PCEHR review report release “sooner than later”

The federal government's review into the PCEHR is likely to be released sooner rather than later, according to the review panel's chair, Richard Royle.

Mr Royle, executive director of UnitingCare Queensland, told the Connect digital health summit in Melbourne on Friday that while the review was in the hands of the government, it was caught up “in the milieu” of the Commission of Audit and preparations for the federal budget.

However, he said “we will no doubt hear, sooner than later, where that heads”.

The review of the system, which was ordered by Health Minister Peter Dutton in November 2013 and handed to him on December 20, has also been released to the Department of Health for its consideration.

The government has refused to set a date on when it or if it will be released. Pulse+IT lodged a freedom of information submission for the full report in mid-February, and is currently awaiting a decision.

An similar application by The Australian newspaper was denied due to the report being considered “deliberative documents”.

Mr Royle made the remarks during a question and answer session following a presentation by Department of Health chief information and knowledge officer, Paul Madden.

Mr Madden provided an overview of where Australia was at in terms of eHealth and information sharing, emphasising that consumers want to access their own health information and that many had an expectation that healthcare providers were already sharing it. They were often surprised when they discovered that was not the case, he said.

Asked to reconcile claims that consumers wanted access to their information with the small amount of shared health summaries that had been uploaded to the PCEHR so far, Mr Madden said the system was still relatively new.

“When you talk to many patients, they expect that the data is available to them and to their healthcare provider,” he said. “It’s only when they get to their next episode of care and they expect the data to be there because they need it, it’s at that point that they figure out how hard it is.”

Mr Madden was also asked if the resistance to the PCEHR on behalf of many clinicians was the due to concerns that patients were able to remove information from it. Mr Madden said the number of patients who had in fact put controls on their own records was very low.

Mr Royle said many of these ongoing concerns had been addressed in the review.

Mr Madden pointed to some positives in laying the foundations for eHealth, including the ability of one-third of all public hospitals to use the Individual Healthcare Identifiers (IHI) system. These hospitals are currently using the IHI when uploading discharge summaries to the PCEHR.

“Individual health identifiers have been with us for quite some time … [and] the value comes from having a patient who can be identified and known to be the same patient who should be receiving the prescription, who should be receiving the pathology, who should be receiving the diagnostic imaging.

“Having that synonymously through primary care, acute care, aged care, prescribing and dispensing – is very powerful. The ability to ensure that you have the right patient, the right treatment, at the right time, and the right record when you need to access those things is very, very powerful.”

He said electronic prescribing and dispensing was growing, albeit slowly. The facility to do so was available, but take-up was slow because it required a change in workflow.

“It’s a little different in that people need to scan the barcode of the script rather than pull out the keyboard and start typing it in. Take-up is slow. Is that a big issue? Well, it is, but we need to learn from that because any change, no matter how small it may be, is still a change and it’s probably not the only change they are dealing with.”

eReferrals were now available and will continue to grow through the use of systems such as the National Health Services Directory, which Mr Madden said “will start to impart a whole range of information about the availability of practitioners for video consulting services, appointments, contact numbers, [and] endpoint location services for things like secure messaging”.

He said there were still major challenges, including many GP desktop systems that were “born of the '90s” and used propriety languages, meaning it was difficult to transition to a model where information is easily viewed from and shared with other sources.

Many smaller hospitals were also unable to use sophisticated electronic medical records, as not only can their software support it but their hardware is not capable of supporting modern software. “There’s a whole scale of redevelopment ... just to bring some of these hospitals up to speed,” he said.

As Australia began to overcome the “rail gauge” issues of differing systems that could not speak to each other, more data will be able to be generated and shared, which can then be used for wider research purposes to the benefit of patients.

“The more information we have about clinical histories and a whole range of other demographic information about a particular patient can get us to start drawing patterns that tell us what might start happening next for another patient earlier in their own journey.”

However, one challenge is to specify what is useful data and what is dross, he said. “When it comes to sharing patient information, it is about making better decisions at the point of care because they have access to the data, but this brings about new challenges and some new risks for health professionals.

“If I use the data, I might make a better decision. If I don’t have the time to do it and it is there and I make a decision that turns out to be the wrong one, what is the consequence? Access to this information is in one sense a blessing and in another sense a bit of a curse because there is so much of it and if I don’t use that I could be liable if something goes wrong.

“You can see through the shared health records that are held in state repositories and even the national level, you’ve got some people [with] thousands of pathology records, because they’ve got type II diabetes. How, even if you’ve got hundreds of records, how does a GP find the discharge summary, how does the GP find the medications list if there is just a tower of information?

“The tools that we need to start creating have got to be about taking that data and making sense of it. Technology's next step has to be to turn that into knowledge.”

Posted in Australian eHealth

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