Progress report on the PCEHR

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

Since its launch in July 2012, a small amount of new functionality has been added to the PCEHR, although progress has been marred by unforeseen difficulties. The next update, PCEHR release 5, was set to include the long-awaited facility to upload pathology results and reports, but again there have been delays, not the least of which is the new government’s review of the system.

As this issue of Pulse+IT was going to press, a decision had not yet been made – publicly at least – on the future of the PCEHR. While it seems reasonably unlikely that it will be scrapped altogether, work on adding new features to the system seems to have come to a standstill for various reasons. These include major disagreements over how pathology results and reports are to be packaged and uploaded, and who would have the authorisation to release those results.

Progress has also been stymied by the air of uncertainty about the whole project following the Coalition’s victory in the September 2013 election. The Liberal Party had long warned it would do a “stocktake” of the PCEHR should it win the election, and that exercise has since taken place, with a review panel convened to survey public submissions on the problems faced during the implementation, as well as to advise on what can be done to fix it.

PCEHR release 5, originally slated for mid-April, looks likely to be pushed back until the government announces its decision. Release 5 was meant to include a number of new functions intended to improve the system’s value to both consumers and clinicians, including pathology and diagnostic images, advance care directives, and the merger of the Northern Territory’s My eHealth Record (MeHR).

Early releases

When the system went live on July 1, 2012, functionality was minimal. A glitch in software specifications during the build meant that no GP desktop software vendor was able to connect to the system, and all were still working hard on designing their own interfaces within their clinical software.

It wasn’t until October 2012 that the first GP software with full PCEHR functionality was released by Zedmed, with other vendors releasing their versions over the following months. The big two – Medical Director and Best Practice – released their PCEHR versions in January and April 2013 respectively.

What that effectively meant was that the only information that could be added to the record on its release was consumer-entered information such as next of kin details, allergies and personal notes.

Needing to get something uploaded to populate the couple of thousand of records that were created in the first few months, PCEHR release 2 in August 2012 added details of MBS and PBS history going back to 2010, along with organ donor registry status and child immunisation records.

PCEHR release 3

That was the way it stayed until May 2013, child development section was included, allowing parents to add details of their children’s health, growth and development. This was accompanied in June by the first app to interact with the PCEHR. Called the My Child’s eHealth Record and based on a similar app designed by Deloitte and NSW Health, the app is still restricted to NSW and Tasmanian users.

The May release also saw a view of the National Prescription and Dispense Repository (NPDR) in the PCEHR. While this was added to all consumer records, very little information was flowing in as the repository itself had just gone live.

As a major data repository, the NPDR is being rolled out slowly throughout the country. It was originally centred around the Barwon region in Victoria and in Tasmania, with 200-odd pharmacists using the system as part of the project. Following its general launch, two of the major dispensing software vendors – Fred IT and Simple Retail – released versions of their software with the ability to send data to the NPDR included.

For GP software, the functionality has taken a bit longer. Genie was the first to release an NPDR-enabled version last year, followed by Communicare, Zedmed and most recently Best Practice. The other GP software vendors are expected to include it in their next releases.

PCEHR release 4

PCEHR release 4, which went live in November 2013, involved some very minor enhancements for consumers and administrative staff, and the first round of feedback for software vendors following the establishment of a clinical utility program (CUP) by NEHTA to improve the way information is rendered in the system.

Aged care software vendors such as iCareHealth, Autumn Care, Leecare, TCM and Commcare all now connected. Most contain functionality to create and send event summaries, and iCareHealth can also create and send shared health summaries.

PCEHR release 5

Release 5 was planned to a big one, with headline functions such as pathology results, diagnostic images and advance care directives (ACDs) to be included.

These functions have turned out to be far more difficult than promised, and it seems likely that the ability to store electronic ACDs or images is some years away. ACD capability was expected to prove a compelling reason for consumers to sign up to a record.

One of the Wave 2 sites, the Cradle Coast project in Tasmania, has been working on the capability with software vendors including Alcidion for a number of years. However, the complexity of the work means it is not likely that to be available soon, so plans have been mooted to allow existing ACDs to be stored on the system in PDF format.

While the PCEHR was never built to use PDFs, it appears to be the only viable option. PDFs have also been mooted for the pathology function, largely due to calls from the pathology sector to ensure that the full pathologists’ report, along with the results, be available to clinicians. The pathology sector insists that simply loading results is not only confusing but potentially very unsafe.

Pathology is also a sticking point for the Northern Territory’s M2N project to merge the MeHR with the PCEHR. That merger was always predicated on the ability to include pathology results and reports, which are currently available in the MeHR. In addition to 60,000 users, the NT system has tens of thousands of clinical documents, adding immeasurably to the worth of the PCEHR, which still holds a relatively paltry amount – 15,000 or so – of shared health summaries.

Acute sector

While the struggle by GPs to use the system and the workload required to curate shared health summaries has stolen the headlines, the acute care sector has begun to move in connecting some of its clinicians to the system. That is mainly due to NEHTA’s rapid integration project (RIP), which built on the experiences of St Vincent’s Hospital in Sydney, another Wave 2 site that has pioneered the uploading of discharge summaries.

As each state uses different acute care systems – some truly ancient and completely unable to deal with the interoperability requirements of the HI Service and the PCEHR – an interim system was developed by the South Australian Department of Health and a vendor partner to allow public hospitals to create and send discharge summaries.

All hospitals in Queensland, all metro hospitals in SA, 27 in NSW and the four big hospitals in Tasmania are now using this software to upload discharge summaries. Royal Perth Hospital is due to go live in the next month, and several in Victoria are also nearly there.

Posted in Australian eHealth

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