PCEHR: it's time for some big changes
This article first appeared in the July 2013 edition of Pulse+IT Magazine.
It seems like clinicians have been side-lined during the development of the PCEHR. This became painfully clear when Dr Mukesh Haikerwal tried to connect his Melbourne practice to the PCEHR: the eHealth records database was not available, so he contacted the Department of Health and Ageing and said: “Hey guys, something is wrong with the PCEHR system!”
The answer from the help desk was: “No there isn’t.” As Dr Haikerwal told the Sydney Morning Herald: “If the Qantas website was like this, you would say, ‘I will go to the travel agent instead'.”
Dr Haikerwal is a clinical lead, and I would expect him to get the Rolls Royce treatment from the help desk (clinical leads are also supposed to promote the PCEHR among colleagues), but if this is the Rolls Royce treatment, then I have no hope whatsoever for other clinicians experiencing problems.
The support from the help desk with regards to the sign-up process has caused frustrations with clinicians and managers. It was and still is chaos. There were technical glitches, crashes and even hacks, but I cannot recall the last time I received communication from the government regarding the PCEHR.
The government has recently announced it is going to save on basic healthcare like MBS fees and the safety net, which makes the PCEHR cost blow-out even more painful. Government officials are chasing up sick patients in hospitals and other healthcare facilities to sign them up. Medicare Local staff are offering people a chance to win iPads and tickets to the zoo when they sign up for a 'free' eHealth record. This raises questions regarding ethics.
Meanwhile the government has signalled it is considering data mining the patient information in the PCEHR. This would be the first time in history that government organisations have full access to patient information, and we've not been clearly warned about this. Doctors are bound by the Hippocratic Oath, codes of conduct and other guidelines but this is clearly not applicable to government organisations as they have consistently played down the risks associated with the PCEHR.
We have been told the PCEHR will reduce medication errors, but recently a Pulse+IT reporter noticed that two medications she had never been prescribed had been uploaded to her record, possibly caused by a human error at a pharmacy. This case was important as it showed that the PCEHR is not immune to errors.
Incorrect medication information in the PCEHR will quickly be disseminated and can lead to disasters, for example because doctors often look at (past) medication lists to find out what medical problems some has (had). It also raises the question of how many less IT-savvy people already have incorrect information in their eHealth records without knowing it. And removing incorrect information with the above-mentioned help desk will be be a challenge.
Clinicians are expected to keep their own records as well as the PCEHR. This simply means extra work, especially for nominated healthcare providers. This work can probably not be delegated to non-clinical staff.
Not being aware that information has been shielded by patients is another issue for many clinicians. We've arrived at the situation where the government has full access and control, and the clinician responsible and liable for the care may not. The PCEHR will be another record that needs to be carefully checked and verified to avoid medication and other errors.
We’ve got to get the balance right and make the system acceptable for all stakeholders. It’s easy to see that a collaborative approach will be more successful: patients together with their nominated health professional should be made responsible for shielding off undesired items from the PCEHR, without creating more liability for providers.
PIP incentive payments go to practices to reimburse the staggering amount of work required to get the organisation PCEHR-ready, including IT upgrades. No doubt this incentive will disappear over time. Interestingly, there is no MBS item number for doctors updating the PCEHR. GPs have been told to either absorb the costs or charge for longer consultations so either the doctor or the patient will pay for the extra work.
The participation contract for healthcare organisations is one-sided. Clinicians lose control of all data once uploaded, and the government gains full control. After cancellation of the contract clinicians will not get their data back but they remain liable as certain clauses in the contract survive termination of the contract.
It would have been better if clinicians would have been able to download and remove their data, for example when the data is deemed insecure at any point in time. The agreement increases liabilities for clinicians and organisations and specific PCEHR data breach fines are part of the contract.
Here are the risks as identified by my indemnity insurance:
- Privacy breaches
- Allegations of negligence for failing to detect critical patient information contained within the PCEHR
- Loss or corruption of electronic documents or data
- Intellectual property disputes
- Fines and penalties.
My medical indemnity insurer MDA National states: “(…) before you opt in or decide to participate in the PCEHR, you should also consider that if your Practice (entity) is a party to the PCEHR contract, the entity itself along with your employees may be exposed. (...)
“Another possible exposure facing medical practitioners participating in the PCEHR are fines and penalties that relate particularly to the administration of the PCEHR. You should make sure you are aware of the obligations that apply to you and your staff before opting in.
“As with all contracts, if you have any doubts about what you are agreeing to, it may be worthwhile taking legal advice. MDA National Insurance policies do not provide cover for fines and civil penalties.”
So it looks like I'm not completely covered.
Technology is not perfect yet, and the PCEHR is a work in progress. But instead of starting from scratch, the government should have adopted one of the already fully functioning Australian eHealth record systems, like RecordPoint from Extensia.
Here are some advantages of RecordPoint’s shared health record system over the PCEHR:
- Less complex
- Community-based custodian model
- No data access by government agencies
- Less liability for health providers and practices
- Needs and requirements can be customised to local preferences
- No honey pot for hackers
- Trialled and tested over many years.
The government seems to think that if they keep pushing the PCEHR, people will give in. But there is a problem with this power approach: health providers will lose interest in eHealth in general and will be hard-pressed to engage with future eHealth developments.
And if clinicians are not on board for 200 per cent, the project will fail. If we want to save the PCEHR, it's time for some big changes.
Dr Edwin Kruys is a GP practising in Geraldton, WA, with a special interest in travel medicine, project management and social media and health. He blogs at doctorsbag.wordpress.com
Posted in Australian eHealth