Dutton looking for quick feedback on opt-out PCEHR

The federal government will take the next few months to assess the recommendations of the review into the PCEHR and wants to gauge community support for a transfer to an opt-out model, Health Minister Peter Dutton said.

The review recommended the system become opt-out from January 1 next year. Mr Dutton told the HIMSS conference in Sydney yesterday that he supported the recommendation, but said he wanted to take the time to assess community views for the controversial move before making a decision.

“The review recommended moving to an opt-out arrangement and I strongly support this view,” he said. “The system in its current form … is opt-in, and that restricts the uptake by patients and limits its use by doctors and other health workers.

“Moving to an opt-out system means clinicians would then have a situation where every one of the patients they see would have a record. This will increase the value of the system for clinicians and provide better health outcomes for our country.”

Mr Dutton said he agreed with most of the recommendations generally, particularly the opt-out arrangements, which he said he thought were necessary. “I need to see whether there is community support for opt-out arrangements, and I sense that there is, and I think from there we can provide a response fairly quickly.”

Change to a an opt-out model would require a change to the legislation, namely the PCEHR Act. Both the Consumer Health Forum (CHF) and the Australian Medical Association (AMA) support the opt-out model and recommended it in their respective submissions to the review panel.

Mr Dutton said the allocation of $140 million in last week's budget to the continuing operation of the system for another 12 months would give the government time to make necessary changes. However, he also admitted that there were contractual obligations that Commonwealth was still under which meant there would be a cost to ceasing funding.

“With the Commonwealth’s contractual arrangements, we saw a need to continue,” he said. “We’ve got some contractual arrangements in place that would have seen a cost to the Commonwealth had we not proceeded. [The $140m] is essentially providing certainty around the funding arrangements now and then we will allocate money in a contingency reserve and look at next year's budget to see if the funding will be ongoing.

“We have allowed ourselves this financial year with the additional funding because there are recommendations around structural change in relation to NEHTA and in relation to other aspects of the governance arrangements … so I’m hoping that from there we can respond quickly and in the next few months I’m hoping that we will have a better map going forward in terms of what we have accepted by way of the recommendations.”

Mr Dutton said there were two other themes that were apparent from the review, namely governance and clinical usability. He said governance of the PCEHR and and eHealth more broadly needs to be fixed, with accountabilities made crystal clear.

“Clinicians, the users and beneficiaries of the system and the health IT industry have not been involved as much as they should have been in the planning and decision-making processes,” he said.

“There is a lot of work to be done here including with the states and territories, all of which are invested in eHealth and we need to be sure we don’t create new rail-gauge issues.”

Clinical usability is a critical issue, he said. “You can’t expect doctors to use a system they don't have confidence in. We need to involve clinicians in decision-making processes and we need to ensure that clinical usability is first and foremost in the systems’ designers minds. eHealth record systems must be completely integrated with clinician workflows and this is a key recommendation of the review.”

He said he wanted to look beyond central government funding for the system and look at exploring new approaches to funding to create incentives to use and sustain it. However, he said the government was committed to a national, shared electronic health system.

“We know that implementation issues have plagued the PCEHR but the Commonwealth government wants to get it back on track so it can provide the benefits to patients,” he said.

“Independent modelling has shown that investment in a shared electronic health system would have benefits to the overall health system. Even under the current opt-in model, there is a net benefit of over $11 billion over 15 years, including in the areas of diagnostic imaging, pathology results and care plans.”

He praised the Northern Territory's My eHealth Record (MeHR), which has 60,000 registered patients and which saw 108,000 documents uploaded very month.

“The MeHR record has become integrated into clinical workflows and is seen as a key clinical resource for NT clinicians. This is the type of success we need to shoot for in the PCEHR on a national scale. State and territory governments will continue to invest considerably in their own eHealth systems … however, without a shared national approach to eHealth we cannot address the issues. Maintaining a national approach to interoperability now will avoid higher costs later on.”

While there were “good news stories” to tell on the PCEHR – including the increasing use of the HI Service and the more recent connection of many state hospitals to the system – there were obvious failings in the system.

“The bad news is that only a small proportion of clinicians are currently using the system," he said. "In order to reap the benefits, the government needs to make the PCEHR effective, functional and easy for all consumers to use and most importantly, for clinicians to use.

“Currently there are 32,700 discharge summaries available on the PCEHR. The big disconnect, though, in my opinion, is still around healthcare providers. Even if we have a system in which the great majority of Australians are registered, without healthcare providers at the other end actively using the system routinely to help deliver information to their patients, the system will simply be, as it is now, an empty shell.

“[The review panel] has identified some key flaws in its design and implementation and has made some recommendations on that. Regardless of past failings … the government intends to ensure that the PCEHR is fixed as quickly as possible.”

In response to last week's budget and the allocation of extra money for the PCEHR, the Medical Software Industry Association (MSIA) said it was pleased to see that the Department of Health appeared keen to tap into its expertise, as one of the key stakeholders in eHealth.

MSIA CEO Bridget Kirkham said the budget papers stated that the department wanted to “continue to work with stakeholders with regard to the recommendations from the recent review of the PCEHR to determine how best to proceed with national shared electronic health records".

"Industry is ready to begin that consultation," Ms Kirkham said. She said she assumed that the emphasis on improving productivity and greater convenience will be in addition to improving safety and patient care.

"The rationale for the PCEHR funding was exactly for those purposes, and whilst that seems to be in a holding pattern, industry is keen to explore other ways of achieving these aims which it wholeheartedly supports," she said.

"It would be useful if there was transparency around the PCEHR review and reports such as the PCEHR clinical safety audits prepared for the Department of Health by {Australian Commission on Safety and Quality in Health Care]. Visibility of the audits on the Healthcare Identifier Service, NASH and other parts of the national shared electronic health record would be useful as they would highlight where the risks are currently hidden not only from the Australian community, but also from industry.

"This government is clearly working toward a smaller bureaucracy with a greater role for the private sector which we commend. The MSIA encourages government to consult with industry to co-design solutions to ensure that IT roll outs are smooth. Through partnership we can help to get it right and get it right the first time."

Posted in Australian eHealth

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