“Mechanics of PCEHR are driving us mad”: AMA
Medical groups and indemnity insurers are close to a final agreement with the Department of Health and Ageing (DoHA) for practitioner participation in the PCEHR, but the Australian Medical Association is still unhappy with the complexity of the system.
AMA president Steve Hambleton said discussions between doctors' representatives and medical indemnity insurers with DoHA over the final wording of the terms and conditions for participation in the PCEHR had achieved a significant reduction in the “crazy requirements” that medical practices were being asked to sign up to and there were now only a few technicalities that needed to be overcome.
“There have been some significant moves although there are one or two definitional issues that are still a problem, but I think the insurers and the AMA are very close,” Dr Hambleton said. “The hard work is done and now we are down to the definitions – it's not to do with terms and conditions, but we are down to technicalities.”
However, he reiterated the AMA's concerns that the access controls built into the PCEHR were making it unnecessarily complex and there was still a large amount of scepticism within the GP community over whether or not to participate.
Dr Hambleton said that while the AMA supported the vision of the PCEHR, “the mechanics are driving us all mad”.
“What is driving us mad is that the PCEHR has been built with so many controls that can be turned on and off by the patient that they have forgotten that you want to make it easy for doctors and hospitals and other health professionals to use,” he said.
“The more complex you make it, the worse it gets. I had a consumer stand up at a meeting the other day and say 'I don't care if I die, I'm not sharing my information with you'. My response really was, clearly you need to opt out and get out of the way and let the other people who do want to share to gain the benefits … frankly, we just want the rabid consumerists to get out of the way and let's just get on with it.”
Dr Hambleton said one of the implications of the ongoing discussions around provider participation was that general practices will need to ensure they have insurance to cover their responsibilities for the PCEHR in addition to individual indemnity policies for practitioners.
“To participate in the PCEHR the practice will need to have a system set up so individuals who interface with the PCEHR are identifiable,” he said. “Say a receptionist accesses the PCEHR and does something, breaks confidentiality for example, that may cause a legal liability that won't be covered by a doctor's medical indemnity insurance. It will be in relation to the practice, which will be vicariously liable for the staff.
“Most practices have insurance but it was part of the problem as even the insurers were unsure. If it is a practice employee that you are liable for we all recognise that's a business requirement but what the original document was going to ask us to do was indemnify for people that the practice didn't control.
“That was part of the original problem so the reality is that this is another reason that practices have to make sure they have appropriate insurance to cover their staff. It's not completely new but the clarity is there now.”
He said that even though several clinical software vendors will have PCEHR-compliant software available in September, it was unlikely it would be used immediately. The software he uses in his own practice, Monet, would not be able to interface with the PCEHR, he said.
“I think there is work happening to retrofit systems like Monet to enable it to interface with the PCEHR but it's different to a simple upgrade that some of the other products will be doing. There is no doubt in my mind that some practices will have to change software entirely to be able to interface with the PCEHR.
“That's just the practice decision, and then the practitioner will have to make a decision about whether they actually interface with the PCEHR.
“We support the end point, but with software upgrades, there are early adopters and late adopters. Whenever you get a significant upgrade, inevitably – and the software vendors would agree – there are going to be some teething problems. So even if it's available in September, there may be practices who choose not to apply the upgrade until October or November.”
The AMA is not recommending either way whether its members choose to participate or not, but it has devised a checklist to help practices in deciding what they need to do if they want to participate.
Dr Hambleton said the checklist would prove a daunting prospect for many GPs. It includes obtaining an HPI-O, HPI-Is for individual practitioners, a secure messaging service, and purchasing or installing PCEHR-compliant software or upgrades to existing software.
“Then decide how to use it, put in the protocol, train the staff and the practitioners in the practice, check your indemnity cover that practice insurance is included, sign the agreement, review the cost of implementation in the practice and also set fees to cover the visits. You can't do it overnight.”
Individual practices and practitioners will have to decide for themselves whether it was worthwhile, he said. Asked what GPs should do if a patient demands that the GP helps them upload documents to the PCEHR, he said a serious discussion would be needed.
“It's a business decision for each individual GP as it is opt-in for both parties. There is no compulsion to have a PCEHR. The doctor needs to make a decision about whether they are going to proceed, and then if there is a business case.”
GPs are perfectly entitled to set their own fees for the time it takes to curate a patient's PCEHR in the absence of a change in the government's stated position that there would be no change in the Medicare rebate structure, he said. The AMA is continuing to push the government for more clarity on this, and for more information on whether any training programs would be launched to help GPs work with the system.
“If significant training is going to be required, it is something that the Divisions would have got involved in in the past, but we have heard nothing from the Medicare Locals. We've heard that there is $50 million in funding for Medicare Locals nationally but we don't know what it is for, where they are going to spend it or if they have already spent it.”
He said he expected a lot of doctors would just wait and see as the roll out continues. “There will be a lot of that. If you look at the PCEHR website, there is something like a 40-page document to take you through the HPI-O process. The vision is fine, the ultimate aim is fine but in terms of the real benefits to the general practice …”
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