I had in mind this rather high level post. Comments welcome!
Where Is The Consensus on Australian E-Health and How Can A Shared EHR Vision Be Progressed?
In recent times the National E-Health Transition Authority (NEHTA) has released a Concept of Operations for the proposed Personally Controlled Electronic Health Record (PCEHR). Submissions providing comment have been requested ending in early June, 2011.
Substantial funding ($450M+) for this initiative has been made available for an initial two years (ending June, 2012) and work is currently underway with a range of solution providers, NEHTA and the Commonwealth Department of Health and Ageing to make this rather grand vision (which originated in the Final Report to Government in 2009 of the National Health and Hospitals Reform Commission) a reality.
At the core of the proposal is that there would be an internet accessible national electronic health record system created in a series of national repositories and indexed in such a way that the patient had control of what information was to be made available to anyone (clinicians, friends, relatives etc.). The information to be held in the record for each individual was intended to be sourced from Medicare, diagnostic test providers, hospitals, specialists and primary care provider computers and assembled into a health summary and then a series of so called ‘event summaries’. There was also intended to be a facility for ‘consumer contributed information’ and commentary.
Review of the currently available submissions suggests that while the concept of an easily accessible and available summary health record to support continuity of care and care in emergency situations is universally supported (provided via either access to provider systems or a health information exchange) beyond this the ‘how’ this might be achieved is by no means clear and additionally it is recognised there are a very large number of barriers (including privacy and security, information quality, currency and reliability, overall system governance and management, consumer and clinician engagement, clinician workflow and incentive requirements and patient consent issues) to successful delivery of what seems like a simple and quite intuitive objective. It also needs to be pointed out that while intuitively it seems such a system would provide obvious benefits and usefulness the evidence supporting the value of such a care record is still by no means clear. This is to be distinguished from the very much stronger evidence for the clinical value of well-designed records intended for use by individual clinicians in their care delivery and decision making.
From this writer’s perspective Australian E-Health has rather got ahead of itself in attempting such an ambitious Shared EHR program without laying and proving the organisational and operational infrastructure as a number of initial and required steps.
These steps include:
1. Developing a Governance Framework and Leadership which properly engages clinicians, consumers and other stakeholders.
2. Recognition of the need to focus on achieving quality standardised implementations of effective clinician care support systems both in practices and hospitals .
3. Development and stabilisation of safe, secure, standardised clinical document sharing between each element of the health sector (as is now being undertaken rather slowly by NEHTA). This needs to cover clinicians, diagnostic service providers, hospitals, allied care providers etc.)
4. Evolution and training of an adequate workforce of clinically ‘savvy’ IT specialists to guide and manage the much increased level of activity.
5. Grasping some high impact ‘low hanging fruit’ in terms of projects that can make a real patient difference. (Consumer and clinical information portals and the like for example).
Only once these projects are well advanced, and the skills and governance in place, should consultation and development of a shared electronic health record be considered. At present the present proposals from Government very much put the ‘cart before the horse’ and in my view will have the effect, in failing to deliver a reasonable outcome, of severely impairing the chances of the Australian population receiving the benefits of technology implementation that has so improved other sectors of our economy and improved the overall quality of life for so many citizens. There is no doubt e-Health has a lot to offer but it needs to be delivered in a planned, considered, careful and consultative way. This is presently not what is happening in Australia.