Feeding the chooks: divining the future of the PCEHR

This story first appeared in the April 2014 issue of Pulse+IT Magazine.

The wave of giddy enthusiasm that greeted the election of the Rudd government in 2007 and the subsequent development of the PCEHR has not been mirrored by the advent of the Abbott government in 2013. A sterner, economically rationalist approach and a 'feeding the chooks' attitude to public disclosure means it is difficult to divine the future for eHealth beyond an increased focus on point to point communication.

In April 2008, flushed by its landslide victory in the November 2007 election, the new Rudd government brought together a range of people prominent in their field to examine 10 critical areas for the future of the nation as part of the 2020 Summit.

The first seven of the areas featuring in the 2020 Summit had direct clinical or business impacts for rural medical practitioners.

These were exciting times, full of great hope, and there was a sense that significant change was on the way. In May 2010, the final report was released. Of the 138 recommendations put forward, just three were adopted.

Tony Abbott and the Liberal National coalition swept to power in September 2013. As previously, the new government has initiated a number of reviews to set the agenda for the future. Since the financial landscape has changed significantly in the last six years, the new government's focus is on cost cutting and efficiency. A number of agencies and commissions have been closed and many of the reviews have been already been delivered to the government so that they can be digested by Treasury and the Expenditure Review Committee prior to the Coalition's first budget, due in late May.

This time around there has been no love-in. The National Commission of Audit will report in a few weeks and provide the overall framework for the government's spending options. It is unlikely to be released to the public before the budget.

Public disclosure

In the health portfolio, the Royle report into the troubled PCEHR project, which was delivered before Christmas, has also not been made public. Options for tinkering with demand for GP services by introducing a small co-payment have been much discussed in the media but may turn out to be a furphy. Rumours about means testing the Commonwealth Seniors Card have surfaced more recently. This too would have an impact on demand for medical services.

Ironically, Steve Hambleton, AMA president and co-author of the PCEHR report, has called on the government to release of the Seniors Card report. "The whole thing should be released so people can assist the government in making appropriate decisions," Dr Hambleton says. It would appear the government does not need any help.

The Abbott government's approach to public discussion has been compared to the Bjelke-Petersen government's communications strategies of the 1980s. However, in these modern times, 'feeding the chooks' involves battery farming and a marked reduction in feed allotment.

Divining the future

So what does the future hold for electronic medical communication in Australia? We have peered deeply into the entrails but have not divined a pattern.

The PCEHR's main premise was that communication would flow from point to portal. While noting claims to the contrary, it is entirely feasible that the PCEHR could have been the ultimate source of truth for some aspects of medical care such as medication management. However, despite the best technical and legal efforts, it is now obvious that a portal can never be as secure as locally held records.

Point to point communication appears to be back in favour, at least for this revolution of the political cycle. It might be dull and traditional but is a model well understood by medical practitioners and fits with their concept of medical care.

The challenge for the new government will be to leverage the significant investment already made in the health authentication infrastructure and to find a workable model for message exchange between the companies providing "last mile" message delivery. Many of the financial issues in this area have parallels with general data exchange on the internet (see interconnect agreements). However, the market has failed to resolve these issues for over 10 years under both Labor and Liberal governments.

Strong leadership is needed to find a solution to this vexing problem. Peter Dutton is the new Health Minister. With a background in small business, he espouses the Abbott government's ethos of hard work, self-reliance, independence and productivity. He is on the Expenditure Review Committee.

Politics may well be “the art of the possible,” but conversely, “war is the continuation of politics by other means”. It remains to be seen which outcome eventuates when, or if, the Minister begins dealing with the big end of town.

About the author

Dr David Guest is a GP at the Goonellabah Medical Centre, near Lismore in northern NSW, and has a long interest in eHealth to improve patient management. He is a former social media director for the APCC's eCollaborative project and helped launch an early shared health record through the Wedgetail project.

Posted in Australian eHealth

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