The following appeared a few days ago.
Government report backs PCEHR incentives
A government report on GPs’ readiness to adopt the PCEHR has backed the profession’s concerns about an increased workload and the need for reimbursement to cover the time spent preparing and explaining the new records.
The results of a 2011 survey of more than 800 GPs show that while most are broadly supportive of the PCEHR concept, there are uncertainties about the details and concerns about the quality and workability of the system
One of the main concerns was with the time required to implement the new system, with 73% of GPs believing it will take at least 15 mins to explain the PCEHR to patients and 52% believe it will take at least 15 minutes to set one up.
The report therefore concludes that “reimbursement for the time taken to use the new national system is a relevant strategy ... to encourage adoption.”
The report found that only a third of GPs thought that e-health applications easy to use and a third were not early adopters but preferred to wait for systems to be proven before adopting.
It seems clear from the 90 page report that the attitudes to the planned NEHRS as mixed with the level of concern being a little stronger among older GPs and actual practice owners.
Note: This report was developed late last year as part of the work undertaken by National Change And Adoption Program for the NEHRS / PCEHR. This program was led by McKinsey.
My reading of the survey suggests - as I have often said previously - is a drop in efficiency that leads to care being slowed down and the associated cost in terms of earning capacity.
It was interesting to read that GPs were not convinced that anything much had been done to reduce ‘red tape’ and that there was a fear the NEHRS would add more to already time-poor clinicans.
The need for payment to compensate for time spent seems pretty clear if adoption is to happen. I certainly doubt the stick will work very well. A real carrot is needed.
It is also interesting that many were concerned about the quality and completeness of information and issues around technical operations of the system.
This paragraph in the report was pointed out to me by a correspondent and seems to somehow devalue the work done by carefully choosing what was researched. Certainly avoided all the tricky bits!
“Note, however, that basic infrastructural readiness was assessed in terms of having access to a computer and an internet connection. GPs generally do not as yet have in place applications that help them share information between providers and/or consumers, of the required foundational components for the national eHealth record system, e.g. NASH (National Authentication Service for Health), SMD (Secure Message Delivery), and HPI-Os (healthcare Provider Identifier for Organisations). This survey did not specifically address these specific foundational elements, nor issues such as the quality of data that exists within existing eHealth applications.”
Go here to download the report. It is still well worth a read.
David.
Late news: I note today we now seem to have payments to GPs well and truly back on the agenda with some announcements from the Health Minister. Seems they have caved and recognised the PCEHR is a time imposition. Smart are they not?
Late news: I note today we now seem to have payments to GPs well and truly back on the agenda with some announcements from the Health Minister. Seems they have caved and recognised the PCEHR is a time imposition. Smart are they not?
If NEHRs was conceived of, and implemented appropriately, there would be no need for GP compensation, as it would support (rather than hinder) GP workflows, replacing faxing, letter posting and phone calls with the click of a button. In doing so, the intrinsic value delivered to GPs would represent an incentive of its own, much like the win-win derived from internet banking.
ReplyDeleteAs it presently stands, NEHRs is just an awful distraction from the main game of delivering clinical care, and cash is the only incentive the department has to salvage any face.
I don't think it's quite that simple - those things are true, but none of them offer an incentive to build a record that's good for the patient and other care providers. Untilo doing that becomes part of the baseline minimum standard of care, incentives will be required.
ReplyDeleteNK said...
ReplyDelete" I don't think it's quite that simple - those things are true, but none of them offer an incentive to build a record that's good for the patient and other care providers. Untilo doing that becomes part of the baseline minimum standard of care, incentives will be required."
I think P got it right when he/she said "As it presently stands, NEHRs is just an awful distraction from the main game of delivering clinical care.." and in the preceding para about supporting GP workflows. If everyone was not so fixated on this health record they could concentrate on electronic communications between GPs, specialists, hospitals, pharmacies etc. If we truly had ereferrals, eReports, eDischarge Summaries, ePrescriptions etc happening on a large scale between the relevant parties we could achieve some real improvement in care as well as significant cost savings. But it won't happen while success is measured only in terms of implementing a PCEHR.
Well, it depends what you mean when you say "NEHRS". If we built a national health exchange, rather than a record, then P would be right on the mark. But we're not. NEHRS is national healthcare record - and that won't be built without incentives.
ReplyDeleteIt's a separate argument about whether a health exchange would be a better choice than a health record. (Of course, we don't have either, just a bucket of documents).
Actually, NEHTA's core mission is closer to the health exchange notion - the pcEHR is a recent political conceit. And while I think that NEHTA didn't do the right things, it's been crystal clear that there's a titanic amount of resistance to the idea. People who claim that it will just happen if we leave it to industry... at least I get a good laugh!
Not everyone is fixated on the PCEHR. Some eHealth companies are, as much as possible, ignoring NEHTA and this whole fiasco as it is a dangerous distraction from the real work that has to be done. The sad part is that 1% of the budget used wisely would have achieved real progress. As it stands every component of this joke is quite flawed and I am not sure there will be much left when it hits the fan...
ReplyDeleteNK said...
ReplyDelete"..It's a separate argument about whether a health exchange would be a better choice than a health record.'
There is perhaps a place for both.
One of the big drawbacks in Autralia's health system is that necessary communications still occur predominantly through the post, or if done electronically it's often using obsolete, unstandardized and suboptimal formats (eg some pathology systems). An EHR does nothing to address this situation.
"Actually, NEHTA's core mission is closer to the health exchange notion - the pcEHR is a recent political conceit."
I couldn't agree more: you've put it in a nutshell.
"And while I think that NEHTA didn't do the right things, it's been crystal clear that there's a titanic amount of resistance to the idea."
I agree that NEHTA's role has been subverted and its attention diverted from what should be its primary role (or core mission to use NK's words), but would you like to expand on what you mean by the last clause? To which idea are you referring?
...still done using suboptimal formats... An EHR does nothing to address this situation...
ReplyDeletewell, I think it does by forcing them to embrace new formats, but this is a by-product - and one they are trying hard to avoid too.
"To which idea are you referring?"
Wasn't clear - to the notion of exchange. The community has been resisting change to improve exchange as hard as it can. All the while declaring that they do want change, and would make it on their own if only NEHTA would leave them to it.
"Wasn't clear - to the notion of exchange. The community has been resisting change to improve exchange as hard as it can. All the while declaring that they do want change, and would make it on their own if only NEHTA would leave them to it."
ReplyDeleteA little unfair. They don't like dictators - and NEHTA is the last specimen of that in the wild!
Proper discussion and consultation would have made a big difference I believe. I could be wrong of course!
David.
> NEHTA is the last specimen of that in the wild
ReplyDeleteCome now, David, I know you don't like NEHTA, but really...?
When it comes to Pathology the community has developed the standards on its own. The problem has been that no requirement to comply with those standards (HL7v2) has ever been enforced by government. Despite this, it still works, but the issues all relate to poor compliance and, with the corporate ownership of pathology a refusal to spend money on compliance, unless they have to.
ReplyDeleteThe critical point is that the solution has to be developed by the community, the the requirement for compliance (Carrots and sticks) need to come from government. The community has developed the standards, but the governance has been non existant and clueless. Legislating for compliance would be cheap and the standards have had input from the involved parties. It would have worked, and would still work, but instead we are building castles in the air that are supported by hot air. They are likely to come crashing down without that expensive hot air.
Sorry,
ReplyDeleteI think they have ruined any hope we might have had through poor governance, rubbish leadership and an excessively technical focus.
And yes they have behaved like dictators if all the people I talk to who have been to their 'consultations' are to be believed.
Why do the think the NEHRS is such a clinician unfriendly mess?
Disagree all you want. I have watched this unfold for 5 years and that is my view.
David.
The bit I was asking about was the "last" bit. I do not think NEHTA I at all remarkable.
ReplyDeleteAndrew, the question is, who sets the direction of the standards in this world you envisage? Does the government pay for the community to do what it wants, or for what the government wants?
In response to: "Andrew, the question is, who sets the direction of the standards in this world you envisage? Does the government pay for the community to do what it wants, or for what the government wants?"
ReplyDeleteThe government did not invent eHealth and there are plenty of people out there who want to advance it for unselfish and selfish reasons. The governments role is to regulate what is happening when it impacts on the health of the community. Insisting that if you do eHealth you do it well for safety reasons is reasonable.
What we have seen is the government trying to do and direct eHealth and they have failed miserably. By bankrolling the process they get people to support things that are less than fit for use, for selfish reasons. In contrast, simply supporting standards compliance allows agreed standards that have been developed at minimal cost to government to work in a safe manner. This is the real alternative.
I am sure when faced with multi-million dollar contracts to oversee the "roll out", large consulting firms are not about to say "Scrap it now and save yourself some money, its a lemon"