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THE Personally Controlled Electronic Health Record was launched last week. It is probably the softest launch of a major government initiative in Australian political history.
Why? Because it is not ready. Not by a long shot.
For months, the AMA has been warning the government that the PCEHR is not ready. Patients are not ready. Doctors and other health professionals are not ready. Hospitals are not ready. The health system is not ready.
I was one of a group of GP leaders who met with Health Minister Tanya Plibersek just before the launch to explain in person our concerns about the lack of readiness for the PCEHR.
We told her we want the PCEHR to work. We want it to work for our patients and for ourselves. We see the electronic health record as a key productivity tool in health.
There is much confusion about how the system will work — from the identification system to software upgrades or, in many cases, complete replacement of clinical coding to secure messaging and beyond.
Even the politicians are confused. The Hansard of the Senate’s deliberations on the legislation is a telling read.
During a discussion last month, many senators were talking about a shared health record, but the PCEHR is not a shared health record — it is a personally controlled e-health record that contains a point-in-time health summary that is curated by a nominated health care provider.
The Senators — everybody, in fact — need to understand that the shared health summary is not the same as the information held by a person’s GP. It is an extra piece of work that provides a subset of the GP’s patient record, which is accurate only for the period of time in which it was created.
It won’t contain details of someone’s MRI scan, it won’t contain pathology results, and it won’t contain diagnostic imaging. Not yet, anyway.
For individual doctors, it is especially confusing. After all, there is no new funding and no new Medicare Benefits Schedule items for PCEHR work.
There has been no information about how the system is supposed to operate at the consulting room level. Most GPs do not even know if their practice software is compatible.
I know that my software is not compatible.
When we met with the Minister we asked her for a review of timelines for the PCEHR implementation to allow general practices a more gradual uptake in line with their capacity to sign up to the PCEHR.
We told her that doctors need more support. And we suggested that the government change the requirements for the e-health Practice Incentives Program and delay the changes until the PCEHR is fully established. Without the delay, GPs will be unfairly penalised.
The Minister said she was hearing significantly conflicting views about the work required to prepare shared health summaries for the PCEHR. We assured her that our advice was genuine. It was from the front line.
Nevertheless, the Minister was stuck with the 1 July implementation date. But this will be a long and slow implementation as there is much more work to be done. And much more discussion. The Minister has asked for our feedback every step along the way.
The promise of reducing adverse events and reducing duplication of treatment is compelling. With the right system and the right support, the PCEHR can help us to improve the patient health care experience.
But we have more than a long way to go to get anything like a critical mass of GPs interested in this scheme, and I doubt that many of them will be prepared to do it for free.
It is a noble target, but an ignoble process.
Dr Steve Hambleton is the federal president of the AMA and a Brisbane GP.
Posted 9 July 2012
I have found that some of the most relevant data about individuals simply cannot be made
public. I am talking about hypochondriasis, anxiety states, immature attitudes toward health, dependency syndromes, marital problems, financial stresses, etc etc
These are often more significant in a given Emergency Dept situation than vaccination records, ECG readings, past routine blood work, all the sort of material likely to accumulate in personal files held by their GP. So while the patient is in extremis, the Admitting Intern would have to wade through all this material. In fact, the story is one that the patient or a friend, would be able to supply, like recent alcoholic intake, history of diabetes, past history of epilepsy, recent complaints of localized pain etc. Un summary, the e=record may turn out to be a long compilation of dubious value, since the current clinical state of the patient. The all-important medical function has always been to TALK WITH and LOOK at the patient in distress.
Well said Beryl. A monumental waste of money for the reasons you have outlined and a real danger to not just health privacy; there are huge Big Brother implications. With unique identifier numbers, an Australia card by stealth. Data banks can potentially be linked (Medicare number, driver’s licence, passport, bank accounts, etc. but most worrying of all “… or any other data determined by the Minister”.
I have been educating health professionals with their communication for many years and I am saying ‘This system will not work!’
For at least 40 years, as a patient I have been asking doctors for copies of letters from other physicians. This was brought on by the numerous times I accidentally discovered that letters out or back had incorrect information. With multiple illnesses that could cause serious complications. I am the only person who actually knows my long health history. And I can only keep track of dates, etc, because I’ve taken the trouble to keep a record
Steve Hambleton’s entry has now alerted me to the fact that only part of my health history will be available for other doctors to read anyway — and I know they will not read even that. Without all my info I could be dead before you could ask ‘Why are these computers running so slow today?’ [Go to your outpatients dept & watch patients lining up while the receptionist waits for the info to come through – frustrating for all. And of course if you are the one who might die really quickly without this info, forget it. You’re dead.]
If anyone thinks doctors are going to add to their already heavy workload to do this, you have rocks in your head. So they either won’t do it at all, or do it poorly. Another dangerous scenario.
Then you have this fallacy that I am going to keep wasting my time accessing the web to read my so-called history and correct mistakes – not going to happen, I have a life to live. And how many millions of Australians do not have web access (many don’t and won’t even have a computer). Many of these people will be of significant age, therefore more likely to have longer and more complicated histories.
Why do I think doctors won’t read these records? Well, they already don’t read the 3 pages of health records I carry with me at all times and have to ask me to translate.
Scrap the whole blooming idea — it’s just a money-wasting furphy; as other countries have already found – and stopped trying to use it.
The dilemma we face is that if we left it up to the bureaucracy they would delay the launch ad infinitum, so there is a need to launch something on a certain date, and then continue to enhance it. Dr Hambleton is right that in its current state the PCEHR is not ready for prime time use, it is effectively in a beta testing mode. Our role now is to ensure it meets our needs as the primary healthcare providers, and that patients are informed of their responsibilities as the controllers of the record. As the old saying goes, with great power comes great responsibility. Now the patients need to share in that responsibility,and the government needs to make sure that clinicians are reimbursed for their professional expertise and effort.