PCEHR needs simplified registration, hospital participation

The overwhelming majority of respondents to a survey aimed at informing the panel set up to review the PCEHR believe there are barriers to further take-up, and that there are many cases of usability issues that require further analysis.

However, few respondents believed there are existing software products available that could replace the PCEHR, and very few agreed that the private sector should host the system or manage the data it holds.

The survey, conducted by the Health Informatics Society of Australia (HISA) and the Health Information Management Association of Australia (HIMAA), has been submitted to the panel reviewing the system, along with a call to support further analysis of the many comments and recommendations made.

The organisations received 673 responses to its online survey, the majority of whom were health informaticians, health information managers and clinicians working in the acute or primary care sectors or health IT companies.

Based on the survey results and the accompanying comments, HISA and HIMAA have come up with nine recommendations within six practical areas of work that they believe the panel should look at to improve adoption and usage of the PCEHR.

In their joint submission to the review, the organisations state that they are mutually supportive of the PCEHR and the role it can play in the general contribution of eHealth to the national health reform agenda.

“The importance to this reform program to the management of information and information flow through the judicious use of information technology cannot be underestimated,” the submission states.

They emphasise that neither organisation was interested in supporting a review that was aimed at switching off the PCEHR or being involved in the blame-game over the PCEHR build and implementation, “preferring instead the principle of quality improvement to address identifiable opportunities to accelerate the adoption of the PCEHR by its end users”.

The organisations says they are assured by panel chair Richard Royle's statements at the HITWA 2013 conference in Perth that the panel did not intend to recommend shutting the PCEHR down, and that the federal government supported the principle of quality improvement.

The submission states that in addition to the statistical results of the survey, “there are also 1,122 contributions in response to a call for six key practical foci for work which, if completed by mid-2016, would significantly improve the value proposition and usability of the PCEHR for clinicians and patients, leading to increased adoption rates”.

The focus areas include:

  • the convening and resourcing of a hand-picked working group to simplify all aspects of the PCEHR registration processes for both providers and the public, which needs to be completed by early February 2014
  • the implementation of phase II of the recent workforce productivity, change and adoption work with the Australian Medicare Local Alliance on eHealth support officers’ competencies and skills
  • introducing medication management initiatives through engaging the Pharmacy Guild, and ensuring the holistic and seamless sharing of pathology and radiology results by engaging the pathology and radiology professions, so that a much richer functionality and usefulness of the PCEHR can be effectively introduced within two to three years
  • the consideration by COAG, through the Australian Health Ministers' Advisory Council (AHMAC), of how to fast-track universal hospital participation in the PCEHR, particularly through universally available electronic discharge summaries in all jurisdictions by mid-2016
  • harnessing the multi-jurisdictional CIO group as the vehicle for developing a practical and collaborative model for designing a national roll-out scheme for the PCEHR and associated infrastructure to enable universal hospital participation.

In terms of the review panel's terms of reference, an overwhelming majority (80 per cent) of respondents agreed that barriers to greater uptake of the PCEHR existed. However, as there were over 1600 examples provided, the organisations say thorough qualitative analysis is still required.

There were also 720 volunteered examples of usability issues with the PCEHR clinical desktop software and portal that also require qualitative analysis.

The survey found that more respondents (44 per cent) disagree that the PCEHR system has met their expectations than agree (18 per cent). Over a quarter (28 per cent) of respondents neither agree nor disagree, while 10 per cent had no expectations.

A strong majority (63.5 per cent) felt that they were not engaged at all in the design, build or implementation of the PCEHR.

Only 15.7 per cent of a total of 484 respondents thought that existing software could fulfil the role of the PCEHR. One-quarter disagreed that there was existing software that could fulfil the role, with 37.4 per cent saying they didn't know.

Of the 53 individual responses to a question asking them to name existing software products that might be able to fulfil the PCEHR role, none received more than six nominations and most only one or two.

On the question of what incentives could be used to increase usage of the PCEHR, a large majority – 78.3 per cent – nominated funding for clinicians to upload health summaries and actually use the PCEHR.

More than 60 per cent also thought funding to link their own service's EMR to the PCEHR would increase usage.

In terms of improvements to the system to accelerate adoption, many selected disease management, medication management, pathology, usability, accessibility and diagnostic imaging as potential improvements.

Less than half thought a consumer/patient opt-out system would help adoption, and only a third thought opt-out system for healthcare professionals/clinicians would improve adoption.

Only 34.6 per cent though the complete rollout of the current program would increase adoption.

In their submission, HISA and HIMAA said they strongly recommended “that a high priority to emerge from the PCEHR review is the immediate, comprehensive and extensive integration of health information/informatics professionals into health provider infrastructure’s implementation of the PCEHR, and its linkage with other EMRs and fund management IT”.

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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