Sunday, December 15, 2013
What Is Likely To Come Out Of The PCEHR Review? It Is Pretty Hard To Pick.
This appeared a few days ago.
· SUE DUNLEVY
· News Limited Network
· December 13, 2013 12:00AM
AUSTRALIANS would be automatically enrolled for an e-Health record and have to opt out to protect their health privacy under sweeping changes to the $1 billion white elephant.
A government review of the troubled computer system is also considering changing the extent to which patients control what appears on the record.
And doctors could get paid to upload patient health summaries onto the record to get more clinicians involved in using it.
Launched in July 2012 the Personally Controlled Electronic Health Record was meant to bring medical records into the digital age and contain an electronic patient health summary, a list of allergies and medications and eventually X-rays and test results.
Seventeen months after it was launched only a million people have signed up for the record and only one per cent of these records has a clinical summary uploaded by a doctor.
A government inquiry into the record headed by Uniting Care Health chief Richard Royle has been charged with overhauling the struggling policy.
The intention of his panel is "not to kill it but build on the foundation base", he says.
"If there is one consistent theme it is that the industry wants to see it work," says the man who will next year launch Australia's first digitally integrated hospital.
Voluntary sign-ups for e-health records have been slow and the Consumer's Health Forum which previously backed an opt-in record has told the inquiry it now wants an opt-out system.
On the basis that there was not actually much hard news in the article a correspondent pointed out that this might be a little ‘kite flying’ on the part of the review to test what sort of reaction was elicited.
Alternatively it might have just been adding just a little pressure for some release on the review’s thinking. As all will recall the Minister is to get an interim report by the end of 2013, but, I would guess there is little chance of the review becoming public for a good while yet.
The one bit of real news for me was that there had been 82 submissions. As of writing Eric Browne’s estimable list convers about 30 or so submissions - so there are apparently a good few that have not yet been disclosed. Missing are just what DoH and NEHTA are saying for example.
With all this said I have thought more about my blog of last week and have slightly changed my view. The main reason for the change is that I suspect (and have been assured) there is furious lobbying going on behind the scenes about the review outcome - and indeed the article mentioned above may be a response to briefings which have led to an awareness of that campaign.
See here for original blog on the topic.
It seems to me there are three possible outcomes.
First there is the option to fundamentally review the intent, information model, consent model, patient control model, design purpose, architecture, planned role etc. for the PCEHR and to develop a major e-Health project that might actually deliver something that is useful for the key stakeholders. This would be smaller, more focused on delivery and clinical outcome driven and would prove itself useful gradually over time at hopefully a lower cost.
This would, however, be a fairly large, long, expensive, risky and complex project (or series of projects) - and it is hard to know what would be happening in the meantime. This would also probably be only slightly cheaper and smaller than the original PCEHR project. Having actually considered what is really needed in a national EHR record, it also might just work!
Second there is the ‘lip stick on the pig’ approach which tarts up a few things, hope pathetically that doing these minor changes will improve usage and utility while not costing much. This is what is being lobbied for as it will assist all the little piglets to stay pretty firmly attached to the funding nipple for a year or so more till the abject failure simply cannot be ignored. A review at that time may even the suggest that option 1 now needs to be done - and more milk and honey will flow. This is the easy political - kick the can down the road - option.
Third the program can be cancelled / phased out and a new better governed and designed approach can be adopted with efforts diverted to more basic activities. This is the preferable - but politically much harder - option.
So we have the PCEHR Heavy Option - fairly expensive and risky, might work but politically costs too much for a cash strapped government - the PCEHR Light Option - costs little but defers problem and gets nowhere- and last the PCEHR No Option, switch off and focus on the important e-Heath basics - right answer but hard sell.
You can be sure the vested interests, rent-seekers and disparate academics looking for a project are in there very hard pointing out how wonderful all this PCEHR is - how the evidence supporting it will flow if only we are supported for a few more years - and what is another billion dollars between friends? Of actual evidence essentially they have none of course! Option 2 is preferred by these souls as it might just keep things going but my how much more we could squeeze from option 1 they must be wondering!
You choose. I would almost bet you some flavour of Option 2 is what we see. If that happens will be a bit sad!
Would love comments!
Posted by Dr David G More MB PhD at Sunday, December 15, 2013