news Shadow Health Minister Peter Dutton has taken a pickaxe to the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) scheme, claiming the costly project was “more about spin than about outcomes for patients”.
The project was initially funded in the 2010 Federal Budget to the tune of $466.7 million after years of the health industry and technology experts calling for development and national leadership in e-health and health identifier technology to better tie together patients’ records and achieve clinical outcomes. The project is overseen by the Department of Health and Ageing in coalition with the National E-Health Transition Authority (NEHTA).
However, last month the Government revealed it had failed to meet it initial 500,000 target for adoption of the system, with only close to 400,000 Australians using the system at that point.
At the time, University of Western Australia software academic David Glance severely criticised the scheme. “… even if the government had met the target of 500,000, it would have been a meaningless gesture,” Glance wrote at the time. “The vast majority of those who have signed up, if they ever get around to logging in, will be greeted with an empty record.”
“Given the lack of active participation on the part of GPs, as well as the lack of public hospital systems to integrate with PCEHR, there’s little evidence to suggest that this is going to change any time soon … GPs still struggle to see the benefit of spending time curating shared records when the legal liabilities are still unknown but are potentially severe.”
Just last week The Australian newspaper revealed that NEHTA had lost a number of senior executives, including clinical lead Mukesh Haikerwal.
“The question is simply: If these experienced clinicians and e-Health ‘experts’ thought the PCEHR was a winner would they be bailing out at this time?” wrote prominent Australian e-health blogger David More in response to the news. “Surely they would want to be around for the kudos and rewards that would flow from a successful program?”
“The answer is really easy. Those who are leaving know vastly more than you about the program and its risks and benefits – and yet they want out. It makes it totally clear this is a lemon on which no more time should be wasted by you or your colleagues until [The Royal Australian College of General Practitioners] and the [Australian Medical Association] are convinced – and say so and it is properly redesigned and fixed, so that the PCEHR is now both useful, safe and fit for purpose.”
In a statement issued late last week, Shadow Minister for Health and Ageing Peter Dutton added to the criticism of the project. “Labor’s implementation of an e-health patient record is a $1 billion disappointment,” Dutton wrote. “With nearly $1 billion spent on the program, it has failed to deliver anywhere near what the Labor Government promised.”
Dutton claimed the e-health program has been shown to be more about politics than about policy and more about spin than about outcomes for patients.
“Australian Doctor has reported that there are only 4,000 e-health records in existence. At a cost of $1 billion that works out at $250,000 per record,” said Dutton. “This latest development proves this government is incapable of delivering on e-health. It speaks volumes about Labor’s incompetence,” he added.
Dutton claimed that apart from the very low take-up rate, the system itself was “deeply flawed”. “The Government has been throwing good money after bad, spending money getting Medicare Locals to sign people up to a program that does not yet have basic clinical protocols in place, let alone support from clinicians,” Dutton’s media release said.
“The Coalition continues to provide in-principle support for e-health, but shares the concern of many in the sector about Labor’s incompetence in managing the process,” said Dutton.
Dutton said the previous Coalition Government achieved significant improvements in the computerisation of general practice, from 17 per cent to over 94 per cent, by working with the profession and implementing effective policy.
“If elected, the Coalition will assess the true status of the PCEHR implementation and again work with health professionals and the broader sector to provide real results on this important reform for patient care,” Dutton said.
Dutton claimed the e-health debacle followed a pattern of waste and incompetence from the Labor Government, joining the ranks of “catastrophically mismanaged programs” such as pink batts and school halls. “It also follows Labor’s failure to deliver on its much promised GP Super Clinics and the 16 Early Psychosis Prevention and Intervention Centres which never materialised,” added Dutton.
Health Minister Tanya Plibersek has been invited to respond to Dutton’s comments.
opinion/analysis
The PCEHR has been having substantial problems for some time, and it’s not surprising — all the warning signs were there from the start. The truth is that the e-health records software field — in fact, the medical administration software field in general — is still quite immature and that health departments all around Australia have struggled with this issue for a decade now. I’m not surprised at all, having followed the history of NEHTA as I have and knowing this scene as I do, that the Federal Government’s flagship e-health records project has gone off the rails. Perhaps things aren’t as bad as Dutton claims — but then, when it comes to e-health medical records, nothing would surprise me.
From a political perspective, damned if you do, damned if you don’t. If the federal government had ignored the calls from professional bodies and Dr’s to implement the eHealth system, they would be criticised for that. If it had been implemented well technically but failed to achieve adoption rates and usefulness demonstrating it’s vast and undeniable success as a platform, it would be heavily criticised. The only way to avoid criticism would be to make it a technical marvel and motivate huge numbers of Dr’s and medical bodies to adopt it comprehensively. I’m not really sure you could do that without legislation – you’d need to somehow protect Dr’s from liability in the event that these very public records showed misdiagnosis, while legally compelling them to use it. Which woulddraw the ire of the whole medical profession, and many others besides.
None of that is to say I excuse fault of the government where it is valid – if indeed there are technical flaws with the system and planning failures then, of course, the cause of those should be investigated thoroughly. But the best technical solution in the world isn’t going to fly if Dr’s are concerned about the security of the information stored, or concerned about possible criticism from other Dr’s even in the absence of legal ramifications.
I’d say the opposition aren’t being entirely fair or honest in their politicisation of this project so close to the election – they have a long list of issues they are going to want to raise to try to make the Government look bad, even if the cause if the issue isn’t obviously or necessarily directly attributable to the Government themselves. It is too close to the election to perform an actual enquiry before the ballots are cast anyway – if the opposition was so concerned about this, why weren’t they talking about it months ago? What is their comprehensive plan to address it, how much will it cost, how will they guarantee Dr participation? Anyone can criticise the efforts of another, but we need criticism of substance, that provides substantial direction, comprehensive planning and a thorough understanding if the issues. All I’m seeing is a bunch of pricks firing cannons from the protection of a rather flimsy looking greenhouse…
TrevorX suggests “the best technical solution in the world isn’t going to fly if doctors are concerned about the security of the information stored, or concerned about possible criticism from other doctors, even in the absence of legal ramifications.” I think he is right and the only conclusion that can be drawn is that health information will never be shared by doctors unless there is some compensatory incentive.
I have recently suggested two possible reasons for my colleagues to reconsider the PCEHR but their realisation is probably several years and another billion dollars off.
https://plus.google.com/103595642866347393604/posts/7PNtukXmLZi
David Guest
General Practitioner
I signed up (with a 25 character randomly generated alpha-numeric password :P)….but he’s right in that my record is basically empty except where I’ve filled it in.
I don’t disagree with them spending money on an e-health record system. But until everything from NBN connections to practices, to training and implementation of real-time gov. database software and consumer awareness of the program all coalesce together….it was bound to be a very niche and fairly mundane system.
What’s that saying…ahead of its’ time…by about a decade I’d say…
It is truly needed, however I agree with both Trevor and 7T. Places an accountability burden on the medical profession from G.P’s to Specialists and Hospitals.
Funny how accountability and personal responsibility all apply to everyone else.
Worth a read, I think it would be most appropriate at this time for the ABC to re present this 4 Corners item.
My Partner was in Hospital for the big C stagre 4 advanced and very agressive, 9now in full remission) and they were pushing Morphine and Endone on her even though she was not in great pain and Panadeine was sufficient, she refused as not worth the risks, just discarded the Endone tabs.
http://www.abc.net.au/4corners/content/2010/s3023253.htm
Scary and open to profitable abuse
Sorry to hear, Abel. Glad she’s in remission :-)
You should always destroy old/unwanted medicines, or hand them in to a chemist for disposal. Great to hear a good outcome for your missus :o)
Thanks guys
The pills were given in the hospital – in for a couple of weeks. Just left the Endone (clearly labelled) in the pill bowl – often wondered myself what happened to them.
I remember way back – (well, 2007) – when the national ID card tenders were underway – (a response to which I was involved with) – and this was to form the basis of integrating many government services, the first of which was to be eHealth.
I was struck by the (relative) vagueness of the tender requirements, and the goalposts moved around a lot as the tender process carried on.
So this doesn’t surprise me.
On the flip side, having a chronic medical condition as I do – (diabetes) – I have an eHealth record, and it does seem to work very well. I get a prescription filled, and that event appears on the record before I get home from the chemist.
The real problem is that not everyone has one, and therefore doctors tend not to look them up when you sit down in their office. It needs to be made ubiquitous so that the value can be achieved.
I think the implementation is fantastic – but the engagement with the medical community seems less than satisfactory.
It needs to be made ubiquitous so that the value can be achieved.
Exactly, while it is optional, it’s devalued vastly…
We have given every GP $50,000 in ePIP payments to install the software and they have taken it but then wont advise patient they can have data uploaded into the PCEHR.
I though Ned Kelly was dead?? Now they decry the lack of use, when in fact they are the controllers of use and the PCEHR’s success.
I though taking government funding under false pretences was fraud?!
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