Basic technology a PCEHR barrier for allied health

Low levels of computerisation – and a lack of incentive to invest in basic infrastructure – along with no clear role for allied health professionals in the national eHealth system have been highlighted as barriers to greater uptake in a number of submissions to the panel reviewing the PCEHR.

Western Sydney Medicare Local (WSML) argues that there seems to have been a basic assumption that all allied health, general practice and specialist practices are computerised. In its area, 30 per cent of private practices are still paper-based, and in many cases this in not likely to change.

WSML says allied health professionals are only just now moving into automation, and if they are interested in participating in the PCEHR, at present they are restricted to using the provider portal.

“Unlike state health departments which were given significant funding to bring their systems in line with the PCEHR standards, the [allied health professional] market is fragmented and it seems there are no attempts to guide this industry with incentives,” the submission states.

There are two or three cloud-based clinical systems for allied health that could have been incentivised to become compliant with the PCEHR, and “It is not too late for this", it says.

“There are twice as many AHPs in Western Sydney than GPs and they are a critical part of a connected system.

“There needs to be wider use across healthcare to ensure success; to date the focus has largely been on uptake though general practice; to ensure greatest benefit, the participation of other practitioners such as pharmacy, aged care facilities, private hospitals and specialists is critical.”

Likewise, the Australian Physiotherapy Association (APA) points out in its submission that there are basic technical barriers to participation. While the APA says it was happy with the level of consultation with the profession on the development of the system, basic lack of infrastructure still remains the main problem.

The APA says some of the barriers include:

  • a lack of a history of support in the computerisation of physiotherapy practices
  • lack of widespread use of electronic clinical record keeping
  • lack of communication about the PCEHR to the profession
  • little recognition of the role of physiotherapists in team care
  • physiotherapists’ inability to input information into a patient’s PCEHR
  • recognition of software compatibility issues for software used by physiotherapists in clinical practice.

“While providing input into the development of the framework around the PCEHR, the APA warned that physiotherapists have not been part of programs to facilitate the use of computers or technology within the clinic,” the submission states.

“Unlike GPs, physiotherapists have not received government support through programs such as Practice Incentive Program (PIP) and e-PIP to assist in the computerisation of practices.

“Despite this, most physiotherapy practices use office management software – however only around 30 per cent of these practices use computers for clinical record keeping. This has not been addressed over the years of development of the electronic health record and thus limits the number of physiotherapists that can be engaged in the PCEHR, impeding the overall quality, effectiveness and success of the system.”

Like some other allied health professions, the APA says one of the other main barriers to more use by physiotherapists is the inability to enter data into PCEHR event summaries. It believes that recognition of physiotherapists as primary healthcare providers and key parts of healthcare teams must be built into the system.

“The physiotherapy profession is currently unable to use the PCEHR through the commonly available practice management or electronic record-keeping software. This is the biggest barrier to physiotherapists’ use of the system, and it is vital that program vendors are facilitated to develop their software to support user-friendly access to the PCEHR.

“Despite the issues with the development of the PCEHR, the APA continues to support their importance, and sees it as a critical enabler of quality health care.”

Rural and remote allied health

Services for Australian Rural and Remote Allied Health (SARRAH), which represents a number of allied health professions working in rural areas including Aboriginal health workers, medical imaging, optometry, oral health, pharmacy, podiatry, psychology, audiology, dietetics and occupational and speech pathology, says in its submission that it too was happy with the amount of consultation it was involved in.

SARRAH says it strongly supports the PCEHR and would like to continue to play a role in the next phases of development, but points out that the use of the system by allied health in rural and regional areas is slow, and is limited largely by the costs of implementing the appropriate computerisation and software.

“However SARRAH is aware of several early adopters in introducing the PCEHR as part of their everyday practice,” the submission states.

“SARRAH has consistently represented its members views that in some rural and remote communities the primary care coordinator role is not necessarily conducted by a general practitioner.

“This is especially the case in some remote communities in the Northern Territory and Western Australia where an allied health professional, along with Aboriginal health workers, are the most consistent health service providers in the community.

“In these instances allied health professional may have a much greater role with the PCEHR.”

SARRAH says it believes that rural and remote health service consumers will benefit greatly from the introduction of the PCEHR, especially in fly-in fly-out health service areas where full-time permanent medical practitioners are not readily available.

Like the Australian Medical Association and the Consumers Health Forum, SARRAH advocates a change to the current opt-in approach.

“SARRAH urges the review to make the decision to make the project moved to an opt-out approach so that the full benefit can be realised after the public considerable expenditure. SARRAH is aware that various state health ministers also share this view.”

Australian Federation of AIDS Organisations

The Australian Federation of AIDS Organisations (AFAO) also agrees that consideration should be given to the opt-out approach, for consumers and for healthcare providers. In its submission, it argues that patchy uptake by clinicians diminishes the usefulness of the system.

“For people with HIV, and other high-frequency users of the health system, a lack of engagement by some healthcare providers will be acutely felt, and will likely lead to disinterest/cynicism about whether the electronic health record is worth bothering with,” it states.

The AFAO points out that people living with HIV are some of the most vulnerable to privacy concerns, but mentions an under-publicised project by Sydney's St Vincent's Hospital and Mater Health, in association with the Eastern Sydney and Murrumbidgee Medicare Locals, which targeted particular patient groups through some of its clinics, including cardiac, diabetes and the HIV/Immunology/Infectious Disease Unit.

“Of all the patient groups the hospital approached to offer sign-up for the PCEHR, people with HIV were the most receptive, with almost 100% of the HIV-positive people targeted signing up,” the submission states.

“The trial was significant as it was the first time a hospital in Australia accessed the national eHealth record system for its patients, as well as the first time a hospital submitted an electronic discharge summary to the national system.

“Despite legitimate concerns about privacy and confidentiality of sensitive information, this high uptake of the eHealth record among people with HIV suggests that for many HIV-positive people an eHealth record is an attractive proposition. Key to building and sustaining community confidence in the eHealth record is that the record meets expectations and that privacy is respected.

“Given the significant privacy/confidentiality concerns of people with HIV and people among affected communities (e.g., for gay men regarding sexuality and sexual behaviours; for people with psychiatric disabilities; and for injecting drug users regarding criminal sanctions for illicit drug use), it may be useful to evaluate the eHealth experience of people with HIV, including benefits they perceive and problems they may have encountered.”

The AFAO believes that greater use of the system by consumers would be boosted when pathology results are available, and if there is a better publicity campaign.

“Generally, there is a need for a publicity campaign re the PCEHR and for development of information materials regarding particular issues such as privacy/confidentiality and record controls, targeting specific consumer groups such as people with HIV, people with multiple chronic medical conditions and people with psychiatric/cognitive disability. It is groups such as these that have the most to gain from the PCEHR.”

National Rural Health Alliance

The National Rural Health Alliance says in its submission that people living in rural and remote communities are also worthy of special attention by the review, as they are also among those most likely to benefit.

However, infrastructure problems like poor internet connectivity is an ongoing issue for private practitioners in many rural and remote areas and for conducting clinics in smaller towns and centres.

It says that successful adoption of the PCEHR in rural and remote areas will rely on the health professionals available locally, such as remote area nurses, Aboriginal health workers and others who are not necessarily associated with GP clinics.

“Many of these other health professionals will face particular time issues with making changes, given health workforce shortages, higher mobility of staff in many areas and substantial travel times required to provide services across a wider area.”

The alliance proposes some interesting considerations for the review panel on improving uptake, including providing incentives related to major national aged care and disability programs such as the launch sites for the National Disability Insurance Scheme (NDIS).

It says these could “provide a potential opportunity for building in information about and encouraging the use of the PCEHR as the new system unfolds and the links are made between health and disability care.

“This is particularly important in rural and remote areas where services are short and many of the service providers are working across health, aged and disability care.”

For aged care, the PCEHR could be linked with the new Aged Care Gateway, the alliance suggests, given the links between aged care assessments and health needs for older people.

Posted in Allied Health

Comments   

# Marcus McDonald 2013-12-09 10:09
The problems facing AHP are shared by CAM practitioners too. In this group though, we have the added problem of no direct consultation. Even at a basic level, SNOMED was extremely under resourced to accommodate the scope of practice of CAM.
The same set of basic barriers as those listed above also exist. There has been little to inform the profession and it's software vendors of the needs the e-records would need to accommodate. The ethics and standards are in their infancy and with little in or out side of the professions to guide, I think we can already see concerning trends.

There HAS to be wider consultation and drastically better support and information to ALL health care professions. I understand pharmaceutical vigilance to be a major driving force, but if it is community engagement that is the key then its use has to be broad and pervasive.

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