This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Sunday, July 07, 2013
I Have To Say This Is Hardly A Surprise - Enrolment in The NEHRS / PCEHR Falls Short. Lots Of Commentary This Week.
THE government has failed to deliver on its 500,000 target for the personally controlled e-health record system, coming up short by about 100,000 consumers.
According to a Health Department spokeswoman, the total number of PCEHR users was 397,745 as at June 30. She could not reveal the average number of logins for last month.
That represents a whopping increase of 313,196 registrations last month alone, compared with 84,549 at the end of May.
The government set a goal of half a million registrations by June 30 this year before the PCEHR went live 12 months ago.
At a budget estimates hearing last month, Health Deputy Secretary Rosemary Huxtable said the target was "still in sight" after getting 10,000 registrations - the highest number in a single day - on June 4. She later said 500,000 "may be a stretch".
Director, Centre for Software Practice at University of Western Australia
The government has failed to meet a self-set target of 500,000 registrations of its Personally Controlled Electronic Health Record (PCEHR) by July 1.
As at June 30, the Department of Health and Ageing said that total number of users was 397,745. The majority of these registrations resulted from a recent push by DoHA using consultants to sign people up at public hospitals and at eHealth roadshows.
Still, even if the government had met the target of 500,000, it would have been a meaningless gesture. The vast majority of those who have signed up, if they ever get around to logging in, will be greeted with an empty record.
Given the lack of active participation on the part of GPs, as well as the lack of public hospital systems to integrate with PCEHR, there’s little evidence to suggest that this is going to change any time soon.
So far, only 4,805 individual providers have signed up to access the PCEHR portal. This is despite the fact that the government provides incentives to GPs to connect to the system by paying them the Practice Incentive Payments for eHealth (ePIP).
Despite these payments, GPs still struggle to see the benefit of spending time curating shared records when the legal liabilities are still unknown but are potentially severe.
The cost of the ongoing maintenance of these largely empty records is about AUS$80m a year. And that’s just the baseline. It’s clear that a great deal more funding will be needed to try and lift the level of meaningful use of PCEHR.
The problem for governments is that increasing spending on a system becomes progressively harder the longer it remains largely unused. What’s more, the devolved nature of the Australian health system makes it extremely unlikely that we’ll ever see true and meaningful use of the system.
What we will continue to see however, are reports of increasing numbers of registrations, data about the number of people who accessed the system and how much administrative data has been added.
The latter figure, in particular, is an easy one for the government. All Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data gets added automatically. This shows when individuals have claimed anything on MBS or filled out a script at the pharmacist.
Again, this data is clinically meaningless and of marginal benefit to an individual. Its only use is for, perhaps, reminding people when they last saw their doctor.
One of the big topics I discuss in my new investment advisory service - Revolutionary Tech Investor - is regenerative and personalised medicine.
These two hot trends fit perfectly into the philosophy of this newsletter too - the idea that you should be positive about and look forward to the future.
That is of course in stark contrast to most of the things you see in the mainstream about the future.
You know what we mean - the irrational fear that rising oceans will drown everyone...that we'll run out of food in some sort of Malthusian Hell...and that robots will kill everyone, just for kicks.
Of course, people have feared the future for thousands of years, so this kind of reaction isn't surprising. But for those 'hoping' for the end of the world, we've some bad news: it ain't happening...
Just one note.
I've seen the government's Medicare eHealth record system promoted as 'personalised medicine'.
Let's get one thing straight. It is not 'personalised medicine'. Or not in the way I and most others in the technology sector think of it.
The Medicare eHealth system is just a sneaky way for the federal government to get you to voluntarily submit your private information to a government database.
Like all government schemes, that's not how they promote it. They promote it as a useful way for you to keep your health info in a safe and secure database...so that doctors and other healthcare professionals can quickly find out your health history and the medication you're taking or have taken.
The reality is that the government is simply getting the kind of information that it would otherwise try to get through the intrusive and compulsory Census questionnaires.
My tip is to avoid the eHealth program at all costs. As always when the government gets involved with anything, it's simply the thin end of the wedge. The government's ultimate goal is to create a UK-style 'Death Pathway'.
Because the National Health Service is so costly to the UK government, it has to set parameters on who, when and for how long hospitals can treat patients.
If the beancounters' spreadsheet says a patient has a low chance of survival from a treatment or that the treatment won't necessarily lengthen the patient's life, the hospital guide the patient towards an early 'exit'.
And by 'exit' I don't mean leaving the hospital to go home. I mean leaving in a box.
I'm afraid that's the result of socialised medicine for you.
As for real personalised medicine, well, that's something completely different...
All in all with advertising in full flight and the commentary collected here there is a lot going on. I have to say I am not sure the whole program is still not as flawed in design as it has always been - with even the NEHTA Clinical Lead saying the whole thing needs more clinical engagement and work!
Docs still do not seem to be happy:
Witness the results of this poll from Australian Doctor:
Are you taking part in the national e-health scheme and writing health summaries for PCEHRs?
- Yes, I am taking part in the scheme and have already written health summaries for PCEHRs. 6.62% (19 votes)
- Yes, I will be taking part in the scheme, but have yet to write a PCEHR health summary. 29.62% (85 votes)
- No, I am not personally taking part, but colleagues in my practice are who I can refer patients to. 7.67% (22 votes)
- No, I will never take part in the scheme and will not be promoting its use to patients. 56% (161 votes)
Most of the Australian doctors surveyed support limiting patients' ability to update their electronic health records. Only 18 per cent said patients should have full access to their own records.
The survey also found 77 per cent of Australian doctors surveyed said that sharing health records electronically reduced medical errors last year. Also, 83 per cent said they actively used electronic medical records and about 70 per cent reported improved quality of diagnostic and treatment decisions by using shared electronic records.
We’ve come a long way with technology in general practice. Technology should make our lives easier. However, in health-IT a good idea can easily go bad. But the opportunities are mind-boggling and we’ve got exciting years ahead of us. Let’s have a look at the good, bad and ugly in eHealth, including cyber insurance, liability issues, telehealth, mobile apps, social media and of course the PCEHR.
The PCEHR has gone ugly. Sidelining doctors and clinical leads didn’t do the project any good. A basic requirement of a successful project is effective stakeholder management. Healthcare evolves around GPs, and if the main stakeholders are not on board for 200%, the project will fail. Meanwhile, the government has started data-mining our patient’s eHealth records. A colleague recently said on an IT forum:
“I demand legislation that simply states something like: Information stored in the PCEHR can exclusively be accessed by health professionals directly involved in the patient’s treatment and exempt from access by any other third-party including by means of subpoena”
I’m not holding my breath here but it’s a clear message, shared by many GPs. By failing to listen to doctors the PCEHR will be added to the already impressive global scrap heap of major health IT fiascos. But the good news is: there are alternatives. Instead of wasting more tax dollars, we should adopt one of the already fully functioning, cheaper Australian shared record systems, like RecordPoint from Extensia.