NEHTA visit: not exactly Khrushchev vs Kennedy

NEHTA visitMy email inbox was overflowing, there were text messages wishing me good luck, journos calling and a press photographer was rocking up at the practice. On Twitter NEHTA’s visit had been dubbed ‘Khrushchev vs Kennedy’, others said that Geraldton was like the little Astrix & Obelix village, resisting the mighty Roman legions of Julius Caesar with the druid Getafix’s magic potions. But the analogies turned out to be wrong (in a good way)…

Dr Mukesh Haikerwal and Dr Nathan Pinskier, the two prominent clinical leads working with NEHTA to get the PCEHR off the ground, had decided it was time to visit us in the west. Also present at the Meeting was AMA(WA) rep Michael Prendergast, Panaceum Group partner Dr Elly Slootmans, CEO Richard Sykes and our operations manager Louise – who has spent about 100 hours earlier this year to get the practice PCEHR-ready before we realised that the risks of signing up would be too high for the business and the doctors.

Dr Mukesh Haikerwal

Mukesh Haikerwal

The good

Mukesh, or ‘Mr eHealth’ as some are calling him, gave a persuasive presentation about the PCEHR, including the challenges ahead. His team is working on an interesting program called CUP (Clinical Utilities Program) to iron out the problems clinicians are facing when getting started or working with the national eHealth record system.

Mukesh and Nathan made a strong case for the PCEHR, including potential benefits such as electronic referrals, discharge summaries, ePrescribing, encrypted messaging etc. They seemed very aware of the issues and are putting in a lot of effort to fix them so the PCEHR eventually becomes a tool that makes our lives easier.

Concerns

After the presentation we had a good debate about some concerns, such as the legal framework of the PCEHR and the governance issues. Interestingly, many of the concerns are not technological but, as our CEO Richard explained, if we don’t resolve them, practices will find it difficult to sign up no matter how good the PCEHR software will be.

NEHTA visit

Michael Prendergast (AMA), Nathan Pinskier (NEHTA), Richard Sykes (Panaceum)

We talked long and hard about the PCEHR participation agreement and why this document is the reason many health care organisations will not sign up. Michael Prendergast explained the pitfalls of signing these kinds of contracts without legal advice.

Other topics we discussed were the lack of indemnity insurance cover for the (harsh) civil penalties related to the PCEHR, the IP data rights problem, and secondary use of data in the system.

We know about the benefits of the PCEHR for patient care, and indeed there are many, but what has been missing is a proper debate about the other ways the data could be used; the PCEHR Act 2012 mentions eg ‘law enforcement purposes’, ‘other purposes authorised by law’, and research. Do the PCEHR Quiz if you want to know more.

The way forward

I was very pleased to see that Mukesh and Nathan acknowledged these problems and understood that we – and many other clinicans – cannot go ahead before this has been sorted out. Michael was very helpful and will take the issues back to the AMA.

It was a pleasure to talk to these tech heads and it once again became clear to me that this is a journey that will take many years. For the first time I saw some light at the end of the tunnel. Khrushchev vs Kennedy wasn’t the right analogy because our interests are not opposed, but I’d settle for ‘Roosevelt & Churchill’. Modesty is my best quality (~ Jack Benny).

Mukesh and Nathan, thanks for listening!

14 thoughts on “NEHTA visit: not exactly Khrushchev vs Kennedy

  1. Hi Edwin,

    Just one question. What specifically did Nathan and Mukesh say they would actually do to address the issues you raised?

    They have been acknowledging the problems for years but not much seems to change.

    Cheers

    David

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  2. So your very comfortable this wasn’t a box ticking exercise pre- election?
    What hard endpoints in resolution on key issues were agreed too?
    I think it’s great that Nathan & Mukesh came and spoke, we trust clinicians, but will it lead to change? Keep up the good work.

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  3. Thanks for asking Edwin.

    There is a place for all Doctors to be involved in the PCEHR as individuals, and as part of the RDAA, ACRRM etc…

    Clinical leads like Mukesh could be expected to represent us well, but in my opinion the restrictions that they act under make it incredibly difficult to enact change or reflect the opinions of the broader clinical community in an unbiased way.

    My own experience of joining Government funded organisations is that where non clinical priorities, political expediency and vested interests collide it it become incredibly hard to separate your responsibilities to the Organisation from those as a clinician and community member. In fact I don’t seem to last long on Boards as I have found the dissonance between heart and toeing the party line to great.

    Having said that I believe that there is a significant challenge for clinicians in being involved. We both know how hard we work, how committed GPs and Rural Generalists are to quality care of their patients, and the deeply personal relationships we develop throughout our careers with our patients. No one else can really say that they have that level of commitment.

    When it comes to consultation, being on panels or fora we GPs often are critically time poor and perhaps unable to have read every bit of paper on the topic, or attend very meeting; often as not in Sydney or Melbourne. This is often misinterpreted as laziness, disinterest, hubris or just an inability to grasp the “big picture” by those who seek to use our presence as window dressing. I have recently experienced the disdain of ” experts” first hand – who have never muddied their boots or descended below the tenth floor to see the “real” issues.

    My concern for the PCEHR is that we GPs are being asked to take our life’s work, our intimate shared knowledge of our patients, and give it to a Health Infrastructure that neither values our deeper commitment nor understands the work that has been done to produce the potted summary they expect us to just spit out. Further to that we are asked to devalue our work to that of a clerk typist, and share our private data without any clarity to its usage, sharing and privacy principles.

    We are asked to collate, review, clean and summarise information at no cost, but significant risk, for a Health System that as yet isn’t able to effectively use the data. We don’t ask specialists to do this, we are still wading through the significant technicalities in the Hospital system.

    So in a long winded reply I say yes we need to be in this space and Government needs to listen. The PCEHR is a great opportunity, but it is not a game changer to the practice of quality person centred care if it doesn’t bring along the key group GPs and Generalists on the journey.

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    • Ewen if you would be in politics I’d vote for you. Agree on all points including what you said about sharing data: “we are asked to devalue our work to that of a clerk typist, and share our private data without any clarity to its usage, sharing and privacy principles”.
      In my opinion the PCEHR Act 2012 should go back to parliament. It’s just not good enough.

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      • Thanks for the feedback, and apologies for the rant. I agree that the PCEHR Act needs a significant reassessment. I believe that our learned Colleges and the favored clinical leads need to revisit their roots and question the Technology both for its purpose and its potential adverse outcomes.

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  4. I am pleased to hear Edwin that the meeting went well from a GP’s perspective. It will be good to track the changes to system and processes that you outlined.

    I am hopefully other stakeholders involved in some capacity with the PCEHR will be given the opportunity to present their opinions as well in due course.

    As you are aware pending the election result, it could be all to nought, if the Coalition hits the reset button on the eHealth program and strategy.

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    • Lack of stakeholder consultation seems to be the no 1 reason for the poor results of the PCEHR at this point in time. I’m not entirely convinced that a different government is going to change this culture.

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  5. Thanks for feeding back. Having been involved with work on the UK equivalent I can see some of the pitfalls ahead. The politicians will be paying for the system so they will have ultimate control over how it is implemented. Once doctors have been sucked into agreeing to the benefits, the new system will steamroller ahead (very slowly) as the only show in town. Suitable cheaper alternatives (such as doctor managed and controlled information sharing) will be shelved and ignored – the political investment in making this work is very high, getting out would be very painful for them
    Keep up the good work!

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