ACRRM supports moves towards meaningful use of PCEHR

The Australian College of Rural and Remote Medicine (ACRRM) has come out in support of moves by the government to transition from rewarding GPs for connecting to the PCEHR/My Health Record to actually using it, but says meaningful use must be predicated on the creation of a clinically relevant and operational system.

The college also believes that changes to the changes to the eHealth Practice Incentives Program (ePIP) and those outlined in the government's recent legislation discussion paper must be considered in association with the wider policy deliberations about primary care currently taking place.

ACRRM president Lucie Walters said the college welcomed the re-examination of the ePIP and supports a transition from rewarding GPs for establishing the ability to connect to the MyHR to actually using the system to upload health summaries of consenting patients with the most to gain – those with chronic and complex conditions.

“This is an essential step in sharing information with other health professionals and the patients themselves via the system,” Professor Walters said. “Clearly, other strategies are required to support other health professionals to participate fully.”

Professor Walters said the significant policy deliberations currently taking place at the federal level could also potentially affect GPs and eHealth use.

These include the work of the Primary Health Care Advisory Group (PHCAG) and the MBS Review Taskforce, which are exploring changes to the funding and administrative models associated with the management of chronic disease.

“This is an area where there are potentially close links with the My Health Record and eHealth initiatives generally,” Professor Walters said.

“In addition, the National Strategic Framework for Chronic Conditions is currently being developed and will be informed by the work of parallel work streams and these government reviews.

“eHealth is an essential consideration and the outcomes of this work will be aimed at policy makers at all levels of government, peaks and health professionals who care for people with chronic diseases.”

While other medical groups have outright opposed linking 'meaningful use' of the MyHR to the ePIP by means of a targeted number of shared health summaries uploaded, ACRRM has taken a more measured approach.

“The Practice Incentives Program (PIP) was initiated to encourage short and long term changes to general practice through a form of blended payment,” Professor Walters said.

“It was designed to complement fee-for-service by providing another funding stream for eligible practices, which met quality and accreditation standards on the assumption that incentivising enhanced quality of care, in addition to fee-for-service, will facilitate improvements in health outcomes.

“Whilst the ePIP incentive was successful in encouraging the majority of practices to become ‘My Health Record ready’, a much smaller percentage actually used the system, due to a range of issues, including clinical usability and utility, uncertain medical leadership, controversy and political uncertainty.”

The government has since committed itself to a redeveloped PCEHR and to changes recommended by the medical profession and others as part of the PCEHR review, she said.

ACRRM has also since become an active participant in redefining clinical usability and content via NEHTA's clinical usability program (CUP) and other arrangements. As such, Professor Walters said, ACRRM supports the move from rewarding GPs for establishing the ability to connect to the MyHR to active and meaningful use of such health information.

“ACRRM believes that meaningful use is predicated on an efficiently configured, clinically relevant, secure and operational system,” she said. “Meaningful use comes from the curation and sharing of appropriate health information and the use of that information by clinicians to who provide clinical care for these patients and by the patients themselves and their support network in improving self management of their conditions.

“The ePIP could be amended to encourage and incentivise participation in the MyHR, by rewarding uploading shared health summaries by general practice as an early step in establishing meaningful use of clinical information.”

She said broader issues as outlined by the AMA in its response to the ePIP changes could form key points for the Australian Commission for eHealth (ACeH) to address when it comes into being.

Rural doctor and ACRRM Fellow Ewen McPhee (pictured above, left) has been appointed as a clinical representative on the implementation taskforce steering committee set up to guide the development of ACeH, a decision that Professor Walters warmly welcomed.

“It will be important that the Commission has the scope and latitude to engage and design a National eHealth Strategy that addresses privacy; quality and meaningful use focused on delivering improved health outcomes for Australians.”

She said a curated shared summary is a key ingredient for improved care between teams at this time, and that as general practice should be the repository of truth for patients with chronic disease, ACRRM's submission identified that the meaningful use of eHealth must be about improving communication of care needs and goals with others in the care team.

“Pragmatically we cannot 'throw the baby out with the bathwater',” she said. “There has been major investment of public funds, and we have a duty to guide integration of eHealth into day-to-day care. Nowhere is this more critical than in rural and remote, resource-poor areas where health outcomes are poorer than that in metropolitan and provincial areas.

“The future will be about ensuring that a core dataset of real time measures is available across sectors to underpin decision support, quality and safety, reduced duplication of investigations. However right now we need to underpin this with a common shared and agreed care plan for those with chronic disease and disability.

“An available curated relevant shared health summary must be the foundation and we cannot have meaningful use if there is nothing for health teams, specialists and other professionals to utilise and respond to in their deliberations.”

She said ACRRM would encourage the new ACeH, the MBS review and the PHCAG to set a common theme around shared data, remote consultation, and home monitoring so that the healthcare sector can reduce the equity gaps that rural and remote people are challenged by every day of their lives.

Many of these issues will be up for discussion at the eHealth stream being held as part of the Rural Medicine Australia (RMA) conference in Adelaide from October 22 to 24.

Dr McPhee and another member of the ACeH implementation taskforce steering committee, former AMA president and current NEHTA chairman Steve Hambleton, will debate some of these issues as part of the forum. Dr Hambleton is also chair of the PHCAG and on the MBS review committee.

The forum will debate which are the key issues and opportunities arising from the National Reform Agenda and consultation that will affect rural and remote practice.

Considerations will include:

  • eHealth reform – MyHR and telehealth
  • Primary care reform – How do we ensure quality practice
  • Financing – MBS review, blended payments, incentives such as PIP, SIP, and MMM)
  • How do we avoid the ‘gaming’ and perverse outcomes which can be associated with the MBS
  • The chronic conditions strategy framework.

Posted in Australian eHealth


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