The Australian PCEHR: Success or failure?

PCEHR: Success or failure?

Image: Pixabay.com

Call me naive, but I was hoping that somewhere in Australia IT-people would be working day and night to fix the PCEHR, based on the abundant feedback from doctors and consumers. I had a rude awakening when I read this article in Australian Doctor Magazine: PCEHR: Patients may see test results before GP.

Sorry? Diagnostic imaging & pathology results may be uploaded to someone’s eHealth record, before they have been reviewed by or discussed with the requesting doctor? This doesn’t sound like an improvement. Worse, it flies in the face of the 2014 PCEHR review recommendations to make the system ‘more usable, and able to deliver meaningful use.’

So where are we at with the PCEHR? I asked four leaders in the field about their thoughts: Has it been a success or a failure? Can it still be improved and if so, how?

Let’s get the basics right first: Frank Jones

Dr Frank Jones, President of the Royal Australian College of General Practitioners: “The concept was always good, but it failed to engage with front line medical professionals and was hijacked by lawyers. I am also really unhappy with the government’s plan to upload results if not viewed by the requesting doctor after seven days – a disastrous situation!”

“The other thing that is never talked about and that people outside GP-land are unaware of, is that GPs can already access their practice patients’ notes, anywhere, anytime. GPs leading the way again – in many ways this has diminished the value of a PCEHR at a front line GP level.”

“Lets get the basics right first: Initially we need the information such as active relevant medical issues, allergies and OTD medications.”

In its present form a failure: Brian Morton

Dr Brian Morton, Chair of the AMA Council of General Practice: “In its present form as a GP I would have to say it’s a failure. There is no recognition nor remuneration for GPs to spend the time to prepare and submit the data which must be done with the patient present. Professional clinical input to the design process has not been given the status needed to make PCEHR workable and relevant to medical practice.”

“Privacy and consumer political correctness have over-ridden safe principles of health care. The very poor uptake of the PCEHR is evidence of this. If we are to reap the benefits then recognition of the cost of data entry needs to be made.”

“Remove and prevent data which is not clinically relevant for care, for example Medicare billing data, as medical assumptions cannot be safely made based on a billing event. Identify clearly in the record that data has been removed or data hidden; the ability to over-ride the control of this is inadequate for safe care. Start the use of PCEHR with small and focused data entry such as active medical history.”

“Make a Medicare item number for the initial entry of data and an item for review yearly by the patient’s usual GP. Enable the functionality of automatic loading of diagnostic imaging & pathology data to the PCEHR when it is received and reviewed by the requesting provider. For example in our software: when it is transferred from inbox to patient record.”

A clear disaster: David More

E-health blogger Dr David More says: “It is a clear disaster as it has failed to be utilised by, and successfully engage with, either clinicians or patients to any significant degree after what is over two years since initial implementation.”

“It should simply be abandoned and a new eHealth Strategy based on serving the needs of clinicians in information sharing and use developed. Patient engagement should be at the level of providing useful e-Health services to such as e-mail, repeats, referrals, results and record access via local practitioners.”

Effectively dead: David Glance

Dr David Glance, Director Centre for Software Practice, University of Western Australia: “I would say that the PCEHR is effectively dead – there is some interesting commentary here. The liberal government has not killed it but they haven’t supported it actively either. Nor have they put forward any other strategy. So given the financial climate we are in now, I don’t expect that to change.”

“I fundamentally believe that Australia has a basic structural issue when it comes to implementing central strategies around eHealth. We are still lagging in electronic record adoption in our hospitals and public health services and to a lesser extent within the specialist community. Until that changes, any shared electronic health record will always have gaps and be less than useful.”

“Clearly NEHTA needs to be disbanded and something else put in its place. It was self-serving, bureaucratic and pretty hopeless when it came down to it.”

“With regard to opt-in/opt-out, I would say that opt-out is always a better option with a far easier access mechanism than was implemented for the PCEHR. But given how awful the implementation was, the point was moot. Talking of the implementation, given what we know about user interface, you would have thought that the interface to the PCEHR could have been a lot better than it was.”

7 thoughts on “The Australian PCEHR: Success or failure?

  1. I would agree with all of the above comments. The PCEHR is up there with Pink Batts and School Halls. Government has proven time and again that they cannot run big projects. As Dr Glance points out, the core systems to actually allow the information to flow are not in place across most of Australia, and the current crop of big, traditional vendors have shown they are incapable of delivering value for money – let alone a usable implementation of their systems. Governments of all colours need to get out of the way, and perhaps step away from the big accounting firms to use as prime contractors.

    Liked by 1 person

  2. Reblogged this on partridgegp and commented:
    This has been a disastrous waste of money from the start where the government’s reach has exceeded it’s grasp. Huge amounts of other people’s money have been used to create…what? More problems!

    What do clinicians and patients want? Did they ask? Did they care?

    Fail. Defund it, liquidate it, sell it off to a private enterprise that may be able to make some use of it.

    Liked by 1 person

  3. A question I keep asking and have never had a reply to is this:

    “What does (or could) the PCEHR do that other local and state based systems don’t already do?”

    Dr Frank Jones’ observation:

    “The other thing that is never talked about and that people outside GP-land are unaware of, is that GPs can already access their practice patients’ notes, anywhere, anytime. GPs leading the way again – in many ways this has diminished the value of a PCEHR at a front line GP level.”

    just provides more evidence that there is no value in the PCEHR. It’s a distraction, it’s a waste of money, it’s an IT system with no purpose.

    Liked by 1 person

  4. And today Pulse+It published another article about problems in the way the PCEHR data displays in the most commonly used systems used by GPs. Makes one wonder how reliable the display would be in the hospitals and other locations. Bottomline of today’s article is that one cannot trust large parts of the PCEHR section of software such as MD and Genie to give a correct account of the record

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  5. RACGP In Practice newsletter

    24 October 2014

    Government PCEHR upgrade sparks concern

    The Federal Government has announced that pathology and diagnostic imaging results will be added to patients’ e-health records from next year. The RACGP has significant concerns regarding this feature of the Personally Controlled Electronic Health Record (PCEHR), which may result in patients learning about clinical results before visiting their GP. Although the Government views this as a major initiative of the $1.25 billion technology, current default settings mean a clinical document could be viewed by any healthcare provider, regardless of whether they are immediately involved in the patient’s care. The RACGP believes there is lack of informed consent and transparency for health consumers registering for the PCEHR, the majority of whom are established via assisted registration, posing great potential for breaches to patient privacy.

    The fact the terminology contained in pathology and diagnostic imaging reports is for healthcare providers is another major concern for the RACGP. The risk of patients attempting to interpret results without full understanding of medical terminology and before seeing their GP could result in significant unnecessary distress. It remains unclear whether the proposed new model incorporates a mechanism to ensure clinicians explain and counsel patients regarding serious results (eg. cancer diagnoses) before they receive them directly in the PCEHR. The RACGP believes the need for a communication loop is of critical importance and that any move to upload reports to the PCEHR must not be at the detriment of patient safety.

    The RACGP advocates for a single model in which both diagnostic imaging and pathology providers are connected to the Healthcare Identifiers Service in order to decrease complexity and ensure seamless clinical workflows are maintained. While the RACGP acknowledges a direct-upload model may be the quickest process, the long-term risks are yet to be determined. The RACGP therefore recommends a privacy impact assessment be conducted to determine risks associated with current registration methods, existing access controls and the impact on direct upload of test reports.

    The RACGP will be meeting with the Department of Health (DoH) regarding current and future developments to the PCEHR in the coming weeks and will communicate outcomes to its members in upcoming In Practice issues.

    Dr Frank R Jones
    RACGP President

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  6. This is a great opportunity for Australia to get something right and to learn from the PCEHR mistakes and also the mistakes made in the UK on the same issue. A centralised database is not needed by Drs or patients, but what can work is real time controlled access to existing local databases, subject to all the IT security approvals and consents. This has the potential to improve care and be cost effective (by avoiding duplication or treating patients without all the available information). The politicians want to hear that the system will save money – but it wont, although it can improve care and be cost effective.

    Great work on this issue Edwin, can I nominate you to lead Australia on taking this forward?

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