Guest editorial: Will the PCEHR have meaningful use?
The Commonwealth government has an ambitious and laudable eHealth strategy, of which the Personally Controlled Electronic Health Record (PCEHR) is a major building block. At the recent Health-e-Nation Conference, the federal Minister for Health, Tanya Plibersek, described the commencement of the PCEHR and its subsequent expansion as the cornerstone of the government’s eHealth strategy.
The PCEHR will have two simple but key deliverables on 1 July this year. Firstly, the new system will be available, and secondly, consumers will be able to begin to register. The original plan for the PCEHR to be available to every consumer from 1 July has been amended subtly to a message that says 1 July is just a first step in a journey of 10 years or more.
In contrast, two Health-e-Nation speakers gave an insight into how eHealth is beginning to mean something in US healthcare right now. Jonathan Schaffer, managing director of the world-renowned Cleveland Clinic in Ohio, described how its electronic medical records (EMRs) and health records (EHRs) connected clinicians and patients across Ohio, the USA and the rest of the world.
The Cleveland Clinic is at the forefront in using eHealth to both reduce the costs of delivery and improve the quality of care. Its healthcare delivery model has eliminated geographical barriers, to connect the patient with the right doctor, at the right time, anywhere. In just one example of how its eHealth strategy delivers better patient outcomes, a patient is given an option online of seeking a second medical opinion. This has revealed that in 25 per cent of cases, the original diagnosis was either incorrect or requires modification changes.
David E. Garets, a long-standing leader in eHealth in the US and worldwide, told the conference of the introduction of the US government’s ‘Meaningful Use’ eHealth program, to drive both greater cost efficiency and quality of care. Through the adoption of EMRs and EHRs, and with more than $US3 billion paid out so far to complying healthcare providers, the ‘Meaningful Use’ program of $US27+ billion was beginning to change US healthcare.
The Meaningful Use program pays health service providers to create EHRs, use certain EHR functions, and to share the data with other providers and patients. In the requirements of stage two of the Meaningful Use initiative, one is the benchmark for a minimum of 50 per cent of each provider’s patients being able within four days to access their EHR online and transfer a copy of their patient histories.
By dangling the carrot of funding assistance for compliance, as well as the stick of financial penalties for those who lag behind, eHealth implementation by healthcare providers is being accelerated. In an effort to cut the ballooning cost of US healthcare, Meaningful Use is being closely linked to ‘Accountable Care’, where health service providers are paid for activity performance based upon quality outcomes.
Poor performance in diagnosis and treatment e.g. hospital errors and other adverse events in hospital, will increasingly receive no funding at all. The legislation provisions for accountable care organisations are linking healthcare funding and reimbursements to quality indicators for patient care outcomes. In conjunction with the Meaningful Use program, Accountable Care is driving cost efficiency at the same time as improving quality of services.
Compared with implementing new technology in a government department, a not-for-profit organisation or a commercial business, the challenge of implementing eHealth nationally across countless health service providers and 22 million consumers faces a debilitating handicap.
The national eHealth and PCEHR project lacks coherent and clearly identifiable governance and ownership by users. In this context users comprise state health departments, boards and executive management of health services (both public and private), clinicians, patients and consumers.
Despite appearances and a semblance of participation, there is much anecdotal evidence that the vast majority of users of all categories are not listening, are not committed in any real practical sense, and are totally focused on their own organisational challenges and priorities. Any government department or commercial organisation, whether a business for profit or a not-for-profit organisation, has a coherence in ownership, governance, responsibility, accountability and financial viability. The national eHealth and PCEHR project does not.
To make eHealth a fundamental part of doing business and delivering day to day health services on a national scale, something else is required. That is why in the US the federal government has sought to impose an eHealth strategy, through a framework of legislated requirements for Meaningful Use and the associated Accountable Care.
Our government’s eHealth strategy, with the PCEHR as its integral heart, is clearly going in the right direction. There are clear benefits to be gained, for Australia’s indigenous and remote communities, and greater quality and efficiency in healthcare for all of Australia’s population. The technology for eHealth is available — the challenge is in its implementation and adoption.
It can be argued that most of the delay, false starts and inertia that have handicapped Australia’s eHealth strategy for a number of years have their root cause in a lack of clear ownership and incentive. Some would say that many of the difficulties being faced by the current implementation of the PCEHR, would be addressed and resolved much more quickly within a more meaningful environment of ownership and governance, assisted by an appropriate regime of regulation, incentives and penalties.
Healthcare’s business processes, work practices and funding model must change, to incentivise and raise the pace of adoption. Australia can be at the forefront worldwide, both as a developed country, and in applying eHealth in disadvantaged, indigenous and remote communities. In the mainstream of urban populations it can bring increased personal responsibility, quality of care and greater efficiency.
But for that to happen perhaps we need a carrot and stick approach, similar at least in principle to the USA – funding incentives to generate take-up, and financial penalties for non-compliance. So much of eHealth can be accelerated now with a dynamic adoption approach, and the right mix of incentives, funding enticements and disincentives for non-adoption, to drive the momentum of eHealth and the PCEHR implementations much faster.
Director, JEMS Consulting
Bryn Evans has many years’ experience as a chief executive of a clinical software supplier, and chief information officer in public hospitals. He is also an author, and writes extensively across a range of categories and genres, notably in the areas of sport, travel, history, information technology and eHealth.
Posted in Australian eHealth