National e-health still has a future despite problems: CIOs

Technology heads in the healthcare sector continue to back the federal government’s controversial and slow moving national e-health record program, saying it has a future despite lacking the critical mass it needs to succeed.

As of July 31, 612,391 Australians had registered for an e-health record, according to a recent National E-Health Transition Authority (NEHTA) report. A further 4500 organisations had registered in the personally controlled e-health record (PCEHR) system and 4585 shared health summaries had been uploaded as of 22 May.

The scheme has come under fire in recent months. In July, Australian Doctor polled 514 general practitioners with two-thirds indicating they will not take part. Earlier this week, a man was accidentally sent another person’s e-health details.

Meanwhile, industry has called for the Abbott government to fix the troubled system. Before he was elected on September 7, Tony Abbott vowed he would seek a review of the struggling e-health program.

Mal Thatcher, CIO at Mater Hospital, said the scheme has not yet reached the critical mass it needs to succeed and is lacking the right policy framework for broad adoption.

“That includes the need for strong ongoing engagement with the entire health ecosystem whether by NEHTA or the current system operator in DoHA. Unfortunately, in my experience at least, engagement has not been nearly effective enough.”

Thatcher also said access to and use of the PCEHR has to be “symbiotic” with clinical practice and electronic medical record systems to convince clinicians that it’s worthwhile. He added that clinicians need to trust the quality and currency of the data and industry needs to articulate a tipping point for adoption.

Bill Vargas, CIO at the Sydney Children’s Hospitals Network, told CIO clincians’ time is fairly precious given their heavy workload, so they have to convinced that using these systems will give them benefits as well as for the patient.

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Vargas believed that more than half the population and health organisations have to be using the national system for it to reach critical mass.

“This will ensure that information gives a holistic picture of a person’s health record and makes it useful for the ongoing care of the patient.”

Despite some doctors baulking at the system or indicating they will not take part, Vargas believes consumers will drive uptake as they will request that their doctor is connected and contributes to their e-health record.

“In discussion with consumers, in particular parents of young children, they have an expectation that this will occur in the future or else they will seek doctors who are connected to e-health,” said Vargas.

Vargas said the benefits of sharing appropriate and concise clinical information between treating clinicians for the benefit of the patient should “no longer be an argument.”

“The potential reduction in clinician incidents by having information about current medications, allergies, diagnostic results or medical conditions would be a great benefit to the patient and the health system,” said Vargas.

“Given the ageing population and the fact that most of our health events and expenditure occurs in our later years, it’s crucial that a concise record of events and key clinical information is available to clinicians and consumers.”

Anna McFadgen, Melbourne Health chief of staff, believes adoption of national electronic medical records is “inevitable and we need to be prepared for that eventuality.”

Melbourne Health does not currently have an electronic health record but is working closely with the government and its partners to make it happen, she said.

“Patient expectations of healthcare provision are changing rapidly,” with each new generation more information-savvy than the last, she said.

“It will be very difficult to healthcare providers in the future to not provide that information to the patient and not engage the patient in the delivery of healthcare.”

But there’s still no real driver for PCEHR adoption or integration in the private acute healthcare sector, said Mater’s Thatcher. Currently, Mater’s internal clinical portal is highlighting to clinicians if the patient has a PCEHR record and if so, provides a link to the PCEHR clinical portal.

“Of course, with only 2 per cent of Queensland consumers registered for the PCEHR, it’s not a great hit rate,” he said.

Integration considerations

There are always technical integration issues between the PCEHR and existing hospital systems, said Thatcher.

“A key consideration is the integration of health identifies into our core systems [is that] most hospital IT solution vendors, at least in Australia, are notoriously slow to make changes, let alone innovate,” Thatcher said.

He said the bigger issue is that the vast majority of Australian hospitals still run on paper and as such, there is limited electronic health information to share.

Vargas said integration between key electronic medical record systems and the PCEHR is based on defined messaging standards – clinical document architecture (CDA) and Health Level Seven (HL7) – which have been developed nationally and driven by NEHTA.

“It’s a lot of work to make the contributing system capable of sending information in CDA format. But this has now been achieved by the HealtheNet project so it will become easier for [organisations] within NSW Health to contribute to e-health,” he said.

Additional reporting by Adam Bender.