Tuesday, September 27, 2011

The AMA and Others Are Stiffening Its Opposition to the PCEHR. Minister Roxon Should Be Really Worried.

A little while ago I pointed out in a blog that the PCEHR was going to go very badly unless the medical profession was on side.
See here:
Earlier this week we had this appear following Ms Roxon’s suggestion the AMA should just stop complaining and ‘get on board’!
Now we have a response from the AMA - a day later!

Dangers of de-medicalising the PCEHR

Guest editorial by Dr Steve Hambleton
The Federal Government has released the final version of the Concept of Operations for the Personally Controlled Electronic Health Record (PCEHR) system — a document that is very similar to the draft version. The AMA is extremely disappointed in both versions.
For a health record that is being promoted as revolutionary for patients and health professionals, including doctors, it is sadly bereft of sufficient medical input to its design and intended purpose.
It appears that the personally controlled e-health record has effectively been ‘de-medicalised’. It appears that consultation has been merely conversation. Medical input has been ignored, while the government has caved in to noisy minority consumer groups.
Everybody in health wants e-health and the personally controlled e-health record to succeed. The AMA has been one of the strongest supporters of the government’s e-health initiatives. If it works properly, it will certainly save lives.
But we cannot support aspects of a system that do not improve on what we have now.
Nor can we support something that potentially creates risks to patient health.
Unfortunately, that is where we find ourselves with the release of the Concept of Operations. Under the proposed arrangements, people will be able to alter their health record without consultation with their doctor. Patients could entirely remove from their record clinical documents they had previously considered worth sharing with healthcare providers.
The personally controlled e-health record will no doubt give patients greater involvement in and responsibility for their healthcare.
We are all for giving patients greater control, but not total control that excludes medical moderation. This is reckless and dangerous. It could undermine all the potential benefits of an electronic health record.
If this goes ahead, we will have a system that doctors want to support but can’t because their patients may not give them access to their records or parts of their records.
The AMA had hoped that the personally controlled e-health record would have contained a shared electronic medical record that sat within it. The medical component would contain reliable and relevant medical information about individuals that had been posted by doctors.
Consumers with serious concerns about privacy, or an objection to their medical and health information being shared, could actively make the choice not to participate in an opt-out system.
Dr Hambleton is president of the AMA.
More here
This article is blazingly clear. Ms Roxon you want help having this work there are some major changes we will insist on. No change, no deal is how I see it.
Of course all this could have been avoided if NEHTA bothered to listen to those who responded to their request for submissions.
We even now have the RACGP seemingly being a bit more concerned about workflow and time impacts:
“Dr John Bennett, chair of the RACGP’s national e-health standing committee, said: “I don’t think the government has any clear idea of what the workload implications are going to be. I think for a small proportion of patients — those with multiple diagnoses on multiple medications, those in aged care — there will need to be more time spent gathering information and updating records.
“No doctor loves spending time doing that work but I think if they see real benefits for patients, that this system works, that will be something they are willing to do.”
Dr Bennett said that despite the safety concerns raised by the AMA, the system would be a “vast improvement” on the fragmented information doctors currently relied on to care for patients.”
Full article here:
Interestingly a small poll from Medical Observer is suggesting that of a sample of 30+ GPs on 12% would not bill for PCEHR maintenance (12% didn’t know and 76% would bill).
This whole thing will run off the rails unless some rapid work is done to fix the basics!
I will leave it as an exercise for the reader to see how many of the Australasian College of Health Informatics suggestions were addressed (see page 4) of their submission which is found here:
“However, there are a number of areas where substantial improvements for the next release of the Concept of Operations can be achieved:
  • Provide clarification if the PCEHR is part of a total EHR and what the specific goals of the PCEHR are
  • Provide more detailed information on the business case for the PCEHR
  • Include recommended implementation approaches and criteria
  • Include "Build on and strengthen the patient‐doctor relationship" in the PCEHR Principles
  •   Include more rationale how practitioners' will use electronic systems vs paper‐based systems
  •  Add features to increase the trust of patients (particularly "opt out" patients) and practitioners
  • Make the access arrangements more implementable and simpler for the majority of users
  • Include more details on a simple and complete audit trail access by consumers
  • Provide more details on PCEHR data retention/archival and access for secondary use of data
  •  Give priority to a small number of useful "low hanging fruit" functions to ensure fast adoption
  •  Combine the approach to Referrals and Discharge Summaries and add hospital dispensing systems
  • Include more details on which interfaces and interface standards are to be used for which function
  • Ensure the 12 first and second wave projects are able to seamlessly interoperate and share data
  • Include specific design guidelines how the clinical quality of unstructured data can be assured
  • Review the value and data quality of consumer‐entered information
  • Include a long‐term implementation timeline with clearly defined major milestones
  • Include consideration of the e‐Health Workforce limitations
  • Include a section on how the PCEHR will compete with and leverage new technologies
It is a pretty long list and not much was addressed! As the AMA etc. say - really just not listening!

1 comment:

Anonymous said...


1. Quality & reliability of the information is going to be suspect
2. No evidence of any efficiencies - actually seems to require extra work
3. Opt in means a long time before a critical mass is achieved
4. Significant potential increase in medico-legal risk if involved
5. Competitive basis of health delivery undermined

Absolutely crazy!