Gulf between PCEHR rhetoric and reality – CeHA

There is a “dramatic gulf” between what the builders of the national eHealth system are saying about the current state of play and the reality of the situation, according to the Consumers' eHealth Alliance (CeHA).

In its submission (PDF) to the three-man panel reviewing the PCEHR, CeHA has highlighted two areas that it believes are the key issues preventing the successful implementation of the PCEHR program – a lack of due governance and incomplete foundations.

CeHA argues that NEHTA has “pretended” for some years that the foundational elements underlying the PCEHR and the wider eHealth system are in place when “close inspection of implementations to date suggest otherwise”.

“We contend that Australia still lacks a workable national ICT infrastructure – the goal of our Commonwealth, State and Territory Governments since the 1997 Health Online Report – that will deliver an e-health system for the future,” the CeHA submission states.

It lists the Australian Medicines Terminology (AMT), Healthcare Identifiers for healthcare providers, a national provider directory, secure messaging and authentication as areas that are not yet in common use or even functional.

“We certainly don't know, for example, the extent to which the Australian Medicines Terminology has been installed into clinical systems in GP clinics, or hospitals, but it is more likely closer to five single installations, rather than 50,000 installations,” it states.

“Without a common clinical terminology, how are we to achieve the basic, accurate medication list so often and so proudly spruiked as a feature of the PCEHR?

“The number of Healthcare Identifiers allocated to individual providers and in active use today is probably more like 5,000 rather than the needed 500,000. And the number of hospitals, public and private, that are routinely processing patients' Individual Healthcare Identifiers can probably be counted on one hand.”

The submission states that while even the AMA president is suggesting the foundations are in place and all the PCEHR needs now is improved usability for clinicians, this is not actually so.

“Through our extensive discussions and analysis, we have concluded there is a dramatic gulf between the rhetoric and the reality.

“It appears the gulf between the vision of what the PCEHR could provide, and what it is currently capable of providing, is profound.”

The Alliance places most of the blame for this situation squarely at the foot of the lack of proper governance of eHealth in Australia.

“We consider the key issue preventing successful implementation is the failure of the various government agencies to act together and engage the community, both public and private, according to the clear advice to create a separate performance oversighting entity directly representing all relevant interests,” the submission states.

“The need for collaboration, and an independent management structure, was clearly set out in the Parliamentary "Health Online" report of 2001 and underscored in subsequent reports underpinning the agreed National e-Health Strategy in 2008.”

CeHA emphasises the importance of a particular recommendation in the Deloitte report, which states that “effective implementations are unlikely to work unless supported by a governance regime which provides appropriate coordination, visibility and oversight of national e-health work program activities and outcomes”.

“Many of those involved in the development process remain frustrated that the many arms of our federated governments, whilst having endorsed the obvious validity of this key recommendation, have not actioned it,” the CeHA submission states.

“The necessary directions to both HealthConnect and the National e-Health Transition Authority have been lacking or ignored. Thus the subsequent shortcomings have been repeated.

“This has resulted in spending over $1 billion of public funding on the PCEHR, but much much more on e-health overall, in a decade of misdirected, uncoordinated programs without any identifiable progress towards the implementation of a much needed, 85% community supported, National Electronic Health Service.

“CeHA hopes momentum can be restored to the e-health program by adopting the recommended collaborative governance approach and initially keeping things simple by building on what exists and in a clinical sense is working.”

Other submissions

To review a table of submissions to the PCEHR review compiled by Pulse+IT, click here. This resource will be updated as more submissions become public.

Posted in Australian eHealth

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