Royle: PCEHR the right platform but better governance required
The chairman of the 2013 review into the PCEHR said he “passionately” believes that the system is the right platform to begin sharing data and better integrate the healthcare sector, but that he is frustrated that little progress has been made since.
Taking part in a panel session on transforming healthcare delivery at the Connect FutureHealth seminar in Melbourne this week, UnitingCare Queensland executive director Richard Royle said that while he believed the PCEHR could go forward with a bit of political and clinical will, it was critical that a good governance model be created to ensure it is successful.
“We are behind the eight ball in this country compared to other western countries, and yet we have a platform that we can roll out reasonably quickly with some clinical will,” Mr Royle said.
“Getting the data to integrate, getting the general practitioners to communicate with the hospital, communicate with aged care providers, communicate with pharmacy, that system has enormous opportunity to reduce the pressure on the health system publicly and privately.
“A lot of the basic stuff could be done in a far better way through the sharing of data.”
Asked by panel moderator George Margelis if he believed that the PCEHR was the platform for sharing that data, Mr Royle said he believed “passionately that it is”.
“If we are able to turn on two or three capabilities such as bringing current medication lists out of the retail pharmacy systems, bringing current pathology results and current medical imaging results, bringing those onto the screen of the GP, which is possible – it would have a huge impact on the heath system of this country. It would be enormous.”
Mr Royle said he found it frustrating that nothing has yet been decided politically on his report, which he put together in six weeks with former AMA president and current NEHTA chairman Steve Hambleton, along with Australia Post CIO Andrew Walduck, but that it was up to non-politicians to get together to drive the implementation.
“There is a group of quite senior people in this country like me who are very passionate about digital health,” he said. “I have spent an inordinate amount of time in Canberra lobbying around this issue. It is getting that group of senior people to come together and actually as a group start to have conversations with … governments and getting them to see the importance of this in a combined way ...
“If you leave it to the politicians it just won't happen, so it is getting that group of engaged and enthused people to drive this. It is about getting passionate people involved.
“What is really critical is that there is an agreement, and dare I say it a policing of the standards to ensure interoperability is workable, that's when you are going to get the success.”
However, he warned that the issue of governance was fundamental to the future success of any digital health program, and that the governance model for both NEHTA and the PCEHR has failed.
“I apologise for any members of the public service here who were involved or have been involved directly in the governance of NEHTA, but the fundamental problem has been that the national governance was not engaged directly,” he said.
“They had a structure of engagement with the health community but it actually didn't work. It was surprising to me – positively surprising – when we undertook our review, just how much support there is within the broader health industry... for the principle of having shared, basic information.
“What was really challenging was how to ensure you got a governance structure in place which represents those who know what it is that makes this work. The governance model is to me one of the fundamental successes or failures in anything you have to do with digital health.
“There are some very passionate people in this country who would dearly love to get involved directly in how this is overseen.”
Miraculous change required
Also on the panel was Tunstall Healthcare managing director Lyn Davies, who said the key to ensuring the adoption of digital health programs – including the telehealth and remote monitoring programs that her company is involved in – was clinical engagement, particularly with GPs.
Ms Davies said GPs understood that there could be good outcomes from well-run eHealth and telehealth programs, but that they needed an incentive to change their workflows if they were to take part.
She said all of the community groups that Tunstall works with are calling for a connected record such as the PCEHR, but if there is no incentive for GPs, “then you are just adding more to their day”.
“Until there is political will, and there has to be political will that sits behind the incentive program for the GP, there won't be a groundswell of support,” she said.
Group CEO of St Vincent's Health Australia, Toby Hall, said there also needed to be clinical will as well, something that he is not yet seeing for the PCEHR.
St Vincent's Health is undertaking a large technology program, including the roll out of a new EMR and PAS, but Mr Hall said he believed the company was about three years away from being digitised.
“We have a lot of hospitals and it is hard enough rolling out the same systems across the hospitals let alone digitising at the same time, but we have a program to allow that to happen across the group,” he said.
Mr Hall, who joined St Vincent's last year after a stint as CEO of Mission Australia, said that what surprised him on joining was that the technology required for sharing information was not that complex.
“You are not talking amazingly complex technology – you are really talking about an issue of will,” he said. “We've got the platforms there but people aren't willing to use them, either at the GP level or trying to get some of our clinicians to move from using paper and written things to using technology.
“We've got to win the hearts and minds of people and say this is the better way forward. That is not going to happen until people can see that there is a benefit for them in that, so we are putting a lot of focus on having our clinicians see where the technology can help them be more efficient and particularly to prevent mistakes from happening.”
Concerning the PCEHR, Mr Hall said he did not see it becoming seamlessly integrated in the next decade “unless a miraculous change happens in people's attitudes”.
“What we will see is hospitals digitise and be able to interact with the health record once our clinicians are prepared to use it,” he said.
Posted in Australian eHealth