Thursday, April 12, 2012

The Polls Are Really Looking Bad For the NEHRS. Rethink Needed!

When releasing their guide to use of the NEHRS (PCEHR) the AMA also released a supporting on-line survey which had over 190 responses.

Survey of AMA Members on PCEHR

The AMA conducted a survey of its members in January 2012 to ensure that the draft Guide to Using PCEHR is as useful and relevant to practising medical practitioners as possible. Responses were used to prioritise and inform the guidance given in the document.
The full report of the survey is available here.
This page is found here:
A direct link to the report is here:
On the same page there is a survey on whether a special fee is needed
Here are the results I saw

Should the AMA develop its own schedule of fees to support the PCEHR?

82% (262 votes)
18% (56 votes)
(As at 3:30 April 8, 2012)
There was also a poll taken on Australian Doctor.
It is currently on the front page here:

Australian Doctor Poll

Will you be taking part in the Federal Government's national e-health records scheme?

I will be opting into the scheme and will actively encourage all my patients to establish e-health records.  11.44%  (43 votes)  
If a patient asks me to set up an e-health record then I will, but I will not be promoting their use.  16.49%  (62 votes)  
I will not be taking part in the e-health record scheme until GPs receive a specific MBS rebate for the work involved.  45.21%  (170 votes)  
I will not be taking part in the e-health record scheme no matter how much GPs are paid.  26.86%  (101 votes)  
Total Votes: 376 (4pm April 8, 2012)
----- End Results.
The most interesting findings are the rejection of the whole thing without proper arrangements of remuneration (as seen by the doctors) and the level of readiness from the AMA survey which was less than 10%.
All this confirms the comments on the topic from clinicians seen on both the Medical Observer and Australian doctor sites. There is not much good being said I have to say.
As I have said often major rethink required.


P said...

This is all just opportunistic positioning by the AMA as they attempt to gouge the community for an "extra service" that their members are NOT providing. Their position is the equivalent of doctors charging for using a fax machine instead of Australia post, when that technology was introduced 30+ years ago. Pharmacy Guild, eat your heart out!
The intended end-state of practically all eHealth initiatives is that they become incorporated into standard clinical workflows, such that user effort is ultimately reduced and/or value and efficiency is improved.
The health minister announced at Health-e-Nation that if contributing to NEHRs extends the duration or complexity of a consultation, doctors will be able to claim an item number with a higher fee. This is a fair, albeit not ideal, response. Any contradictions to this position dredged up by the AMA reflect the bureaucratic inertia imbedded in the Health Department, rather than the policy moving forward.
If the government were to provide a special levy for contributing to the system, it would bake in extra costs where none were justified, thereby killing off any opportunity for an efficiency dividend, especially if at some point, it were to end up reducing effort.
A better policy instrument might resemble something like that being deployed in the US – early incentives, eroding into penalties over a predictable period, say five years.
While I share many doubts about the potential efficiency gains delivered by NEHRs, it seems that some already being experienced (see Raymond Seidler’s post
I just hope that the politics of greed and short-termism don’t torpedo the potential health dividends that this amateur hour extravagance might one day deliver.

Anonymous said...

So why exactly did the government agree to pay pharmacists 15 cents every time they retrieve a script from an electronic exchange hub?

Isnt that time-saving for pharmacists because they no longer have to enter the info into their own systems?

Are all the fees negotiated by the Guild under the pharmacy agreement baking in costs that aren't justified, like being paid for printing off an information sheet for a customer?

Your point about the intended end-state of the ehealth system is telling. We all know this is going to be a bloody long way off.

Doctors are being asked to do more - and different - work to create a duplicate record system that "may" benefit other providers in the healthcare system.

Any prospect of getting something useful in return - like discharge summaries or pathology results from local hospitals - is also a long way in the future.

DoHA and NEHTA now readily concede that the only data available initially will be dredged from the MBS and PBS systems, immunisation registers etc - and that's already available to patients if they want to sign up for a Medicare Online account

Anonymous said...

4/13/2012 10:15:00 AM said "DoHA and NEHTA now readily concede that the only data available initially will be dredged from the MBS and PBS systems".

Well that would be pretty well next to useless if you think about it. What can the MBS and PBS systems provide that I could really use as a doctor in treating my patient?

Anonymous said...

Well, the data may not be very useful for doctors or patients but, hey, it may be very useful for government agencies, workers compensation insurers, private health insurers, employers - managed care anyone?

Oh, of course, drug companies, medical researchers and so on. Now, that may indeed be beneficial over time, but what about the little matter of personal consent to take part in such research?

De-identified data from PCEHR records? Well, that only works up to a point in relation to rarer conditions, small patient bases, people in remote locations...