General practitioners concerns with the PCEHR program are understated

In mid-October an interesting press release appeared from United General Practice Australia (UGPA), the peak body representing GPs. Titled UGPA Calls on Government to Address Clinical Utility of the PCEHR as an urgent Priority, the release highlighted the General Practitioners’ Concerns. Dr David More addresses its key points and shares his thoughts.
Australia’s general practice (GP) leaders are calling on the Government to heed concerns raised by GPs regarding the significant clinical utility issues associated with the Personally Controlled eHealth Record (PCEHR) system and address them as an urgent priority.
At a recent United General Practice Australia (UGPA) meeting in Canberra, representatives of the GP sector unanimously agreed that the focus of the PCEHR needs to be redirected to clinical utility and standardisation to ensure seamless clinical adoption.
Significant issues have been identified and currently there is no alignment between consumer registration and meaningful use through engagement of the clinical community and assurance of improvement of patient health outcomes.
In August, 2013, a number of key clinical leads resigned from National E-Health Transition Authority (NEHTA). This was amidst ongoing concerns and requests for NEHTA and the Department of Health and Ageing (DoHA) to review the PCEHR development cycle and re-establish meaningful clinical l input. Since August, DoHA has become the PCEHR system operator and opportunities for clinical engagement have been less clear.
UGPA is calling on Government to implement strategies to ensure the PCEHR is best structured to improve the health outcomes of all Australians. The process should be profession led and include:

• GP input at every level of the PCEHR development life cycle; including planning through to implementation


• Ensuring the system is clinically safe, usable and fit for purpose


• Supported by an acceptable, and robust legal and privacy framework


• Secure messaging interoperability is a critical dependency priority.

E-health and the PCEHR have the potential to transform Australia’s health system and provide superior, safer and more efficient healthcare to all Australian patients. UGPA members believe that this potential will only be fully realised if there is meaningful clinical engagement at a grassroots level. You can access the full release from this link:
http://www.gpra.org.au/ugpa-calls-ongovernment- to-address-clinical-utility-of-the- pcehr-as-an-urgent-priority
Not surprisingly, the release attracted a lot of attention in the technical and clinical press but, as seems usual these days, there was minimal coverage in the mainstream media.
To me, what the UGPA is requesting really understates what is needed.
At of the time of writing we have a PCEHR and an associated program that was designed in an environment that bordered on clinician free. Within six months of the system go-live some sixteen months ago, with the design largely set, NEHTA and the then DoHA sought consultation with a number of clinicians (The so-called Clinical Leads). Clinicians were paid for providing commentary and support for commencing the program but even at the time expressed concern regarding their influence on and access to the evolving system. They struggled on, doing the best they could until recently, when virtually all of them bailed out and resigned, realising the totally unsatisfactory nature of the system they had been given and having realised - from the inside - that no substantive change was likely or indeed possible.
Worse, even at this point, there was still no real public business case done on the actual final design to assess just how well the PCEHR would deliver clinical outcomes and benefits and fit with all our health system future needs.
In my view, tweaking around the edges will not result in clinical outcomes that are needed - let alone genuine clinical utility where the PCEHR will actually add seamlessly to the present capabilities of current and future GP systems. There is a really simple question to be addressed here. This is: “Is the money presently being spent to revamp and possibly improve the PCEHR well spent on this or would it be better spent improving the quality and utility of the present GP Clinical Systems and in improving the information exchange between them via secure messaging (as is happening to a large degree already but could be enhanced)?” To me, the answer comes down very clearly on the latter and a new direction is needed if we are to see real clinical benefits flow from the present and any future investment.
“In my view, tweaking around the edges will not result in clinical outcomes that are needed - let alone genuine clinical utility where the PCEHR will actually add seamlessly to the present capabilities of current and future GP systems.”
Someone needs to tell the bureaucrats in Canberra that the concept of a large centralised national e-record system is a dud, there are better ways to achieve the same outcomes, and that the time has come to put a very bad idea out of its misery as it simply can’t be fixed in its present form. It is only with a change of Government will it be possible to have a review with all options, including just scrapping the PCEHR, on the table.
If we can’t be swiftly shown a detailed plan that will meet what clinicians need now and into the future - as well as improving patient engagement with their care - then we need to start again. It really is simple as that. To just keep ticking along, based on little more than hope, would be very, very sad indeed.
I really feel sorry for the new Federal Health Minister. He is going to be told by all the bureaucrats that all is OK and that what is needed is a just a few more dollars for some extra payments to consultants and the like and that all will be well. My view is that this is simply wrong. Time, quite soon, will tell who is right.
Dr David More is a Health IT consultant with more than 20 years’ experience in the e-Health area. His blog can be found at www.aushealthit.blogspot.com and covers all matters e-Health. He may be contacted via the links provided on the blog.