Territory's MyEHR points to potential value of PCEHR: report
The feat of registering 50 per cent of the Northern Territory's indigenous population for its My eHealth Record (MyEHR or MeHR) back in 2010 appears to have been the point at which critical mass for the system was achieved, leading to a surge in clinical use and the service becoming embedded into routine clinical and administrative workflow in the NT health system, a new report has found.
The report, an evaluation of the MyEHR system carried out by Mitch Burger and Andrew Ingersoll from the National E-Health Transition Authority (NEHTA) and presented at the COAG Health Council meeting in Darwin last Friday, weighs up the benefits of the NT's system and compares them with the potential benefits of the national PCEHR.
The report concludes that the success of the MyEHR, which is currently undergoing a migration to the national PCEHR in what is known as the M2N transition, provides evidence “validating the value proposition” of the PCEHR, but highlights that the NT system took 5.5 years to reach critical mass, after which there was a noticeable upsurge in both adding to and viewing the clinical content stored on the system.
However, on current rates of consumer registrations, the PCEHR would take a further 12 years to reach critical mass, and usage figures show that even early on there were higher levels of clinical viewing and accessing of the MyEHR than the PCEHR.
The federal government is planning to move the PCEHR to an opt-out system, running trials beginning next April to find the best model. It is also planning to change the name of the system to My Health Record.
The MyEHR, formerly known as the shared electronic health record (SEHR), was first developed by the NT Department of Health in 2005 and was aimed predominantly at the indigenous population of the NT, although it is available to the wider community. In addition to the NT, it is also used by some indigenous people in central Australia and northern WA.
While both are a shared EHR, the main differences between the MyEHR and the PCEHR are that the former is not controlled by the consumer, and it is not GP-centric. Most document uploads are done by nurses and most views are carried out by hospital-based pharmacists, predominantly to check on medications.
The system aims to allow a variety of healthcare providers, including community nurses, Aboriginal health workers, GPs and hospital-based clinicians, to easily access healthcare information on consumers. It contains pathology reports – still lacking in the PCEHR – as well as overall health summaries, event summaries, discharge summaries and antenatal information.
The NEHTA evaluation shows that one of the real successes of the MyEHR has been that the vast majority of all documents viewed in the system are accessed at facilities that are not the person's place of usual care, meaning the system is fulfilling its original purpose of allowing sharing of information no matter where or what healthcare facility the person is treated in. This overcomes the limitations of point-to-point communication, it says.
It has also become embedded in routine workflow, with clinicians using the system in four different ways: targeted use, in which they are seeking specific pieces of information; investigative, where it is used in preparation for unknown patients or for recalls and tracking; opportunistic use, in which access is triggered by a prompt such as a recent hospitalisation; and supplementary, in which it is used to update the data in other clinical information systems.
Another success factor is that almost a third of all MyEHR records have been accessed by more than two providers in the last 12 months. The most viewed documents are the health profile (or shared health summary), event summaries, pathology reports, emergency department discharge summaries, inpatient hospital documents and antenatal reports.
The NEHTA report says that the evaluation provides “very strong” qualitative and quantitative evidence of the value that the MyEHR provides, including increased access to health information, reduced time spent sourcing information, support for clinical decision making, improvements to continuity of care and an increase in the capacity to deliver population-based primary healthcare. However, there is no evidence as yet of improved health outcomes.
“Importantly, providers across all professions who currently use the MyEHR service reported receiving immediate benefits,” the report says.
“For example, by acting as a bridge between unconnected clinical information systems, the MyEHR service facilitates vast flows of clinical information between different sectors.”
It has also got to the stage where consumers expect healthcare providers to use the system and to know what their medications or medical history is without having to repeat that information at each encounter, the report found.
This all provides lessons for the PCEHR roll-out, the report says. “[T]his evaluation provides strong evidence validating the value proposition of the national PCEHR system,” it says.
“With continued enhancement, benefits realisation management, and initiatives to stimulate use, there is good cause to believe the PCEHR system will become core eHealth infrastructure, and a valuable tool for clinicians.”
NT Health Minister John Elferink said that the evaluation showed for the first time in Australia that there was strong evidence of the benefits of eHealth records in bridging the gaps in information that occur as patients move between different healthcare providers.
Mr Elferink said the NEHTA evaluation provided a clear case in support of the national PCEHR system.
“The Northern Territory government is committed to providing the highest level of care to Territorians and we are extremely pleased to be leading the way with online health records,” he said.
"The evaluation showed that eHealth records reduced the time clinicians took to find information, and supported improved clinical decision-making and continuity of care for patients.”
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