Pitfalls and problems of PCEHR go-live
The Pangula Mannamurna Aboriginal health service that went live a fortnight ago with the PCEHR found the experience extremely complex, with a lack of information and a number of technical difficulties to overcome.
Pangula Mannamurna, a not-for-profit Aboriginal community-controlled health service that provides free healthcare to the lower south-east region of South Australia, acted as a testing ground for the first go-live of the system for users of the Communicare software package in SA.
Pangula is based in Mt Gambier and runs monthly outreach clinics in Bordertown, Kingston, Millicent and Naracoorte. It has four part-time GPs and a GP registrar on staff, along with two nurses, two Aboriginal Health Workers and a number of specialists who attend weekly or monthly, including a respiratory nurse, an endocrinologist and a mental health counselling service.
Funded by the Department of Health and Ageing and the Department of Families, Housing, Community Services and Indigenous Affairs, the service has about 700 Aboriginal clients on its books, and provides a number of social well-being as well as medical services. It is a member of the Aboriginal Health Council of South Australia (AHCSA).
Stefanie Birkholz joined Pangula in October last year as a personal assistant and administration officer, but she quickly found herself assigned to cover all things eHealth and has now become the font of all knowledge about the PCEHR system.
Ms Birkholz has been involved in getting Pangula registered as a seed organisation for the eHealth system and enabling the clinicians to use it, along with assisting clients to register for PCEHRs and helping to work through the technical issues that all general practices and health services will face if they decide to take part.
And technical issues were aplenty, Ms Birkholz said. “There were a lot of teething problems. It took us over a week of constant phone calls between all of the IT specialists – our personal ones, Dan Kyr from AHCSA, Communicare's top IT people – they were working on it 24/7 for a week to try to work out why we were having issues.
“For example, we installed the NASH certificate and it should have automatically been there and that wasn't the case. It took them a long time to work out the issues. We got there in the end, but it literally was a week of constant phone calls and ping-ponging backwards and forwards.
“Hopefully, because we were the first ones with Communicare to go live with it, they now know exactly what the issue is so it won't be a problem for anyone else.”
Sarah Ahmed, AHCSA's eHealth program manager, told Pulse+IT recently that the main problem health services were facing was a lack of communication from the different government bodies involved, including the HI Service, DoHA's PCEHR branch and the Department of Human Service's eHealth business branch.
“[They] don't really understand that little health services do not have people dedicated to doing this, and the amount of phone calls, cross communication, paperwork and follow up that needs to be done from the health service end is phenomenal,” Dr Ahmed said.
“We have a very good relationship with Communicare, who are a very supportive software vendor; I can’t imagine how we could have got to this point if we hadn’t had the relationship we do have with them.”
Ms Birkholz emphasised that she sees the benefits of the PCEHR for Pangula's clients, but acknowledged that the implementation of the system has not been made easy.
The paperwork involved is “expansive”, she said. “There is paperwork in every single area with registering the organisation, the doctors, the RO and OMO – there is ongoing paperwork that comes in and there's all of the time delays as well.
“That's why they put me into that role in order to have somebody who had the time to read through the paperwork and find out what information they need and getting it in on time. I keep getting told that I'm the expert, but I feel that I only know a drop in the ocean.”
Some of the service's GPs were initially reluctant to take part in the system, mainly because there was a dearth of information, but they are more keen now, Ms Birkholz said. Communicare has also made the actual process of compiling a shared health summary and uploading it very easy.
“[The GPs] have realised now that it's not something that is going to be time-consuming to them,” she said. “Communicare communicates with [the national system], so when they write a health summary in Communicare, they can click on a button to make a shared health summary and they can edit it. They can remove anything they don't want to go into the consumer's personal health record, and they then just have to click upload.
“I did speak to one of our doctors who has a practice in Adelaide and I asked him if he was going to get eHealth, and he said he was holding off on it because it was such a long, drawn-out process. He quizzed me quite heavily about it and about what the benefits are, and he is now much more keen.”
Ms Birkholz recommends that other practices and clinics appoint one administrative officer or the practice manager to take charge of getting the system up and running. “I just don't see how an individual, practising doctor is going to have time to get their head around it.”
Ms Birkholz has so far helped to register 90 people for a record, a process made much easier with the release of the assisted registration tool (ART). The previous routes to registration – online, by telephone or in a Medicare office – proved very clunky and too difficult to negotiate, she said.
“Initially I was [explaining the system to clients] in-depth, because the only real process for signing up a client was going through the website. That was a really difficult process. There were a lot of technical issues with the website crashing all of the time. It was very difficult to find how problems could be solved because it kept coming up with errors.
“You were also supposed to be able to go to a Medicare office and get signed up there, but when I approached them and asked about it, they really didn't have a clue. Initially it was do it over the phone, do it at a Medicare office or by online, but online was a real problem, the Medicare office didn't have a clue about what was going on…
“Even the website – once you've got your identity verification code (IVC), to go onto the website to get your PCEHR is not straightforward. I've got a cheat sheet that I can give out to clients so they can follow the steps. Some of the staff here, I gave them their IVC and they came back to me and said it's not working.
“It was purely because it wasn't obvious on the website which part they need to click into. It's not very helpful at all. You really need to have somebody in your office that is trained, that can assist clients to sign themselves up.
“But now that we have assisted registration, that has made things a heck of a lot easier. I have the assisted registration tool installed on my computer so I can get people's numbers immediately back. They really should have brought that out in the beginning.”
Ms Birkholz is now giving clients an overview of the eHealth record and what benefits it will bring to them. She then helps register them through the assisted registration form, and when they receive their access code, helps them set the record up and decide who will be able to access it.
The service's clinicians will be requested to ask patients if they have a PCEHR each time they see them, and Communicare has put an icon on the patient file screen to allow doctors to upload a shared health summary or access a PCEHR.
“That's is what we are prompting doctors to do – ask them if they have a record and then if they don't they can be referred to me to assist them with signing up and the education about what it means,” she said.
“By asking them each time, that means that people will start to understand that it is the real thing and it is taking off. Because there has been no publicity around it, people seem to think that it's not genuine and it's not going to be everywhere.”
Despite the many teething problems and difficulties, Ms Birkholz said there were a lot of benefits to the system, particularly for transient clients and those with complex medical needs.
One client in particular, Howard Nicholls, speaks eloquently about how he sees the system benefiting him.
In an email to Ms Birkholz which Mr Nicholls has agreed to make public, he writes of how he hopes the PCEHR will improve his interaction with health services and his healthcare overall.
“This program is a welcome one to me, due to the many complex health issues I have,” Mr Nicholls wrote. “I get very anxious when I have to change doctors, when this program gets underway, I will most certainly welcome it. When I change doctors, my health takes a huge step backwards due to the new doctor not being familiar to my health issues and they change all of my medication because they feel I do not need to be on some of the medication that I currently am on.
“My last report organised by [Pangula GP] Dr Kavanagh proved that my current treatment is working perfectly and my report on my current health was an excellent one. If all doctors are able to have access and are able to view this information at any time they keyed into my program on their computer, then gee that leaves me with a sigh of relief, because I then would not have to cart huge amounts of Dr's reports, scans and notes with me each time I change doctors. ”
Posted in Australian eHealth