Pathology, radiology and the PCEHR

This article first appeared in the February 2013 edition of Pulse+IT Magazine.

The integration of pathology and radiology results and reports into the PCEHR has long been heralded as one of the most important drivers for wider clinician acceptance of the system, but while much work has been done on designing a safe way of delivering those results, negotiations as to when this will be achieved are at a standstill, and there is no word yet on when it will begin.

While the PCEHR system has been designed to provide patients with control over their healthcare information, advocates behind the project have long touted the wider benefits of better information sharing between clinicians, and nowhere is this seen as more important than in pathology.

The ability of general practitioners and acute care clinicians to have access to a full history of a patient's healthcare, including their most recent test results and a cumulative view of these results over time, should surely provide a better and safer basis for clinical decision-making.

The importance of delivering diagnostic test results to the PCEHR is in some minds the make or break of the system. A record of a patient's sniffles is not going to be of much value and clinicians will quite rightly ignore it. Easy access to diagnostic test results, on the other hand, would be of great value.

This is why the public and private pathology and radiology sectors were important parts of the different reference groups set up by NEHTA when it began the planning and design of the system.

The plan was to have results from private pathology delivered to the PCEHR system by June this year, with some smaller private providers and the public sector to follow a year later. Diagnostic imaging was to come at a later date due to the complexity of delivering images to the PCEHR, even if this was desirable or not.

There were a number of issues to work through, but NEHTA and the pathology sector have devised a way that up-to-date and cumulative reports can be delivered to the PCEHR. What is holding it back from happening is a standstill over funding.

Katherine McGrath, CEO of the Australian Association of Pathology Practices (AAPP), the national peak body for private pathology in Australia, said the private pathology sector has participated in the reference group very willingly, and was keen to become part of the PCEHR system. She also said she believes that requesting doctors are keen to see pathology results integrated into the system.

However, there are some special needs in the pathology, she said. “The pathology sector, particularly the private pathology sector, is very computerised. One of the absolutely critical factors in any system that delivers pathology results into a computer process, is that if there are any changes to the results, pathologists must be able to refresh those results automatically.

“In some tests, for example, you give an initial result and then a follow-up result further down the track, when you might realise for various reasons that that result is not the correct one. So it is redone and a new result is sent out. The current systems that are set up in private pathology are able to refresh doctors' systems with the up-to-date results.

“One of our concerns has been that in terms of building a system to deliver pathology results into the PCEHR, there is still that ownership of the results by the pathology provider so they can keep the report refreshed with up-to-date knowledge.”

Professor McGrath said it was critical that the ownership of the result and the responsibility for keeping it up to date lies with the pathology provider, and that the system needed to be designed to allow this. A solution has been worked out, she said, but there has been no progress in implementing it so far.

“That system is designed, it has been tested and it is capable of being delivered. But our problem is that of course there is a cost in delivering that. Our sensitivity in this space is that we are ready, willing and able, but the federal government has not shown really any interest in having pathology in the PCEHR, which is a surprise to us.

“Basically, we have knocked on their door and said this system is designed and with appropriate cost recovery, we are ready to do this, but their response to us has been really showing very little interest in getting that up and running.

“We see pathology as an important part of the PCEHR and it would be a reason for many doctors to start using it more if pathology was in there, so we can't quite understand their reluctance.

“We are ready and the ball is in their court, because we believe that we have done everything that we need to, working with NEHTA and the government, to get this up and running.”

To read the full story, click here for the February 2013 issue of Pulse+IT Magazine.

Posted in Australian eHealth


0 # Privacy Paul 2013-02-18 20:48
Simplest way is to set up a seaprate Health Information Exchange to handle Pathology and other clinical results, that allows flexibilty of ownership and access controls. The PCEHR is limited in scope in its current form and certainly needs work to sure up issues with privacy.
0 # Anon 2013-03-06 13:00
It sort of reads like a funding request more than an article. There appears to be no detail on how much money they are talking about when they say "this system is designed and with appropriate cost recovery." It certainly is the question that immediately comes to my mind.

I think everyone would agree that having path results in is a great idea. But I'm guessing (hoping) that the days of blank cheques to industry insiders are largely over.

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