Sunday, January 30, 2011

The RACGP Provides A Budget Submission for 2011/12. In E-Health They Seem To Have Got A Bit Lost!

This report a few days ago prompted me to go and have a look what the RACGP had to say in the e-Health Domain - given their close sponsored relationship with NEHTA.

GPs not ready for e-health records

General practitioners association calls for greater focus on education and support

General Practitioners are not technically nor functionally ready for the advent of personal e-health records, a representative body for the industry has warned.

In a public submission to the Department of Health and Ageing (DoHA) on the federal budget for 2011-2012, the Royal Australian College of General Practitioners urged the Federal Government to spend more on programs to aid implementation of software, communication standards and comprehensive support for general practitioners looking to implement the government’s $467 million personally controlled electronic health record (PCEHR).

“The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training,” the association’s submission reads. “General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.”

While GPs are widely recognised as key stakeholders in the widespread implementation of e-health, they are often stereotypically portrayed as Luddites and obstacles to cultural change within the health system.

However, according to the association this was largely due to the relative lack of technical resources available to individual doctors, leading to poor processes and security culture when using electronic equipment such as e-health records.

As a result, the submission argues for ongoing education and training programs as well as incentives provided to doctors to encourage adoption of e-health standards.

Here is the e-Health text of their submission.

The College summarised the overall submission thus:

Key messages

The RACGP advocates that the Federal Government should:

  • Continue significant investment in e-health
  • Build the capacity of general practice
  • Enhance health outcomes for regional, rural, and remote communities
  • Enhance the health of Aboriginal and Torres Strait Islanders communities
  • Recognise and reward for general practice
  • Support international medical graduates.

The document is here:

The specific e-Health component of the submission is here (Pages 4 and 5):

1. Investing in the future of e-health - readiness for a Personally Controlled Electronic Health Record (PCEHR)

The implementation of an efficient and effective e-health system is a long-term undertaking across the stages of planning, implementation, and financing. The effective up-take and implementation of e-health initiatives requires investment in information, communication, and technology systems as well as education and training. The method of delivery of general practice services will need to evolve in order to incorporate nationally established guidelines and solutions, ultimately achieving safer, more accessible, and efficient health services.

The RACGP supports and encourages a national standards based approach to e-communication, and acknowledges the work of NeHTA in establishing standards that will build consistent messaging and communication between different software solutions. However training and support is required to up-skill the general practice profession in the technical and functional interoperability of e-health solutions.

A Personally Controlled Electronic Health Record (PCEHR) will be available from July 2012. Expansion of investment in e-health, to include support to develop user skills and knowledge in the importance of quality patient information, will be well received by health care providers.

To prepare general practice for the PCEHR and to be e-health ‘ready’ will require an investment across:

· Change management within the practice

· Training and education of practice staff

· Implementation of systems (technical systems).


  • Invest in the national implementation of e-health guidelines and standards and ensure access to e-health communication tools and decision support solutions.

1.1 Technically ready for the PCEHR

An essential pre-requisite for an efficient and effective e-health system is the electronic exchange of accurate and relevant patient information across the health sector, including different health care providers, private and public sectors, and patients. General practitioners require access to technology that allows clinical communication to be timely, meaningful, and secure.

General practice requires investment in development or enhancement of existing software systems to better address patient identification and authentication, and investment in hardware infrastructure to securely share patient health information via the PCEHR.


· Invest in general practice software and hardware to ensure that practices have the technical capability to support implementation of the PCEHR.

1.2 Functionally ready for the PCEHR

Uptake of the PCEHR by health care providers will be aligned to confidence in the quality and usefulness of the PCEHR in being able to support continuing care across geographical and professional boundaries.

Further investment is needed to deliver change management and education and training in general practice to ensure rapid dissemination of new knowledge, support change, and guarantee adoption of the new technologies and systems.


· Invest in education and training for general practice staff in the use and benefits of the PCEHR.

· Provide incentives for general practices to dedicate human resources specifically for the quality analysis, and quality improvement, of data in GP e-health summaries outside of the patient consultation through either Practice Incentive or Service Incentive Payments.

1.3 Information Security

Increased use of e-health initiatives must be combined with effective security measures. These security measures must be designed to ensure that highly sensitive and confidential information relating to: individual patients; the health professionals who provide care; and the business component of the general practice is securely managed.

General practice has specific needs for computer and information security, as it can often be a challenge for general practices to find security experts and technical service providers who understand the business of delivering care in the general practice environment.

Some issues contributing to this challenge include:

· Inadequate risk analysis and identifying gaps in security

· Lack of designated authority (person) to ensure robust security processes are documented and adopted

· Poor data management processes to ensure that information is backed up and can be recovered easily if there is a system failure

· Inadequate business continuity and disaster recovery planning

· Lack of and/or poor password security

· Lack of security ‘culture’ and leadership.


· Introduce a national strategy aimed at providing ongoing education and training for general practitioners, practice nurses, and practice staff regarding data security in primary healthcare.

---- End Extract.

I think a few comments on this are warranted - remembering that this is a Budget Submission - i.e. a request for funds for General Practice:

1. Despite all the wonderful stories the RACGP publishes with NEHTA about how wonderful things are in e-Health the very first paragraph says more ‘evolution’ is needed.

2. The College then goes on in paragraph two to suggest that GPs need more training and support to move forward on e-Health.

3. In paragraph 3 they rather bizarrely seem to suggest that improving user ( public ) skills and knowledge in ‘quality patient information’ will be well received by health care providers and that the PCEHR will all be available by July 2012. I don’t know many providers who are looking forward to patients providing their view of ‘quality patient information’. Do you?

4. Before this date we are alerted to the need for change management, training and education and to actually get new improved systems in place.

5. Then we are told we need investment in national implementation of ‘e-Health guidelines and standards to ensure access to e-health communication tools and decision support solutions’. Does anyone actually know what that collection of words actually means?

6. The rest of the section then goes on to ask for support for new improved systems and all the activities to foster their adoption and use.

7. As best as I can tell there is not a single dollar amount attached to any of this.

Bottom line is that this is the sort of budget submission you put in, on e-Health, when you really don’t know what the PCEHR is, what impact it might have and how you may be impacted.

They would have done better to say ‘we think we will need some help with aspects of the PCEHR once we are clear what it will actually turn out to be and when it will be ready’. That way they would not have had to put in this rambling un-costed and un-scoped drivel.

I note there is not one word on the place of General Practice in provision of clinical summary information for the PCEHR. I wonder why that is?

I wonder which marketing genius in the College came up with these 2 pages and how closely the e-Health Subcommittee scrutinised what was done?



Anonymous said...

I couldn't summarize it any better myself - as you say it is "rambling un-costed and un-scoped drivel".

Is there no-one with any common sense in the RACGP who knows anything about e-health?

The RACGP has an e-health committee - who is on it? H

How how could anyone attach their names to this rubbish. It leaves me numb, speechless and flabbergasted.

Anonymous said...

The RACGP has demonstrated it is quite ineffectual when it comes to advancing ehealth in primary care. Its goals and objectives for ehealth are ill defined without which they have no compass and no map with which to demonstrate they know which way to head.

They have had plenty of opportunity and many years to get their act together on ehealth both of which have been wasted. Of course they are not alone - the AMA is no better. Is it any wonder we despair.

Sam said...

Sam Heard: I do not want to defend the document but I do want to put the case that we do need bodies like the RACGP deeply involved in standards and maintaining quality. The problem at the moment is that the standards are highly technical but that will change rapidly: standards will become focused on what we want to share in eHealth and who can offer what services under what conditions.

GPs and Consumers are likely to be allies in this space and a body like the RACGP will need to speak for the profession. It is a massive shift and we haven't seen much of it yet.

It would be good to consider what sort of things we will need from the RACGP in future - they definitely have a role to play.

Dr David More MB, PhD, FACHI said...


The whole point of this post was to point out that they are sure not doing that now - and that maybe e-Health in the College should be 'under new management'. Whoever is doing it now is just hopeless IMVHO.


Keith Heale said...

Agreed that, as a budget submission, this document is sadly lacking. However some of David's criticisms may be a little harsh. For example "User skills" in para 3 may refer to GPs, not the public.

Two things which this submission fails to say clearly (and which I think should be central) are:

1. Standards are not going to make any difference unless they are a) accepted by the main players, b) implemented and c) universally used. I actually think that is what the author is driving at in Section 1.1. These standards are identified in the document as mainly around communication and information interchange.

2. ehealth should not be equated to the PCEHR. Time after time discussions about ehealth which are potentially useful get hijacked by the wretched PCEHR. Until we see a credible explanation of how this hare-brained idea can be turned into reliable, authoritative, regularly updated information it is simply not worth discussing. It is sickening to see bodies like the RACGP obligingly repeating, perrot-like, the government mantra when it is obvious that "the emperor has no clothes". What makes this so destructive is that there are scores of ehealth initiatives which would make a difference if they were given priority and implemented, but they get pushed down the stack becuase the focus is on the bl..dy PCEHR.

Dr David More MB, PhD, FACHI said...


I looked very closely at the whole text - and my bottom line was that I could not actually work out what they were saying. It is not hard to write ideas you understand down clearly - so my conclusion was that all this is a reflection of not knowing what they are on about! There may be some valid points (I agree) made accidentally but I really am not prepared to give them the benefit of the doubt.

This was written by people who don't get it in my view!