Reflections of an eHealth early adopter

Port Broughton, South Australia-based GP Alison Edwards was an early adopter of the PCEHR as part of her interest in eHealth and in improving general practice data quality through initiatives such as the Improvement Foundation's eCollaboratives. Almost three years since the launch of the PCEHR, we ask her to reflect on progress.

Pulse+IT: What is the general reaction to and use of the PCEHR by your patients?

Alison Edwards: When we were first promoting it all, one of my patients came in and said they’ve been talking about it at the quilting group. Someone said they wouldn’t want their information where anyone could break into it, but everyone else said 'who cares, everyone knows that I’ve had breast cancer or depression or whatever'. We live in a little country town. Everyone knows whose car is parked at the doctor’s surgery.

For most people, and certainly the vast majority of patients that I’ve got, they don’t care about accessing it themselves. They just want to know that the doctors who are looking after them can access it.

I know it’s been set up very much so that the patients can access it and I think that’s a fine thing, and some health-literate, IT-literate people have been using it and think it’s great, but by far most say 'I’m not going to worry about looking at it myself, but I want to know if I go into the Royal Adelaide that they’ll be able to have a look at it'. And unfortunately I have to say that at the moment they can’t. They can post to it, but to the best of my knowledge, none of the South Australian public hospitals have got any way of accessing it.

Pulse+IT: Have you found it useful at any stage as a GP? For instance, have you received any discharge summaries?

AE: Yes, I have had one. I wouldn’t have known that it was there, except this is one of my very IT-literate patients who said they had seen it on their record. They may have been logged in and looked at it themselves. Because discharge summaries are not always received by GPs in a particularly timely way, that was the quickest that I could have accessed it, so that worked for her. I tried it with someone else who I knew had a record, but there was some stumbling block, either because it had been done as a day case that didn’t count, or because it wasn’t done as a day case that didn’t count … there was some reason why his didn’t come out. But yes, that’s a useful thing.

The other two occasions that I have actually found it useful was one patient who had got herself and her kids registered, but hadn’t gone to the GP to get health summaries done. She then moved down from Darwin and it proved an easy way of getting their immunisation data without having to log into the [Australian Childhood Immunisation Register] system. And there was a lass who had previously been a patient of mine, had moved to NSW and probably been signed up by the people that were head-hunting in public hospital outpatient departments. She had not been back to a GP to get the GP to upload anything, but I could at least access her PBS records reasonably easily and find out any of the medication she was on, if doses were changed or anything. So I have found it useful. I’m sure it’s going to get a lot more useful when more people use it and start promoting it again.

Pulse+IT: Do you also receive discharge summaries through secure messaging or faxed or posted?

AE: Generally faxed. Unfortunately, none of the South Australian public hospitals seem to have been able to get their head around the idea of Argus or Medical Objects or HealthLink, all of which we have on our desktop. The breast screen people can’t get their head around sending things electronically. The cervical cancer screening people can’t get their heads around sending things electronically. We keep whingeing.

Pulse+IT: From a technical level, do you find the PCEHR usable? Can you find things you need and does it function as it is supposed to?

AE: I’m hoping that they've resolved a lot of [the teething trouble] because the system really is quite simple once it is set up. The ART [assisted registration] processes are a lot simpler. Because we were early adopters with it, we were sending patients off to a local Medicare office which is 60km away, but they knew nothing about it, didn't know what to do. Or you'd try it online, which is what I tried to do from my end but things needed to be a perfect match. I was born in Mount Gambier but is it spelled Mount or is it Mt? And do you put in a full stop or not? By the time you have tried two or three combinations, sometimes it logs out on you. So, the actual registration process initially was a bit clunky for us but we now are doing the ART and the registration is great. I’ve done it a few times and it has been quite seamless.

Pulse+IT: Do you register patients yourself or have a nurse or receptionist do it?

AE: We’ve kind of let it sit for the moment, because it’s hard to promote something that’s got minimal usage. We’ve promoted it to all of our grey nomads and uptake from that has been good, and every now and then someone says they did register but we haven’t gone any further with it. With the initial standalone ART process I was getting one of my receptionists to do that. With the one in Best Practice it depends on who they are. My colleague is not quite up with it all, so if it's one of his patients, the staff will do it. And if it’s for my purposes, depending on how far behind I'm running, which is usually my problem, I’ll either say right, take this and read it and bring it back next time you come and we’ll get it done then, or go to the lady at the desk and she will talk you through that and then we will upload next time.

Pulse+IT: You say that once the notes are cleaned up, it's about two minutes' work on a shared health summary?

AE: Yes, the actual process of it is quite quick. The hard bit with the registration is getting them to read the documentation. Because we’ve been focused on doing this, we’ve been trying to improve our data quite considerably in the last couple of years. Probably our biggest stumbling block, because we’ve been using a computer since ’97, is that we’ve got a lot of data in there. Most of the time-consuming stuff is actually getting rid of stuff that shouldn’t been there. You know, every time they come with a cold to the doctor, it doesn't need to be recorded in their past history. There are defaults about recording “reason for visit” or “reason for script” in past history that you can easily change but there has not really been the drive to change it. Tidy records certainly make for much cleaner referral letters. It’s been a very useful process just spending the time tidying all that, but once it’s all tidied, the actual process of uploading is very quick. And if people are whingeing that it takes too long to tidy it, that’s just a reflection that they’ve not been very diligent in maintaining tidy records.

Pulse+IT: Are you claiming more C level consultations to take into account the time you have been interacting with the PCEHR?

AE: I'm a bit of a nerd with things like this so I’ve often just done it. There’s probably been a few that might have gone from a level B to a level C, but often if I start running a little bit behind, I will leave my records open and come back to them at the end of the session and finish things off. That time is no longer with the patient so it doesn't count as part of the consultation. I probably have done quite a bit of it in my own time just because I don’t mind doing it. To do it thoroughly, if you’ve got untidy records, it certainly can take probably 10 to 15 minutes. Adding in things missing from the past history list is a little more time consuming if there are significant events from years ago or surgery that has been overlooked.

Pulse+IT: Do you know how many shared health summaries you have uploaded and how many times you may have looked at the PCEHR?

AE: Yes, I had a running bet on this with [NSW GP and eCollaboratives colleague] David Guest as to who would get to a hundred first, and I whopped him. I've got about 120, 130 uploads, which doesn't sound a lot but we are a two-doctor plus registrar practice with a population base of about 3000. But probably the ones that I’ve tried looking at and had some sort of practical use from it were the ones with the discharge summary downloaded and the ACIR data and trawling the PBS. Probably about three, in all honesty.

Pulse+IT: To get this thing to a critical mass, do you think GPs will need an item number or to be paid in some way?

AE: Probably for some. History has shown that GPs will dance to the tune of the dollar, so if there is a specific item number that they can tack on and say right, well I’ve done this, they will.

Posted in Australian eHealth

Comments   

# Thinus 2015-04-21 14:48
How often have you updated those uploaded shared summaries Allison. My concern is when the patient has withheld information yet the system does not remember that choice the next time you upload - easy to send info to the PCEHR without consent when rushing around
# Terry Hannan 2015-04-21 22:53
IF I HAVE READ THIS INTERVIEW CORRECTLY this is a fairly damming critique of a system i.e. the PCEHR in that there is no evidence that it improves the patient care process. The access to effective clinical information management, the cornerstone of eHealth, would appear to be minimal or none at all. Where is the interoperabilit y, the timeliness of data and information access and the "measured outputs" of care, These are but a few observations and comments.
# Andrew ,Howard 2015-04-22 09:59
The real question is why in Christchurch NZ have hospital admissions flatlined despite a growing Aging population? This region uses an equivalent of the PCEHR to share health information across the health continuum. This interview highlights that we have an enthusiastic GP investing the effort to share information for the benefit of her patients. That's fantastic. But where is the support from the state government and private hospitals to share the discharge summary? That's basic. Governments need to get behind the massiv investments to date and deliver the information needed by all clinicians to improve outcomes.
# Jack Oster not a gp 2015-04-22 17:11
In Victoria, 84% of BreastScreen results are sent electronically
# Cathy Thiry 2015-04-24 09:59
Do you think that SA's focus on EPAS and its implementation, has come at the detriment of other e-health projects - for example PCEHR in SA?

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