Wednesday, April 11, 2012

The AMA Tries To Make Some Sense of the National E-Health Record System (PCEHR). They Are Not Sure About All This.

A few days ago we had the AMA release a draft guide for AMA members to assist with their involvement with the NEHTS.
The report has been covered here:

PCEHR explained in AMA draft guide

4th Apr 2012
THE extent of the change to general practice to be brought by the government’s e-health records system has been outlined, with the release of a 26-page draft guide on use of the new system.
The guide was released today for public comment by the AMA, which compiled it at the request of the National E-Health Transition Authority. It explains how practitioners might use the PCEHR in their day-to-day practice.
AMA president Dr Steve Hambleton said while the system would “put the patient in the driver’s seat for managing their health” it would also have “practical clinical limitations for medical practitioners… in respect of the content, accuracy, and accessibility of the information”.
The guide emphasised the system is voluntary for both patients and practitioners and there will be “no indication to medical practitioners who view the patient’s PCEHR how a patient may have modified their PCEHR”.
“It is safest to assume the information in a patient’s PCEHR is not a completely accurate record of the patient’s clinical history or current health status, so all information should be verified from other sources of patient information, and ideally, with the patient,” the guide said.
More here:
There is also coverage here:

Doctors worried about PCEHR admin: AMA survey

An Australia-wide survey of specialist and general practice clinicians has found significant concerns about the administrative requirements of the PCEHR. It also uncovered worries about the financial impact the PCEHR will have on clinicians who guide their patients through the PCEHR process.
The survey, conducted online by the AMA, garnered 197 responses. The majority of respondents were GPs, although a total of 18 specialties were represented overall. Responses were also heavily skewed towards clinicians in private practice.
Clinicians also indicated a desire for more, and greater, detail on the workings of the PCEHR. The AMA has sought to plug this knowledge gap with a forthcoming publication called The Essential Guide to Using a Shared Healthcare Record. The publication is currently in draft, and can be found here.
More here:
Here is part of the AMA Release:

Draft Guide to using the PCEHR

The AMA has produced a draft guide for doctors on how to use the personally controlled electronic health record (PCEHR), which is due to commence implementation from 1 July 2012.
The draft guide has been circulated for feedback from doctors and is available on the AMA website for professional and public comment prior to final publication.
The guide will assist medical practitioners to make choices about participating in the PCEHR system and explains how they might use the PCEHR in their day-to-day practice.
AMA President, Dr Steve Hambleton, said today that the AMA supports patients taking responsibility for their own health and recognises that ‘personal control’ of their health information could empower and encourage them in this role. 
“The PCEHR system will put the patient in the ‘driver’s seat’ for managing their health information,” Dr Hambleton said.
“But the PCEHR has practical clinical limitations for medical practitioners in the treatment of patients in respect of the content, accuracy, and accessibility of the information. 
“We accept that the intention is for people to be able to register for the PCEHR from 1 July, but we have advised the Government that there will be very few medical practitioners who will have the capability to interact with the system from that date. 
“The AMA would have preferred the PCEHR to be an opt-out system, rather than opt-in, to ensure the success of the system in healthcare delivery,” Dr Hambleton said.
“Nevertheless, the AMA considers the PCEHR will become a valuable addition to quality health in Australia over time and will work with the Government to ensure that the best possible PCEHR is available for patients and health professionals.”
The Draft AMA Guide to Using the PCEHR is at
More here:
The direct link to the file is here:
I also had the following e-mail from an expert commentator.
“David I've just been reading the AMA's guide to using the PCeHR Apart from the AMA developing it - should NEHTA not have done this, rather than help the AMA? IMHO this is a system behaviour document written by a bunch of well-meaning amateurs.
 It still contains many of the flaws in the ConOp, especially the Personally controlled bit. At best the access control will work at the organisation level so a patient who wants to restrict a particular class of user (e.g. only specialists of a certain type, not nurses etc. etc.) cannot do that. IMHO this level of access control is just not good enough. They are making access to patient health information easier, but also much easier to be misused.
 The real reason for this rant is an amazing set of statements in section 5.5 specifically
5.5.4: Patients should be encouraged to exercise their responsibility/control over their PCEHR by seeking to have errors addressed by their healthcare providers that uploaded the document.
Are they seriously saying that patients need to understand and ensure the correctness of the information in their PCEHR????
It seems that the whole of section 5 is saying that there is no guarantee of accuracy or consistency of a patient's health information and that it is up to the patient to do this. This is madness.
And even worse there is nothing I can find in this document or the ConOp about disputes and dispute resolution. If a patient disagrees with a medical professional or is two or more medical professionals disagree, what is the process for resolving the situation?
The train wreck is happening, but very slowly.
Also  there seems to be a lot of things in section 5 that are not in the ConOp. What is the authority of this document? Are all the statements about responsibilities agreed by and consistent with NEHTA/DoHA and the proposed legislation.
---- End e-mail.
I note, in passing, the AMA says they had NEHTA input / help with the draft.
For me reading the draft I see a political document where it is clear there are aspects of the NEHRS design and implementation they are really concerned about, on behalf of their members, but they also feel that continued engagement is - at present - the best way of having the NEHRS be as useful and valuable as possible. As sensible stance in my view.
There are a lot of unresolved issues for many of the stakeholders in the NEHRS and sadly the present DoHA/NEHTA approach seems to be denial of this fact. That approach simply cannot hold in my view.
The ongoing rejection by both the AGPN and the AMA of a range of very 'doctor-unfriendly' aspects of the present proposals around the NEHRS is both rational and sensible. It will be much harder to have sanity prevail once the 'train has left the station'.
The sooner we get past July 1, and some sensible planning can begin on the whereto from here question the better!


B said...


re: "The sooner we get past July 1, and some sensible planning can begin on the whereto from here question the better!"

There's an old saying: if you can't change the people, change the people.

You and others on this blog as well as people making submissions to NEHTA/DoHA have been trying to change the behaviour of the people responsible for this initiative.

That has not succeeded. The only option left is wait until the people are replaced.

It happened with the Access Card, it'll happen with the NEHRS.

Anonymous said...

The doctors initiated the drive for better e-Health in primary care a few years back. The Government responded by establishing NEHTA, establishing projects and pouring in money to enable their development.

Now the doctors (AMA, AGPN) are complaining, they want more money to participate, they don’t like this and they don’t like that, yet the Department and NEHTA say they have consulted with them every which way. Even the RACGP has tentatively tried to breathe some life into it all with OXYGEN. To what avail? If the doctors don’t like it they should stop whining and do some leading. Isn’t that what these peak bodies are there for?

Dr David More MB PhD FACHI said...

Sorry, if you are not Government (DoHA/NEHTA) there is no way to really lead. The PCEHR was invented without almost any clinician consultation - it is deeply flawed and attempts to verbal clinicians to accept 6th rate solutions won't work.

The clinicians are becoming much clearer just how flawed all this is and so you are seeing what is now happening.