PCEHR promise yet to be fulfilled

The Australian Medical Association (AMA) supports the concept of the PCEHR and the ability to share information with other healthcare providers. However, the PCEHR as it stands today is still proving overly complex for many practices. Targeted government support and more clinician involvement in the system would improve functionality and take-up by medical practitioners.

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.

Author Details

Dr Steve Hambleton
MBBS FAMA
President, AMA
This email address is being protected from spambots. You need JavaScript enabled to view it.

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

Comments   

# Dr George Margelis 2013-07-02 14:23
Dr Hambleton makes a very important point. It is the healthcare profession's responsibility to take a leadership role in turning the currently available technology into a healthcare solution that delivers better healthcare for our patients.
We cannot do this alone, so we need to work out how to collaborate with patients, industry, and academia to deliver this. I don't think we should rely on government to deliver all this for us. Healthcare is far too important to be just left to government to solve. We need to take personal responsibility and leadership and agree that we are all on this journey together.
# A/prof Terry Hannan 2013-07-02 14:37
Comments on Dr S. Hambleton’s statement.
1. 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 Federal Government has a Clinical Leaders Group so why are we not getting it right at that level? As Professor Coiera documents the role of the “health informatician”, a new scientific discipline, is crucial to e-Health reforms and the understanding of the problems we have to resolve.]
2. 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. [Many are aware of the flawed nature of this implementation as it defies the logic associated with the implementation of established e-Health systems. So no matter what other aspects of the PCEHR project are used it remains dysfunctional as a “clinical information management tool-“informati on management is clinical care” (WHO charter).]
3. 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. [Up to now the patient has generally been left out of the information management flow because of the “doctor knows all/specialist model of care". How is this model going to change when the PCEHR is poorly accepted or understood by clincians?]
4. 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. [This is a significant topic of concern. Incentivisation through $ is the wrong focus. The clinical professions need to understand that we are significant contributors to the costly inefficient health care model we exist within. This is in addition to the poor Federal and State e-Health projects.]
5. 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. [This is a critical point that Dr Hambleton makes. There is a deception that new e-Health technologies will solve our problems. The varying roles of these technologies in health are covered in Eric Topol’s, The Creative Destruction of Medicine. We also know that 30 plus years of effective e-Health is able to improve care. We need to use this knowledge as health is already unaffordable and quality is not improving.]
# Mark McCartney 2013-07-02 16:28
Surprised to see the AMA sounding vaguely positive about something that is so expensive and has not yet delivered. The same mistakes have been made in the UK with centralized records, is it too late for a complete rethink?
# john serpanos 2013-07-02 21:00
Practice incentives are clearly no longer effective given the lack of support from ama members, spending more is illogical. Citizens should be incentivised instead as well as medical software providers to align the stakeholders. No body is incentivising allied health which are long overdue for this type of assistance. Clinical consultation has merit. EHealth is about australians health care which extends beyond simply incentivising ama member take up...
# Neville Jones 2013-07-03 14:15
It astounds me that every time there is a change to the system the doctors, particularly GPs have there hand out for cash!

Why is it or should it be that doctors, who run small businesses just like me, get a leg up to engage with the PCEHR when this makes good sense and should be funded by them. And why do they expect people like Medicare Locals, who are funded by the taxpayer to run around and hold their hands? There isn't anything so complex about implementing the PCEHR that a competent computer business couldn't set it up, so spend some money rather than begging from the government!

The waste from governments of both political persuasions to help doctors modernise over the years has been unbelievable, yet I get nothing. Drag these guys into the business world and make them pay their way. And in terms of incentives, tell them if they don't with the program their accreditation will be revoked!

You need to log in to post comments. If you don't have a Pulse+IT website account, click here to subscribe.

Sign up for Pulse+IT eNewsletters

Sign up for Pulse+IT website access

For more information, click here.

Copyright © 2017 Pulse+IT Magazine
No content published on this website can be reproduced by any person for any reason without the prior written permission of the publisher.