Frustration grows for aged care, the forgotten child of eHealth

The aged care sector is frustrated at its position as the “forgotten child” of the national PCEHR roll-out and has called on the government to provide clarity over the central client record due to launch next year as part of the Aged Care Gateway.

CEO of Leading Age Services Australia (LASA) Patrick Reid has echoed concerns raised by other aged care sector experts over the development of the central client record, the design of which appears to have deviated from the original plan to either be linked to or be part of the PCEHR.

While the Department of Social Services (DSS) says there are plans to link the record – which will be assigned to every person accessing aged care services from July 1 next year – to the PCEHR some time in future, many in the sector are still convinced that the PCEHR itself should be the single record, having been designed to allow non-clinical information to be added.

The idea of two separate records rather than one that follows the individual through life and different care settings fills many in the sector with dread, and according to Mr Reid, has the strong potential to fail.

Mr Reid also expressed the sector's frustration at the support provided to other parts of the health system, such as the funding announced this week for private hospitals and the grants provided to GPs and pharmacists for equipment, at what could be seen as the expense of aged care, where the PCEHR might have the most value.

“Nobody is going to come to aged care as a neophyte in our health system,” he said. “For me it’s a no-brainer when you are looking at a million-plus Australians receiving care in the aged care system.

“We’re also one of the frequent flyers in terms of hospital admissions and transition care, so within that I guess we are a little bit frustrated to see these other groups getting money or getting support or getting change management assistance. Meanwhile we limp along, doing what we do.”

Mr Reid pointed out that of the four key priority areas for the PCEHR – mothers and babies, indigenous people, those with chronic illnesses and older people – aged care covered two: chronic disease and older Australians.

“And yet, we seem to be the forgotten children in terms of the preparation for PCEHR,” he said. “In terms of getting ready for PCEHR and the change management required to move aged care into this sphere, and this across not just residential but community and retirement, it’s a forgotten child.”

Mr Reid, who is a qualified pharmacist with several IT credentials and who worked with the Pharmacy Guild in a number of roles, including four years as national manager for business development, IT and eHealth, said there were real dangers in developing two records that did not work together.

“Historically, with any IT program, and it doesn't just apply to health, if you have two records that have to remain in sync, it’s pretty hard to do and normally ends in failure. So the holy grail, the endpoint, should be one record.

“Nobody is coming into aged care without having been in the health system previously. Many of these people will have had some contact and intersection with the PCEHR before they reach aged care, so it makes sense that you would either build out that existing record if it is not sufficient or you would use that record to move forward.

“The problem I have in looking at the architecture of phase one and phase two of the Gateway, is that the architecture has been set without the PCEHR in mind, because it was sort of developed during that hiatus with the PCEHR, that post-election period. So to say that there could be two that are linked, I think that’s fraught with concern and problems.

“One record is preferable, and in fact if we don't have one we'll just end up chasing our tails in the future.”

At a time when every bean is being counted, the large amount of funding required to implement the PCEHR and the central client record across residential and community aged care could be a stumbling block, but Mr Reid argues that this consideration is a false economy.

“The longer it takes to integrate aged care the more it will cost them in terms of hospital admissions, in terms of transitions,” he said. “For many people, the last few years of their life are when they are intensive users of acute and sub-acute care, so any reluctance to fund this process is really just delaying the inevitable, but also too it's a false economy.

“The sooner they get this thing in the sooner they are going to find areas of duplication, areas of streamlining but also too minimising errors, minimising adverse outcomes. In terms of that argument I think it's a false economy and they'll realise they should have done it sooner.”

Many in the sector argue that the roll-out of the PCEHR should have started with aged care rather than general practice, but Mr Reid believes it should actually have involved pharmacy first to ensure medications management was the priority.

“Medication management should have been done first and pharmacy was best placed to pick up and run with the IT,” he said. “The second port of call should have been aged care.

“In terms of the outcomes, there was a lot of low-hanging fruit. We were told there was low-hanging fruit in both medication management and aged care; in fact to roll up medication management into aged care is an absolutely a no-brainer.

“They should have done that, but they still persisted with this holy grail approach of we are going to do everything at once and the GPs are going to be the gatekeeper. This fixation with GPs as the gatekeeper … it's rare that you get someone holding the key saying that they don't want to own the door.”

With consumer-directed care (CDC) now set to begin in earnest and demand for community and residential aged care set to increase, Mr Reid said it was imperative that the electronic systems envisioned to handle this demand were in place.

“Figures show that most people live disability-free until about 62 years. We have 1000 people turning 65 per week in Australia, they are all over that median when complex intervention is required, so this means they need a record and they need it now. It's as simple as that.”

Posted in Aged Care

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