PCEHR consultation report released, Deloitte refresh delayed

The Department of Health has publicly released a report compiled by Deloitte Australia summarising the outcomes of a series of public consultations held last year about the recommendations of the Royle review into the PCEHR.

Deloitte and the department held 37 consultation workshops around the country between July and September 2014, along with an online survey. The workshops were aimed at gauging the opinions of consumers, healthcare providers, software vendors and other stakeholders about the recommendations of the Royle review, completed in December 2013 and released publicly in May 2014.

The results were used to inform the federal government's plans for the PCEHR, including whether to retain the system, whether to move to an opt-out model, how to increase participation in the system by both consumers and providers and any new functionality that would be considered useful.

While the consultation report was made available (PDF) this month, Deloitte long-awaited refresh of the 2008 national eHealth strategy has not. A draft of the refresh was provided to the PCEHR review panel, but according to a spokeswoman for the department, the full strategy is still being developed.

“The eHealth strategy is a national strategy and is the result of collaboration between the commonwealth and state and territory jurisdictions,” the spokeswoman said.

“Work is currently underway with states and territories to finalise the national eHealth strategy which will include updates to reflect the recent federal budget announcements in relation to eHealth.

“The eHealth strategy will then require consideration and approval by the commonwealth and state and territory health ministers before being published, potentially later this year.”

In this year's federal budget, the government tipped in an extra $485 million to keep the system going for the foreseeable future, but said it planned to change the name to My Health Record, set up a new Australian Commission for eHealth to replace NEHTA, and most importantly to change from an opt-in to an opt-out system, which will require a number of legislative changes.

The department recently released a discussion paper on those changes, with submissions closing last week.

To date, submissions made publicly available include those from the Royal Australian College of General Practitioners, the Australian Primary Health Care Nurses Association, the Royal Australian and New Zealand College of Psychiatrists, and the Australian Privacy Foundation.

Consultation report findings

Deloitte's public consultation paper states that the “overwhelming conclusion” from the workshops was that a significant majority of those consulted supported the concept of the PCEHR and wanted to see much more widespread use.

There was also a great deal of support for the recommendations of the review panel, including support by consumers for a move to an opt-out model and for the access and privacy controls already existing in the system, even if few of them planned to use them.

And while clinicians also overwhelmingly said opt-out would remove some of their concerns over the efficacy of the system, they said a move to an opt-out model by itself would not deliver meaningful use.

Instead, clinicians were convinced that any benefits from the PCEHR would arise from a “virtuous circle” of contribution by other clinicians.

“Meaningful use will only come through the utility of the record and everybody in the continuum of care contributing in a virtuous circle to the record,” the report states.

“Concerns were regularly expressed amongst providers, that moving to an opt-out model will result in the majority of consumers having a record but will not in itself drive meaningful use by providers or consumers.

“Meaningful use will only be driven by the record delivering value to providers and consumers. Providers will receive value from the record if it contains useful content that assists in the delivery of care and when the record is easy to access and use.

“GPs, in particular, feel that they are the primary contributors to the record to date and that they derive limited benefit from this contribution. Other clinician groups (in particular allied health) have limited capacity to contribute but would like to do so.”

The highest priority for both providers and consumers was getting the content right, and this meant the inclusion of accurate and up-to-date alerts, allergies and medications. The report states that while there is a number of medications information sources in the PCEHR, including PBS data, event summaries, and prescription and dispense data, this is very difficult to reconcile into one list of current medications.

Clinicians also had concerns about the utility of the system, which the report says were primarily driven by the poor integration that software vendors had implemented.

“This has resulted in very little automation of the accessing of PCEHR information and poor alignment to clinical workflows resulting in impacts on provider time and making it difficult for providers to find information and to upload information,” the report states.

“While some software providers have since improved their software, these initial versions have left a poor impression with many providers resulting in them being reluctant to continue to try to use the PCEHR.

“It will be critical to address these issues of record utility prior to a move to an opt-out model to remove the barriers to provider participation. If the system remains difficult to use when and if an opt-out model is introduced, providers will remain reluctant to use the record and consumers will not realise the benefit of having a PCEHR.”

Software vendors for their part wanted an end to the stop-start process for implementations and specifications, sufficient lead time to test standards compliance, and a robust, transparent black-box testing process.

They also felt their expertise in the development of standards and specifications had been ignored.

What they wanted to see was a clearly defined roadmap of the planned PCEHR development over the next three to five years describing when new functionality will be implemented in the PCEHR, when new standards are available or standards will be changed and when standards compliance will be required “with sufficient lead time for development and testing”.

“Vendors are willing to innovate around the PCEHR and implement new functionality to use the data in the record, but ultimately this will be driven by the demands of their users,” the report states.

“In the absence of this they appear to have little incentive to undertake the cost of functional development. To enable innovation, vendors will need easy access to increasingly atomic data from the PCEHR through infrastructure that supports traditional and mobile device access and will also need to understand a more clearly defined (and adhered to) roadmap for the planned development of the PCEHR.”

Summary of findings

  • Need to articulate a clear end game for the PCEHR and a roadmap to reach that point, which is also a critical requirement for software vendors
  • Communication that is targeted and delivered consistently across time is needed to rebuild momentum and engagement – the report found that many providers had not heard of the PCEHR and even fewer consumers
  • Consumers overwhelmingly support the concept of an opt-out model, and their greatest concerns are that healthcare providers may elect to opt out
  • Issues of information security and misuse still exist but are not predominant concerns
  • Clinicians said the near universal usage envisaged with the move to an opt-out model removed a part of their concerns but clinical utility needed to be fixed
  • Usability improvements for clinicians ranged from the actual interface and integration into existing workflows to clarification of issues of consent in the use of information in an opt-out environment, clarification of medico-legal issues and reliance on the record as part of the clinical process
  • The majority of consumers and some providers strongly believe that provider participation should be made mandatory or at the very least also move to an opt-out model of participation to drive provider participation and contribution of information to the PCEHR
  • The majority of consumers said they were unlikely to use the controls to block access to their record, or to particular documents in their record, except in very special circumstances.

Posted in Australian eHealth


0 # David Wrede 2015-07-01 08:44
This report tells us nothing we did not already know (how much were Deloitte paid this time?) It is frustrating that the presentation is again to spin the unquestioned acceptance of the strategy of creating a PCEHR as an early goal of an overall e-Health initiative. We can all imagine the perfect result and the benefits that would/might(?) flow from a successful outcome. The difficulty is getting there and having the software vendors referred to in the first recommendation rather than the users (sixth and soft recommendation) shows lessons have not been learned. It's the USERS stupid (see http://mikebracken.com/blog/the-strategy-is-delivery-again/) Apple know this Google know this, and unless the question of modern, slick, intuitive interface and back end software is not central to PCEHR2.0 we will move from 20% of people being able to use the system to about one third… Questions of privacy and security continue to be played down, but recent hacks of health systems in the US and Government software around the globe, show that this is not yet solved either.
Deloitte - C+ could do better, PCEHR2.0 - must do much better than that produced with the first $500m.
0 # Cris Kerr 2015-07-07 08:02
What is the primary purpose for the PCEHR?

Ill-defined purpose (see below), will always result in ill-defined goals and outcomes and associated ill-defined activities.

2.2 Purpose of the PCEHR system
The purpose of the PCEHR system is to address information fragmentation by allowing a person to more easily access their own health information and make their health information securely accessible to different healthcare providers involved in their care: http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/Content/pcehrlegals-document-toc~pcehrlegals-document-ch02

'The Conversation': Cris Kerr re eHealth
0 # Sophia Avery 2015-07-07 12:23
The unanswered questions for me remain around privacy and security. This project being in private hands, with a (presumably for-profit) private company NEHTA guiding the implementation, apriori creates a setting of mistrust, for me at least. What is next, floating on the ASX this company which 'trades' in complete health data of all Australians? What an excellent strategy to become a sole information broker in the health space, like Veda or Dun&Bradstreet are in the financial space.

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