PCEHR implementation to be slow and methodical: Halton

NEHTA and the Department of Health and Ageing will roll out the PCEHR in a slow, careful and methodical way with further functionality to be added later this month, DoHA secretary Jane Halton told the Health Informatics Conference (HIC2012) yesterday.

Ms Halton reiterated the department's and the federal government's intention to aim for consumer registration capability first with real functionality to be added later in a careful manner. In her keynote address at the conference, she said the government had only begun to roll out the national system but its potential was clear.

“We will focus in the first instance on registration and on consumer and personal controls,” she said. “We will continue working through the national frameworks and we will bring, fairly soon, late in August, the next phase of roll out of the PCEHR.”

She told Pulse+IT that she was pleased but surprised that over 4000 people had registered for a PCEHR despite its launch with little fanfare, noting that the ehealth.gov.au website had received tens of thousands of unique website visitors.

“We took a huge step forward on the first of July, because people actually can now register for the PCEHR. Without any fanfare at all, over 4000 people have registered for the PCEHR. Registration is only the very first and very preliminary step. We have always said we will roll out the PCEHR in a very careful, staged and methodical way. It won't happen overnight.

“The fact that we've said this to almost nobody – with all due respect to your good selves, let's be honest, most people don't read the IT pages of the newspapers or blogs or whatever … It's a huge number, in the tens of thousands of individual hits, on the ehealth.gov.au website, [which] says that there's a whole group of people out there watching this, and the fact that we've had that many registrations, I think is quite miraculous to be honest.

“One of our challenges [is] we want to deliver to people who are interested in a way that doesn't lead to disappointment, but we have to do it in a careful and methodical way. We will add functions over time. The ability to view information held by Medicare will be early and then the uploading and viewing of discharge summaries and medication management and eventually, pathology and diagnostic imaging. The commitment is rock solid and progress will be – and I use this as a positive – methodical and deliberate.”

Greater consumer adoption is not yet on the agenda, with the focus still on the 12 Wave sites to test functionality in healthcare settings, she said. “There are a number of extra pieces of functionality that we need to have and I think we need to be clear: our priority has always been to roll out in the Wave sites first. We talk about Those Wave sites as being are our opportunity to test in a real environment, how things are going to work, how consumers are going to react, as well as working with the clinical community – that's why we've got the Wave sites.”

She also said both DoHA and NEHTA agreed with the launch date of July 1, saying a delay was not considered. “As [NEHTA CEO Peter Fleming] said, with IT we all know that you don't clean the house until your mother-in-law is coming around for a visit. You've got to have a date that you are aiming for, and we have aimed for the first of July for registration, which we delivered.

“Then we always said we would sometime later go with electronic registration. All of that enabled us to really focus our efforts; being able to do that first – really work out how it works, knock any bugs out of it – and then be able to move on in a methodical way was actually the right thing to do.”

Additional functionality available later this month will include access to Medicare data, she said. This will include MBS and PBS information, along with childhood immunisation and organ donor status. The medicines information will only be that held by Medicare, including scripts that are below the co-pay, although privately issued scripts will not yet be included, she said. This functionality will come when electronic transfer of prescriptions is more widespread.

“What will be available in late August will be access to Medicare data,” she said. “The beginnings of the GP software we anticipate to be a bit later than that – probably the following month – and we are working with all of those providers. Again, we have to do this in a methodical way and it has to be right ... IT in particular doesn't get delivered according to the fact that someone has put a deadline on it.”

Ongoing funding for the Wave sites was still being considered. “As with everything the funding is complicated,” she said. “The Wave sites will not disappear and they will continue work". We have funding in various different places so how we support some of these activities going forward will vary depending on the site, depending on the particular initiative, so it's hard to give a categorical answer on that, but we need to continue to work with the Wave sites.

“Now that we've got Medicare Locals, they are getting money as well to assist with adoption so you will see some of the focus shift a little bit.”

She would not reveal details of the $50 million in funding recently awarded to Medicare Locals to help with the implementation of the PCEHR, saying some would be in the vanguard and some would be at the tail. “Until we've got the GP desktop software up and running and we've had some of those early experiences in the Wave sites, we don't want to get everyone around the country recreating the same experiences. We want those experiences to inform how they have been helping others roll out.”

Ms Halton reiterated the importance of the role of general practitioners in the new system, telling the Q&A panel that the government had invested heavily in providing incentives to the sector to invest in upgrading their IT capabilities.

“Let's stand back and remind ourselves that we have been on the journey to an electronic health record for a long time. It is no accident that almost all GPs have access to computers because we have been investing in them, we have been crossing their palms with silver for a long time …

“We know that 34 per cent of GPs say that they see at least one person a week where they have no information about them and more than one in five doctors face that situation every day. A similar proportion of GPs will see a patient without complete information.

“It is in this day and age an anachronism that GPs handwrite or type a referral to a specialist that they then give you in an envelope, which you then carry yourself to that visit. Where else in the modern world do we use that form of communication? It is important that we don't duplicate existing systems and it's important that we connect the existing treasure troves of information.”

She clarified the position of GPs as curators rather than custodians of their patients' PCEHR, saying doctors should work with their patients on what should be uploaded and how. If there are errors in the information, doctors and patients should also work together to resolve them.

“Essentially, you will be able to work with your doctor to curate the information. This is the role of the patient. The doctor should talk to you about what it is they are going to curate and put up as a summary on your record. That does enable you to say, hang on a second, that seems to contradict what someone else has curated into the record.

“The advantage of course is that a number of other clinicians who are looking at it will be able to see who those clinicians are. If they are worried about the care of that patient, they can have a dialogue with those clinicians. Think about the current world – you see a patient and you don't necessarily know who they have been to see.

“If there is a conflict, say in a matter of observable fact, in which case they are going to check it. In one case it says your blood type is A positive and in another case it says it is B. Well, you check.”

She used the example of the Northern Territory shared electronic health record, which shows all of the interactions the patient has had with different healthcare providers. “[That] then forms input into the care that the clinicians they are sitting in front of is actually going to deliver to you. That is a much more sophisticated approach than we currently have.”

She also dismissed claims that NEHTA's ongoing funding was in peril, responding to some media claims that as eHealth was not discussed at the recent Council of Australian Governments (COAG) meeting, which failed to come to an agreement about the National Disability Insurance Scheme, both NEHTA and the PCEHR itself had not been provided with the security of ongoing funding.

“eHealth wasn't even on the COAG agenda,” she said. “That last COAG meeting had nothing to do with this particular agenda. This agenda has to do with a forward momentum, it has a structure and a framework and we are working cooperatively with the states. We've all made funding commitments.

“NEHTA is much more than just the PCEHR – it is the electronic shared agenda between us and the states and territories. There is a lot of work that still needs to be done on creating those foundations and they have a role in delivering the PCEHR. [DoHA] has a role in operating it. NEHTA has some very important work to do that does not finish with the current wave of changes with the PCEHR.

Memorably describing NEHTA as “the lovechild of COAG”, Ms Halton said she did not predict that the PCEHR would be scrapped under a new government. In a Q&A session hosted by the ABC's Tony Jones, Ms Halton and Mr Fleming pointed out that NEHTA was first established by a Coalition government, with Tony Abbott as health minister.

“I can't speak for a Coalition government but I'd be surprised if they did not wish to continue with this,” she said. “Why not continue this if it is inevitable?”

The delay in establishing the National Authentication System for Health (NASH), being built by IBM, would not halt the roll out of the system, she said. An interim NASH has been established using exiting technology developed by Medicare Australia.

“Essentially what we'll do is leverage technology that is available through Medicare Australia. It is fair to say that some of that technology has now been able to be deployed in ways that perhaps we didn't always understand it could be and certainly wasn't able to be some time ago. That's because of continuing work with Medicare Australia and their technology partners.

“So we have deployed interim NASH and contractual details between NEHTA and other parties are a matter for them and not for me.”

She said she was unsure if the budget target of 500,000 consumers signing up for the PCEHR in the first year would be met, as the figure was set only as an estimate for operating costs in the budget.

“We have to have an estimate of PCEHR registration, because we have to estimate what the operating costs are. We are being quite careful to say this is about a careful and staged roll out … What we do know is that we have well over 4000 people without any publicity. I'm astonished by the number of people we have – we haven't even raised this out there in the Wave sites.

“Can we say confidently that there will be a lot more than now? Absolutely. The 500,000 was an estimate based on some international evidence, but every country is different. We'll see. I think the important thing is that what we do roll out we roll out successfully, and that we deliver the kind of functionality that people want and they are going to use.

“I said today about what happened in the Northern Territory, about how there were a very small number of views to begin with and then it has just picked up as confidence has been generated and as the roll out becomes more ubiquitous. That's what will happen here, but we had to have a number to generate the operating costs to put in the budget.”

Posted in Australian eHealth


0 # John Frisken 2012-08-03 05:43
Releasing software with known bugs in it is not an accepted development appropach. The approach described is most closely aligned to an Agile or Incremental Delivery method, but the idea is to deliver small, well scoped, error free code releases. Keeping software bugs and security hacks out of future releases would be a good idea.
0 # PCEHR head 2012-08-05 15:19
So by my very rough calculations, 0.02% of the adult population has registered for a PCEHR. That is a very low figure figure, so I'm not sure why the minister is pleased. I suspect most of these people are in Mensa, or have a lot of time on their hands, because the registration process is not easy. Even if the target of 500,000 is met, that is still only 1/40th of the population, probably not worth a doctor's time asking the patient if s/he has a PCEHR. Unless it is a spin-doctor of course.

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