Coalition kicks off promised PCEHR review

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news As promised during the Federal Election, the new Coalition Government has kicked off a formal review into Labor’s extremely troubled Personally Controlled Electronic Health Record initiative, with Health Minister Peter Dutton claiming the previous administration had wasted “over a billion dollars” on the project.

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 in coalition with the National E-Health Transition Authority (NEHTA).

However, in July 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.”

And in August The Australian newspaper revealed that NEHTA had lost a number of senior executives, including clinical lead Mukesh Haikerwal.

Federal Health Minister Hon Peter Dutton, over the weekend announced a review of the initiative, stating it had failed to attract enough doctors to participate in the project. The Coalition had flagged plans during the election campaign to review the project.

“While the previous Coalition government laid the foundations for e-health by getting computers into doctors’ practices, Labor comprehensively messed up the next stage and has wasted over a billion dollars in its failed attempt at the second phase – moving to personal electronic health records,” Dutton said in a statement.

Dutton said a year after the introduction of the electronic health records system only a fraction of Australians have established a record and for those who have, only a few hundred doctors have added a Shared Health Summary..

“This defeats the purpose of having a national, electronic system that is meant to help save lives,” the Minister said. “The government fully supports the concept of electronic health records but it must be fit for purpose and cost-effective. I am therefore announcing today a review of ehealth records to be chaired by Richard Royle, Executive Director of the UnitingCare Health group in Queensland.”

“Mr Royle holds a Bachelor of Arts and Masters of Health Administration degrees, and is an active member of the Executive Team responsible for all of UnitingCare’s services in Queensland, including Bluecare and UnitingCare Community, as well as UnitingCare Health.

“In addition, Mr Royle is Vice-President of the Australian Private Hospitals Association and he brings more than 30 years experience in management of public and private health services to the position of Review Chair. He is also overseeing the implementation of Australia’s first fully integrated digital hospital in a pilot project at Hervey Bay in Queensland.”

Dutton said Mr Royle will be assisted in the Review by Dr Steve Hambleton, president of the Australian Medical Association and Andrew Walduck, Chief Information Officer of Australia Post.

“The Review team’s expertise encompasses information technology, patient and medical services and business administration which I believe is the right mix to put the electronic health records program back on track.”

The review panel will invite submissions from the public along with key stakeholder groups including peak clinical bodies. The review will report back to Minister Dutton by mid-December 2013, after which the government will consider the recommendations and respond.

According to the terms of reference for the review, the panel will conduct a Review into the personally controlled electronic health record system dealing with implementation, uptake and including, but not limited to: The gaps between the expectations of users and what has been delivered; The level of consultation with end users during the development phase; The level of use of the PCEHR by health care professions in clinical settings; Barriers to increasing usage in clinical settings; Key clinician and patient usability issues; Work that is still required including new functions that improve the value proposition for clinicians and patients; Drivers and incentives to increase usage for both industry and health care professionals; The applicability and potential integration of comparable private sector products; The future role of the private sector in providing solutions; The policy settings required to generate private sector solutions.

opinion/analysis
As I wrote in late September:

“I have to say, I’m fully in support of the new Coalition Government reviewing this scheme. It’s been far from clear since the PCEHR project was initiated whether the technology exists yet to do this thing right; those who work in e-health will very likely agree with me when I say that the IT systems of centralised health authorities such as hospitals, clinics and so on can be likened to a huge soup tureen full of extremely tangled spaghetti. It is extremely common for major e-health projects in Australia to fail, and the PCEHR is the e-health project of all e-health projects.

Then too, it’s unclear to what extent the National E-Health Transition Authority, which is overseeing the project, is capable of delivering it. NEHTA’s had its problems in the past, and with a cluster of senior staff exiting recently, is likely to have more problems in the future. Let’s hope Dutton can get his hands dirty with this one and sort it out. Personally, I’d be having the project formally audited. It shows all the usual concerning signs.”

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