HIC2015: Towards meaningful use of the PCEHR

From next year, GPs will likely be required to actually use the PCEHR to continue to be eligible for the eHealth Practice Incentives Program (ePIP), but the federal government is also banking on the proposed move to an opt-out system to encourage a broader range of healthcare providers to take part.

Federal Health Minister Sussan Ley told the Health Informatics Conference (HIC 2015) in Brisbane yesterday that the eligibility requirements for the ePIP were currently being reviewed, and changes will require doctors to use the system to continue receiving the incentives, not just show they have access to it.

“They may, for example, be required to upload shared health summaries for a proportion of their patients, and we will be consulting with peak bodies on these changes,” Ms Ley said.

Meaningful use of the PCEHR and other forms of electronic health records was also the main topic of conversation during the annual Q&A event at HIC earlier in the week, hosted as in the past by the ABC's Tony Jones.

Q&A panellists included Paul Madden, special adviser for strategic health systems and information with the Department of Health; David Hansen, chair of HISA and CEO of the Australian eHealth Research Centre; Michael Cleary, chair of HIC 2015 and chief operations officer of Queensland Health; Nilmini Wickramasinghe, chair of health information management with Epworth Healthcare; and Doug Fridsma, CEO of the American Medical Informatics Association.

While Mr Jones said he had hoped to extract some new information for the audience on the four trial sites for the opt-out system, Mr Madden said the federal and state health ministers would be meeting in Darwin on Friday and news on the sites was not expected until next week.

With uptake through the opt-in system at about 10 per cent of the population after three years in operation, Mr Jones asked Mr Madden if opt-in had been a “fatal mistake”.

“I don’t think it was a fatal mistake,” Mr Madden said. “With every step you take there is always going to be a first one … and if you had put this out as an opt-out system on day one, and you turned up with the results that we have now, that would have been fatal.”

Dr Cleary said getting the PCEHR in place with an opt-out option would be “a huge step forward” from a policy perspective. “It means that in Australia, people are comfortable now to have their information uploaded,” he said. “This is a significant change for lots of people.”

In addition to seemingly low take-up by consumers under an opt-in system, one of the other main problems that has plagued the PCEHR since its inception has been lack of use by clinicians, with only a small number of shared health summaries uploaded over the last three years.

As it was the US that popularised the term 'meaningful use' of EHRs, Dr Fridsma was asked to explain the meaningful use provisions of the US HITECH Act, a $28 billion part of the overall $900 billion stimulus package introduced by US president Barack Obama in 2009 to help fend off the worst of the global financial crisis.

The policy was hugely successful, Dr Fridsma said, in that it saw the use of electronic health records by US doctors go from 17 per cent in 2009 to about 80 to 90 per cent of hospitals now using EHRs with sophisticated clinical decision support and electronic prescribing.

In addition, about 60 per cent of primary care practices are now using electronic health records, he said.

While this is a different situation from Australia – it is estimated that over 90 per cent of Australian GPs use an electronic system and have done so for some years, and it is the hospital sector that is lagging – Australia is now likely to follow the US in requiring the systems be used, rather than just installed.

“The scope of change has been really remarkable,” Dr Fridsma said. “Meaningful use was tied to clinical outcomes, so it wasn’t money to simply install the systems – it was money that a physician or clinician got as a result of demonstrating the use of a product to write a prescription or to manage diabetic care …

“By aligning the reimbursement with the actions you want the doctors to take, whether it’s a $28 billion investment as part of a stimulus package or something tiny like saying we’ll give you $1 for care if you use an electronic health record but we’re only going to give you 80c if you use paper ... those are levers that have a dramatic effect on behaviour.”

However, in addition to things like targeted incentives, Dr Fridsma said there were some very powerful forces that will prompt behaviour change in the very near future, especially generational change and consumer demand.

“When I think of the generation of doctors that are coming through, the way we do travel reservations and all the other aspects of our life, those are forces that are going to be far greater than anything else that will happen in the healthcare sense,” he said.

“To me it’s not a question of if but a question of when. As healthcare providers and a healthcare community, it is our job to clear the path for folks because if you don’t put in an electronic health record, our phone will become our electronic health record.

“There are a whole host of things happening outside in society, and it's not a question of it but a question of when. We can either celebrate that by getting information out and realising that it's not perfect, but we can't let [striving for] perfect end things.”

Responding to Professor Wickramasinghe's comments on data quality and a lack of trust in the data held by EHRs holding back their adoption in hospitals, Dr Fridsma said the best person to look at the data is the patient. “If they see the data they will correct errors,” he said.

Dr Cleary agreed that generational change would be a powerful driver. “Healthcare is a bit slow to change but the drive for change will come from two things,” he said.

“One is activated consumers who want to have systems in place so they have all of the information on their mobile device – and I think that’s a very reasonable driver for change – and the second is going to be the workforce itself. Clinicians are wanting to have simple, easy to use, rapidly deployable systems in place.”

Mr Madden said the plan was to reassess incentives for using the PCEHR from next year, changing the requirements from simply installing conformant software to requiring actual use.

“We've gone down this path for a while,” he said. “To get access to incentives on an annual basis, the software has to conform. What we have done is we've got the incentive pitched towards the users of the system, so we are not [giving money] directly to the software vendors to do things, as we are trying to inspire users to demand this from their suppliers.

“What we have done is put in the incentives to say the systems you use need to be capable of interoperability and if your system does you are eligible for an incentive, and from next year it will be for using it as well.”

Asked whether the department will measure the success of the trials purely in terms of take-up, Mr Madden said there would be a number of markers.

“Based on international experience we'd expect that one per cent would opt-out, so that is a target that we need to measure for the confidence of the community,” he said.

“The other measure is take-up and use by the GPs, specialists, private and public hospitals, pathologists, radiologists, allied health. The theory is that if the majority of my patients have got one, then I will use it for my patients.”

Posted in Australian eHealth

Comments   

# Dr Horst Herb 2015-08-07 23:05
Well, Minister Ley can deposit her ePIP where only a colorectal surgeon will be able to retrieve it.

Apart from the technical disaster the PCEHR infrastructure consists of, I would be unethical and unprofessional in betraying my patient's trust by submitting their confidential data int a repository that lacks even the most basic defence against access against the patient's interest, eg by overly broad subpoena which seems to be the rule for subpoenas in Australia.

Unless the privacy issue is not fixed (eg by exempting the PCEHR completely from any subpoena) and prohibiting any commercial reason (eg by insurance companies) from excusing access I will never use the PCEHR and keep discouraging all my patients from it (ant teaching them how to opt out of course)
# Tim Rankin 2015-08-10 22:30
One of the very few assets we GPs have left are our clinical records. Goodwill is almost worthless, only the records we hold give any concrete value to our practises. PCETR effectively nationalises our practises without compensation. Wonderful.

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