Karen Dearne, freelance journalist and former e-health writer for The Australian, has produced a review of the PCEHR, on behalf of the Consumers e-Health Alliance.
The conclusion is disappointing: It appears that the government has been successful in uploading non-clinical documents about users, but otherwise our expensive national e-health record system seems to be in a pilot stage.
The full document can be downloaded here. Below are a few quotes from the report.
The numbers are telling
“After two years and more than $1 billion in costs, only 26,332 shared health summaries have been uploaded by doctors to the troubled Personally Controlled e-Health Record system.
While the Department of Health and the National e-Health Transition Authority trumpet their ‘success’ in signing up 1.7 million Australians to date, the truth is that the system holds a mere 288,368 clinically useful documents.
Obviously, if every person who had registered had just one clinically relevant document uploaded to date, there would already be 1.7 million documents available.
For all the millions of hospital admissions across the country over the past two years, only 42,397 discharge summaries have been uploaded. Just 2,403 event summaries have been created. Specialist letters? Seven. Electronic referrals? Six.
These are the key items of value consumers want – and expect – to be available through a national e-health system.
So where does that 288,368 come from in relation to clinical records? Prescription records (55,206) and dispensing records (162,030) from pharmacies account for almost all, at 217,236 in total.
“That means there are only 71,132 potentially medical useful records available for just a tiny fraction of those 1.7 million people who signed up in the hope of better healthcare through information-sharing.
Now, some consumers were keen enough to enter their own health summaries, notes, observations and advanced care directives so there are 61,674 consumer created documents. Healthcare providers cannot access this material.
But hang on, the annual report of the PCEHR System Operator says more than 140 million records – 140,639,585 to be precise – are now in the system.
Well, yes, but more than 140 million – 140,289,543 – of these are Federal Government documents – Medicare has supplied MBS and PBS items, childhood and organ donor registry documents, while Veterans Affairs’ has handed over medical and pharmaceutical benefit claims.
Oddly, with only 1.7 million people registered for a PCEHR, it appears that each of these has generated an astonishing 80+ government record documents each.
And that assumes everyone has requested that this data be provided by Medicare, as it’s optional. (Medicare holds records on around 23.3 million individual Australians.) See Table 2.”
A persistent lack of engagement?
(…) “The silly thing about the situation is that almost 100 per cent of GPs have been using their own electronic patient health record systems for years.
Their frustration lies still in the lack of a secure national information-sharing infrastructure and useful clinical decision-making support, no matter how many times NEHTA claims delivery.
“(GP) frustration lies in the lack of a secure national information-sharing infrastructure and useful clinical decision-making support.
Doctors are being asked to use a ‘national e-health system’ that is far inferior to what they have on their desktops, and what the average consumer uses at home.
The usage figures revealed in these various annual reports demonstrate that the national PCEHR system has not yet moved beyond the pilot stage.
Could this failure be due to the basic reluctance of NEHTA and the Health Department – over many years – to properly engage all of the participants in the process and effectively address their issues and concerns?
It is worth noting that the key recommendations in the agreed National e-Health Strategy related to strong governance and practical engagement with all stakeholders from day one.”
Time to revisit the National e-Health Strategy
(…) “The big questions that have to be considered now by the Federal and State Health Ministers are what exactly is the PCEHR intended to achieve, and is it worth spending further large sums on a vast overhaul, when there may be other options and better alternative approaches.
Perhaps it’s time to revisit the National e-Health Strategy.
Wait a minute. Wasn’t Deloitte employed to do just that, last year, under a ‘Refresh’ banner? Sadly, Deloitte’s revised strategy document has not been released.
The Health Minister might find that publishing this material for public consultation would be a great way to restart a national discussion.”
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An analysis of Commonwealth Government annual reports covering e-health and PCEHR activities in 2013-14. A review of progress. Karen Dearne, on behalf of the Consumers e-Health Alliance. December 2014