This appeared a few days ago:
'We got screwed over': e-health GPs speak out
"We got screwed over, didn’t we? We didn’t realise. We were there in the middle of it all trying to make it work, but we were like the woman with the abusive husband, thinking every tomorrow would be a sunny day.”
This is one voice of the many senior doctors who joined the National E-Health Transition Authority to create Australia’s personally controlled electronic health record (PCEHR) system.
It was envisaged that the system would help track patients’ labyrinthine journeys through the health system. One of its central aims was simply to save aeroplanes of patients from falling out of the sky as a result of the two million medication misadventures that happen each year.
The lesson etched in capital letters across the tombstone of every dysfunctional high-cost e-health project around the world has yet to be learnt here, these doctors say. And the lesson is simply that you are wasting your dollars unless you make a system that doctors can trust and use, that offers clear, real-world improvements to their care of patients.
The narrative arc of Australia’s e-health panto-tragedy is reaching a critical phase. The PCEHR is not quite buried. But the new Federal Government’s review of the system — announced this month — is being sold as one last chance to rewrite a script where the corpse is resurrected.
Australian Doctor recently spoke with the main clinical players to get an idea of what has gone wrong and what needs to be done about it. Many of them preferred to remain anonymous, but their stories tell a tale of bureaucratic bungling, expensive errors and minimal understanding of what doctors want.
Chasing the numbers
One measure of the political sensitivities wrapped up in the PCEHR is the effort and expense that was lavished on signing up patients. The government had declared it wanted 500,000 patients registered by July this year. And in politics, when you give bureaucrats a target, the target gets met — however ludicrous the means employed.
One measure of the political sensitivities wrapped up in the PCEHR is the effort and expense that was lavished on signing up patients. The government had declared it wanted 500,000 patients registered by July this year. And in politics, when you give bureaucrats a target, the target gets met — however ludicrous the means employed.
Recruiters were sent out to Medicare offices to get people to put their names down. There were recruiters also camped out in EDs, signing up relatives of those needing treatment. The target was met, just, and the political blushes avoided.
Today, there are more than one million people registered. But who are they? And what benefit has that registration gained them? The joke is that the backpacking community is fully on board with a PCEHR. The problem is that backpackers and many other registrants have no immediate need for e-health records. And so there is no incentive for doctors to enter and curate the information onto the system.
As once clinician put it:
“What we wanted was a group of frequent flyers in the system, those going in and out of hospital, through the hands of different doctors."
"You, as a doctor, would have seen benefits in terms of the care of the patient. Signing up young people with no real health problems ... what is the point?”
The problem is borne out by the numbers. How many GPs have become nominated providers managing a patient’s e-health record? There has been no response from the Department of Health to that question. How many patients have a ‘live’ shared e-health summary? Australian Doctor has been told about 4000. It is these numbers that furnish Health Minister Peter Dutton’s calculation that the PCEHR is costing $200,000 for every patient it is currently supporting.
Many more war-stories (some which seem a bit exaggerated - possibly by frustration) are found here:
What this really show us is that it is very easy for a reporter to find a good number of doctors who have had contact with Government run e-Health have had very bad experiences.
While ever Australian e-Health is being run in a fashion that leads to outcomes like this we can be sure no progress will happen. The big picture, governance, legislation and trust are all important.
I hope the review team are listening.
David.
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