Doctor supergroup calls for PCEHR overhaul



news A super-group composed of six of Australia’s major medical and doctors’ associations has called for the new Coalition Federal Government to listen to significant concerns raised by general practitioner doctors about the previous Labor administration’s troubled Personally Controlled Electronic Health Record (PCEHR) system.

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, 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.

Last week a statement was released on the issue by the lobby group United General Practice Australia. The group is composed of six major medical associations working together on primary healthcare issues, involving the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine, the Australian Medical Association, General Practice Registrars Australia, the Australian General Practice Network and the Rural Doctors Association of Australia.

At a recent United General Practice Australia (UGPA) meeting in Canberra, representatives of the GP sector unanimously agreed that the focus of the PCEHR needs to be redirected to clinical utility and standardisation to ensure seamless clinical adoption.

“Significant issues have been identified and currently there is no alignment between consumer registration and meaningful use through engagement of the clinical community and assurance of improvement of patient health outcomes,” the group’s statement last week noted.

“In August 2013 a number of key clinical leads resigned from National E-Health Transition Authority (NEHTA). This was amidst ongoing concerns and requests for NEHTA and the Department of Health and Ageing (DoHA) to review the PCEHR development cycle and re-establish meaningful clinical input.”

The group noted that since August, DoHA has become the PCEHR system operator and “opportunities for clinical engagement have been less clear”.

“UGPA is calling on Government to implement strategies to ensure the PCEHR is best structured to improve the health outcomes of all Australians,” the group’s statement noted. “The process should be profession led and: Include GP input at every level of the PCEHR development life cycle; including planning through to implementation; Ensure the system is clinically safe, usable and fit for purpose; Be supported by an acceptable, and robust legal and privacy framework; and ensure secure messaging interoperability is a critical dependency priority.”

UGPA further noted: “E-health and the PCEHR have the potential to transform Australia’s health system and provide superior, safer and more efficient healthcare to all Australian patients. UGPA members believe that this potential will only be fully realised if there is meaningful clinical engagement at a grassroots level. The Government has announced it will review implementation of the PCEHR. UGPA supports the review and look forward to contributing to the review and expect that the clinical voice and the concerns raised will be heard.”

This may sound a little extreme, but I believe the PCEHR project is a major problem child for the incoming Coalition Government. E-Health projects are never easy, and this one shows all the signs of going massively off the rails. The GP supergroup mentioned in this article is correct — the project urgently needs to be realigned to better meet the needs of doctors, who will be the primary participants interacting with the system.


  1. I find it unfathomable that the publically funded Personally Controlled Electronic Health Record does not mesh with all public hospitals. It is absolutely essential that this occurs. All your discharge summaries, discharge medications and other inhospital documents could be linked to your PCEHR and be available to every GP you choose. This would improve continuity of care.

    GP’s and private specialists could be brought on board by further incentivisation. As mentioned, uploading and curating records will take considerable time which GP’s are notoriously short of. An integrated target-based incentive system should improve uptake.

  2. I mentioned this to my GP the other day. None of the dozen doctors in the practice are using PCEHR.

    I’m really curious as to how the 400,000 registrations was achieved.

  3. Hmmm … the PCEHR project has been off the rails for years unfortunately. This is just yet another dismal example of the failure of central planning in very complex and decentralised environments. Hopefully this is the last gasp and the program can transition to an approach which is more aligned to (a) healthcare system realities and (b) the opportunities of the next generation of cloud services technology.

    The essence of problem is that decision makers in central government agencies are just too out of touch with the front line and with technology trends … and too arrogant to care. The operating assumptions were a double fail. Firstly, the assumption that is was practically and financially possible to herd all the cats into a centralised system (doomed to fail from the outset). Secondly, that it was possible to get all the cats moving in the same direction at the same time (sounds improbable … and turns out to be so).

    Looking forward, a better approach is to embrace the diversity of approaches across the healthcare system (as if there was really any alternative anyway) and to simply seek to propagate systems that work and to grow critical mass. Industry standards, of course, are critical … but the most critical ingredient for success is to find solutions that are proven to work (i.e. are already in use by doctors and other medical practitioners today) and then to explore ways that these solutions can be both scaled up and integrated with other systems that work.

    Onshore-based cloud services will be the solution because the SaaS delivery model and APIs remove barriers to adoption and integration and also to scaling up to achieve critical mass. Individual healthcare provider organisations can make their own decentralised decisions and still evolve towards a more interconnected healthcare system over time as more integrated solution platforms emerge driven by adoption behaviours and competitive market forces … coordinated by practitioner-led industry leadership.

    This may sound sub-optimal but is is a darned sight better than the centralised approach which promises more, and faster, progress … but just leaves folks stranded on the station waiting for a train that never arrives (perhaps because it went off the rails). The biggest tragedy of these big centralised programs is that they waste TIME … all of that time and energy and money would have been better spent trying to work out ways to accelerate organic evolution of healthcare systems rather than headbutt folks into accepting … and waiting for … the GRAND PLAN.

  4. Who actually has a PCEHR? I have a chronic condition and I use it all the time…. I have a onestop shop now where I record all my notes and medical appointments. I had to “encourage” my GP to generate a health care summary. Jurisdicitions around Australia have started to send discharge summaries to the PCEHR and this will definitely provide more of the meaningful use to GPs that they say the system doesnt currently have … the infrastructure has been put in place and the use and refinement and user interfaces will occur over time. Yes these projects are hard, complex and expensive but I applaud the government for having the vision to put this in place. The system is growing with consumer registrations as of September 30 near the 1,000,000 mark and GPs and pharmacies registering at increasing rates. See NEHTA scorecard on their website

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