Tuesday, March 22, 2011

Australian Doctor Reviews Some Implications Of the PCEHR Proposal. It Seems The Docs Are Being Alerted to Some Worrying Things Coming!

The following couple of articles appeared in the Australian Doctor last week.

EXCLUSIVE: GPs to be e-record guardians


Paul Smith

GPs will take the key role in “curating” millions of patients’ e-health summaries to ensure they are accurate, safe and clinically relevant, Australian Doctor has been told.

A three-month consultation on the $467 million system is due to start shortly with the patient-controlled e-health records to be launched from July next year. The records will include a patient summary listing medications, diagnoses and allergies, which in most cases will be uploaded from a GP’s own patient summary.

The system will also include records detailing hospital discharge summaries, diagnostic results, event summaries and details on Medicare claims.

Patients will have to decide who can access which parts of their records and they will also choose the health practitioner to manage the information in their summary. In most cases, this is expected to be their usual GP. However, patients will also decide what clinical information appears on their summary record, meaning GPs will have to gain their consent to make changes.

Critics are concerned about the workload impact, but also point out that some people with sensitive conditions — such as mental illness, HIV or epilepsy — may choose to omit clinical information considered medically necessary to ensure safe patient care. It has yet to be decided if it will be clear to other health professionals that clinical information has not been included.

More here:


The article is followed by a range of comments many of which were concerned about practicalities which have yet to really be addressed by anyone.

There was also a commentary on the initial report by the same author.

Some big questions remain


Analysis by Paul Smith

The biggest issue in general practice this year is going to be these e-health records. Don’t allow yourself to be befuddled by the painful jargon employed by IT nerds, the meaningless acronyms they spout and the impenetrable way they explain their work to the wider world.

These records are meant to provide the basis for doctors — and others in the health system — to do their work. The core issue is the integrity of the information the records offer and whether that information is in a form that makes it clinically meaningful and usable.

In theory the ability to access summary health records — that list event and discharge summaries, perhaps diagnostic tests, along with medications and diagnosis — has the potential to fill the systemic cracks in modern day healthcare. But this means nothing if the clinicians cannot trust what they are reading. The initial experience of doctors with the UK’s own billion pound e-health experiment is an expensive testament to that.

The big questions facing those leading Australia’s e-health revolution were raised by Professor Enrico Coiera, a health informatics expert at the University of Sydney, in a Medical Journal of Australia article last year — and those questions are not about healthcare identifiers, interoperability issues or terminology domains. Professor Coiera, who is yet to be convinced of the need and value of summary health records, asks: “Who is to decide whether a drug should remain on a patient’s current medications list when they are treated by multiple clinicians? How do old drugs get dropped off the list?

“This synthetic act requires time, access to a wide variety of detailed data sources, clinical knowledge and familiarity with the patient. It might also require team consensus. The quality of a [summary care record] is compromised if crucial data are missing, if old data persist, and if no one is there to ‘join the dots’ across the data.”

Ultimately it will be patients who choose the health professional to “join the dots” but in most cases they will choose their usual GP.

More here:


Again we have multiple comments related to the vagueness and lack of practicality of the PCEHR proposals that have managed, thus far, to make their way into the public domain.

What these two articles show is that the PCEHR proponents are not doing a very good job of either communicating their plans or making it clear what the implications will be for those involved. Of course not getting this right will dramatically increase the risk of overall failure of the total project.

If the professional clinical newspapers are pointing out major flaws in what is proposed maybe some form of rethink is needed!

I get the sense those attempting this flawed project really don’t have a clue as to what is required to have any chance of success. They don’t seem to understand that a high level of clinician understanding and support is a binary critical success factor. Low levels of support it is finished - high levels of support are necessary but by no means sufficient for success!


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