Is There Any Chance the PCEHR Dog Will Hunt? I Think Not. It is Fundamentally Flawed.

Key Point:

Does it make any sense for the Government to be operating a Patient Controlled EHR System in parallel and alongside provider managed patient EHRs with the associated risks of inaccuracy, confusion and lack of currency?

Now read on:

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I thought it would be useful to go back to the official source on the PCEHR.

NEHTA HomeeHealth Implementation

What is a PCEHR?

A Personally Controlled Electronic Health Record (PCEHR) is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view.

Information in a PCEHR will be able to be accessed by you and your authorised healthcare providers. With this information available to them, healthcare providers will be able to make better decisions about your health and treatment advice. Over time you will be able to contribute to your own information and add to the recorded information stored in your PCEHR.

The PCEHR will not hold all the information held in your doctor's records but will complement it by highlighting key information. In the future, as the PCEHR becomes more widely available, you will be able to access your own health information anytime you need it and from anywhere in Australia.

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Here is the link to the page (Accessed March 14, 2011)

http://www.nehta.gov.au/ehealth-implementation/what-is-a-pcher

If you read closely you can extract the following points:

1. The PCEHR is “is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view.”

2. The information in the PCEHR is accessible by the patient - and with permission their clinical provider.

3. The record will gradually also become a Personal Health Record (PHR) as the patient will be adding information.

4. The PCEHR does not replace but is in addition to information held in an EHR by the responsible clinicians.

In summary the PCEHR is an additional EHR controlled by the patient which will contain information that the patient my decide to disclose to their carers - or not.

What is needed for this form of Electronic Patient Records to be successful and valuable?

The list I would suggest includes:

1. A compelling reason for use by Clinicians.

It is hard to see this being the case since Clinicians already have their records. Only if there is unique information that the patient highlights as being important is the record even likely to be accessed.

An alternative might be to provide a fee for use to the clinician to compensate for the time and professional effort involved but this does not seem to be on any agenda I have seen.

Expecting clinicians to use and update the PCEHRs for no charge will be about as successful as having lawyers stop charging for their ‘billable hours’!

2. Demonstrable and proven clinical benefit of the approaches adopted.

International experience does not provide much evidence that running parallel systems (clinician and patient controlled systems) will add much value or be widely used.

3. Essentially zero interference with present work practices unless there is a reward associated with any negative impact.

It is difficult to imagine how this can be achieved with parallel systems. The clinician has no reason to trust an external system as opposed to their own records.

Overall the PCEHR looks likely to be an expensive, time wasting, nuisance for the vast majority of clinicians. The chances of significant adoption without major re-design and major financial incentives seems remote.

Yes I know all the arguments about involving patients in their care, co-ordinating care delivery and so on but this macro architecture does not get there I believe.

The ideal of IT system design over the last 20+ years has always been to try for a single ‘source of truth’ for any data element as it is this that makes sure only current and as accurate as possible information is that presented to the user. The NEHTA approach guarantees there are multiple sources which may lack both currency and accuracy. How idiotic is that? Take it from me the CBA does not have multiple sources of information regarding your bank balance - one is plenty!

David.