Clinicians have to renew PCEHR security token by fax

Healthcare providers who applied for a National Authentication Service for Health (NASH) PKI certificate to participate in the PCEHR have begun receiving renewal notices for individual NASH tokens that require them to fax in an application form to Medicare.

Former NEHTA clinical lead Mukesh Haikerwal has vented his frustration at receiving a renewal notice in the post last week, saying it was an arduous process to get the NASH PKI certificate in the first place and the expiration date was too short.

Known at the time as the eHealth record PKI certificate for individual access to the provider portal, the subsequently renamed NASH PKI certificate for healthcare provider individuals did not begin to be made available to clinicians until December 2012, almost six months after the PCEHR went live, he said.

Dr Haikerwal said that in December that year, the then Department of Health and Ageing announced that all practices that wanted to take part in the eHealth Practice Incentives Program (ePIP) had to apply for NASH certificates – in addition to a number of other steps – by February 1, 2013.

Dr Haikerwal said “gigantic efforts” were made to let ePIP practices know about the three different forms that had to be filled out manually, and the sequence for applying for them in time. “It was actually a very arduous process, and our practice did pretty well to get across the line on that date,” he said.

Now, renewal notices for the individual NASH token have started to be sent out as they only last for a year. The renewed tokens will last for two years, but Dr Haikerwal said many doctors would be reluctant to bother reapplying, as many were not using the PCEHR system at all.

“Despite participating ePIP practices being able to use the technology, hardly any are doing so with a paltry number of clinical documents being available on the PCEHR, not that anyone other than the GP that wrote the document could or would read it,” he said.

“The onerous participation agreement and the horrendous user interfaces and tortuous user experience don’t inspire the effort.”

Applications for a renewed NASH PKI certificate must be faxed in to the Department of Human Services (DHS), which will then post out a new token, which takes the form of either a smart card or USB token.

Other location or individual PKI certificates, such as those for HIC Online – now known as Medicare Online – are done automatically through clinical or practice management software.

For example, Genie has informed some of its users just this week that HIC certificates, which last five years, are soon to expire. Users simply need to follow simple instructions to renew.

Dr Haikerwal said he understood Medicare was working on developing a similar system for NASH PKI certificates through HPOS, and that Medicare had been very helpful. However, he said the developers and administrators of the PCEHR system had made unrealistic demands of clinicians and software vendors when setting it up, introducing it and in its use.

He also criticised the way clinical information was rendered in the PCEHR. As illustrated in a report in Medical Observer, the manner in which information is shown in the PCEHR is different to how it appears in his clinical system.

The dates of procedures appear in incorrect order, and some don't appear at all, he told Pulse+IT.

“Somebody somehow, and I don't know who, deemed what is and what is not a procedure,” he said. “So somehow a CT scan becomes a procedure but some other things don't become procedures.

“[As a GP], you have already curated in your own record what you consider important information here and now, and stuff that is important to know but is not current, and it is nicely curated. But when you upload it, it does not come up looking like that.

“They've pulled out the procedures and allowed some stuff to stay as current, but it also has another category called 'other'. I don't know what that means and it is not in any clinical textbook that I've ever read. Then the dates are in reverse order, the earliest is the first and the most recent is the last, and if it doesn't have a date in terms of year it doesn't make it onto the list.”

Dr Haikerwal and the vast bulk of NEHTA's clinical leads team resigned in frustration in August last year or decided not to renew their contracts. Three other clinical leads, including Kean-Seng Lim and two others who wished to remain anonymous, have also told Pulse+IT that the system was too onerous.

NEHTA has put in place a Clinical Usability Program (CUP) to work with software vendors to improve the PCEHR interface, but Dr Haikerwal said the problems were more severe than that.

“[Software vendors] did what they were told to do,” he said. He said that he, along with RACGP representative Nathan Pinksier, the AMA's Brian Morton and Melbourne GP Rob Hosking, had met with representatives from the Medical Software Industry Association (MSIA), including eHealth experts Vincent McCauley and Trish Williams, in Melbourne last week.

Dr Haikerwal said neither clinicians nor software vendors concerns were listened to in the development of the software. Now, these groups had come together to discuss the way forward, he said.

“This is an agenda that is important for the health system in Australia and it's important for us to get it right. I think there is an awful lot riding on it but we have to get away from what I call the tomfoolery.

“If you want consumers to use it, you have to ask them what they want. If you want providers to use it, you have to ask them what they want. If you wanted it to be mandated and something that people will have to use, whether they are a health professional or a consumer, you have to make sure it is safe, useful, has utility and is actually able to be used seamlessly.”

Posted in Australian eHealth

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