AIIA calls for action to implement the PCEHR plumbing
The operators of the PCEHR need to concentrate on implementing the “plumbing” of the national eHealth system and ensure that standardised secure electronic messaging and health identifiers are widely used so that effective technical integration between software across the health sector and the PCEHR is possible.
In its submission to the PCEHR review, the Australian Information Industry Association (AIIA) has also called for a transfer to an opt-out system once the underlying PCEHR solutions are at a reasonable level of maturity, and that the PCEHR platform be opened up to allow third parties to create different provider and consumer portals across different platforms, such as smartphones, tablets and smart TVs.
The AIIA said it does not support any consideration that investment in the PCEHR be abandoned, but that there is scope to open the system to innovation and mainstream third-party applications of value to clinicians and patients.
It said that in addition to the “clunky” registration process, the official PCEHR provider and consumer portals are obstacles to wider adoption, arguing that “there cannot be a one size fits all approach to a user interface”.
“Opening up the presentation layer and allowing innovative new front end and specialised interfaces to be created will drive innovation, improve usability and increase adoption by clinicians and consumers,” it said.
From its vendor members' perspective, the AIIA said a lack of engagement with industry in change management processes was of particular concern, as it has led to vendors being unaware of changes to the system.
“Industry change management processes ensure that any change in software is tested against every system it interacts with prior to release.,” it said. “This has not been the case in the PCEHR and again increases cost and risk, including for patients.”
It also said that current testing requirements by NEHTA and NATA need to be reviewed as a matter of priority as arrangements are very expensive, especially for smaller vendors, and vendors have also questioned the rigour and consistency of some test cases developed by NEHTA.
It places some blame on the problems with enrolling patients to a delay in allowing vendors to implement web service calls to the PCEHR for nine months and in the meantime providing what it calls a “very labour intensive” registration tool.
“While a key priority going forward must be addressing the quality, usefulness and ease of access to information in the PCEHR, we acknowledge that complex electronic record systems, particularly those of scale, take many years to evolve and mature into solutions that are content rich, seamlessly integrated into health care workflows and supported by appropriate education and training by all relevant parties.
“Nevertheless members working directly with clinicians advise that the overwhelming priority for clinical staff is access to existing core documents such as referrals, discharge summaries and specialist letters and to communicate these across organisational boundaries.
“These are primary documents in most acute and primary care settings – frequently used and immediately relevant to current and future patient management. To the extent that these are not available, the value of the PCEHR is limited.”
It wants the operators to open up repository-based solutions and to work more closely with the state jurisdictions, but most importantly to maintain and enhance PCEHR information exchange foundations.
“[I]mplementing the 'plumbing' and utilising standardised secure electronic messaging and health identifiers to communicate with other software systems in the health care sector is a key foundation step before effective technical integration between systems and utilisation of the PCEHR infrastructure across all software in the health care sector can be achieved,” it said.
“While good work is underway in the area of standards development, there is an argument for increasing the focus on software systems actually implementing and adopting initial standards and ensuring these are tried and tested in the field before moving forward with additional standards development initiatives.
“In other words, get the fundamentals – the basic standards – right in the first instance.”
Posted in Australian eHealth