Wednesday, June 01, 2011

The Australian Medical Association Wants Nothing to Do With the PCEHR as Presently Proposed By NEHTA. Time For Plan B!

The following appeared today.

PCEHR an expensive legal trap: AMA

The AMA has spoken out against proposals for the Personally Controlled Electronic Health Record System saying it will create “medicolegal risks” and a financial burden for doctors.

In its submission to the Department of Health on the draft concepts of the introduction of the PCEHR, (see link) the AMA says the proposals have “fundamental flaws” and its complex design could see medical practitioners unable to access or contribute to it.

The doctors’ group insists the flaws are a consequence of the decision to make the record system opt-in rather than opt-out, which will lead to doctors not able to find a record for some of their patients, which could eventually see them giving up on the system altogether.

It says giving patients the option of several access settings will mean doctors may not be able to access important information.

Meanwhile the doctor’s obligation to discuss the system’s clinical risks with their patients will create a “medicolegal minefield”.

More here:

Here is the summary of the AMA Submission:

AMA Submission to the Department of Health and Ageing on the Draft Concept of Operations Relating to the introduction of a Personally Controlled Electronic Health Record System

The AMA submission on the proposed PCEHR expresses concerns that the proposed form of the PCEHR will provide only limited safety benefits and these are significantly outweighed by its inherent clinical and medico-legal risks for medical practitioners and the administrative burden it will impose on medical practices.

The AMA submission advocates for:

  • a shared electronic medical record (that sits within a personally-controlled electronic health record) that contains reliable and relevant medical information about individuals that has been posted by medical practitioners;
  • health consumer participation in the PCEHR to be opt-out. An opt-in system will mean that doctors eventually give up looking for PCEHRs after failing to find them for other patients; and
  • system protocols that align with clinical workflows and integrate with existing medical practice.

The submission highlights that the proposed PCEHR:

  • will be extremely complex to use because it is built around exceptions to clinician access and input to the record;
  • allows health care providers who are not medical practitioners to upload information;
  • allows patients to hide key pieces of medical information, thus compromising its usefulness to medical practitioners;
  • creates significant exposure to medico-legal liability for participating medical practitioners;
  • must not impose penalties on medical practitioners if they do not use the PCEHR; and
  • imposes significant administrative and financial burdens on participating medical practitioners and practices.

The submission concludes that the cumulative effect of these points will mean that medical practitioners are unlikely to use the PCEHR in the form proposed.

The full submission is linked to from this page:

To me this spells the end of the present incarnation of the PCEHR. The AMA is clearly not happy Joyce and unless they are on board no amount of change management will be enough!

No substantial change in the Health System has ever succeeded without at least tacit support from the AMA and their Submission is a long way from that!

They have been saying they are not happy for quite a while as has been mentioned on the blog.

See here:

(Point 8 of the body of the Submission).

I can see it all now - Ms Roxon and Ms Halton blaming the AMA for blocking their brilliant proposal when in actuality they are actually saving them from themselves.

Time for the ‘big rethink’! That the AMA is not ‘pre lined up’ only shows how incompetent NEHTA and the e-Health Group at DoHA actually are.



Anonymous said...

The clinical view of 'opt out is best' is highly convenient for doctors. What will consumer health and privacy groups think? Suspect that they will strongly oppose an opt-out model (remember the bad experience of NSW Healthelink which used opt-out).

So, which national approach sucks less and can be sold to clinicians and patients? The opt-in model is a lower bar to clear... Nobody is ever truly happy in healthcare.

Anonymous said...

Here we go.... it's all about the $$$ for the gatekeepers.

Dr David More MB, PhD, FACHI said...

See my submission. The $$$ issue is only one of 10 that are wrong with the Conops I my view. Link in blog. I think the concerns are much broader than just money.


Anonymous said...

Please note gatekeepers is no longer politically correct. We are now referred to as gateopeners. I hope you understand the difference.

Anonymous said...

Absolutely extraordinary to watch this whole charade unravel.


Anonymous said...

Or more appropriately "Kafkaesque"!

Anonymous said...

It's dead... as a Dodo. let's move on...

Anonymous said...

Close NEHTA and transfer them to the NBN

Anonymous said...

When you fight with the biggest union in Australia, you normally lose.

Plus as much as the AMA were always going to be a pain in the arse, want it slanted towards Docs and ask for some extra $'s .....try doing it without them and see how far you go.

It is about give and take , however to not have the AMA pre-consulted and at least some ground given on a core clinically clean EMR, well it is NEHTAesque.

Why are the Coalition not wailing on this is beyond me. Makes me want to cat call them (not sexist but for being a mob of pussies).


Anonymous said...

Consumers I have spoken to are very worried that they will be disadvantaged with increased risks of sub-optimal treatment and adverse events if their GPs or other health professionals chose not to participate and contribute to the PCHER.

Consumers will vote with their feet by opting in and finding GPs who wish to engage.

Anonymous said...

I'd speak to a few more consumers if I was you.

I find it hard to believe that any sizeable numbers of people would walk from a GP they have a relationship with on the basis of the PCEHR.

From my experience, a good GP is worth his/her weight in gold - I'd hardly be disrupting my families health care on the basis that another GP is using the PCEHR.

ALso expect GP Land and the AMA to have a back up defence laid out by the time the PCEHR goes live, it may just be give you some very basic info and you upload it.

In doing this they will also warn of the risk of being part of the PCEHR with incomplete information and how because it is not a full record there will be doubts about the info.

For the record - fighting the AMA and calling their bluff aint ever a good idea. With consumers, they are the main players in this game ....we need them inside the tent not outside.

Attack A was always going to the Docs, we still have Attack B to come - the security scaremongers and Big Brother conspiritors, followed by Attack C - why is this expensive thing not delivering anything useful or being utilised in the first few years of operation.

Voting with your feet will be lucky to exceed an informal vote IMHO.


Anonymous said...

I suspect that "Anonymous" who commented at Thursday, June 02, 2011 11:48:00 AM about Consumers has never implemented one of these systems before.

90% of consumers will never give a stuff about their health information until they cop a chronic disease. This is historically the case, and there is no silver bullet provided by the PCEHR system in this case.

One only needs to look at Google Health being put into "stasis" and Microsoft exiting the HealthVault space to realise that there is no consumer engagement even when mega companies decide to push it.

Doctors are going to need to push this to patients - and if the AMA is off side then NEHTA (who has been masterminding this so poorly with the assistance of their highly paid consultant mates Deloitte & McKinsey) are in deep trouble.

The other stakeholders who have been completely disenfranchised by this whole process are the Providers who submitted Wave 2 proposals only to have them rejected. There were 90 consortiums who submitted responses - 9 selected and 81 rejected and not a single skerrick of feedback from DOHA, NEHTA or Deloitte. This is completely abhorrent.

The private sector has also been completely left out of the loop.

And software vendors (ie HCN, Argus Connect, Global Health etc) have been totally screwed over.

This is a classic case study in how to stuff this up.

Pump it up to a massive high profile with National eHealth Summits - blow $360m on Deloitte to take notes at it.

Over promise.

Under deliver.

Miss the 31 July 2012 deadline.

Piss off the docs.

Piss off the providers and anybody who was interested in participating.

Blow all the dough on management consultants so they can look at your watch and tell you what the time is.

Continue to burn $XXM per annum on NEHTA with no deliverables.

And then watch it fall in a massive heap.

How predictable.

The sad thing is we saw this happen with pink batts, green loans, set top boxes and we're also seeing it with the totally cowboy NBN outfit.

Although this is not front page newsworthy - it is as big a stuff up as any of Labor's other stuff ups.

Anonymous said...

"Although this is not front page newsworthy - it is as big a stuff up as any of Labor's other stuff ups."

That was a very good post and I think echoes the passion of a lot of very frustrated folk!

The question really is how do we - I mean that in a very collective sense - apply pressure and create change!

Should we start a major campaign aimed at firing up the opposition - perhaps feeding Senator Sue Boyce more information? Or even Abbot who has the background as previous health minister.

$1/2 Billion wasted and pissing off the majority of providers is heading towards Royal Commission stuff!

Anonymous said...

The reason eHealth has become so expensive is that the government has been inflating the costs with public money. The sharks are well fed and have the smell of blood.

They are verging on "Too big to fail" wrt PCEHR when the majority opinion is that NEHTA and the DOHA drongos should have failed long ago, and in fact have failed and are failing.

The longer they are painted in a good light by clever PR to more silly its going to look. IT projects fail and sensible people accept that. They have backed the wrong horse and its time to cut the losses and allow the landscape to return to some normality. Failure to do this soon will result in a big front page story just before the next election. It is also likely to destroy the people capable of picking up the pieces and doing real work for very modest costs. The government cannot innovate and does not know enough the govern sensibly. We have the worst of both worlds currently. How many ex Nehta staff are ardent supporters??