Sharing the Spin

My spin detector spun into the red zone last week following an article posted on a well known commentary web site in the Australian e-health space. The article opened with:-

“As the adoption of the personal e-health record (PCEHR) in Australia starts to snowball, we are likely to see fewer medication errors and improved diagnostic and treatment decisions according to a recent global survey of 3,700 doctors.”

The Accenture Doctors survey report makes no mention whatsoever of shared electronic health records. Neither is there any attribution by the survey respondents of health IT, let alone shared EHRs, leading to “fewer medication errors”. None! 

The Accenture report defines 3 key concepts used in the survey questions, and I assume and hope that these terms were clearly passed to the participating doctors prior to answering the questions. The key term repeatedly referenced in Accenture’s doctors survey is HIE – Health Information Exchange. Accenture’s definition matches that of Wikepedia –
“the mobilisation of healthcare information electronically across organisations within a region, community or hospital system”.

Now the Accenture survey report itself is of questionable utility as a source for understanding doctors’ attitudes to health IT – its perceived benefits and the changes that doctors have witnessed over a recent 12 month period ( up to November 2012). However, the commentary posted on eHealthspace.org took Accenture’s questionable conclusions to new heights, and applied a level of spin reminiscent of the days of the NEHTA-sponsored blogger Charles Wright.

I could forgive the writer’s slip of transforming “medical errors” to “medication errors” as an innocent, uncharacteristic journalistic error in its own right. But I cannot condone the way the article was crafted to misrepresent the findings of the doctors’ survey.

Moreover, quotes from Health Minister Tanya Plibersek and AMA President Steve Hambleton were creatively woven into the eHealthspace article to lend further weight to the article’s theme of qualified support for the “snowballing adoption” of the PCEHR.

Back to the findings of the Accenture survey which concluded that “over the last two years, [Australian] doctors’ use of healthcare IT and HIE has largely remained constant”, but that there was a belief by over 2/3rds of the respondents in both the 2011 and the 2012 surveys, that Health Information Exchange leads to reduced medical errors and better decision-making. The doctors were responding about HIE – not, as eHealthspace might have you believe, shared electronic health records – let alone the PCEHR.

Comparing the e-health world to the world of economics and finance, Health Information Exchange in the former, is akin to liquidity or circulation of money in the latter. Electronic Health Records are like banks - repositories that can be drawn upon at some future date. And the PCEHR is a strange kind of bank – a central bank if you will – not designed for the day to day transactions of the clinical community. So depositing 16 million old documents in a central bank where they will accrue little interest is not something to crow about. Far better would it be to strengthen the economy by facilitating the circulation and exchange of money ( clinical information ) for useful purposes.

Health Information Exchange does not require the dumping of documents into a central repository. It requires improvements in the quality, quantity, efficiency, modality and reach of information exchange amongst a broad range of participants for a diverse array of purposes. A small fragment of these may be facilitated by, or involve shared electronic health records, or even central document repositories such as the PCEHR.

Using the PCEHR as the prime vehicle for “mobilising healthcare information electronically across organisations” is engineering, economic and privacy policy folly. Misrepresenting doctors survey results in order to promote the PCEHR for this role (if that is the intention) is as disturbing as it is shameful.