PCEHR incentives for GPs likely but industry may miss out

New or revised incentives for general practitioners to use the PCEHR are likely under a three-pronged strategy developed by the Department of Health (DoH) to improve the system over the next three to four years.

The federal government announced earlier this month that it would continue to support the PCEHR to the tune of $485.1 million over four years, but would make some changes as recommended by the 2013 Royle review into the system.

DoH officials are holding a series of consultations this week with stakeholders to explain the strategy, which includes changing the name of the system to My Health Record. Pulse+IT was refused permission to attend one of these meetings but has received a copy of the department's presentation and spoken to some attendees.

The department outlined three areas of focus: continued and improved operation of eHealth records and foundations; new eHealth governance arrangements; and trials of participation arrangements, including opt-out.

A move to an opt-out system, while recommended by the Royle review and the preferred option of the government, is still not a certainty. An opt-out model will require changes to the PCEHR Act, with the department set to release a discussion paper on proposed legislative amendments at the end of this month. It will also trial other options besides an opt-out model, the presentation shows.

The department is also set to begin a project setting out how to improve the usability, utility and accessibility of the PCEHR and a roadmap to achieve it. This will include mapping the long-term vision for the PCEHR user experience over the next three to four years, with a roadmap outlining a number of incremental stages to begin in late 2015.

The department's presentation mentions several times the potential for new or revised incentives to be paid to GPs for using the system, something that was recommended by the National Health and Hospitals Reform Commission Report in 2009.

However, while GP incentives seem to be on the agenda, incentives for the medical software industry do not appear to be. Emma Hossack, CEO of software vendor Extensia and president of the Medical Software Industry Association (MSIA), said there were some positives and some negatives from the meeting for the industry.

In terms of positives, the department acknowledged that this would “not be the first and last consultation between government and industry”, Ms Hossack said. “We are optimistic that the Minister will meet with us soon to discuss the critical role of industry involvement in this project.

“The department wants to ensure that they don't build another system which no one has a desire to use, which is obviously sensible, although some would say a little late. The briefing made it clear that this wasn't going to be a repetition of the type of attitude industry previously experienced, where we were told what is going to be happening without much, if any, real consultation.

“Fundamentally, the PCEHR needs information from clinical systems to make it useful. This requires agreement from the clinicians and individuals as well as the co-operation and work of industry.

“Actually seeking industry input in transparent fashion would be a great step forward from the less than open methods previously used, such as with the panels. [DoH special advisor on eHealth] Paul Madden responded clearly to a question about this that the process would be open and transparent this time. That’s another positive.”

However, Ms Hossack said that while she got the distinct impression that financial incentives were on the table for GPs, it looked like there would be no incentives for the industry.

“The general practitioners are being incentivised under this new PCEHR regime, or new My Health Record regime, because their engagement is essential,” she said. “The general practitioners don't need My Health Record at this stage as much as My Health Record needs the general practitioners.

“That's a sensible rationale – if you want someone’s help, there ought to be a good reason for them to give it. If it’s not to offer a really useful rich source of information, which it is not at present, then encourage clinicians to spend some time creating that through incentives.

“That's what seems to be the plan with the general practitioners, and there was clear discussion about that. There's also going to be general practitioner training, online tutorials – everything that they can do to make this system as easy for general practices as possible.

“However, in relation to what's in it for industry, there was no detail or any specifics in any dollar sense at all.”

There was also no detail on any structural changes to the PCEHR itself beyond increasing usability, and improving the infrastructure of the health identifier (HI) service and National Authentication Service for Health (NASH). Ms Hossack said there was, however, recognition from Mr Madden that the government needed to look more at decentralisation and using more of what he called conformant or distributed repositories.

“Possibly many of the gaps in the PCEHR, which cannot be fixed in the foreseeable future, may be able to be bridged or filled by industry solutions. I think that's a positive.”

One of the biggest positives in Ms Hossack’s opinion was the recognition that governance underpinning this system was crucial and a significant portion of the budget dollars would be spent on getting this right.

She said the department also mentioned that there would be an 'Independent Assurer' who will have an overseeing role over the new Australian Commission for eHealth (ACeH) and would report directly to the Minister for Health. This person would also be in place for the planned opt-out trials.

The department confirmed that the ACeH board would have a different structure from that of NEHTA's, including industry representatives as well as clinicians, public and private hospitals, government and bureaucrats. “That's quite a different composition from the current composition of the NEHTA board and refreshing to see that the need for a fresh representative approach has been recognised,” Ms Hossack said.

However, while she said there some positives, if asked if the new regime would be great for the industry, “you'd have to say no”, she said.

“Money for changes to the existing system to make it more usable will presumably continue to flow the way of that one large international vendor, which doesn’t help most of the Australian medical software industry. There does seem to be this view that software companies make a fortune and don't need to be recompensed for their time, effort and skill.

“I think the department is ready for education on the reality of our industry and it’s the role and intention of the Medical Software Industry Association to work with the departments of Health and Human Services to provide that.”

Ms Hossack said a popular move at the meeting was a commitment by the department that there would be no more buses plastered with NEHTA logos trundling around the country, a reference to the much derided eHealth bus that was part of the early marketing plan for the system.

“No more drink bottles, no more supermarket recruitment, and no more sausage sizzles,” she said. “That's good.”

The department also outlined some of the most recent data on uptake:

  • There were 2,223,960 consumer registrations as of May 18, which is increasing at a rate of around 2000 per business day
  • 57 per cent of consumers registering are female and 43 per cent are male
  • 171,117 newborns have been registered, which is increasing at 200 each month
  • 7735 healthcare organisations are registered to access the PCEHR and this is increasing at a rate of 20-30 per month
  • This figure includes 5139 general practices, 179 hospitals, 144 aged care residential services, 1158 retail pharmacies and 1115 from other provider types, predominantly allied health
  • 10,796 individual clinicians have been linked to the PCEHR provider portal by their registered organisation
  • 42 software products have access to the PCEHR production system.

Posted in Australian eHealth

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