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THE benefits of having an effective electronic health record seem obvious. Rapid sharing of information, reduction of duplication and greater ownership by patients of their health information offer hope of reduced harm and savings in time and money.
The review of the personally controlled electronic health record (PCEHR) commissioned late last year by the federal government certainly thinks so.
The reviewers point to modelling which suggests that e-health changes could lead to savings of $7 billion a year by 2020. The modelling estimates implementing e-health would avoid 5000 deaths, two million outpatient visits, 390 000 hospital admissions and 10 million laboratory and imaging tests by 2020.
The overwhelming majority of those making submissions to the review were also supportive. According to the review, more than 1.2 million Australians have demonstrated support by registering for an e-health record, exceeding the 2013 target.
The new federal government has affirmed its commitment to e-health and continued funding to implement the recommendations of the review. One of the reviewers, GP and former AMA president Dr Steve Hambleton, has been appointed the new chair of the National E-Heath Transition Authority (NEHTA).
Those of us at the coalface of general practice know that the reality of implementation to date has had problems. Uptake by health professionals is well below targets and has plateaued.
The review points to “classic issues of change management” such as lack of strategic direction and clear policies, poor understanding of potential benefits, unengaged or unwilling stakeholders, and poor execution of e-health initiatives.
To be useful, My eHealth Record (as the PCEHR has been renamed) needs high-quality information from GP record systems. This means that investment in engaging, training and supporting general practice is crucial if we are to achieve the e-health dream.
How to achieve successful implementation and use was explored by the Improvement Foundation and 54 general practices through a NEHTA-commissioned Quality Improvement Collaborative. Small practice teams attended workshops separated by supported action periods.
Practical work focused on the changes needed to create and upload patients’ Shared Health Summary (SHS) — a list of conditions, medications, immunisations and allergies.
Those involved in the collaborative identified what new work is needed in the 7000 general practices providing care for the vast majority of Australians every year.
The new tools, skills, processes and systems needed to upload the SHS include:
• obtaining patient consent
• processes to register patients, providers and organisations in the online system
• updating computers and software to be compliant with the new system
• processes to improve and maintain data quality to ensure the SHS is useful
• engaging patients in ensuring the accuracy of clinical information
• processes to upload summaries.
Making practice systems ready and usable will require investment and a lot of work. Once software is compliant, the hardware is upgraded and the certificates are in place it is likely that this work will become routine.
However, the work to achieve and maintain good data quality will never end. It will require sustained, targeted, systematised effort.
Practitioners will need to use recognised coding systems for diagnoses. Medication lists need to be continually updated. General practices need to embrace these tasks as they consolidate their role of supporting patients at the core of an efficient and effective primary care-centred health system.
Australian general practices are currently busy providing more than 2.4 million patient encounters each week. Increased support is required if they are to find the people, time and money to make the e-health changes while continuing with their core mission of providing patient care.
Practices have already demonstrated their ability to achieve extraordinary outcomes when properly supported, including rapid computerisation and rapid improvements in immunisation rates.
History has taught us that important enablers include adequate financial support, local training and practice support and systems that have been properly designed and tested in the real world to be fit for purpose.
Failure to invest effectively in general practice will seriously delay e-health. We need an effective implementation plan which will properly resource and support general practice for success if Australians are to receive the benefits of the e-health revolution.
Dr Andrew Knight is clinical adviser at the Improvement Foundation, Australia, staff specialist at the Fairfield GP Unit, Sydney, and conjoint senior lecturer at the University of NSW.
In my out patient internal medicine office, for the past 6 months have been using a durable affordable 14 inch chromebook, with VNC viewer made for Chrome. I remote access my data base/EHR with VNC viewer and with the HDMI port mirror to a 24 inch TV wall mounted in the examination room.
I can display, educate and edit the projected EHR and work along with the patient for maximum visual and auditory effect.
Thanks to my 13 year old son, who helped come up with this approach. My patients really love this approach and it integrates the EHR extremely well in the examination room.
The key to a successful ehealth imlementation is education of users not just on how to enter data, but more importantly of the information model behind it and the clinical value of the ehealth solution. The key to achieve this is to teach some basic medical informatics at the medical student level, and the development of a clinical specialty of medical informatics so more clinicians can play an active role in the development of the ehealth system. It is very positive that a clinical person has been made the chair of NEHTA, a shortcoming which I have been protesting for many years. A good example is the US Office of National Coordinator for Health IT (ONCHIT) which has had clinical leads from the outset, and has now supported the development of a clinical specialty in medical informatics.We need to recognise that ehealth is now a core part of healthcare delivery, and we as clinicians need to take responsibility for ensuring it is an effective tool.