been altogether diligent in relating their patient data to Medicare numbers – it indicated that the hospital data left a good deal to be desired when it came to procuring HI matches.

But the fact is, the report does not show “glitches in patient identity details for the new ehealth system”. What it indicates is data management and data accuracy issues, none of which surprise anyone who has been involved in the area of ehealth for more than five minutes.

And while the report might be “secret”, in fact it’s more than a year old, and the information has already been used to adjust the search strings used in HI matching, so things have progressed significantly.

What the report revealed, essentially, was that batch HI matching using public hospitals’ historical data was not a very good idea. Matching is significantly improved, however, when patient data is uploaded on an individual basis, and particularly if the patient’s Medicare number is verified at the time a shared health summary is uploaded.

I’m told that procedure is producing a matching rate of as high as 99.9 per cent out in the wild.

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Personalised – REALLY personalised – medicine?

July 26, 2012

Larry Smarr is just the teeniest obsessed with his health – he’s had his stool samples analysed nine times in a year; had his blood tested eight times – but he says we are on the verge of a complete revolution in healthcare, which will see the “one pill fits all” approach to prescription drugs, […]

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Buggy journalism called to account

July 25, 2012

We students of Dearne-alism have been enjoying a veritable feast of sub-optimal journalism over the past couple of weeks, as The Australian’s anti-ehealth roundsman has been cementing her reputation for getting stuff wrong. There was that piece last week, for instance, that claimed GPs would have to wait three years before they could receive hospital […]

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Patient records: Now you see it. Now you don’t.

July 24, 2012

Here’s an irresistible puzzle for students of human nature: if someone opts in to the PCEHR, are they likely to risk compromising their health by removing a document their doctor has uploaded to it, without leaving a trace of its existence? AMA president, Dr Steve Hambleton, thinks patients are quite likely to do so, and […]

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Life with my PCEHR

July 23, 2012

What secrets I am sharing with my Personal Health Summary, located under one of the menu items on the left side of my NeHRS/PCEHR. (I do wish someone would tell me definitively which abbreviation I should use!) Today I have news of my adhesive capsulitis in my left shoulder – a diagnosis from my physiotherapist, […]

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An app that makes patients more accountable

July 18, 2012

I couldn’t help but think, as I  read health economist Jane Sarasohn-Kahn’s article in Health Populi connecting the accessibility of personal health records and patient engagement, that it points to an obvious and immensely attractive future … one where we can access our personal health records – and for that matter our family’s EHRs – […]

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PCEHR positives shock

July 17, 2012

Here’s a real shock: a professional health journal has actually found something positive to say about the PCEHR! According to Pharmacy News, “ehealth record trials show there will be some real practical advantages for pharmacists”, as the national electronic record  is bedded down and information begins to flow. How can this be? Have they too […]

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eHealth: What’s in it for me?

July 16, 2012

I loved the pragmatism in the abstract of a paper from Israel’s Clalit Health Services – the country’s largest and the second largest world-wide – on “e-Health, m-Health and healthier social media reform: the big scale view”. Authors Yossi Bahagon and Orit Jacobson declare that, “In the upcoming decade, digital platforms will be the backbone of […]

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More progress on my PCEHR/NeHRS

July 11, 2012

Obviously some progress has been made on the matter of online access to the PCEHR, or as it appears in my browser, “The National eHealth Record System”. I just logged in and updated my emergency contact details and added my current medications to my Personal Health Summary. I also set up email and SMS notifications […]

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