GPs to recruit allied health to PCEHR for diabetes care

General practices in western Sydney are being encouraged to each recruit two allied health professionals who are involved in the care of patients with diabetes to register to use the PCEHR.

NEHTA's measurement and validation manager Heather McDonald told an Australian Information Industry Association (AIIA) forum in Sydney last week that as part of a 'meaningful use' project centred in western Sydney, 150 people with diabetes were being targeted in an attempt to get health professionals other than GPs involved in the system.

“That is who the [Department of Health and Ageing] and ourselves have been targeting: GPs with their ePIP payments,” Ms McDonald said. “Now we are encouraging each GP practice to register two allied health professionals that will support the diabetic patients – podiatrists, pharmacists, physiotherapists, dieticians.”

Ms McDonald defended what some have called the slow uptake of the PCEHR, comparing it to the example of internet banking. Since the system went live last year, 750,000 people have registered but it is only now that healthcare providers are beginning to upload information in earnest.

She said approximately 5000 shared health summaries had been created and uploaded. As Pulse+IT reported recently, public hospitals are now beginning to upload discharge summaries, including from nine in South Australia, and last week the aged care sector uploaded its first event summary.

Ms McDonald compared the figure of 750,000 registering for the PCEHR in one year with the 37,000 who started using internet banking when the Commonwealth Bank launched a service in 1998.

“In 2000 they launched a browser version with 320,000 users and it took them four years to get over one million customers,” she said. “So it took a while to start using it and to find stuff in there that you can look at.

“Even though we think it has been a slow uptake of the PCEHR, these things take time and I think the more we start using it the uptake will be higher.”

Ms McDonald said there were now 29 software vendors that can interact with the PCEHR, including 14 servicing primary care and five for aged care. She said there were seven vendors from the hospital sector that can interact with the PCEHR.

“We are starting to look at what the uptake is but also what the downloading is – how many people are starting to view the records, because until people are starting to view them, we can't even think about meaningful use,” she said.

The biggest issue for not just the PCEHR but for the design of all health IT systems is usability for clinicians and for patients, she said.

“If you have five doctors you'll get seven opinions, so it is quite challenging to work out when to engage and how to engage, but the biggest issue is usability.

“They have to be able to use these systems efficiently and effectively and it can't add extra time to what they are already doing. That has to be in the designer's mind. You don't want to have press four buttons before you send something out.

“Clearly there is an issue with usability, and then when you have introduced it, does it connect with any other system? It has to be useable, it has to be connectable to whatever else they've got already going.

“For GPs it has to connect to their admin systems as well as clinical systems, for hospitals there are a dozen clinical systems and for aged care they have their admin systems, so you can't design stuff in isolation.”

Ms McDonald said the challenge for the PCEHR was now change and adoption, and overcoming usability and workflow issues.

“Some of the technology is there now and it needs to be adopted and needs to be used, so from our point of view the people who need to be in the room are the clinicians and the consumers who will be using it.”

Ms McDonald was joined on the panel by renowned public health expert Stephen Leeder, along with Sue Hanson, the national director of clinical services at acute, palliative and aged care provider Little Company of Mary Health Care, and Ross Low of aged and community care provider Baptist Community Services.

The panel was sponsored by aged care software vendor iCareHealth and was brought together by the AIIA to discuss how IT can help link up primary health, acute health and aged care.

Professor Leeder summed up this challenge with a quote from the Dalai Lama, who recently addressed clinicians at Westmead Hospital in Sydney.

Asked by a doctor in the audience if he thought he had the same moral and therapeutic duty to a patient who has taken care of their health with one who has abused their body by smoking, drinking, eating too much and exercising too little, the Dalai Lama smiled and said, “I don't know, you'll have to work that out for yourself.”

Professor Leeder said that in western Sydney, where he is chair of the Western Sydney Local Health District board and director of its research network, ICT is “the biggest infrastructure challenge in the health service today”.

“We are a long way behind, I'd say two decades behind, best practice as I've seen it in places like [US organisations] Kaiser Permanente, Veterans Affairs, Mayo, InterMountain ...” he said.

“We've got a bit of this here and a bit there, but it was declared some sort of miracle about three weeks ago that we now have a relatively uniform email system.”

He laid the blame for the problem with poor quality management, both in the public and private sectors.

“How many billions of dollars has NSW Health invested?” he said. “Over the years that I've been working in it, my goodness the amount of money that has gone into bright ideas that have ended up going nowhere. It's just stupendous. That is not the problem of the ICT, it's the problem of management.”

Asked what role he thought clinicians should play in health IT, he said it would be very useful if clinicians were able to better engage in discussions with IT developers about the design of the systems they will be asked to use.

“When talking about clinicians I'm not just talking about doctors but a very generic term for healthcare providers,” he said. “If you can get them into the conversation you will be moving well, alongside the patients and members of the community.

“You talk to the clinicians to help you decide what system to develop and then once it is developed, you help them through the dialogue. And – this is helpful from the PCEHR perspective – then you iterate.

“No one claims there are perfect first systems. Change management is not about sending glossy brochures – it is about holding the other person's hand and having a conversation.”

Posted in Allied Health

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