Thursday, September 22, 2011

Here Is What Patients Want From Electronic Health Records. The PCEHR Is Going Off In the Wrong Direction.

The following very interesting study was reported a few days ago.

Majority back online GP services

12 September 2011   Fiona Barr
A survey of almost 3,000 patients and health professionals has found significant support for online GP services such as repeat prescribing requesting and appointment booking.
Patient.co.uk ran a survey of 1,700 visitors to its website and questioned more than 1,000 clinicians - including more than 500 prescribers - about online functionality in primary care.
Of those questioned, 88% of health professionals were in favour of online repeat prescription ordering and 87% of patients wanted to use such a service.
Meanwhile, 86% of health professionals and 85% of patients supported an online appointment booking system.
The vast majority of patients responding to the survey (91%) also said they would use an online tool that allowed them to identify the side effects of drugs and 90%said they would use an online symptom checker.
Patients also wanted an online tool to make product suggestions for specific conditions (86%) although this was only supported by 60% of clinicians.
Conversely, ordering prescriptions for home delivery received greater support from professionals (91%) than patients (78%).
More here:
There is really nothing to be said. The functions patients want most are simply not possible in the context of the PCEHR as reflected in the current version of the Concept of Operations.
If Ms Roxon wants voluntary adoption to happen at anything other than a snail’s pace the answers are staring her in the face!
Here is what NEHTA / DoHA thinks is needed as enhancements:

2.8 Potential enhancements

The National E-Health Strategy proposed that the PCEHR System rollout be undertaken via an incremental approach, with the capabilities of the system being expanded over a four-year implementation period.
Potential enhancements could focus on delivering quality improvements and enhancements based on stakeholder demand and lessons learned from implementation and adoption activities. Candidates for later potential enhancements could include, but are not limited to:
• Enhancements to the registration processes.
• Support for collection of a broader range of health information from healthcare providers, such as:
- Delivery of any optional elements delayed from the first release of the PCEHR System.
- Advance care directives (i.e. storage of the directive itself in the PCEHR System rather than just information about the custodian).
- Pathology requests.
- Diagnostic imaging reports, images and requests.
- Health information from registries.
- Care plans.
- Assessments tools.
- Reports from practice-based diagnostic tools (e.g. electrocardiograms).
- Pharmacy based medicine reviews and medication profiles.
- Extensions to the Shared Health Summary to include fields such as infectious disease status, information about implants, etc.
- Information to support an individual with disabilities.
- Information around palliative care.
• The addition of consumer-oriented features, such as:
- Integration with consumer-oriented personal health records enabling an alternative form of interaction by an individual with their PCEHR.
- Collection of information from consumer devices such as blood pressure monitors, blood glucose monitors, etc.
• Access to information within other sources, such as:
- Screening registers, such as the National Bowel Cancer Screening Register, BreastScreen Australia registries, pap smear registries, etc.
• Addition of new views to the PCEHR System to support the needs of specific groups, such as:
- Views to support management of chronic diseases.
- Views to support individuals and their representatives.
- Views to support specific healthcare providers, such as nurses and allied health providers.
• Enhancements to the template service to support more dynamic and flexible approaches to templating.
• Enhancements to the reporting service to support a wider range of approved uses.
• Enhancements to the PCEHR System access controls.
• Enhancements to support mobile devices.
• Enhancements to facilitate implementation of clinical decision support tools within clinical systems and portals, which leverage information from the PCEHR System.
Initial consultation with a cross-section of stakeholders indicated that some of these features are important to pursue early. However, progress on the above enhancements depends on work being delivered outside the PCEHR Program.
----- End Extract.
Not much in the way of interactivity between clinician and patient there.
This paragraph is quite fun!
“The National E-Health Strategy proposed that the PCEHR System rollout be undertaken via an incremental approach, with the capabilities of the system being expanded over a four-year implementation period.”
First it statement is just untrue and second they again admit - if it can be believed - that 4 years is the implementation period. Make of that what you will.
David.

2 comments:

Anonymous said...

While access to repeat prescription and booking services are probably a good idea, trying to add these to the PCEHR is inappropriate. These are both interactions directly between a provider/practice and a patient. The PCEHR does not sit between these parties, but is a third party that provides information. These services are much better supplied by the provider/practice themselves. The PCEHR could have a link to the provider's website, but that is all.

An analogy: Should the tax department be responsible for providing a portal where you can request your employer to make some sort of deduction?

Dr David More MB PhD FACHI said...

"There is really nothing to be said. The functions patients want most are simply not possible in the context of the PCEHR as reflected in the current version of the Concept of Operations.
If Ms Roxon wants voluntary adoption to happen at anything other than a snail’s pace the answers are staring her in the face!"

That is what I am and have been saying..the design they are implementing is wrong if they want any one to use it. They need to change what they are planning,

I utterly agree this is a provider function and it is those people this hopeless Government should be supporting!

David.