Thursday, November 14, 2013

Interesting Discussion On The PCEHR Enquiry From The USA. Their System Is Really Different.

This appeared last week.

As Aussies struggle with e-health, is meaningful use that bad?

Author Name Jennifer Bresnick   |   Date November 5, 2013
Occasionally, it’s helpful to raise our noses from the grindstone and look around at how the world is progressing around us.  When it comes to EHR implementation and health information exchange (HIE), the United States isn’t the only one facing some serious issues.  This week, Australian Health Minister Peter Dutton announced an inquiry into the sluggish uptake of the country’s Personally Controlled eHealth Record System (PCEHR), which has cost AU$1 billion so far while attracting only a fraction of the providers and patients expected.  Can Australia’s EHR woes teach us a little something about the effectiveness of meaningful use?
Since 2010, Australia has been developing the PCEHR system as a national, all-in-one health information exchange.  Intended to hold up-to-date, interoperable clinical summaries in the HL7 format, the PCEHR uses a unique individual healthcare identifier to tag patient records across a network of connected systems.  Officials hoped to have 500,000 patients using the system by the end of June 2013, but as of October, the system has fallen short by 100,000 opt-in sign ups, and only a few hundred providers have actually uploaded and shared fewer than 5000 documents in the country of 22 million residents.
“On those numbers it runs out at about $200,000 a patient in terms of investment,” noted Dutton.  “We want to make sure for argument’s sake that we get good numbers around the electronic health record because we think there can be savings if people have their records coordinated at accessible emergency departments or general practice.”
Unlike the American EHR Incentive Program, Australia’s PCEHR provides no financial incentive for adoption, nor does it institute penalties for non-use.  A lack of participation in meaningful use will cost US providers up to 3% of their Medicare reimbursements by 2017.  While 98% of general practice EHR software in Australia is compatible with the PCEHR system, a clear advantage over the fragmented EHR landscape in the United States, the lack of a business case for PCEHR could be its downfall.
Australian Medical Association (AMA) President Steve Hambleton acknowledged the problem with the system’s “strategic direction” in an interview with ABC Radio. Hambleton has been appointed to the three-person inquiry panel to review the PCEHR in the coming months. 
More here:
In answer to the question “Can Australia’s EHR woes teach us a little something about the effectiveness of meaningful use?” I would suggest the answer is a firm no!
I keep seeing discussions from NEHTA about pursuing “Meaningful Use” but the differences between what is being done in the US and what is happening in Australia are vastly different.
First in the US the capabilities of the actual EHR systems are certified - which is different to what is done with our ePIP program where the requirements are much broader and less specific.
Second we have only incentives but no penalties which do exist in the US to get the equivalent of our Medicare payments.
As far as the article is concerned I suspect they have not really grasped the nuance the that PCEHR is an add on system rather than the sole EHR system and they have not grasped we have ePIP.
The US on the other hand has, in their program, taken an interesting approach of incrementally increasing the level of capabilities required for continuing payments - and it does seem this is having a good effect. The scale of the payments are now in the 10’s of billions.
I think we could learn more from the US and they can learn from us.

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