The eHealth year in review: part 1

In what has been a ground-breaking year for the eHealth sector in Australia, Pulse+IT takes a look back at the biggest developments of the year, the headlines dominated in the first six months by the imminent launch of the PCEHR, and by the fallout in the second.

When then-Health Minister Nicola Roxon introduced the long-awaited legislation that would enable the establishment of the personally controlled electronic health record (PCEHR) in November last year, she heralded it as the beginning of a new era in Australian healthcare.

“Electronic health records have the potential to save lives, time and money and make the health system more efficient,” Ms Roxon said. “There’s no doubt that Australia needs to drag the management of health records into the 21st century.”

The 13 months since have certainly been an interesting one for the eHealth industry, to say the least. Whether you are a fan of the PCEHR, neutral or implacably opposed, it has been a fascinating experience watching the many hurdles the industry has had to jump over to get to where it is today.

While the development and rollout of the PCEHR itself has been fraught, there are a number of other initiatives that the industry has witnessed this year that will provide long-standing benefits for the healthcare sector.

These include the beginnings of the integration of the Health Identifiers Service into all aspects of healthcare provision, the moves towards interoperability by the secure messaging service vendors and the electronic prescription exchanges, the launch of the National Health Services Directory (NHSD) – an essential move, even though it has flown under the radar somewhat – and even the surprise announcement by the dominant GP clinical software vendor, HCN, that it was happy to open up its venerable Medical Director software to outside influences.

In January, Mater Health Services in Brisbane, a tertiary hospital and a participant in one of the Wave 2 sites for the introduction of the PCEHR, announced it had achieved accreditation for the HI Service.

The Australian Association of Practice Managers joined the Wave 2 Medview project, promising to promote the use of the HI Service and ePrescribing to its members, and HCN released new versions of Medical Director and PracSoft containing HI Service functionality.

The rush to roll out the PCEHR, however, hit a few of those hurdles, with NEHTA announcing that it was pausing the rollout of GP software to the Wave 1 and 2 sites due to a glitch in its specifications. It promised to have the situation ironed out by March.

February saw the start of Senate committee hearings into the PCEHR Act, with many organisations raising serious concerns about the planned structure of the system. The RACGP raised concerns over its perceived lack of governance, its potential to add to the administrative burden on GPs and the professional and financial risk it posed in the case of an unintended breach.

The Medical Software Industry Association called for a 12-month delay in rolling out the system to ensure there was no risk to patient safety, raising a number of concerns about the HI Service and what it called the use of “parasitic software”. MSIA president Jon Hughes said the PCEHR was “a laudable goal and a desirable end point but it is not possible before the first of July”.

NEHTA hit back, however, telling the committee that there were 'no systemic problems' with the HI Service and the Department of Health and Ageing defended its chosen governance approach.

Intense discussions on the PCEHR continued into March as the PCEHR bill passed the lower house. New Health Minister Tanya Plibersek rejected claims by The Australian newspaper that the cost of the system had blown out by $200 million, while NEHTA moved to calm fears that the system was inherently unsafe.

At the end of the month, Ms Plibersek took a conciliatory tone when she announced at the Health-E-Nation conference that the rollout would be slow and gradual and confirming that GPs would be able to claim work on the system under the MBS schedule.

DoHA, meanwhile, hinted that changes to the eHealth Practice Incentives Program (ePIP) would be likely. It later became clear that this would include GPs agreeing to participate in the PCEHR in order to qualify for the payments.

Ms Plibersek's conciliation didn't work too well, as the AMA launched an all-out attack on the terms and conditions for registration for the PCEHR as well as continuing its campaign for separate remuneration for curating a patient's record.

May brought the federal budget and the first details of the new requirements for the ePIP. AMA president Steve Hambleton said the changes were not a requirement, but a threat.

And in an up-and-down year for telehealth – in which money seemed to be given and then taken away – new rules for the telehealth incentive payments were introduced, cutting the one-off payments a year earlier than expected.

Senate estimates hearings were held in late May, and the debate continued. DoHA announced that while the system was on track for launch to consumers on July 1, September was a more likely target for the rollout of GP software that would enable the system to actually be used. As to 'who takes the rap' for any breaches of patient privacy or safety – that was still to be decided.

Patient safety was also in the news with the launch of the TechWatch study, while the vast sums that have the potential to be wasted in eHealth were exposed when the Victorian government put an end to the HealthSmart project, following a scathing report by the Victorian Ombudsman.

As the industry geared up in June for the launch of the PCEHR on July 1, some very welcome news came in the form of an agreement between three of the secure messaging service vendors that they would work together to make their products interoperable.

NEHTA also announced that the aged care sector was gearing up to take part in the PCEHR, announcing the formation of the aged care software vendors panel. A pharmacy panel was promised but has yet to eventuate.

The PCEHR legislation passed the Senate, but problems again arose with the announcement that the promised National Authentication Service for Health (NASH), being built by IBM, would not be ready for the launch of the system.

This was an issue that later in the year became headline news.

See the second half of our two-part review of the year in eHealth here.

Posted in Australian eHealth

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