The Commonwealth government has announced a review of the Personally Controlled Electronic Health Records (PCEHR) program, perhaps not surprising as the program represents Australia’s first comprehensive attempt to establish a national eHealth records system.
The experience of similar programs across the world has shown just how difficult it is to bring accessibility and usability of information to the health sector, something we take for granted in many other walks of life. Australia’s PCEHR experience has been no different.
eHealth approaches such as the PCEHR are an enabling technology; that is, they are not meant to solve health problems but rather to assist those providing services to do a better, more efficient and indeed safer job.
In Australia health services are plural in nature. There are multiple funders and providers of services. Information about the people these services manage and care for resides in multiple systems. In some cases these systems have not yet entered the digital age or are incompatible with their contemporary cousins. Introducing a PCEHR to such a fragmented health system landscape is complex and relatively expensive.
Whatever the difficulties, patients and their carers rightly expect their care to be coordinated. They expect professionals and administrators to communicate and organise together, as a team. They don’t want to be shifted or referred to different parts of the system only to have to tell the same story multiple times, or worse still, present for help in an emergency situation where those caring for them do not have access to vital information.
Patients and carers also rightly expect information about them to be available to them when they need it. Information about them should be theirs, not locked away in a propriety database, where any access would require access payments, fees or ongoing membership. If access is available they also don’t want this to be at the end of limited, messy and time-consuming regulatory requirements.
Electronic health records are created as a result of a service being funded and then provided. The consumer would reasonably expect that their payments, or governments’ payments on their behalf, are reasonably sufficient to include access to the necessary infrastructure for that care to take place in a highly competent and coordinated way.
This includes eHealth infrastructure regardless of whether the point of care is in the public or private systems. A review of the PCEHR has come at a critical stage. Appropriately sharing health information sharing is everyone’s business as it affects us quite personally and goes on to impact on all parts of our health and human services systems.
This review must consider how we approach electronic records in a wider community and primary health care context, not just a centralised hospital based context. This seems obvious because it reflects the need for the health system to keep people well and out of hospital, and the people’s desire to receive services close to where they live, in their community, and where possible at home. Investing in health information systems in hospitals make sense as this is necessary infrastructure. eHealth investments in primary care and community health settings are at least equally important.
It may be challenging to invest effectively in eHealth at the primary health care level. There cannot be a single solution because of the diversity of public, not for profit and private providers at this level and the complex interfaces required with secondary levels of care. We also know that the costs of change and adoption of new ways of doing things has to be borne by someone. Ignoring incentives will simply mean that things are unlikely to improve.
eHealth will be best applied in circumstances when it can support an integrated approach to health care. This approach demands that health care is organised around patients and carers in often diverse regional environments. Many Medicare Locals have done a good job at joining up the PCEHR to existing structures and in a way that is already increasing access to information and improving quality of care. Bringing eHealth initiatives into coordinated regional approaches to integrated care are likely to be most effective in the end.
It is also critical that those who can least afford it should not miss out on the benefits of an eHealth system that supports their care. The ability to pay for care should not be an entry point to better quality and choice of health care. Private sector approaches should be inclusive and not propriety; that is, they should not use patient information as a barrier to entry or competitive advantage. Such approaches will potentially undermine the independence of clinical decision making and increase health care costs.
The PCEHR review should not seek to decrease investment. The question is how the PCEHR can support better integration of health care with a focus on the needs of primary care and general practice. Achieving better health outcomes against a constant backdrop of increasing need is dependent on that.
Walter Kmet is CEO of WentWest, which is both a Regional GP Training Provider and Western Sydney Medicare Local. He has led eHealth projects in the private and public sector including within the PCEHR program.
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