It looks like a refresh of the national e-health strategy will come soon – we sure need it

Over the last few months I have been hearing that a range of stakeholders have and are being consulted as to their views on what will be the best way forward for e-Health in Australia, recognising that we need e-Health to work well as a part of the larger strategic health reform response to addressing the rising cost of healthcare in the context of the ageing society.
In thinking about any strategic change in direction, the first thing to do is to assess just where we are now. As I see it now, we have reasonable basic use of Electronic Health Records and practice management systems among GPs, rising but much less use among specialists, rising levels of the use of private secure clinical messaging services and gradual improvement in the levels of private and public hospital automation. Adoption of actual use of the Government’s Personally Controlled Electronic Record (PCEHR) is still very low with less than three per cent registered for the service and many less than that actually using the service. At this level of adoption and use the PCEHR remains an e-Health intervention which is yet to prove itself.
Despite claims to the contrary, no review or evaluation has yet been conducted so, other than the odd anecdote, no one has any idea as to how useful the PCEHR will turn out to be.
Interestingly, there also seems to be an emerging level of resistance among GPs to the use of the PCEHR based system. This presentation found on the web and written by a Geraldton GP Dr Edwin Kruys summarises some of the key perceived issues with use of the system.
Check it out for yourself here:
doctorsbag.wordpress.com/2013/07/29/pcehr-who-is-the-customer/
Issues covered include information ownership, the real purpose of the PCEHR and so on.
Most especially there is a lot of concern regarding this paragraph in the PCEHR Participation Agreement, with many not clear just why such broad and ongoing permission is provided.
“7.3 You grant us a perpetual, irrevocable, royalty-free and licence-fee free, worldwide, non-exclusive licence (including a right to sub-license) to use, reproduce, copy, modify, adapt, publish and communicate (including to other healthcare provider organisations and to organisations that store health information) material you have uploaded to the PCEHR system for the purposes of the PCEHR system.”
“The common thread in all this is that the views of clinicians and professionals are being treated with less importance and respect than they reasonably ought to be and that this is having long lasting implications for how effective e-Health can be into the future.”
The full document can be downloaded at: http://bit.ly/14ewm9Y
As well as concern about the PCEHR and just where it is heading, there is also rising concern regarding the way Standards Australia is managing the process of developing Standards in the e-Health domain. This most especially revolves around the way volunteers working on the relevant committees are being treated and the excessive directional input and pressure being applied by DoHA bureaucrats who are not really technically equipped to be making such contributions.
The common thread in all this is that the views of clinicians and professionals are being treated with less importance and respect than they reasonably ought to be and that this is having long lasting implications for how effective e-Health can be into the future.
As they say, I believe it would be fair to describe the progress in e-Health under Labor in the last six year as being something of a curate’s egg - good in parts with some progress and some serious missteps.
As to the future it is my belief that what is needed are a few major strategic e-Health initiatives. These include most importantly a major revamp of the leadership and governance of e-Health nation-wide.
Additionally, we need re-orientation of the focus of e-Health so it is clear that the major objective of e-Health is the support of clinicians to assist them in delivery and co-ordination of quality and safe care for their patients. Within this it seems it would also be useful to reshape the PCEHR to become a patient resource to assist patient engagement with their health problems and to improve the communication between patients and their clinicians.
Improving clinician support will involve taking steps to improve the useability of clinical systems, the support of clinician workflow and the breadth of information and decision support.
Lastly - at the highest level - we need to work to improve the direct information flows between all the actors of the health system to assist co-ordination and safety. What is needed here is to properly join up practices, hospitals, laboratories, community care and so on to optimise the content and quality of these flows.
There is a lot of detail that sits under each of these steps and what I am hoping is that the Strategic Refresh will, in general, agree with the directions I am suggesting and hopefully provide some rich detail of the steps needed.
In summary, in my view, the present PCEHR initiative is not a clinician friendly plan and it is not at all popular with either clinicians or patients. Improvements are more than possible and could preserve the value of most of the investment made so far and actually get better clinician and patient engagement and use. Just remaining stubborn and pushing on with programs which are clearly not working without reconsideration of the plans and directions is in no one’s interest.
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