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Plotting a path to the PCEHR

Amanda Bryan
Med J Aust
Published online: 18 June 2012

Electronic health records go “live” on 1 July. Will everything change?

The much trumpeted personally controlled electronic health record (PCEHR) officially launches on 1 July, but if you’re feeling a little underprepared, you’re not alone.

The $467 million project to provide a seamless source of patient health data has hit a few obstacles along the way.

As a result the PCEHR  “go-live” date is likely to pass by quietly and without fanfare - something most medical practitioners will be grateful for.

There are a few hoops to jump through to participate in the PCEHR: once a practice is registered, doctors will need to familiarise themselves with the web-based system, upgrade their clinical software to integrate with the system and, ultimately, create and manage patients’ shared health summaries.

If that sounds daunting, it’s worth noting that doctors are not actually obliged to participate. There is a catch though — those who don’t will not be eligible for the eHealth Practice Incentive Payment.

The end goal, however, is a worthy one: boosting patient safety by reducing errors, improving health care delivery, and cutting waste and duplication from the system.

According to industry commentators, that end goal will only be achieved when PCEHR-capable clinical systems have been developed, doctors are suitably compensated for their extra work and potential legal risks have been addressed.

However, Dr Mike Civil, a general practitioner and e-health spokesperson for the Royal Australian College of General Practitioners says there’s no need for panic.

“Lots of doctors are feeling the pressure. They think that they’re going to have to be ready from day one and are worried that they’ll appear to be behind the eight ball. This is a misconception. The PCEHR rollout is going to be incredibly slow and things will become clearer over time”, he said. “1 July is a big step but it won’t immediately create big changes in what we do.”

As with any new journey, it helps if you have a map to follow. Here’s a basic blueprint of what will be involved:

Registration

At the moment, all patients can register their interest at the government’s PCEHR site at ehealth.gov.au.

Once the shared health summaries are up and running, this is also the portal where practices will access them but, to do so, they will need a health care organisation identifier from Medicare Australia.

Practices will also be obliged to keep a tight rein on exactly who’s authorised to access their patients’ PCEHRs, as employees come and go, with stiff penalties for privacy breaches.

Only doctors and other health workers with a health care provider identifier will be able to add information to the PCEHR system.

If a patient asks who’s accessed their record, practices are obliged to provide them with a list. Industry bodies have noted that these additional tasks will add extra layers of administration for practices.

Dr Civil says his practice may opt to help patients with the registration process once there’s more clarity around what will be involved.

“The consumer registration system is a little clunky at present. We may be able streamline that process for patients, depending on how many are interested”, he says.

Software

The PCEHR will be viewed, at least initially, via a government-run web-based “provider portal”.

This portal can be accessed from any computer that meets the technical requirements and has an internet connection. Authorised users will be able to check whether a patient has a PCEHR, seek permission to access a PCEHR, view and search a PCEHR and download and print clinical documents and views.

To upload patient data or documents, though, practitioners will need to use clinical software that’s compatible with the new system — and this area remains a work in progress.

The software programs are under development and, over the coming months, upgrades that enable practices to create and update shared health summaries are expected to be released.

This software capability will be crucial to practitioners who want to create and manage PCEHRs, according to Dr Civil.

Ultimately it’s hoped that clinical software will automate much of this work so as to reduce double handling of patient data between the clinician’s records and the PCEHR.

Once this occurs, the most crucial factor would be the extent to which doctors keep their own summaries up to date, according to a spokesperson for the National E-Health Transition Authority (NEHTA).

According to NEHTA, a few sites have already deployed elements of the e-health infrastructure and standards. They are now moving to the next stage: integrating these with the national PCEHR system.

There will be a call centre to provide support in accessing the system and to answer general questions about it.

The record

The PCEHR will run in parallel to the health records held by health care providers. It will include a summary of key information such as basic demographic data, allergies, regular medications, vaccinations and health conditions.

It will also include an indexed summary of specific health care events, dubbed “event summaries”. These may include referral letters and test results.

Specialists can also upload information when needed — event summaries and test results, for example — provided they also implement clinical software. Otherwise, they will largely be restricted to viewing records.

When it comes to their creation and ongoing management, however, most of the work will fall to GPs. GP groups also say the onus will be on them to ensure the accuracy and completeness of the PCEHR.

This remains a controversial area, with much of the debate surrounding what rebates, if any, would be claimable for the substantial legwork involved.

Although Health Minister Tanya Plibersek has announced that GPs can claim MBS items B, C or D when creating or changing a shared health summary, depending on the length of time it takes, there are caveats.

“I want to confirm that use of the longer consultation items will be seen as appropriate by the Medicare Australia Practitioner Review Process and the Professional Services Review in circumstances where there is clear evidence of patient complexity and there is documentation of substantial patient history”, she said in a speech in March.

The Australian Medical Association, meanwhile, has developed its own item numbers for doctors preparing and managing a shared health summary for guidance purposes. These items, which apply to all the medical professions, are time-tiered and can be billed in addition to any consultation that is provided to the patient on the same day. Whether these ultimately attract a Medicare rebate is yet to be seen.

Dr Civil says that although everyone would like some clarification around incentives, it is important to remember that doctors are unlikely to be suddenly swamped with patients requesting PCEHRs.

“I think we just have to get the ball rolling, and adapt and accommodate things as it all rolls out”, he says.

 

E-health exposure

Medical defence organisation MDA National has pinpointed some potential legal hazards as the personally controlled electronic health record (PCEHR) rolls out:

Sharing data

The shared health summary could be a potential source of legal liability for practitioners when inaccurate and outdated information is uploaded by other health providers accessing it.

Patient control

The patient’s ability to set access controls and control their content has a number of medicolegal implications for practitioners. For instance, the practitioner will not know if a patient has prevented them from accessing certain information.

Parental control

Parents have control of their children’s PCEHR from 0 to 14 years. From 14 to 18 years this could provide a challenging situation for practitioners when patients request certain information not be included in their PCEHRs.

Use of pseudonyms

The use of pseudonyms by patients could provide a significant basis for inconsistent clinical decision making. Patients’ motivation for using pseudonyms could include fear of being traced when escaping family violence or fear of exposure due to the public nature of their work.

PCEHR on trial

Sydney general practitioner, Dr Kean-Seng Lim, has had a sneak peak at what the personally controlled electronic health record (PCEHR) may look like.

He’s been involved in HealtheNet, a Greater Western Sydney PCEHR trial that was tasked with testing some of the PCEHR components such as shared health summaries, discharge summaries and the mother-and-child “Blue Book”.

He found that for everyday care of the patient, some components, such as the electronic discharge summaries, represented a big step forward. However, because underlying systems were still in development, he says the project’s key challenges revolved around integrating all the different systems such as the GP–Hospital communication interface.

He says some of these problems have required interim solutions and it has often been a case of learning as they go.

“From what we’ve seen so far, ensuring PCEHRs are kept up to date is not going to be a simple one-click task. It will require time and cognitive effort on the part of the practitioner, to review all the new information that may become available at each visit”, he says.

Some practices would also need to re-examine their current record-keeping format in order to facilitate the creation of a shared health summary, according to Dr Lim.

On the positive side, he says, practitioners will have access to much more information than in the past.

“This system has huge benefits in terms of patient care but it does appear to offer fewer benefits for GPs”, he says.

  • Amanda Bryan


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