I have been mulling this nonsense called the Personally Controlled Electronic Health Record (PCEHR) and have formed the view that it is the wrong thing for those who are concerned for Australian E-Health to be working on.
What NEHTA and the three trial implementation sites should be working on is delivering a connected Clinician Controlled Electronic Clinical Record (CCECR) to our working clinicians so they can make a difference to the quality and safety of patient care available to the community.
NEHTA has developed a list of benefits from the PCEHR that reads like this:
“More specific benefits of PCEHRs include:
- assisting the self-management of stable chronic diseases (for example, high blood pressure, diabetes and asthma)
- increasing communication between clinicians and individuals by using e-consultations and online services to support self-care management using broadband services and online records to share relevant health information
- reducing hospital re-admissions by making accessible timely and accurate health information essential to the better coordination of post-hospital care
- improving use of scarce resources through better quality health information, faster clinical assessments, more accurate diagnoses and referrals, and more effective treatment and prescribing of medication
- better decision making by healthcare providers and individuals through the availability of more complete, more accurate and more up-to-date health information
- better policy development as a result of the high quality data potentially available for use in research and planning.”
The list is found here:
If you consider this list the elephant in the room is the assumption that clinical practitioners and other service providers are and will be fully automated when the PCEHR arrives and that they will even be interested to get involved given all the other things the Government is asking of them. While we are part way through automation this is a job that is not completed both in either functionality or adoption.
Of course clinicians will also want to understand the disruption all this might cause and how they might be compensated for inconvenience and cost.
Let us be very clear, improvement in clinical outcomes relies on improvements in clinician behaviour as much, if not vastly more, than improving patient behaviour. If your clinician does not suggest to you what you need to do you are pretty unlikely to find out on your own!
It is bizarre that if you look at NEHTA implementation plans there is just total denial that any serious financial support is required to foster change in work practices and in adoption of the HI Service as well as their approach to Secure Messages.
What is happening with things like e-Referral and e-Prescribing is that specifications are being developed but not trial implemented and the expectation seems to be that all the learning and trialling of the NEHTA’s work will be done at the expense of providers.
NEHTA makes this quite explicit!
This is a quote from a presentation by NEHTA Clinical Lead Dr Leonie Katekar that is found here (Page 16):
“Computerisation and uptake of nehta products are the responsibility of the health sector (some funding is available through nehta through PCEHR)”
All this is frankly unhinged and just plain wrong! The US and UK have both recognised that the change management and adoption of Health IT is something that need direct financial support. NEHTA and DoHA have this utterly wrong and will get nowhere until they articulate a totally different approach.
That may start with sponsoring and guiding the development of, and then supporting delivery CCEHR capabilities to all who need it. Only once this is achieved in and out of hospital, and information flows between providers are working, does it make sense to think about what the patient access components of an overall e-Health system may look like.
My view is that the PCEHR is little more than a dangerous, politically correct and motivated thought bubble, dreamt up by someone who really did not understand e-Health in the National Health and Hospital Reform Commission, and which will do vastly more harm than good unless we build, activate and stabilise a conceptual distributed CCECR first!
The PCEHR is a political not a practical solution to Australian E-Health! It also probably won't work as the polys expect. What a mess we are in for!