PCEHR promise yet to be fulfilled
Twelve months on since the PCEHR’s introduction, it is now a good time to take stock and consider how we should move forward.
Let’s be clear at the outset. The AMA supports a system that provides reliable, key clinical information – the information that can enhance a clinician’s decision-making about the healthcare the patient requires.
This is as true for the GP providing ongoing care to their regular patient as for an emergency doctor or anaesthetist providing care to an unconscious accident victim. Such a system that allows multiple health practitioners to share clinical information about a patient is good for patients and good for the healthcare system.
As the PCEHR system has rolled out and clinical practice software has become more integrated, we are seeing significant constraints on the clinical usefulness and usability of the health record, flowing from its original design.
It is now up to the medical profession to drive improvements so it can achieve its purpose: to support patients and their doctors providing the best possible healthcare for our community.
The AMA recommends that a clinical advisory group that represents the views of practicing clinicians should immediately be established to oversee and advise the government on the practical implementation of the PCEHR and its use in clinical practice.
The clinical advisory group should also work with the System Operator on the technical adjustments that need to be made to the system, based on experience with its use in clinical practice.
As part of the PCEHR implementation, the government has pursued a range of activities to encourage uptake, including assisted registration schemes and recruitment squads targeting patients in healthcare organisations.
In a perfect world implementation support activities should have been coordinated so that as a patient registers for the PCEHR, their medical practice is also ready to provide them with PCEHR services, such as preparing and loading their shared health summary and viewing event summaries from other providers.
A patient who has been convinced to register for a PCEHR should not be confused and disappointed by discovering their medical practice is not ready to participate.
Unfortunately at this point it is difficult to know where patients are being registered and where practices are already providing PCEHR services, and to what extent the two align.
Despite government funding of $50 million for PCEHR support through Medicare Locals, there is little quantitative information about what impact any funded services have made on practice readiness and PCEHR capacity.
Practices that have started using the PCEHR and providing services to their patients seem to have done so with very little support.
We should be aiming for the best possible match between registered patients and PCEHR-capable practices, ensuring the core relationship required for the PCEHR is built in from the start.
We also need to bed down the current system. We need to make using the system easier to get practices using the current system more confident in their processes and usage. There is a long way to go here.
Clearly it’s not the time to introduce non-core functions that distract us from the main task. Any changes to the PCEHR should be to increase the efficiency of medical care, and not clog it up with other information that is not directly relevant to clinical care.
To make the complex legal framework and technology requirements easier for practices to navigate, we need to have a single, reliable source of information, accessible through a single website. Government should also unravel the unnecessarily complex arrangements and paperwork currently required of medical practices to participate in the PCEHR.
If Medicare Locals are funded to provide implementation support, they should be contacting and physically visiting all the practices in their catchments to ensure actual PCEHR readiness and capacity.
Government support to practices for PCEHR capacity through the Practice Incentives Program (PIP) eHealth incentive is very welcome. To truly get the ball rolling on clinical use, government should consider also incentivising PCEHR activity, for example, by paying practitioners an incentive to complete a certain number of PCEHR shared health records for practice patients.
Medical specialists are also critical to the long-term success of the PCEHR and eHealth more broadly. Government should implement specific support strategies to assist specialist practices to participate in the PCEHR.
The eHealth PIP incentive also includes requirements for clinical coding and secure message delivery. The use of standardised clinical coding across medical care holds great promise for improved communication of medical information at all levels.
Reliable and secure sending and receiving of electronic health information is also a critical building block to improved healthcare.
Both these elements highlight the need for other medical specialists to be fully engaged in eHealth, supported by specific government strategies and activities.
The PCEHR, together with these other key eHealth developments such as clinical coding and secure messaging, holds the promise of significant improvement to healthcare.
We should be mindful, however, that technology does not and should not drive clinical care. Where health technology is well designed and carefully implemented, it can greatly enhance the care provided by our clinical professionals.
That potential is closer today.
Dr Steve Hambleton
Steve Hambleton graduated from the University of Queensland in 1984 and commenced full-time general practice in Brisbane in 1987. He was recently re-elected as president of the AMA for a third term.
Posted in Australian eHealth