NEHTA continues PCEHR development despite cloud over future

The National E-Health Transition Authority (NEHTA) is continuing with plans to improve and add functionality to the PCEHR, despite a recommendation in the Royle review that the agency be dissolved and its role transferred to a new statutory authority.

Internal communications seen by Pulse+IT show that NEHTA plans to create a new PCEHR landing page in clinical information systems that would improve the current document list and enhance clinicians' view of pertinent information.

A meeting of NEHTA's clinical usability program (CUP) steering group is also planned for July to discuss how to develop a communication strategy to create greater engagement for eHealth and the PCEHR and develop educational strategies to address what it says are misconceptions about the uncertain future of the PCEHR, the usability of software, medico-legal and liability issues, and who to call when assistance is required.

NEHTA's future has been under a cloud since the release of the Royle review last month, which recommended that the organisation's current overarching role be dissolved and that a new Australian Commission for Electronic Health (ACeH) be established with a board that includes representatives who are actively using the PCEHR.

The review states that the current board of NEHTA is predominantly comprised of the state and territory health department directors-general as well as the secretary of the federal Department of Health. It also has two independent members, including chairman David Gonski.

The review found that while this was appropriate in the early phases of NEHTA and the development of the PCEHR, “the board membership did not change to match the role expansion that has occurred”.

The review also repeated criticisms from the medical software industry, medical associations and clinical groups that there was a lack of transparency in the decision-making process for the PCEHR within NEHTA, and that NEHTA's governance structure does not have the confidence of the industry.

“The review has heard from multiple medical industry associations and software providers,” the review panel wrote. “A strong theme of constraints being imposed on the industry due to the centralist approach taken with the PCEHR, has been shared.

“A perceived centralist approach, led by NEHTA and the Federal Department of Health has been identified as reducing confidence of the private sector to invest in product development and evolution, reducing the willingness to collaborate given multiple comments that information was often shared with NEHTA with little received in return.”

NEHTA is an agency of the Council of Australian Governments (COAG) and comes under the responsibilities of the COAG Standing Council on Health (SCoH), made up of the state, territory and federal health ministers.

SCoH is also responsible for the national partnership agreement on eHealth, which expired on June 30, 2012. While that agreement was not renewed, a memorandum of understanding (MOU) on eHealth was signed by all state and territory health ministers and the former federal minister for health, Tanya Plibersek, in June last year.

That MOU is due to expire on June 30 this year, as does funding for NEHTA, unless an extension can be agreed upon. That will not require that the SCoH meet in person – the council generally meets only twice a year, the most recent meeting being held in April – but neither the new minister for health, Peter Dutton, or the Department of Health would detail the next steps.

A DoH spokeswoman said that as announced by Mr Dutton recently, “the government will continue considering the PCEHR review recommendations over the coming months to understand the issues, their implications and in consultation with key stakeholders, determine the best ways to deliver on the intended outcomes.

“This includes the recommendations to change and strengthen the PCEHR governance arrangements.”

Mr Dutton told a conference in Sydney last month that there were key themes in the submissions to the review that were reflected in the report and its recommendations.

“Three of these are firstly the governance of the PCEHR and and eHealth more broadly and that needs to be fixed,” Mr Dutton said.

“It needs to be strengthened and 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.

“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.”

While he did not confirm it, Mr Dutton intimated that part of the $140 million allocated in the May budget to the operation of the PCEHR could be used to continue NEHTA's funding until a decision on its future is made.

“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...” Mr Dutton said.

“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.

“We’ve got some contractual arrangements in place that would have seen a cost to the Commonwealth had we not proceeded. This 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.”

NEHTA refused to respond to a detailed list of questions about the next steps for the PCEHR, including plans to add extra functionality such as pathology results or diagnostic images, and refused requests for an interview with NEHTA CEO Peter Fleming. NEHTA has not responded to any questions about the PCEHR since November last year, when Mr Dutton first announced the review.

However, according to internal emails seen by Pulse+IT, a meeting is planned for June 26 to discuss the creation of a landing page within the information systems used by clinicians.

This would include measures that would improve the document list to highlight documents added since the last shared health summary (SHS) was written. It would also include options for the SHS to be the landing page, depending on the use case for the doctor and patient, and to enhance the viewing ability to ensure all documents are able to be viewed easily including pathology and diagnostic imaging, and Medicare data.

The steering committee for NEHTA's CUP program is also due to discuss how the group can commence increasing the use of the PCEHR by providers, particularly concerning the uploading of clinical documents.

This has been a sticking point for the system since software became widely available that allowed clinicians to actually contribute data to the system. While public hospitals are increasingly adding discharge summaries to the system – Queensland, South Australia, some hospitals in NSW, the ACT, Tasmania and Victoria now have that capability – the amount of shared health summaries being uploaded by GPs has ground almost to a halt.

NEHTA plans to hold a workshop in Sydney in early July, an internal email shows, with the aim of confronting two areas that need strategic action: barriers to adoption that are creating a perception that there are no benefits for eHealth, particularly to GPs; and data quality.

The workshop plans to discuss:

  • Developing a communication strategy to create greater engagement for eHealth and the PCEHR
  • Supporting peak bodies and colleges to develop education strategies regarding eHealth, including developing programs that attract CPD points and “on the job” learning
  • Developing educational strategies to address misconceptions about the uncertain future of the PCEHR and the usability of software
  • Publishing successful patient outcomes and case studies relating to the use of the data from the PCEHR such as discharge summaries for changed medication prescriptions
  • Working with the standards setting bodies to review current standards related to data quality specific to eHealth.

It also plans to look at mechanisms to retain the current Medicare Local eHealth workforce to provide continued support to general practices. As reported recently, funding for the Medicare Local eHealth programs has been cut.

Posted in Australian eHealth

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