How to get doctors to use eHealth

How to get doctors to use eHealth

Although doctors are in the top three of most trusted professions, they also have a conservative image.There is the perception that doctors are resistant to change, such as the introduction of eHealth in their practices.

Nothing could be further from the truth.

Doctors are used to change. Medicine and healthcare are areas where new developments happen on an almost daily basis.

However, just because something is new, doesn’t mean it’s better. Many doctors have learned this the hard way. That’s why we need to be convinced before we change our current practices. Not with arguments but with evidence.

It’s best to try a new idea out on a small scale. Prove that a product or service has benefits to patients and doctors – but no major disadvantages – and we will consider it.

The benefits of consumer online access to health records

Consumer access to electronic health records may not be far off. In the not-so-distant future people will look up their file from home or a mobile device. They will also be able to add comments to their doctor’s notes.

In its current version the Australian PCEHR allows limited access, but the US OpenNotes record system has gone a step further by inviting consumers to read all the doctor’s consultation notes.

Pulse+IT magazine reported that 18 percent of Australian doctors believes consumers should be able access their notes; 65 percent would prefer limited access and 16 percent is opposed to any access at all.

What are the pros and cons? Here are some of the often-mentioned arguments:

Pros

  • Improved participation and responsibility
  • Increased consumer’s knowledge of their health care plan
  • Better self-management
  • Consumers can read their notes before and after a consultation as reminder
  • Consumers can help health practitioners to improve the quality of the data, eg by adding comments
  • Consumers can better assist practitioners in making fully informed decisions

Cons

  • Consumers may interpret the data incorrectly creating unnecessary concerns
  • Increased risk of security breaches and unauthorised access
  • Unwanted secondary use of the data by eg insurance companies or governmental organisations
  • Practitioners may need to change the way they write their notes
  • Increased workload

An article in the New England Journal of Medicine reported that OpenNotes participants felt they had a better recall and understanding of their care plans. They also felt more in control. The majority of consumers taking medications reported better adherence. Interestingly, about half of the participants wanted to add comments to their doctor’s notes too.

Most of the fears of clinicians were, although understandable, ungrounded:

  • The majority of participants was not concerned or worried after reading what their doctors had written (many just googled medical terms and abbreviations)
  • Consumers did not contact their doctors more often
  • A minority of doctors thought OpenNotes took more time, others thought it was time-saving

According to the OpenNotes team transparent communication results in less lawsuits. I couldn’t find any information about the security risks of the system.

Overall, consumers were content: 99% percent preferred OpenNotes to continue after the first year. Doctors were positive too, see this video:

Culture change

Consumers have the right to know what information is held about them, and they have the right to get access to their health records. Online access therefore seems to be a logical step to exercise these rights. Although the PCEHR allows consumers to see a summary, the consultation notes cannot be viewed. OpenNotes is about sharing all consultation (progress) notes between a consumer and his/her practitioner.

I believe there are 3 trends happening that will push this development:

  • The culture of sharing data online
  • The increasing consumer participation in health care
  • Evolving digital and mobile technologies

The 3 main reasons why it will not happen overnight:

  • An attitude change towards full access takes time
  • Security and privacy concerns
  • Lack of incentives for software developers and practitioners

Improving transparency 

Online access to electronic records (viewing and commenting) will boost transparency. It will change the interaction between consumers and practitioners and may even improve quality of care. I’d love to see more trials and experiments in this area. What do you think?

Is the new eRx electronic prescription service beneficial to consumers?

About ten years ago I did a locum in an innovative GP practice in The Netherlands. When prescribing medications, the computer system allowed me to either print the script and hand it to my patient, or send it electronically to the pharmacy. Consumers who elected the second option, were able to collect their medications at the pharmacy twenty minutes later.

I’m not sure how secure the system was, but it was easy to use, saved a lot of paper, and prevented lost scripts and medication errors.

ePrescribing in Australia

Here in Australia doctors are printing or handwriting scripts. This month however I noticed a little QR code in the top right corner after printing a script. It took me a while to figure out what it was for: Patients can scan this code with a mobile device, submit the information electronically to the pharmacy of their choice and pick the script up on a preferred day and time.

eRx express
Source: erxexpress.com.au

The app, developed by the Fred IT Group, is called eRx Express. It can be downloaded for free on mobile devices. It seems that the benefit for health consumers is reduced waiting time at the pharmacy – which is great, especially if people have already been waiting to see their doctor.

I also have a few reservations…

First of all, consumers have to scan and send information via their smart phones, and they still need to bring in the paper script when collecting their medicines at the pharmacy. So it involves a few more steps and we’re not yet saving trees.

Second, as always, I would like to know what happens with the data during and after scanning, transmission over the internet and on the servers of the Fred IT Group and others. Is the information sold or disclosed to third parties?

It would be good if consumer details and their prescription history would not be collected or used for other purposes. But usually, when something is free, we become the product. In other words, there is often a price to pay with regards to our personal data.

The small print

So, after a little search I found this information in the patient terms and conditions and the privacy policy:

You agree that we may disclose your de-identified prescription data to selected third parties for the research and marketing purposes of those third parties.

We do not warrant (…) that any data transmissions between you and us will be secure and that any data you send us shall at all times remain secure.

We reserve the right to (…) charge for the App or service provided to you at any time and for any reason (whether stated or not).

Conclusion

As long as private or governmental organisations want control of our health data for other purposes than patient care, eHealth initiatives will not take off. Of course health consumers are free to use this service, but at the moment the benefits do not seem to outweigh the risks.

Does the PCEHR meet the GP Data Governance Council criteria?

The General Practice Data Governance Council is “committed to profession-led governance regarding the issues of data collection activities in general practice,” in particular secondary use of patient data generated through clinical care delivery to patients.

GPs and consumers have voiced concerns with regards to secondary use of data uploaded to the PCEHR, so I thought it would be interesting to have a look at the PCEHR and see if it meets the goals of the Data Governance Council.

As outlined in an earlier post, it appears PCEHR data can be used by the government for:

  • Law enforcement purposes
  • Health provider indemnity insurance cover purposes
  • Research
  • Public health purposes
  • Other purposes authorised by law

The eight goals of the General Practice Data Governance Council are in the context of secondary use of data from general practice. They are listed below, followed by my pass or fail verdict with brief comments.

1. Protect the needs and interests of all data stakeholders

FAIL – The PCEHR Act 2012 and the PCEHR participation contract increase liability for health professionals and remove control by consumers and clinicians.

2. Ensure integrity in the use of data for secondary purposes

FAIL – There is lack of information about how the data in the PCEHR is used outside the general practice setting.

3. Increase availability of data and information to support general practice and patient health outcomes

PASS – It is expected that in the future hospitals, specialists, allied health providers and others will be uploading information (this is currently only happening on a small scale). This should eventually support general practice and patient health outcomes.

4. Promote consistent approaches to management of data and data requests

FAIL – Although the process of data requests and uploading etc is consistent and clearly outlined, there is lack of information about the how the system operator (read: Department of Health) deals with the data.

5. Promote compliance with privacy legislation

PASS – It appears the PCEHR is compliant with privacy laws.

6. Provide open and transparent processes

FAIL – There is a lack of information about secondary use of PCEHR data by the government or other organisations with access to the PCEHR database.

7. Identify opportunities for secondary data use

PASS – The government has certainly been creative in identifying opportunities for secondary use. Consumers and clinicians are generally not aware of this and specific informed consent is missing.

8. Promote data quality improvement processes

FAIL – Although quality assurance and improvement processes may exist within NEHTA or the Department of Health, they have not been made public to the best of my knowledge.

Conclusion

Fail x5, pass x3.  This may explain the lack of enthusiasm by GPs. In my opinion the uptake of the PCEHR will improve if these eight goals are met.

Feel free to agree/disagree and leave a comment below.

The PCEHR: Moving forward

I can confirm that the Government is not going to build a massive data repository. We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks (~Nicola Roxon)

I’ve studied the PCEHR but I’m still not sure what the government has built and for what purposes. I was always under the impression that the PCEHR was designed to assist clinicians to improve patient care through better data flow. But this may not be the case.

The recent resignation of NEHTA’s top National Clinical Leads is an ominous sign. If the Department of Health does not start sharing ownership of the PCEHR soon and improve governance of the system, the PCEHR will fail. Here’s a quick rundown of the issues and how to move forward.

Legal issues

A first glance at the PCEHR Act 2012 seems to confirm that the PCEHR is built with clinicians in mind, as its four purposes are clinical in nature:

  • To help overcome fragmentation of health information
  • To improve the availability and quality of health information
  • To reduce the occurrence of adverse medical events and the duplication of treatment
  • To improve the coordination and quality of healthcare provided to consumers by different healthcare providers

So far so good. But the Act is 93 pages long and I could find at least five other ‘non-official’ purposes of the PCEHR spread out throughout the Act:

  • Law enforcement purposes
  • Health provider indemnity insurance cover purposes
  • Research
  • Public health purposes
  • Other purposes authorised by law

And this is where the concerns begin. These ‘non-official’ purposes are not directly related to the care doctors provide to their patients. In general, one would say that patients and clinicians have to give informed consent before their health information can be used for research or other purposes. It seems informed consent is missing here.

Contractual flaws

Combine this with certain clauses in the one-sided PCEHR participation agreement and you’ll forgive me for thinking that the government, contrary to Roxon’s reassuring words, has built a massive data repository:  Once clinicians sign the agreement, they grant the Department of Health and Ageing a perpetual, irrevocable, royalty-free and license-fee free, worldwide, non-exclusive license (including a right to sub-license) to use all material they have uploaded to the PCEHR.

Those who think that you can always opt out are mistaken. Even if health care organisations or practices cancel the participation agreement, seven of the fourteen clauses survive termination, including clauses regarding liability. It is good to know that the government will continue to use the information after cancellation by a clinician or consumer for up to 130 years.

Another concern is the fact that the Minister may make or change PCEHR rules without legislation, and the Department of Health can change the participation agreement at any time without the need for input from clinicians. We thought the After-Hours and PIP contracts by Medicare Locals were a disaster, but this agreement is possibly worse.

Other problems

By now it is obvious that Clinical Leads and professional organisations have not been involved in many important decisions. There is a range of other issues, which I won’t discuss here in detail, including technical software glitches and the absence of MBS item numbers. Under the PCEHR Act 2012, all clinicians are appear to be seen as employees, which could be a problem as many doctors may be employed as contractors for various reasons.

Moving forward

If the PCEHR can be used for data mining, legal purposes, insurance purposes etc, then that is fine, but, I would strongly advise the profession to stay clear from it. If however we agree, that the PCEHR is a clinical tool, then clinicians must be involved.

What we need first of all is an open, well-informed discussion about the purposes of the PCEHR. What are consumers and clinicians exactly saying yes to when they sign up? A proper, transparent, independent governance structure with specific executive authority should be formed. This PCEHR Board should include members from professional and consumer organisations and act as a watchdog over the PCEHR. Any changes to the rules require a consultative process with professional bodies including AMA and RACGP before the Board can sign off. The current PCEHR Advisory Committee and Council are not fulfilling these criteria at the moment.

Consumers should know exactly what happens with their data after they have visited a health care professional and who has access to their information. The purposes of the PCEHR must be clear and agreed upon by all stakeholders. Clinicians own the rights of the data they create and upload, there is no need to grant the government a perpetual irrevocable license to use this data.

The PCEHR Act 2012 and the participation contract must both be reviewed and made 100% acceptable to clinicians and 100% opt-out must be possible for clinicians and consumers at all times.

This will take time, but if we don’t start now there is no hope for the PCEHR.

This article has been published in Medicus, the journal of the AMA(WA)

7 online eSafety tips for doctors

It is good to see that social media and eHealth are becoming mainstream topics at national health conferences. At the recent GP Education & Training Conference in Perth (GPET13) I attended two workshops about our professional online presence.

The first one was about the benefits of social media and was attended by GP supervisors, registrars and students. The second one, sponsored by a medical defence organisation, warned about the dangers of the online world, and interestingly there were mainly GP supervisors in the room.

Before I continue I must declare that I was one of the presenters at the first workshop. But it was good to be reminded by professor Stephen Trumble about what can go wrong. His excellent presentation created a lively discussion. Here are seven random points I took home from the workshop:

Tip #1

Doctors should be careful when looking up patients online, eg via Google. In general this is only acceptable if doctors are acting in the interest of patients, for example when trying to find contact information in an emergency.

Tip #2

Privacy settings of Facebook and other social media tools may change or fail, therefore: do not trust these settings. Assume that everything posted online, even in private networks and groups, is public. I have blogged about the elevator test, which is one way to check if something is suitable before posting.

Tip #3

Taking pictures of patients or their body parts is fine as long as the patient has been made aware of the purpose and who will see the picture, has given consent prior to taking the picture and has been de-identified. When doctors publish the picture online, consent must be noted within the publication. If the picture is later used for other purposes, the patient must again give consent.

Tip #4

When doctors collect patient information on their mobile devices, eg when taking a picture with a smart phone or when using a transcription service, these devices must be protected from misuse, unauthorised access, alteration or disclosure. The simple passcode on iPhones is generally deemed insecure (but can be made more secure in the phone settings). If patient information is stored overseas on cloud systems, local security laws apply and they may not meet Australian standards.

Tip #5

Old smart phones, even if factory settings have been restored and the data erased, still contain information. This is of course also true for USB sticks, practice computers, photocopiers with a hard disc etc.

Tip #6

I have blogged about the issues with Skype in patient care. From the handout: “Skype is not recommended for telehealth consultations but has not been deemed ‘unsuitable’. There are privacy, confidentiality and quality issues and many doctors who start with Skype end up upgrading to commercial systems.”

Tip #7

Last but not least: email is not suitable to transfer patient information. Encrypted email is the preferred option.

It is sad that the eHealth practice incentive payments (PIP) by the government are only paid to practices taking part in the PCEHR. As a result costly software, system and security upgrades will not be a budget priority for many practices.

Sources:

  • Online communication for education: risks, responsibilities and rewards. Workshop by Prof Stephen Trumble, Ms Nicole Harvey. GPET 13 Conference, Perth
  • General professionalism online – handout by MDA National
  • Informed consent and Telehealth – handout by MDA National
  • Telehealth tips – handout by MDA National

How to save the PCEHR

The resignation of NEHTA’s top National Clinical Leads in August 2013 was the final straw for the PCEHR. I have said it before and I will say it again: if clinicians are not on board the PCEHR will fail. There are some big decisions to make by the relevant authorities if they want to save the project, and making these decisions without clinical advice is impossible.

The PCEHR Act 2012 states that the data in the PCEHR can be used for law enforcement purposes, indemnity insurance purposes for health care providers, research, public health purposes and ‘other purposes authorised by law’. This is far from reassuring. There are many grey areas and unanswered questions. There are too many agendas. The PCEHR should first be a useful clinical tool to improve patient care.

What we need is an open, well-informed discussion about the purposes of the PCEHR. What are consumers and clinicians exactly saying yes to when they sign up?

Dr Mukesh Haikerwal
Two of NEHTA’s Top National Clinical Leads: Dr Mukesh Haikerwal and Dr Nathan Pinskier in Geraldton (August 2013). Photo: Dr Ian Taylor

Consumers must know exactly what happens with their data after they have visited the doctor or the hospital. We need to agree on secondary use of the data and informed consent by clinicians and consumers is a basic requirement here. The PCEHR Act 2012 and the participation contract should both be reviewed and made 100% acceptable to consumers and clinicians.

Most of all we need genuine stakeholder engagement. This is a big challenge but certainly not impossible. Let’s hope common sense prevails.

Consumer’s opinion of the PCEHR

It is not easy to find balanced information about the PCEHR. For that reason I welcome the information prepared by the Australian Privacy Foundation. The APF has been an advocate for privacy protections, representing the public interest to governments, corporations and industry associations.

The APF has always strongly supported eHealth, but in a press release Dr Juanito Fernando said: “Neither clinicians nor the rest of the community understand the system, let alone the full implementation details.”

The APF has prepared two FAQs: one for health consumers (great for waiting areas) and one for clinicians. The government’s FAQs about the PCEHR can be found here.

Let’s hope the new information will improve awareness about the PCEHR and stimulate discussion about the many grey areas.

NEHTA visit: not exactly Khrushchev vs Kennedy

My 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, one of our practice partners Dr Elly Slootmans, our 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 at this stage for the business and the doctors.

Dr Mukesh Haikerwal
Dr 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), Dr Nathan Pinskier (NEHTA), Richard Sykes (our practice CEO)

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 (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.

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.

The 2013 PCEHR Quiz for clinicians and managers

Reliable information about the issues surrounding the PCEHR is not easily accessible, unless you read the 93 pages of the PCEHR Act 2012. How good is your knowledge of the national eHealth records system and are you aware of the pitfalls and risks? Do the 2013 PCEHR Quiz to test yourself.

1. Who has access to the data in the PCEHR?

a. The consumer and their clinician(s)
b. The consumer, their clinician(s), the system operator, health care organisations, repository operators, portal operators and contracted service operators
c. The consumer, their clinician(s), and the system operator in case of emergencies

2. The PCEHR Act 2012 allows secondary use of PCEHR data for the following purposes:

a. Public health emergencies
b. Statistical analysis of de-identified health data
c. Law enforcement purposes, health provider indemnity insurance cover purposes, research, public health purposes, and any other purpose authorised by law

3. Once practices or health care organisations have signed the participation agreement, their clinicians become liable for unauthorised access and data breach penalties. Are these penalties covered by all medical indemnity insurances?

a. Yes
b. No

4. If a clinician accidentally uploads information to the PCEHR (against a patient’s advice), what civil penalty is applicable?

a. $2,400
b. $12,400
c. $20,400

5. A clinician who has contravened a civil penalty provision may need to pay the government a pecuniary penalty of up to:

a. $20,400
b. $52,000
c. $102,000

6. The participation contract can be varied at any time by the government. What happens if a practice or health care organisation does not agree to these changes?

a. The government will not change the contract unless both parties agree
b. The PCEHR registration of the organisation will be suspended or cancelled
c. An independent mediator will be engaged to resolve the conflict

7. The PCEHR is opt-in. If consumers or health care organisations change their mind after they have signed up, is opt-out possible?

a. Yes
b. No

8. Once clinicians upload information to the PCEHR, the government owns the IP rights and grants all other participants rights to use the data. Do clinicians get their IP rights back if they cancel the participation contract?

a. Yes
b. No

9. What happens if practices or health care organisations cancel the participation agreement?

a. 7 of the 14 clauses survive termination of the agreement
b. Nothing in the agreement is valid anymore
c. The uploaded patient data will become inaccessible

10. How long will the information in the PCEHR be accessible after cancellation or death?

a. Up to 130 years
b. Up to 10 years
c. 28 days

Answers: 1B, 2C, 3B, 4C, 5C, 6B, 7B*, 8B, 9A, 10A.
*You can cancel but you don’t get your data (rights) back and you remain liable etc (see Q9)

Disclaimer: As with any contract, get independent legal advice.

PCEHR: Who is the customer? (slideshow)

PCEHR: Who is the customer?When starting up a project, service or business, an important question is: Who is the customer? This is not always the one who pays the bills. There may be other users or stakeholders. I’ve said it before: Everybody has to be on the same page for a project to be successful.

I’m not sure who the customer is in the case of the PCEHR. At first glance this seems to be the health consumer, as they have some control – unlike clinicians. Most GPs agree on one thing: the current PCEHR is not making their jobs easier or adding value. Are they customers too? Are there others?

Key to success?

Adding more features without reviewing the basic principles of the PCEHR-framework, is not going to make the problems go away. In the slideshow I’ve tried to capture the issues and some suggestions for improvement based on the feedback from doctors. Have a look and let me know what you think. Feel free to share, download or embed the presentation (view the slideshow on SlideShare).

3 reasons to avoid Skype for telehealth

Is Skype safe for a clinical consultation? In June last year, the Royal Australian College of General Practitioners said in their publication RACGP advice on Skype: “There is currently no clear evidence to suggest that Skype is unsuitable for clinical use”.

This year however, new information came to light suggesting that Skype, owned by Microsoft, may not be as safe as we thought. Here are three reasons why you should be careful to use Skype as a professional video conferencing tool:

  • Skype is not encrypted from end-to-end. Microsoft can intercept information transmitted via Skype.
  • Skype tells the world where users are by exposing IP addresses. This allows criminals to target cyber attacks.
  • The US National Security Agency (NSA) can listen in and watch Skype chats with their data collection program Prism.

Interestingly, Skype’s privacy policy states:

Skype is committed to respecting your privacy and the confidentiality of your personal data, traffic data and communications content.

But this, it seems, needs to be taken with a pinch of salt. The Guardian reported that Microsoft “worked with the FBI this year to allow the NSA easier access via Prism to its cloud storage service SkyDrive, which now has more than 250 million users worldwide.”

The big question of course is: If US government agencies are listening in on our video chats, what other governments and organisations are collecting our online data?

NEHTA is coming to town

“Be a yardstick of quality” ~ Steve Jobs.

First of all, many thanks to the GPs, registrars, practice managers, journos and eHealth-specialists who made suggestions how to move the eHealth-records system forward.

The original comments can be found here. It’s an excellent read and summarises the sticky PCEHR-issues from a clinician point of view.

On Friday afternoon I received a phone call from NEHTA (National E-Health Transition Authority). Their clinical leads are coming to Geraldton to discuss the PCEHR. Our team of doctors and managers is getting ready. We have invited the AMA, and they’re flying in to Geraldton as well.

It will be good to hear first-hand why it is so hard to make the system more acceptable to clinicians – and for our clinical team to give feedback. But the main question is: will NEHTA and the Department of Health go back to the drawing board and change what needs to be changed to get clinicians on board?

It’s late, but hopefully not too late to make the PCEHR work for everybody. If there’s anything you want us to bring up (apart from the wish list mentioned above), feel free to leave a comment below and we’ll pass it on.

Will more money fix the national health record? What’s on your wish list?

According to Pulse+IT magazine NEHTA wants to make their e-Health records system (PCEHR) more useful and usable for clinicians and consumers. A steering committee chaired by GP Dr Mukesh Haikerwal will meet next week for the first time.

When I expressed my enthusiasm on LinkedIn, the following two spot-on responses made me smile:

Agree Edwin lets hope. However from the look of the makeup of the steering committee it does not look like there will be much input from regular GPs and is mostly in house between NEHTA and DoHa.

Why didn’t NEHTA do this at the scoping stage (before a line of code was cut). Now they are trying to do this retroactively and hope that it works…. Nothing short of amazing….

My wish list

Minister for health Tanya Plibersek has announced yet more money today ($8M): pathology and diagnostic imaging will be stored in the PCEHR.

How to improve the uptake of the PCEHR by clinicians? I will send in my wishlist. Here it is:

  1. A public list should be made available of all organisations with access to clinical patient information
  2. Government and affiliated organisations are not allowed to use any uploaded clinical data for e.g. insurance purposes, audits, police/immigration/background screening etc. This needs to be spelled out in the participation contract
  3. Data mining and scientific research can only be performed after doctor and patient have given consent. This needs to be spelled out in the participation contract
  4. Remove the dreaded IP clause from the participation contract that states that all information can be used by the government world-wide, perpetually etc
  5. When health care organisations or individual clinicians no longer want to take part they must be able to remove all their uploaded clinical data from the database
  6. Ensure and facilitate that clinicians are not exposed to higher medicolwegal risks when participating
  7. Registration for the PCEHR as well as cancellation should be quick and easy
  8. Ensure a 24/7 knowledgeable and custom-oriented help desk with minimal waiting times
  9. Send out a quarterly newsletter to all participating clinicians to keep them up-to-date with PCEHR and NEHTA developments
  10. Cherish the clinical steering committee, make sure it’s involved at all times, and ask for lots and lots of feedback from clinicians!

What’s on your wish list? Leave a comment below and I’ll send it to the steering committee.

6 issues that need to be addressed to make the PCEHR a success

Have you made up your mind? Are you going to sign up for the personally controlled e-health record (PCEHR)?

I believe six issues need to be sorted out as soon as possible to make it easier for consumers to take part:

  • Confidential patient data is potentially unsecure in the PCEHR Govt cloud
  • Too much risk & liability for health professionals
  • Uploaded PCEHR data will be used by Govt for other purposes incl data mining
  • Up to 5 minutes extra per patient is needed to upload and manage online PCEHR data
  • Longer consults create higher fees & increased costs for patients
  • More red tape, difficult to understand rules and regulations

It’s got a lot of potential, but the devil is in the detail.

PCEHR