Wednesday, October 02, 2013

Two Good And One Not So Good Individual Suggestions On How To Fix The PCEHR.

First the two I liked.
First we have this.

The PCEHR: Moving forward

I can confirm that the Government is not going to build a massive data repository. We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks (~Nicola Roxon)
I’ve studied the PCEHR but I’m still not sure what the government has built and for what purposes. I was always under the impression that the PCEHR was designed to assist clinicians to improve patient care through better data flow. But this may not be the case.
The recent resignation of NEHTA’s top National Clinical Leads is an ominous sign. If the Department of Health does not start sharing ownership of the PCEHR soon and improve governance of the system, the PCEHR will fail. Here’s a quick rundown of the issues and how to move forward.
Legal issues
A first glance at the PCEHR Act 2012 seems to confirm that the PCEHR is built for clinicians, as its four purposes are clinical in nature:
  • To help overcome fragmentation of health information
  • To improve the availability and quality of health information
  • To reduce the occurrence of adverse medical events and the duplication of treatment
  • To improve the coordination and quality of healthcare provided to consumers by different healthcare providers
So far so good. But the Act is 93 pages long and I could find at least five other ‘non-official’ purposes of the PCEHR spread out throughout the Act:
  • Law enforcement purposes
  • Health provider indemnity insurance cover purposes
  • Research
  • Public health purposes
  • Other purposes authorised by law
And this is where the concerns begin. These ‘non-official’ purposes are not directly related to the care doctors provide to their patients. In general, one would say that patients and clinicians have to give informed consent before their health information can be used for research or other purposes. It seems like informed consent is missing here.
Read the rest of the concerns and the author’s preferred  fix here:
Second we have this:

Aniello Iannuzzi: Time for change

Aniello Iannuzzi
Monday, 23 September, 2013
EVEN though voters consistently place health high on their list of important issues, both sides of the political divide somehow managed to dodge the issue in the recent election campaign.
“Voting for change” and “6-point plans” seemed to grab the media’s attention rather than health.
In the hope that new Prime Minister Tony Abbott and new Health Minister Peter Dutton read MJA InSight, here is my 6-point plan for health change:
1. Change our approach to Indigenous health
Whatever we’re doing now is plainly not good enough. Programs are disjointed, lack penetration and are often bogged down for several reasons, including lack of funds, geography, politics and red tape. Many health professionals lack cultural awareness and experience in Indigenous health and therefore miss opportunities to intervene.
Given Tony Abbott’s zeal to address Indigenous disadvantage, I want to again suggest a free and open model of Medicare for Indigenous people based on the Department of Veterans’ Affairs system. No matter what it costs, the results will be worthwhile.
…..
6. Change e-health
The profession has not embraced the National E-Health Transition Authority or the personally controlled e-health record. Part of this failure is poor communication from the government and ongoing suspicion about privacy and intellectual property issues.
Another big reason for the lack of engagement is that practices are already overwhelmed with the administrative burden of running a viable e-health-based practice. We need to step back. Many doctors still have not come to terms with electronic prescribing and medical record keeping.
The change of government brings with it an opportunity to listen to health experts — practising doctors — about how to improve medicine for patients and the profession, and to begin a program of positive change.
Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.
Interestingly what both are recognising are the clear need to clinician input in the design and deployment of any proposed national record so there is usability, usefulness and evidence that the system will actually make a difference as well a real bi-directional communication to ensure the program stays on track. 
Sadly here is a view that I think is vastly over-simplistic. See the bold paragraphs.

Why clinicians don’t like national e-health

And what needs to be done to change their minds
If a recent survey by Australian Doctor is anything to go by, many general practitioners (GPs) across the country don’t want to participate in the challenged national e-health program.
There are two key reasons for this: time and money. In recent months, several prominent healthcare professionals have criticised the time it takes to prepare information that can be submitted to a patient's personally controlled electronic health record (PCEHR), particularly to ensure the accuracy of data recorded about a patient’s health.
They’re also concerned about information contributed to a PCEHR system being viewed by the wider health community and the time it takes to ensure the data is concise.
As expected, the majority of Australians will nominate their GP as their primary healthcare provider. Consequently, some GPs claim they will spend even more time managing their patient’s shared health summaries.
Although GPs are compensated by Medicare – through several MBS codes – for contributing information to the PCEHR, they believe that having to complete these administrative tasks will mean there’s less time available to care for patients.
But over time, the national e-health program will actually enable GPs to focus more on treating their patients.
As a patient’s primary healthcare provider, the national PCEHR system will help GPs co-ordinate care and cut the amount of time spent chasing information from other healthcare providers, such as hospitals, pharmacies, and specialists.
This will particularly benefit older Australians, and people living with chronic disease or ongoing health conditions.
So given the potential, how can GPs be encouraged to contribute the necessary clinical information so the benefits of the PCEHR will be realised?
Perhaps most importantly, software vendors need to demonstrate maturity in their implementations to support the PCEHR to make access easy and ensure little impact to current work practices. This will go a long towards encouraging GP adoption.
Creating a consumer’s shared health summary could be (and should be) as simple as pressing a button.
The information required in the standardised electronic summary can be updated from the GPs clinical software that stores local consumer e-health records and should require little or no human involvement.
In addition, the GP’s clinical software should provide seamless access to a consumer’s PCEHR and make available information that they would not currently have access to. It should present a consolidated summary of a consumer’s important health information through the series of views already provided by the PCEHR.
This will ensure that the right information is available to GPs in the right format to help them make the right decisions at the time of care.
Lots more here:
My view is that there is much more than time and money involved in clinician rejection. It is about recognising the system was not architected as a system to help clinicians, that the Government is excessively unresponsive and over legalistic and that usage is presently excessively complex and risky.
In essence the clinicians recognise this is a system that is not addressing any of their needs in their efforts to best treat and communicate with their patients. It really is as simple as that.
David.

1 comment:

Anonymous said...

Right on.

Yet the email circulars from those in RACGP and Medicare Locals seem to suggest nothing but evangelical zeal fro the PCEHR which 'must' be imolemented.

Very little voice of dissent from the medical bureaucrats...and much apathy-ignorance from frontline grunts.