Cautious approval for ePIP from medical groups

The Royal Australian College of General Practitioners (RACGP) and the Australian Medical Association (AMA) have given a cautiously positive response to the new requirements recently announced for the eHealth Practice Incentives Program (ePIP), saying that while the incentives are welcome, there are still some issues to be ironed out.

Mike Civil, eHealth spokesman for the RACGP, said the official position from the college was a positive one but that the impact of upgrading practice IT systems and interacting with the PCEHR on daily workflow was not yet known.

“We recognise and welcome the fact that the government is going to continue to offer practices incentives to embrace eHealth and to do things that will fit in with the PCEHR,” Dr Civil said. “People tend to forget that this is an ongoing incentive for practices and it is a significant sum of money. It's great that the government does recognise that to be eHealth compliant and to embrace this, general practice does need incentives.”

He said there was concern within the profession about the amount of time it will take to upgrade systems and that GPs will need ongoing financial support, but that the funding on offer was generous.

“We have to remember that this is an eHealth incentive for practices and it is there to help up keep our systems up to date, to keep them state of the art really. And if you look at in that light, I think it's a generous incentive when you consider it is just for eHealth. This is a fairly big chunk that is clearly for eHealth purposes and it's great to see the government does recognise that.”

AMA president Steve Hambleton said the final ePIP requirements were an improvement on what was originally proposed and he was pleased to see they are aligned with broader eHealth building blocks such as secure messaging and the PCEHR.

However, Dr Hambleton said the AMA remained concerned about the timeframe for compliance, despite having persuaded the government to delay the fifth requirement – full PCEHR interaction – from the original date of February 2013 to May.

“The AMA remains concerned that the timeframe for compliance is very tight, and that the PCEHR regulatory framework is onerous, particularly given the impact of the end-of-year/holidays period, and the fact that the required software products and enhancements to interface with the PCEHR system and secure messaging facilities are not yet available,” Dr Hambleton said. “Once such products are available, practices will need time to acquire them, install them, and where necessary train staff in their use.

“In addition, practices will need time to acquaint themselves with their obligations under the PCEHR regulatory framework. [As] Health Provider Organisations under the PCEHR participation agreement, practices will need to prepare, document and implement associated policies and procedures.”

While the most commonly used clinical software packages are expected to be fully compliant with the five ePIP requirements within months, both Dr Civil and Dr Hambleton expressed concern that many older software packages – including those used in both of their practices – will not be.

The ePIP payments will help defray the costs of upgrading to new versions or new systems, but there were many concerns over the transfer of patient files from one system to another, Dr Hambleton said.

“If the relevant software products are not available in a reasonable timeframe that would enable practices to implement them within the ePIP time requirements it would be appropriate that the effect date of the new ePIP requirements be reviewed,” he said.

“While at this stage it is expected that the most popular practice software products will be compliant with their next upgrades, this will not be certain until these upgrades are actually available. Practices using non-compliant software will either not be able to access the incentive or face the additional transition costs of shifting to compliant software.”

He said practices in this position will need to make a business decision on the costs and benefits of staying with their current vendor or switching to a new one. “The AMA encourages practices to speak with their software vendors about the product's ongoing ability to meet the practice's needs.

“Where applicable, practices will need to consider the direct and indirect transition costs and any associated data issues of moving to a new software product. This is a significant undertaking and any practices who need to change clinical software are unlikely to be able to change over in the timeframe to be eligible for the new ePIP.”

Dr Civil agreed, saying progress seemed to be mainly reliant on the software vendors. “Certainly there is a concern that it is almost out of our control,” he said. “If our software package doesn't do it you won't get the incentive. My particular practice falls into this. We for various reasons have an older version of a current package and we are certainly going to have to take a big step to get onto compliant software.

“We are keen to do it and motivated to do it, but yes, we have an awful lot of data on our systems, and to be honest the cost involved in transferring the data isn't to me personally a big issue but it is about having total confidence that all of that information that has been put into our system over 12 to 15 years is it all going to be there.”

However, he said from a personal viewpoint, the concentration on getting general practice systems up to speed with the new requirements was a good thing.

“I think this an opportunity to say this is where we are at currently with our eHealth systems and practice software and this is where we need to be at. We've got this incentive, this driver at the moment with the PCEHR, so it will be a good thing to reflect on how we are doing generally with our software packages.

“That has been a wake-up call for my practice – what we have is a good package and it does the job and it serves me and the patients well, but it's really not up to the grade for what we want in the PCEHR. And perhaps there are a few other areas where it is not up to the grade.”

In addition to concerns over timeframes, both the RACGP and the AMA, along with the medical indemnity insurance industry, have recently been at loggerheads with the Department of Health and Ageing over the agreements that practices will have to sign to participate in the PCEHR, and therefore be eligible for the ePIP payments.

While MDA National president Julian Rait recently gave “qualified support” to the final version of the agreements, there are still some objections, in particular over the amount of paperwork required.

Dr Hambleton said the regulatory framework for the PCEHR, comprising the PCEHR Act, its regulations and rules and the participation agreement, was “complex and onerous”, with substantial penalties for breaches of a range of statutory provisions.

“Practices will need to give careful consideration to these and will need to develop specific policies and procedures to fulfil their obligations,” he said.

“The PCEHR participation agreement was improved considerably over the initial version proposed by DoHA as a result of AMA lobbying with medical indemnity insurers and other medical groups. However, the agreement, by virtue of the PCEHR regulatory framework, still imposes obligations ... that practices must understand and address within their specific circumstances if they intend to be registered as a health provider organisation.”

Dr Civil said the arguments had been resolved “to some degree”, but that the RACGP admits there have been some wins and some things it was unable to achieve.

“The College as well as the AMA were very concerned about quite a few aspects of the agreement and the College continues to work to further streamline things,” he said. “I think some of the nitty-gritty has been resolved and some of these overarching concerns have been resolved.

“Practices are still going to have to develop policies and procedures that will address ensuring their staff get the appropriate education and training, that practices are going to need to have a good understanding of the risks and benefits of the system.”

He also said it was hoped that the process of signing up for the PCEHR from a patient as well as a practice perspective would be streamlined.

“On the whole, the big step that needs to be taken with these practice agreements is making the whole process of getting the agreement and signing up for it more streamlined, and my understanding is that NEHTA is very aware of that,” he said.

“If you wanted to register today, you would still have reams of paperwork to work through and phone call after phone call. I would imagine that the bulk of us who won't be in a position to sign up for this agreement will be looking at it early next year, perhaps in February, and I'm hoping that the process will be a whole lot more streamlined.

“That's something that the College is certainly working on with the AMA and the government, to streamline that process. But it's the old story – it's a new process, it's a new sort of agreement and there are going to be stumbling blocks. The indications that I get when I go to NEHTA presentations is that they are very receptive to the comments that this is a bit clunky. I'm sure it will get better.”

He said many GPs would wait and see before becoming involved in the PCEHR, but that consumers would ultimately drive greater GP participation.

“There will be a large number of people who have made the philosophical move that yes, we are going to do this but we'll wait, let it get a little bit more slick and let it get a little bit more streamlined and then we'll do it. One of things that has become apparent to me is that there is still a huge lack of understanding about what it is all going to mean and how it is going to affect us.

“Within the profession there is still a lot of work to do and certainly within the College we have developed some active learning modules and education, but the other area of education that is going to be a big driver of all of this is the consumers, the patients.

“I really get the feeling that there is not a lot of knowledge out there in consumers and patients to drive it. Once a few patients come in and say they have registered for this PCEHR stuff, what do you do from your side as my GP. When a few doctors get asked those questions they'll have a new motivation to get up to speed a bit quicker. It is happening – it is slow but there is good reason for that.”

Posted in Australian eHealth

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