Saturday, December 1, 2012

The Phoney War Regarding The PCEHR Is Almost Over. The Rubber Hits The Road In The Next Few Months.

Ever since the so- called ‘soft launch’ of the Personally Controlled Electronic Health Record on July 1 this year there has been a ‘cone of silence’ descend upon the project. The fundamental reason for this has been that key elements for the program were simply not ready - and some still aren’t.
If the Department of Health and Ageing has its way this is all going to change over the next six months (or a little less depending on when this is published). The key is the updated and toughened  ePIP program which was introduced in the May 2012 Budget.
Essentially to continue to receive Practice Incentive Payments (PIP) for e-Health activities, which can amount to $50,000 per practice per year, there are some new and pretty demanding requirements. The key requirement is that there be a dramatic update in the capabilities of GP Practice Systems over the next five months (with most of the updates needed in less than 2 months).
Here is the summary from the NEHTA web site:
eHealth Incentive Introduction
The eHealth incentive aims to encourage general practices to keep up to date with the latest developments in eHealth to assist in improving administration processes and enhancing the quality of patient care by, for example, by supporting the capacity to share accurate electronic patient records.
The Australian Government announced as part of the 2012-13 Budget that new PIP eHealth Incentive requirements had been developed in order to support the delivery of current eHealth initiatives particularly the personally controlled electronic health (eHealth) records system.
The new requirements and associated dates are:
Integrating Healthcare Identifiers into Electronic Practice Records
1 February 2013
Secure Messaging
1 February 2013
Data Records and Clinical Coding
1 February 2013
Electronic Transfer of Prescriptions
1 February 2013
1 May 2013
This information is found here:
Given that many practices have been receiving considerable funds from the older ePIP initiative(s) you can understand these practices would be keen to not take a pay cut and so will almost certainly aim to do as they are incentivised to do.
All this was only clarified 3-4 months ago so you can understand that the software providers for these practices are working away like crazy to have software which meets the (detailed requirements) at least a few months ahead of deadline. Sadly their efforts have been somewhat hampered by the NEHTA / DoHA test environments being unstable and frequently unavailable.
Interestingly all this is being done in rather of a policy rush with there being a number of gaps in the current standards environment (Data coding and Electronic Prescriptions) and little certainty as to the robustness of both the Health Identifier Service and the PCEHR Service Infrastructures. Precious little time seems to have been left for the testing of the system as an integrated whole and there are strong rumours that some major performance issues remain unresolved.
Nevertheless, once all this development - and hopefully careful supervised testing - has been completed and a few other elements fall into place such as robust secure practice and user identification, we are assuming - courageously - we will have a PCEHR System which is fully tested ready to go.
As the title of the article says it will be at this point that we will see just how many patients and how many GPs are prepared to become involved and spend the time and effort to prepare, consent and upload the Shared Health Summaries for their patients - assuming that all the deadlines are met and PCEHR and associated systems are actually ready to use close to a year late. It does need to be remembered that to date getting on towards a billion dollars has been spent by the Government to get this far along. There is certainly more to come.
While I will be happy to be proven wrong I suspect a year from now the usage of the PCEHR will be still very low and that leading into the next election it might just be decided to quietly let the program slide. We have already seen very substantial reductions in the NEHTA workforce - on the basis of the rather absurd claim that the PCEHR has been delivered - and I suspect the same fate awaits the DoHA eHealth group next year unless fortunes turn around dramatically.
As of November 2012 less than 20,000 patients have registered to have a record and less than 20 summaries have been uploaded.
Having been one of those who have registered for a record I can attest that the system is, at present both slow and ‘clunky’ to use a technical term.
We will not have long to wait to be able to assess whether the billion dollars (and the ongoing operational costs) have been well spent!
(This is a draft article for a magazine - comments welcome).