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.

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.

Let’s stay out of where they are from and why they’re here

A long time ago I did a locum stint in an asylum seekers centre in The Netherlands.

What struck me was the vast amount of physical and mental illnesses like depression, malnourishment, and neglected chronic and infectious diseases, together with uncertainty, fear, cultural differences and challenging language barriers.

It all came back to me when I saw the people on board of the small, fragile vessel that earlier this year sailed into the Geraldton harbour.

Asylum seeker boat
When the boat sailed into the Geraldton harbour, it didn’t feel like the ‘unprecedented breach of border security’ we heard about in the media. Whatever the reason for their journey, these men, women and children should be looked after properly while they are in Australia.

The sad reality is that many asylum seekers, including children, spend many years in immigration detention facilities. This creates more (mental) health problems. AMA president Steve Hambleton said at the National Press Conference this week:

(…) let’s stay out of where they are from and why they’re here and all the other stuff. Once we are in control or once we take responsibility for people, we should be providing them with first-rate health care.

Whatever the reason for their dangerous journey, let’s hope these men, women and children will eventually find a place where they can live a safe, healthy and peaceful life.

In the meantime, while they are here, we have to take care of them. We are responsible for their health and well-being, including appropriate access to quality healthcare.