Pulse+IT Blog

The trouble with shared care planning

Welcome back to a new year of the weekend edition of Pulse+IT, in which we cast our glance over the events of the week and pontificate for your reading pleasure on what we think it all means for the eHealth and health IT sector. It looks set to be a make or break year for the My Health Record as it goes opt-out at some yet-to-be-decided date towards the end of the year and 20 million people are suddenly presented with a storage receptacle for their health information.

It might be a make or break year for the Health Care Homes project as well, already off to a rocky start with delays and bickering over bundled payments. There was also a bit of a kerfuffle at the end of last year over what shared care planning software the participating practices could choose from and the accuracy of the product information about them.

Team care arrangement have been promoted as the way forward for the primary care sector but actually getting GPs and other members of the care team such as specialists and allied health to use these tools has always been a tough gig. Precedence Healthcare was one of the pioneers of shared care plans in primary care through its cdmNet product, although there are a number of others out there, but even Precedence has found the going tough and shifted its focus once it was acquired by Sonic Clinical Services. It's a struggle for all of these companies, fighting it out for a small market share.

So it was not a big surprise when we discovered last week that Ocean Health Systems, which in addition to its other solutions co-designed a shared care planning tool with Western Sydney PHN called LinkedEHR, had entered voluntary administration. In what proved to be our most-read story for the week, we spoke to administrator Peter Krejci about the future of the company, about which he was positive. It looks likely that a company restructure will be undertaken to put it on a sounder financial footing and in the meantime, it will continue trading as usual.

It brings up the question of not just how hard it is to get practitioners to use shared care plans but who should pay for them. Precedence always boosted the practice efficiency benefits of cdmNet, a sales pitch common to other offerings aimed at GPs such as online booking services, apps and data extraction tools. However, general practices are notorious for not wanting to spend what meagre profit they make on what can be rarely used technology, unlike their practice management software. Besides which, half of the specialists and allied health practitioners they refer to aren't even computerised so coordinating shared care plans can be an administrative nightmare.

It's not that the technology is not readily available. As Adam Powick argues in his opinion piece this week on what he as a consumer, rather than a technologist, would like to see from the health system, his list of things the healthcare industry should offer are both technologically possible and what we would demand from other industries without a thought. Consumers expect their healthcare teams to share information between them and it often comes as a surprise to them to learn that they don't.

Again, this isn't due to a lack of available technology but cost barriers and more importantly, workflow. And like everything else in healthcare, anything that disrupts existing workflow is likely to fail.

That brings us to our poll question for this week: Do you think shared care planning tools will ever achieve widespread adoption? To vote in our poll, sign up for our weekend edition or leave your comments below.

At the end of last year we asked this question: Do you think the opt-out My Health Record will be a success? While success is a relative measure, 61 per cent of readers say opt-out is a goer, with 39 per cent still in the negative.

Opinion: Reflections of a health consumer with greater expectations

I am 52 years old and a little on the portly side due to an aversion to strenuous exercise and a (in)famous inability to walk past a nice dumpling, pizza, burrito, stir fry or glass of red wine. I have gout, which I am told is genetic, but then again I haven’t met too many skinny, teetotal gout sufferers over my time.

I am starting to feel the first signs of arthritis in my wrist, knees and ankles and I have collected the odd more exotic disease along the way, in my case Gilbert’s Syndrome. I am not sure who the original Gilbert was but it is quite nice to know we at least have something in common.

Season's bleatings

It wasn't a good look for online news outlet The Conversation this week when it was forced to retract an article by Deakin University academics Danuta Mendelson and Gabrielle Wolf about the My Health Record. The article was taken down in a flash once several egregious errors were pointed out but is still available online if you search hard enough.

It wasn't a good look for the authors either. It seems they misread the recent legislative rule enabling the opt-out model for the My Health Record to be applied next year and thought it started a fortnight ago. They also seemed to think health practitioners can search for patients' records just with their Medicare number. We suggest that the Australian Digital Health Agency and the Department of Health put their heads together to see how these misunderstandings can be avoided in future.

L for licence to operate

Health Minister Greg Hunt had the conspiracy theorists in a bit of a tizz last week when he lodged a little piece of paper authorising that the opt-out model for the My Health Record begin some time next year. Everyone thought he'd already done this but it turns out it is a three-step process, with the actual date for the three-month opt-out period yet to be announced but most likely to begin in mid-2018.

That didn't stop the tinfoil hatters, though, who insisted that the three months actually began on the date he lodged the rule, namely last Thursday, and that the government was tricking us all into getting a MyHR without our knowledge. The horrors that lie within the MyHR are such that only by conning us will the government get anyone on board, they reckon.

Listen to the heartbeat

Primary care was back in the news this week, highlighted by yesterday's announcement that Fred IT had won the tender to build Victoria's new real-time prescription monitoring system, with ReferralNet and Argus scoring a few runs on secure messaging, a new survey out looking at the digital general practice, and a whole gang of diagnostic imaging software vendors signing up for the My Health Record.

The survey, carried out by online booking, recall and reminder service HotDoc, had a number of very interesting nuggets – not the least of which is that yes, sometimes your patients will pay to not have to come in to see you – but also the finding that most people use online booking systems not for their own convenience but so they can book their personal doctor more conveniently. A good proportion are also willing to follow their doctor when they change practices, which just reiterates what everyone has been banging on about for years now about how the relationship between doctor and patient is a special one.

What's going on with Health Care Homes?

The flurry of activity in the primary healthcare sector continued to dominate the news this week, with the big guns in the private pathology sector all now signing on to connect to the My Health Record, patient education getting a run and patient portals also in the news.

But while our most popular story for the week was the news that Primary and ACL are joining Sonic in working towards uploading private pathology reports to the national system, there was also news about other big public initiatives kicking off, including the cervical cancer screening program renewal and the second tranche of practices going live as Health Care Homes.

ADHA's positive self-report card

The Australian Digital Health Agency released its first annual report this week and gave itself a nice pat on the back for a few milestones reached. The agency, which likes to style itself as the Agency with a capital A and which we like to imagine is modelled after a certain bureau (of investigation) with a capital B, laid out its strategic priorities and how it reckons it measured up.

Turns out it reckons it did OK, fulfilling a number of strategic priorities such as setting up the secure messaging trials, writing the national digital health strategy, and increasing the number of people and organisations registered for the My Health Record. While the agency has been set up to handle a few different things, progress with the MyHR is of course the biggie, so we were keen to see what it had to report.

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