Sunday, October 20, 2013

I Fear The GPs Are Not Ambitious Enough In Demanding Changes In The PCEHR Program. It Needs A Major Rethink.

The following Press Release appeared this week.

UGPA calls on Government to address clinical utility of the PCEHR as an urgent priority

Australia’s general practice (GP) leaders are calling on the Government to heed concerns raised by GPs regarding the significant clinical utility issues associated with the Personally Controlled eHealth Record (PCEHR) system and address them as an urgent priority.
At a recent United General Practice Australia (UGPA) meeting in Canberra, representatives of the GP sector unanimously agreed that the focus of the PCEHR needs to be redirected to clinical utility and standardisation to ensure seamless clinical adoption.
Significant issues have been identified and currently there is no alignment between consumer registration and meaningful use through engagement of the clinical community and assurance of improvement of patient health outcomes.
In August 2013 a number of key clinical leads resigned from National E-Health Transition Authority (NEHTA). This was amidst ongoing concerns and requests for NEHTA and the Department of Health and Ageing (DoHA) to review the PCEHR development cycle and re-establish meaningful clinical l input.
Since August, DoHA has become the PCEHR system operator and opportunities for clinical engagement have been less clear.
UGPA is calling on Government to implement strategies to ensure the PCEHR is best structured to improve the health outcomes of all Australians. The process should be profession led and include:
  • GP input at every level of the PCEHR development life cycle; including planning through to implementation
  • Ensuring the system is clinically safe, usable and fit for purpose
  • Supported by an acceptable, and robust  legal and privacy framework
  • Secure messaging interoperability is a critical dependency priority.
E-health and the PCEHR have the potential to transform Australia’s health system and provide superior, safer and more efficient healthcare to all Australian patients. UGPA members believe that this potential will only be fully realised if there is meaningful clinical engagement at a grassroots level.
The Government has announced it will review implementation of the PCEHR. UGPA supports the review and look forward to contributing to the review and expect that the clinical voice and the concerns raised will be heard.
UGPA comprises the Royal Australian College of General Practitioners (RACGP), the Australian Medical Association (AMA), the Australian Medicare Local Alliance (AMLA), the Australian General
Practice Network (AGPN), General Practice Registrars Australia (GPRA), the Australian College of Rural and Remote Medicine (ACRRM), and the Rural Doctors Association of Australia (RDAA).
Last Updated:
Wednesday, October 16, 2013
The release is here:
This release got a lot of coverage with this also being useful.

Doctors ready to pull plug on eHealth

By Julian Bajkowski 
Australia’s long and troubled efforts to create a functioning national system of electronic health and medical records system is once more close to collapse.
The Australian Medical Association has expressed serious concerns over clinician input into the project following the shock resignation of highly respected clinical representative Dr Mukesh Haikerwal from the National eHealth Transition Authority (NeHTA) this week.
Other crucial clinical advisors, including Dr Nathan Pinksier and other clinical leads are also understood to have quit signalling a severe breakdown in relations between doctors and Department of Health and Ageing.
A loss of confidence by doctors in either DoHA or or NeHTA would, in practical terms, shut-off political life support for the circa $1 billion Personally Controlled Electronic Health Record (PCEHR) project because the scheme cannot work unless doctors voluntarily agree to use it.
The urgent warning from the AMA in the wake of the clinicians’ walk out now puts substantial pressure on DoHA’s high profile secretary, Jane Halton, to personally intervene to get the project back on track.
Questions are already swirling around Canberra as to how DoHA managed to shatter the support of the medical lobby on a project that has bi-partisan support during the delicate pre-election caretaker period.
One possible trigger for the breakdown is what appears to be a bureaucratic power grab by DoHA in a ham fisted bid to gain central control over the complex and difficult eHealth project.
It has been reported that a DoHA spokesperson issued a statement that said the department would be “taking the lead” from NeHTA in dealing with medical and health technology interests and would take “a fresh look at the design of the PCEHR system.”
However AMA president Dr Steve Hambleton said he still had confidence in Ms Halton, but called for swift action.
“Jane’s got some good credentials on the board over her time in [DoHA] but she may have to make this a personal focus of hers,” Dr Hambleton told AAA sister publication Government News.
Even with support, Dr Hambleton is not mincing words about how much support from doctors has evaporated.
“It’s really undermining confidence in the profession that one of our senior leaders can’t continue,” Dr Hambleton said of Dr Haikerwal’s resignation.
Lots more here:
To me this understates what is needed. We have a PCEHR and an associated program that was designed in an environment that bordered on clinician free. Most of the way through, with the design largely set, they got a collection of clinicians to get involved  (The Clinical Leads) . The clinicians were paid for commentary and for support and even with all that they eventually bailed out realising the dog they had been given.
Worse there was no real business case done on the actual final design to assess just how well the PCEHR would deliver clinical outcomes and benefits and fit with our future needs.
Tweaking around the edges will not result in outcomes that are needed - let alone genuine clinical utility where the PCEHR will actually add seamlessly to the present capabilities of current and future GP systems.
There is a really simple question to be addressed here in my view. This is: “Is the money being spent to revamp and possibly improve the PCEHR well spent on this or would it be better spent improving the quality and utility of the present GP Clinical Systems and in improving the information exchange between them via secure messaging as is happening to a large degree already but could be enhanced?”  To me the answer comes down very clearly on the latter - if we are to see real clinical benefits flow from the investment.
Someone needs to tell the bureaucrats in Canberra that the concept of a large centralised national  e-record system is a dud and that the time has come to put a very bad idea out of its misery as it simply can’t be fixed in its present form. It is only with a change of Government will it be possible to have a review with all options, including just scrapping the PCEHR, on the table.
They also need to be told that while e-Health may help the quality and safety of the health system, and save some money, it is not going to be anywhere near the panacea for rising health costs as described in the Intergenerational Report. Much more fundamental changes will be needed to keep the total costs of healthcare in Australia to under 10% or so of GDP.
If we can’t be swiftly shown a detailed costed plan for e-Health and the PCEHR that takes what now is toward something that will meet what clinicians need now and into the future - as well as improving patient engagement with their care - then we need to start again and utterly re-consider what we are doing. It really is as simple as that. To just keep ticking / stumbling along, based on little more than hope, would be very, very sad indeed.

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