The NSW HealtheLink Evaluation – The Devil is in The Detail.

This is an interesting report but as usual what is said is less important than what is omitted.

The report – such as it is – is found here:

An Evaluation of the Healthelink Electronic Health Record Pilot (Summary Report) (272K)

A comment made on the announcement in many ways said it all – to paraphrase “one or two clinician evaluations is worth more than a host of accountants”!

The random points I found interesting were (given the trial period reported is from March 2006 to September 2008):

First any thought of reporting costs of the pilot was blocked by the terms of reference.

Second there was no attempt reported to make any assessment of clinical impact.

Third, despite the time allowed for adoption, only 165 of 800 clinicians had actually used the system at all in the last 90 days.

Fourth, despite 2.5 years of trialling, and compulsory enrolment, a useful critical mass of patients and information is yet to be gathered.

Fifth, it seem pretty clear that while there are claims of technology success the time allocated has not permitted development of any really useful seamless integration of Healthelink and GP client systems. Clinician access and workflow problems remain major issues.

Sixth is appears the project team have, for whatever reason, failed to get GP software providers to co-operate and successfully integrate Healthelink into their client systems.

Seventh the benefits claimed are anecdotal and not evaluated in any hard way in terms of time saving, clinical improvements, patient satisfaction or anything else I can spot.

Eighth what has been done has been rather ‘National Standards Free’ and it is suggested this should be addressed sooner rather than later.

Ninth, despite the time available for improvement, the system is functionally poor and does not yet even provide a basic patient summary for each patient. (This really should be the core of any Shared EHR in my view as it is in Denmark, Scotland etc).

Tenth 35% of patients wanted an opt-in – not opt-out consent model – hardly a number to be ignored despite the clinicians being happy with opt-out. (Amazing that 66% of patients first found out they had been enrolled when the information pack turned up in the mail and then almost ½ did not read it fully!)

The scope of the pilot involved approximately 40,000 at the end of the trial with ½ being enrolled in the last 4-5 months.

Of the records created 95% of the Maitland records and 98% of the Western Sydney records were not accessed during the trial – hardly a heavy use!

Patients ignored internet access to their record in droves – only one in 492 looking at them in Maitland and one in 1078 in Western Sydney.

Overall it really seems to me this is one of those trials which should have been conducted as a learning experiment – given the length of time it ran – to get things really working. It seems that has not really happened and that the opportunity to really find out what might works has for now been lost.

Even the report we have should force a total re-think and a much improved approach before broader implementation is planned. The recommendations for improvement in Section 6.0 of the document need to be taken very much to heart.

The final point is, of course, if this pilot was actually a success, why are we not allowed to see the whole evaluation report - and if less than that why can't the most learnings be obtained through full disclosure?

Right now we can only say ‘Healthelink and NSW Health needs to try much harder’



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