I had an e-mail today from the author pointing out a new article on the PCEHR.
Alarm bells ringing over botched introduction of electronic health records
The Federal Government is introducing a new system for electronically managing health information — and given its botched implementation so far failure is almost guaranteed.
Called the PCEHR (personally controlled electronic health record) the idea is to give patients access to an electronic summary of their health records that can be shared among healthcare providers who will also update the record when they have contact with the patient.
The PCEHR will include information about the patient’s medications, test results, medical history and any other health-related information.
Having a PCEHR will be optional. Once a patient has decided to have one (and provided it is supported by the doctors and health services the patient uses) he or she can apply for a user name and password through Medicare or another approved agency.
The PCEHR will be web-based, so patients will be able to log in and view their entire PCEHR record. The patient will also be able to control who gets to access her or his information. Providers who have permission will access the information using their own username and password, perhaps in combination with a smart card or special USB key.
A patient may also be allowed to hide parts of her record and it is this feature amongst many that has started the alarm bells ringing among doctors facing potential liability claims after basing decisions on incomplete information.
The purported benefits of PCEHR
Sharing your health records between providers, the theory goes, increases your mobility and improves their ability to treat you without having to get the information from potentially multiple sources.
This is especially useful if you are not in a position to disclose that information yourself, for instance, when you arrive at an emergency department.
In principle, the idea is sound, but other implementations of a shared summary records around the world have not been very successful. The United Kingdom’s recent experience has shown little uptake by either consumers or health professionals.
The fact that PCEHR is optional, both for the suppliers of the information and the patients themselves means that relying on its use will be almost impossible.
Even if a patient has a PCEHR, it will be very difficult to say how complete and how up-to-date the information is. This is made even worse by the fact that a patient can hide parts of her record.
At the same time, there is little research evidence to show that shared summary records provide any significant benefit in patient health outcomes.
In the face of all this, it is fair to ask why Australia is trying to implement the PCEHR in a extremely ambitious timeframe, at a cost of $470 million dollars when budgets are tight and cuts are being made across the board.
Why PCEHR?
PCEHR was another of Kevin Rudd’s bold plans that arose out of the National Health and Hospitals Reform Commission (NHHRC) Report in 2010, but it’s built on a fairly lengthy history of government-funded eHealth programs.
Like other things cherry-picked out of this report, the commission had recommended PCEHR as part of a comprehensive action plan on eHealth.
Lots more here:
The author is David Glance. His bio follows:
“Associate Professor David Glance is director of the UWA Centre for Software Practice, a UWA research and development centre. Originally a physiologist working in the area of vascular control mechanisms in pregnancy, Professor Glance subsequently worked in the software industry for over 20 years before spending the last 10 years at UWA. The UWA CSP has developed the eHealth platform MMEx which has been used to provide electronic patient management in WA and other parts of Australia. Professor Glance's research interests are in health informatics, public health and software engineering.”
He is the third Professor who has suggested to me this is not quite the fabulous idea the Minister thinks it is.
Elsewhere there have been three main additional sets of issues raised.
First technical feasibility is under something of a cloud.
See here:
Tech metrics missing from e-health records blueprint
NBN expected to 'facilitate new opportunities'.
The National E-health Transition Authority (NEHTA) has released a 125-page blueprint for Australia's $467 million personally controlled e-health records system (PCEHR), but was unable to provide further detail on the technology required to deliver the service.
The draft report (pdf) made no mention of response times, latency or any other key technology details behind the PCEHR -- intended as a centralised system for collecting and sharing Australia's healthcare data.
While viewing rates, the number of records added, and consumer surveys were highlighted as 'key performance indicators', there was no explicit reference to critical issues such as the speed of access to data repositories.
"The existing Internet capability in Australia is able to support most current eHealth applications," NEHTA wrote.
"Once implemented, the National Broadband Network will extend broadband support and facilitate new opportunities in eHealth."
Lots more here:
http://www.itnews.com.au/News/254197,tech-metrics-missing-from-e-health-records-blueprint.aspx
Of course the NBN is a decade long project and just what happens in the meantime who knows?
Secondly the recognition that there are some huge and at present un-recognised costs have also emerged.
Doctors seek payment for e-health records
- Sue Dunlevy
- From: The Australian
- April 13, 2011
DOCTORS will have to be paid to set up personally controlled patient e-health records or the government's $466 million e-health system will not get off the ground, two doctors groups have warned.
The Australian Medical Association and the Royal Australian College of General Practitioners said yesterday that creating the records would take time and doctors would have to be paid to do it.
More here:
Thirdly there is an increasing recognition that the ‘opt-in’ approach to the consent model is going to mean it will be a very long time before user numbers really grow.
Softly softly skewers e-health savings
Tuesday, 12 April 2011 09:40
By insisting on a softly softly approach to electronic health records, the Government has missed out on an opportunity to revolutionise health care in Australia, instead paving the way for a two track national healthcare system for the foreseeable future.
The release this morning of the 135 page draft concept of operations document regarding the use of personally controlled electronic health records (PCEHR), makes clear that individual Australians will be able to choose whether to sign up for the programme, determine who can access the information stored in those records, and withdraw from the system whenever they want.
While civil libertarians may applaud the approach, it will lead to significant problems for healthcare providers which will have to respond to the whim of individual patients. Even if a patient opts into the system, if they later opt out, it will be up to healthcare providers to then scramble to assemble health records for that individual.
Lots more here:
Looks like there are a good few others who have seen through this nonsense!
David.
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