Senate committee queries delay over decision on PCEHR review

Greens health spokesman Richard Di Natale has questioned the federal government's delay in responding to the recommendations of the Royle review into the PCEHR, saying he understood momentum for the system had stalled and GPs had gone cold.

Department of Health officials told a Senate Estimates community affairs committee hearing in Canberra yesterday that the government had yet to respond to the recommendations of the Royle review, which was completed in December 2013 and released publicly by former health minister Peter Dutton in May 2014.

Asked for an update on progress on the system, the secretary of the Department of Health, Martin Bowles, said a decision on the recommendations of the Royle review, whether there would be ongoing funding for the PCEHR and whether the National E-Health Transition Authority (NEHTA) would be closed was still before government.

Senator Di Natale said he was “waiting with bated breath” for a resolution to the future of the PCEHR, which he described as an important reform.

“What was Mr Dutton doing for all of the time he was health minister?” he said. “Seems like he was sitting on a lot of reports. You've got to wonder.”

For the first time, the department also released figures on how many healthcare practitioners were using the PCEHR. DoH first assistant secretary for eHealth Linda Powell said there were 10,721 individual practitioners registered to use it from 7645 healthcare provider organisations.

Senator Di Natale asked the department to provide figures on how many individual practitioners and organisations were registered out of the total number that would be eligible. The department took the question on notice.

“The sense that I get is that momentum has completely stalled in this, that GPs have gone cold on it, there hasn't been much progress,” he said. “I'm asking because I think it is important, I think it's a really important reform. Is that consistent with what you are seeing? Are the number of clinicians who are actually accessing the PCEHR – has that plateaued?”

Ms Powell said the department was “finding that the number of documents that are loaded into the system continues on a slow but steadily upward trend”.

Ms Powell provided a breakdown of where funds from the $140 million provided in the 2014-15 budget were allocated. $82m went to DoH to operate the system, $21.8m went to the Department of Human Services, and $2.3m to the Office of the Australian Information Commissioner. The federal government's contribution to NEHTA for the year was $34.4m.

She said the PCEHR cost $233m to initially establish, with funding for eHealth over the four-year period between 2012-13 and 2015-16 totalling $538m.

Ms Powell also said that $28 million had been set aside to operate the PCEHR beyond the end of this financial year. However, Mr Bowles said any decision on further funding was still with the government.

Senator Di Natale voiced his concern over the government's delay. “We had an announcement in 2013 that there would be a review, we spent six months hanging around for the outcome of that review, we got the review half way through the year, we are now coming into March…” he said. “This is supposed to be the thing that is going to take healthcare into the 21st century and beyond, and we still don't know what we are doing with it?”

Health CIO Paul Madden said the department had carried out consultations in 2014 on the recommendations of the Royle review. “The outcomes of that consultation have been provided as input to the decision for the government, which they need to decide on,” he said.

Posted in Australian eHealth

Comments   

# Terry Hannan 2015-02-26 13:41
All one can say is "Oh dear, what a mess"! For readers to get an understanding of the public and professional use and perceptions of the PCEHR (i.e. those who are supposed to use it) readers should see the audience's response to the question about the PCEHR on INSIGHT shown on the 24th February 2015. A cacophony of "WHAT'S THAT?"
# Kate McDonald 2015-02-26 13:46
Watch Terry in action on Insight here: http://www.sbs.com.au/news/insight/tvepisode/saving-health

Jenny Brockie's reaction to the fax question was pretty good too.
# Phil 2015-02-26 15:10
Seems like their response to this ongoing issue is like most other things under this governments watch....chaos!
# Diane 2015-02-27 04:31
Terry, it isn't just that people don't know what PCEHR is, it's also that we don't trust it. Our health data is too sensitive to be putting it in online systems that *will* be hacked.

Ehealth is for things you would tell a stranger at a bus stop, nothing else.
# Simon 2015-02-27 10:18
They need to stop counting the number of consumers signed up and the number of records uploaded. Money buys you that. They need to count the number of times GPs have accessed the PCEHR in the course of treating patients.

If the system is not trusted, it will not be used.

An incomplete health record can be a dangerous health record.
# Terry Hannan 2015-02-27 10:33
To add to Simon's comment here is a list of fundamentals for the successful implementation of eHealth systems.
The last criterion being the most important.

• COLLABORATION:
• SCALABILITY / SUSTAINABILITY:
• FLEXIBILITY:
• RAPID FROM DESIGN:
• USE OF STANDARDS:
• SUPPORT HIGH QUALITY RESEARCH:
• WEB-BASED AND SUPPORT INTERMITTENT CONNECTIVITY:
• LOW COST: preferably free/open source
• “feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL(Patients included) it will not be used. “(1)
1. Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C, et al. Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2006:529-33. Epub 2007/01/24.
# Phil 2015-02-27 11:14
But the only reason it isn't populated and therefore clinically useful is because doctors won't upload to it. They are the custodians of your information but refuse to upload when we ask and yet complain about it not being clinically useful. Now pay them and watch the avalanche of shared health summaries appear. Who is playing with who here? Its my data and yet my doctor refuses to upload the data I have requested because they believe the system is safe. I am the customer or am I?
# Cassandra Jordan 2015-02-27 12:03
The criterion listed by Professor Hannan are important. As a qualified Health Information Manager I need to add that the inclusion of our profession, Health Information Management of Australia, and colleagues is important too. The protection of patient information is paramount. The information must be considered credible to be clinically useful. Thanks for all the interesting comments.
# Robyn 2015-03-11 20:55
I've watched the SBS Insight program twice and written about the values of eHealth. http://theaimn.com/ehealth-and-the-silo-culture-of-medicine/

We need to get this happening and happening properly. As a patient, I was very disappointed in the usability of the system and some of the information I learnt watching the Insight program worried me even more.

As someone with multiple health providers, an eHealth system is vital to me, yet I am another patient who has to create my own hardcopy file to cart around with me.
# Terry Hannan 2015-03-11 22:37
Robyn, a very good posting as I was on the program. Can you post some of the specifics that worried you? It is good to receive the perspectives of the most important "clinicians" in the health care system-YOU the patients.
There are core principals associated with success and one of these projects is openmrs. Have a look at www.openmrs.org.
Depending upon the level of complexity I would be happy to share materials with you and even give you an e-summary record format that YOU can complete and update.
I am happy for you to use my email address terry.hannan@dhhs.tas.gov.au
# Helen Robertson 2015-03-14 19:22
Remarks on the whole PCEHR experience and particularly considering Phil's second comment; I'm registered as a patient and I'm also registered as a GP to up load to it; I up loaded things for a couple of patients just to see what it was like. Very few of my patients locally are registered (I can tell because, as I'm registered, my computer indicates their status). I would up load things if the process was fully funded. To up load a summary (for example) I would need to tidy up the medication list and past history list and make sure all appropriate diagnoses were included and no duplications. This could take an extra 15 minutes with some cases, checking history with patient. There's no time in the consultation they have booked and I'm not going to do it in my time off. Phil's right, if the doctors were paid to do it a lot more would be up loaded. It is his data but he's asking some-one else to do the work for free.
# Phil 2015-03-14 21:38
Yes it is my data but you control it and I'm not allowed to upload, so I cam caught in the middle.
The whole PCEHR is going nowhere. This Minister couldn't care less about the PCEHR, The Royle Review languishes in no mans land, there are as many vested interests wanting it to fail as want it to succeed. Having spent the last 3 years truing to involve GPs and specialist in telehealth and the PCEHR, I can tell you the majority don't care. It will wither and die over the next 12/18 months, particularly if NEHTA is abolished and as I suspect not replaced.

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