No. 244

NOT WHAT THE DOCTOR ORDERED

STONE the crows! Health Minister Sussan Ley has commissioned a review of the 5500 services, (who knew!) on the Medicare Benefits Schedule.[i] Quite right, millions spent on tests here, a motza on procedures there and pretty soon you are talking about serious Medicare money. Adam Elsghaug and colleagues estimated in 2012 that just three per cent of scheduled items were formally assessed for efficacy, efficiency and cost effectiveness. [ii]

But what confounds the Crows is how much time and money is wasted by the absence of uniform and universal patient information. According to the ABS, 16 per cent of Australians saw three or more “health professionals” for the same condition and of them 14 per cent reported “issues caused by a lack of communication between the health professionals.”[iii] Australia spent $140.2bn on health in 2011-12 and we could save five per cent of that by digitising healthcare data. [iv]

Sounds like a saving any health minister would welcome.

So, in June 2012, the previous government commissioned the Personally Controlled Electronic Health Record, to make the health system, “more agile and sustainable.”[v] Apparently, we control what goes into it and who is allowed to access it. “Your eHealth record allows you and your doctors, hospitals and other healthcare provides to view and share your health information to provide you with the best possible care.” [vi]

No, the Crows have not got one either and you don’t need a second opinion to know it’s not working. Yes two million people have signed up, but their doctors have only uploaded records for 40,000 of them, meaning each patient history costs well over $20,000. [vii]

The benefits of an e-record that can tell a casualty doctor that the Crow unconscious on a stretcher has x blood group and y allergy should be a no brainer. But it isn’t, largely it seems because GPs, who will do the work of creating and maintaining records, do not see enough value.

The PCEHR is cumbersome and complex, separate from GP records and hospital files, isolated from existing records and hard to integrate. And the whole system has a structure that only a bureaucrat could love.[viii] As the AMA warns, in May 2013 80 per cent of PCEHR applications were completed incorrectly, due to the complexity of the legal framework and the requirement the Department of Health placed on GPs:

If other medical practices and healthcare organisations are going to participate in the PCEHR, the registration arrangements must be streamlined and proportional, which in turn will reduce the resources needed to undertake the registration process.[ix]

Even worse, PCEHR expects a bunch from GPs but presents them with not much more than risk in return:

It is the GP’s data that is being uploaded and it is ultimately the GP’s responsibility to ensure that the data is complete, accurate, timely and relevant. It is the GP who will be held responsible if anyone else acts on this data and something untoward happens.

The GP does not have control over what happens to the record, who it is shown to, what the patient can show or hide and ultimately how another person decides to act on the basis of their information. The GP does not determine how that data is subsequently used by the government or what it is used for.” [x]

As for specialists, only 37 per cent rely exclusively on digital patient files, but mainly for administration and patient notes, keeping test results, diagnostic imaging reports and referrals in hard copy files.[xi]

Which makes the Productivity Commission optimistic (and how often does anybody write that?) when it writes, “Electronic health records are inevitable. There is scope to realise greater value from electronic health records by facilitating greater participation by patients and, especially, health professionals.” [xii]

Former health minister Peter Dutton commissioned a PCEHR review which concluded that we all should be automatically enrolled, and have to ask to opt out. This would mean each of us having an empty record in the system which will be populated with “hospital discharge summaries, current medication and adverse event lists” and, eventually, “diagnostic imaging and pathology would automatically populate the record (subject to appropriate clinical workflows)”. While people would be able to remove or restrict access to documents, that this is done would be flagged.[xiii]

Conspiracy theorists and libertarians aside, the Crows suspect most people, having no reason to fear the state, will wear this on common sense grounds. But signing people up will not mean it works – only if those who have to fill in the files, the doctors and nurses in the health system, are on-side. And for now it seems they are not.


 

Stephen4@hotkey.net.au

Speeches, opeds, research papers all written faster than your agency. Call me, 0417 469 093


 

ENDNOTES

[i] Sean Parnell, “Sussan Ley pushes new Medicare deal,” The Australian, April 22

[ii] Adam G Elshaug et al “Over 150 potentially low-value health care practices: an Australian study,” Medical Journal of Australia 2102 197 (10) 446-560

[iii] Australian Bureau of Statistics, Patient experiences in Australia 2013-14, November 28 2014 @ http://goo.gl/NQzYDq

[iv] Department of Health, Review of the Personally Controlled Electronic Health Record, December 2013 @ http://goo.gl/ioj7r0 recovered on April 25

[v] National E-Health Transition Authority, “PCEHR” nd @ http://goo.gl/mfSFcm recovered on April 25

[vi] e-Health, “Get your personal e-Health record now,” December 15 2014 @ http://goo.gl/e15e9 recovered on April 25

[vii] Sue Dunlevy, “E-health record scheme a $1bn flop,” The Mercury February 27

[viii] Department of Health, Review of the PCEHR ibid

[ix] Australian Medical Association, AMA submission to the National Commission of Audit @ NCoA, Submissions, organisations and business nd @ http://goo.gl/dSJEDU recovered on April 25

[x] David Glance, “Unfixable: time to ditch personally controlled e-health record scheme,” The Conversation, November 6 2013 @ http://goo.gl/jeidgc recovered on April 25

[xi] Department of Health, “The eHealth readiness of Australia’s medical specialists,” May 30 2011 @ http://goo.gl/Li1gNa recovered on April 25

[xii] Productivity Commission, Efficiency in Health: Research Paper, April 2015 @ http://goo.gl/sBi1Ty

[xiii] Review of the PCEHR ibid

'2012