more_vert
AUSTRALIA’S experiment with the personally controlled electronic health record has had a bumpy start — the resignation of key clinical advisers from the National Electronic Health Transition Authority does not augur well for its future.
Hundreds of millions of dollars have already been spent on setting up and promoting the PCEHR. Perhaps it’s time to acknowledge that our precious electronic health dollars could have been better prioritised elsewhere.
There will be many reasons given for the disappointment of the PCEHR, which had failed to reach even its own modest target of 500 000 registrations by July 2013. However, in simple terms, the success of electronic and information technology (IT) projects, large or small, depends on leadership and clinical engagement.
Both have been lacking in the rollout of the PCEHR, as borne out by low participation by GPs and the inability of public hospital systems to integrate their records successfully.
IT in health care is an enabler which augments good clinical care — projects are likely to succeed when project teams follow the basic principles of good planning, effective clinical leadership and a commitment to stakeholder engagement.
There are several successful examples in the Australian health sector where these principles have been taken seriously, including two in Queensland — the new UnitingCare Health St Stephen’s Hospital at Hervey Bay and the new purpose-designed Health City precinct at Greater Springfield, south-west of Brisbane.
At the heart of both these initiatives are clinical leaders, health planners and administrators whose aim is to share information using digital technology and create synergies between primary, secondary and tertiary care.
St Stephen’s Hospital at Hervey Bay, which opens next year (2014), will be Australia’s first fully integrated digital hospital. It is an example of a workable public–private partnership, with $47 million from the federal government’s Health and Hospitals Fund going towards the estimated $87.5 million cost.
A key objective for the hospital is to improve the patient and clinical experience, with an electronic record system a vital component in the plan. Medical staff will use shared information and wireless technologies, and all medical records, and diagnostic and pathology results will be accessible by doctors and nurses anywhere in the hospital through computers in patient rooms, electronic devices and laptop computers.
Features include patient and medical portals, an integrated voice recognition communication system to improve the speed and quality of communication, the ability to develop information linkages with other parts of the health system, and the ability to track equipment electronically to increase efficiency of use.
The other initiative, Health City, is Australia’s first purpose-designed health precinct. Part of the first stage is a private hospital incorporating the latest digital technologies. There is a long way to go, but it’s an exciting concept that is an example of sound planning.
An exciting aspect about Health City is not only its size — a 52-hectare site adjacent to a significant area of open space — but the fact it is being planned to integrate hospital and tertiary care, combine public and private initiatives, as well as provide primary health care and a host of other related services such as radiology, pathology, allied health and aged care.
Both Health City and St Stephen’s Hospital are examples of where IT professionals, health planners, industry and clinicians can work together across the private and public health systems to provide optimal health care throughout a person’s life.
The original simple objective of the PCEHR was similar — to create an e-health record that health professionals can easily access to ensure the best possible health care throughout a patient’s life.
For the PCEHR to succeed we need to return to basics — get the planning right, ensure the project is led by clinicians, and don’t forget to engage the very people who will use the system: the doctors and their patients.
Dr Christian Rowan is the President of the AMA Queensland, an Associate Professor of Addiction Medicine and Public Health at the Centre for Medicine and Oral Health, Griffith University, Queensland, and Director of Medical Services at St Andrew’s War Memorial Hospital, Brisbane.
COI: Dr Rowan is the Deputy Chief Medical Officer of UnitingCare Health
By no means would I call the PCEHR a success, but I find it hard to hail the above examples as successes just yet when they are both yet to demonstrate the mythical beast that is ‘clinical usability’. I think that the statement “There is a long way to go, but it’s an exciting concept that is an example of sound planning” says it all. Let’s talk to the clinicians once some benefits have been realised and then talk about success or failure.
The fundamentals of the PCEHR have always been wrong. They fail to address existing knowledge and experiences of over 30 years. Even the “clinical leads” did not improve the implementation processes. WHat we have now is a porridge of e-health systems that are nonl-standardised, non interoperable, non scalable and have poor clinical functionality – if not clinically useful then the systems will not be used.
What we have is a costly non-funtioning mess with no clear guidance for any particular group.
Many groups need to “read” the established literature and COLLABORATE.
It may also be good to involve individuals and groups who have actually “done it” and achieved success.
@janukisan – I’ve been following the legislative process for the PCEHR, and the regulations it operates under certainly does allow patients to control the information. At the moment, the system is not fully functional and only allows for a health summary, so all the controls are not yet in place. If you check the actual legislation you’ll find that the patient (registered consumer) can “effectively remove records from their PCEHR” and that even in emergency situations the system operator “must not permit access to records that have been effectively removed”.
<http://www.comlaw.gov.au/Details/F2012L01703>
Therein lies the danger, if doctors actually believe that the record is complete and accurate when it may well not be.
The statement “The PCEHR as it stands allows patients to add and remove components of the health record without tracking (i.e. nobody can tell if something has been removed)” is not quite accurate in my understanding. Only the health practitioner, with the consent of the patient, can upload a health summary. A doctor curating the PCEHR record can choose to shield or not disclose part of the record in consult with the patient, just as they sometimes do now on paper based records. The patient can see their summary of course, but cannot independently modify it. Behind the scenes all changes are tracked and in an audit situation the operators of the system can tell which practitioner did what, if there was a need to investigate any breach. The patient can independently modify only their own health notes, not the PCEHR health summaries or any other part of the visible record. Additionally health practitioners cannot see the patient’s health notes.
I have performed a number of PCEHR summary uploads with patients who have seen value in the process and have give their informed consent after considerable discussion. I have my own PCEHR and suggest that over time the PCEHR will deliver a benefit that outweighs the supposed risks.
I decided to have nothing to do with the PCEHR asa doctor or as a patient. I had information about me (a supressed home address) leaked to a persistent stalker some years ago via contacts in two government departments, which resulted in my wife being threatened. Before that one of my receptionists used a family member in the Police force in the relevent state to trace practice debtors. I don’t trust the bureaucracy to provide adequate security. If I had reason to have anything about my health on line I’d want total control of it.
I do not expect to use the PCEHR while patients are editing it.
Patients have good information but are not qualified to interpret this information.
Dave FFPMANZCA is 100% correct.
Add an electronic viewing system accessible via the internet to significant hospital records such as emergency presentations, discharge summaries and reports/results of in-hospital investigations and you provide access to the complete set of information required by a treating clinician to provide informed care to the patient in front of them.
The PCEHR was always all about power and money and never about practical outcomes for patients. Good riddance when it finally falls over.
PCEHR aimed too high. An accessible repository for doctors letters to other doctors, a health summary from the primary GP and a real time medication/prescription record is all we need. Our notes should remain our notes and patients granted read only access. Maybe I’m a dinosaur but the waste of time and money thus far with the PCEHR is mind boggling.
Thanks Christian. I am one of the GPs involved in the Springfield Health City. We have taken the first few steps & started the Brookwater medical centre earlier this year. The next step is the hospital development as you mentioned. Hats off to the Springfield Land Corporation bosses Maha Sinnathamby & Bob Sharpless. They have had the vision from the beginning of planning & integrating all the public services. I am proud to be involved with them & the Mater group in trying to innovate & intergrate to provide the one stop healthcare facilities, from primary to tertiary to aged care all in the same locations. It has the potential to be world class & as you said Christian its all due to the leadership which engaged our group of GPs & Mater health services & listened to us to help develop a workable model. Their attitude has been so different to the usual govenment prescriptive approach which has been so refreshing. World class leadership developing world class healthcare, all in our own back yard!!
“The original simple objective of the PCEHR was similar — to create an e-health record that health professionals can easily access to ensure the best possible health care throughout a patient’s life.”
I remain a firm believer in the original vision of an electronic health record that would hold up to date, accurate health information that health professionals could use in order to improve patient care and reduce the risk of medical error. The PCEHR very quickly diverged from that ideal due to the focus on patient control at the expense of accuracy and reliability of health information.
Whilst I think it is reasonable and appropriate for a patient to determine who has access to the health record, I don’t believe that lay people are the best placed to determine the contents of the record. The PCEHR as it stands allows patients to add and remove components of the health record without tracking (i.e. nobody can tell if something has been removed). As a medical practitioner, how can I then trust that the contents of the health record are complete enough for me to base any sort of treatment decision upon?
As a doctor working in the area of Addiction Medicine (as I note does A/Prof Rowan), abuse of prescribed opioids and sedatives is a growing problem in my patient group. An electronic record which allows patients to alter the contents of the record actually increases risks associated with doctor shopping as patients would be able to selectively choose the health information that doctors see – the CT showing a disc bulge might stay in but the prescription written by another doctor yesterday probably won’t.