Sunday, September 27, 2015
Is The Government Outsmarting Itself With The Changes To The ePIP Program? The Blowback Might Be Considerable.
This seems to me to be the biggest news of the week.
The Practice Incentive Program, eHealth incentive (ePIP) looks set to change from February 2016 to encourage general practices to actively use the PCEHR system. (ref)
The ePIP was introduced in 2012 and has five requirements that practices must fulfil to receive a payment of up to $50,000 per annum. An estimated 72 per cent of practices Australia wide are known to be participating in the ePIP scheme.
Criterion number four of the ePIP requires practices to submit the majority of their prescriptions to an electronic prescription exchange service (PES), such as MediSecure.
The fifth ePIP measure is the one pertaining to the use of the PCEHR, which the Federal Government is considering reviewing and is to be renamed My Health Record. Currently, in order to receive the ePIP payment practices simply need to show readiness to use the PCEHR by using software that is compliant with the system.
According to statistics from the Department of Health, of the estimated 72 per cent of practices that are currently receiving the financial ePIP incentive for eHealth preparedness, just 16 per cent are actually uploading clinical information to the federal PCEHR system. Clearly, the Government believes that pushing practices to be PCEHR prepared is no longer enough to promote its use.
There was also coverage here:
21 September, 2015 ||
GPs may have to upload a mandatory number of files to their patients' personally controlled electronic health records before they can claim incentive payments as part the Federal Government's latest attempt to boost the system.
The suggested clampdown on accessing the E-health Practice Incentives Programme - worth up to $50,000 a year - is set out in a consultation document released by the Department of Health earlier this month.
Under the current PIP scheme, practices have to meet five criteria to access the payments. The criteria include applying to access the universal PCEHR system and installing software that marries up with it.
However, the health department’s paper says that while the PIP has been successful at encouraging practices to adopt systems that allow them to access PCEHRs, this had not translated into active participation in the system.
Only 16% of the 4569 practices receiving the payments had actually uploaded clinical information to patients records, it says.
And just 242 practices had uploaded five or more shared health summaries, which include details on current prescriptions, allergies and immunisation, between August 2014 and February 2015.
A consultation paper was issued a few weeks ago - 10 pages - and it can be read here:
It is difficult to know why it has taken a while to be noticed but it is not easy to find on the DoH site and seems only to be published by interest groups like the AMA and RACGP.
Bluntly what is going on here is the Government is conducting a pretend consultation (as always it seems it does) and is planning to start insisting that GPs upload patient records to the PCEHR to continue to receive their (quite substantial) payments per practice.
In passing I would note that as far as I am aware there has never been a published audit showing the impact and value of earlier PIP e-health initiatives, which means it has been pretty easy to get ongoing cheques.
This also means that this is the first part of a proposed ePIP that will be easily monitored by DoH and thus mean there will be some interesting responses to these enforcement and monitoring initiatives (getting between GPs and their perceived money and all that.)
There is also a risk that compulsion will lead to less that trustworthy data being uploaded - which could be seen as a rather perverse incentive.
My issue with all this - other than the potential risks relating to data quality and privacy - and the possible government misuse of personal information - is the lack of any evidence at all that the PCEHR is actually of any use and that the cost of this ePIP program will just add to the money wasted on this unproven national e-Health folly.
Where are the explicit and detailed plans describing how the utility of the PCEHR will be made attractive and the evidence this will actually work. Of course if the system had been useful and well-designed up front none of this funding would be needed.
This really is a self-propelled unproven fantasy that reminds one of a run-away train. Sadly it is also costing all of us a fortune!
How we can have an ill-conceived system such as the PCEHR consuming virtually all our e-Health funds while good, evidence based and valuable projects are just ignored beats me!
Posted by Dr David G More MB PhD at Sunday, September 27, 2015