Steve Hambleton: Jumping the e-health gun

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

[poll id="199"]