Thursday, May 10, 2012

The E-Health Changes To The Practice Incentive Program (PIP) Seem To Be Causing Consternation.

We have had a couple of reports on the issue of the last day or so.
Examples are found here:

Sticks and no carrots as govt pushes GPs on e-health records

9th May 2012
THE government will bar GPs who don’t participate in the personally controlled electronic health record system from receiving e-health PIP payments, while stripping money from the existing telehealth incentive program to fund it.
Last night’s budget announcements finally answered the oft-repeated question of how the National e-Health Transition Authority would continue to function and how the PCEHR would be rolled out once the current funding for both projects expired on 30 June.
The government will spend $233.7 million on e-health over the next two years, contributing $67.4 million to NEHTA and $161.6 million to operate the PCEHR and another $4.6 million on privacy and security safeguards for the system.
But that money will come from a total of $257.5 million stripped out of the existing telehealth initiative - which will now end on 30 June next year instead of in 2015 as originally planned - and the HealthConnect program which was designed to standardise secure electronic messaging.
RACGP president Professor Claire Jackson said it was “very disappointing” to see the government using the e-health PIP as “a stick” to prod GPs into using the PCEHR.
“There’s absolutely no detail about what’s going to be available to support practices in their preparation and readiness for the PCEHR and it launches in seven weeks,” Professor Jackson told MO.
More here:
and here:

GPs to pay, says AMA

10 May, 2012
David Ramli
Australia’s peak medical body has slammed Labor for cutting millions of dollars from incentive programs, claiming this could push general practitioners to the wall.
In the budget the government said it was raising the bar for GPs wanting to get money from its practice incentive programs (PIPs), which are designed to encourage doctors to adopt new ways of treating patients.
The move is set to save taxpayers $83.5 million over four years as Labor guns for a budget surplus.
But according to Australian Medical Association president Steve Hambleton it’s a bar that GPs simply can’t clear because the government has failed to deliver its programs.
One of the new conditions for getting PIP payments is that GPs take part in the $467 million Personally Controlled Electronic Health Record (PCEHR) system, which is designed to provide Australians with computerised medical notes whenever they visit doctors or hospitals.
Although its original launch date was July 1 this year, Health Minister Tanya Plibersek has been forced to downgrade expectations of what will be available. On Tuesday the government pledged an extra $234 million over three years to bring the system online.
“It’s premature to link the PIP payment to an infrastructure that doesn’t exist and is still being built,” Dr Hambleton said. “For example, in my practice my software can’t link to anything yet ... and it won’t be ready by July 1.
“This is just another blow to the engine room of health care.”
More here:
There are a range of issues around all this and at the present time it seems odd for the Government to be announcing new rules without having first discussed and agreed them with the profession - as would seem to be the case.
Here is what the budget said on the topic.
Here is how the changes are described:
“In 2012-13, the Australian Government will introduce new eligibility requirements for the Practice Incentives Program (PIP) eHealth Incentive to encourage general practices to keep up-to-date with the latest developments in eHealth and to promote uptake of the Personally Controlled Electronic Health Record (PCEHR).
The new requirements will encourage general practices to safely and securely share accurate electronic patient records to enhance the quality of care provided to patients and undertake activities such as electronic prescribing and use of the PCEHR system.
The Department will continue to consult closely with the National eHealth Transition Authority, the PIP Advisory Group, medical software developers and Medicare Australia in the development of the new requirements and to ensure that the appropriate software is available to practices with sufficient lead time to prepare for implementation. In 2012-13, the Australian Government will introduce new eligibility requirements.”
---- End Extract
Adoption of the NEHRS can really only occur when:
1.The system actually does something useful.
2. The system is demonstrably safe to use.
3. The system does not expose clinicians to any legal liabilities
4. The impact on clinical workflow and so on is minimal to non-existent.
5. All the integration and interfacing work with all systems is done.
6. There is confidence that the time spent looking up the record will be well spent.
Also it is also of interest to note that actual consumer adoption is hardly likely to run people over in the rush. Again from the budget papers the people registering (not actually even using) are projected as follows:
2012-13 500,000
2013-14 1,500,000
2014-15 2,200,000
2015-16 2,600,000.
That means that actual record holders will not reach 10% of the population until over 4 years from now. Clinicians are hardly likely to be checking PCEHR’s if there is only a 1 in 10 chance of a record - let alone something useful.
This thing is going to be a very slow burn - will probably not survive a change of Government - and is still to demonstrate any utility.
I still struggle to know just why a decent option analysis was not done before all this started. There are better ways to skin the e-Health cat!
Anyway - alienating the docs is a very bad idea and won’t help get acceptance in my view. They should have managed this much better!
David.

3 comments:

Bruce Farnell said...

All good points David.

The registration target is the wrong target - it should be based on usage. Despite this a 10% registration target in 4 years is optimistic in my opinion. It is not just the clinicians who will stay away in droves.

Anonymous said...

Hell will freeze over first

Anonymous said...

There is a post on another article which is worth anyone - GP or Consumer, thinking about the risk of joining the PCEHR

http://www.youtube.com/watch?v=wWBNjDmloS8