Opinion: Why national e-health is not for everyone

The national e-health initiative is missing its take-up targets. According to a report last month in The Australian, the federal government hoped to see 500,000 Australians with a personally-controlled electronic health record (PCEHR) by July, but as of early March there were only 73,648 consumer registrations.

For those registered with a PCEHR, there were only 108 shared health summaries and 51 discharge summaries uploaded into the PCEHR system that consumers could share with their healthcare providers.

There has been a big focus on hitting targets for the PCEHR but quite frankly, Australians who are in good health are unlikely to have the same need for a PCEHR than those who require ongoing care.

A PCEHR is not for everyone, and nor should there be an expectation that 22 million Australians will have one; well not right now at least.

However, given the expected benefits to the community from the electronic sharing of consumer health information, it’s worth considering what will influence greater consumer and healthcare provider uptake of the PCEHR service.

As part of the national e-health agenda, the PCEHR initiative is expected to deliver reduce avoidable hospital admission and GP visits due to more effective medication management, and improve continuity of care.

All consumers have access to a PCEHR. For those consumers who chose to “opt in” and register for a PCEHR, they can expect their healthcare providers to have access to electronic clinical documents that provide accurate medication information and summarise the current status of their health.

Promoting national health to the right people

To encourage take-up, the initiative needs to be promoted to the people who will benefit from it right now and better understanding their motivations to register is vital.

Elderly Australians, people with a chronic disease or ongoing health condition generally take an active role in the management of their health. They act as their own “care manager”, helping coordinate their interactions with healthcare providers.

A PCEHR is an ideal tool for patients to manage their health by recording and sharing health data between their healthcare providers. Consumers motivated to actively manage their health (or the health of a family member) are the right people to educate on the use of a PCEHR.

To improve uptake, government bodies and healthcare providers should be more proactive in promoting the benefits of the PCEHR to these consumers.

Establishing meaningful and beneficial relationships between consumers and their healthcare providers is fundamental to the success of giving and receiving health care. This relationship is also the key to the sharing health information through the PCEHR service.

The long-term value of a relationship between a consumer and healthcare provider encourages information sharing and the desire for better access to better health information.

Both consumers and healthcare providers are more likely to contribute health information to a PCEHR when there is a long-term and meaningful relationship (since the information contributed is seen as benefiting both parties).

Patients managing the continuity of care between multiple healthcare providers are unlikely to establish relationships with more than one healthcare provider of a particular service.

Other issues impacting take-up

The PCEHR service requires consumers to nominate those healthcare providers that will contribute information to, and retrieve information from, their electronic health record.

Consumers establishing beneficial relationships with providers should see fewer concerns raised by their healthcare providers on health data ownership, and reluctance to participate in the PCEHR service.

While the single health record provides registered consumers with a portal to access their personal record, healthcare providers must wait for e-health software vendors to contribute information to and retrieve information from their patient’s PCEHR. This dependency impacts on the rate of healthcare provider participation.

For software systems to integrate with the PCEHR, they must conform with the key national e-health standards.

This includes the secure messaging, health identifiers, and national authentication service standards, as well as each clinical document type supported by the PCEHR. These include a shared health summary, discharge summary and event summary electronic document formats.

To encourage the adoption of these standards and support for the PCEHR service by the e-health industry, a number of incentive and funding programs have been offered by the government. This has resulted in a number of e-health software systems now supporting the PCEHR service, particularly in GP programs.

But continued government financial support is required. For those patients receiving ongoing care from multiple healthcare providers, the e-health industry is yet to provide the necessary capability for all healthcare providers to easily and seamlessly provide access their patient’s PCEHR.

The outlook for e-health

In November last year, the COAG Standard Council on Health agreed on a new memorandum of understanding on e-health for delivering healthcare funding and management. The MOU is expected to be released a day after the federal budget May 14.

Almost $10 million has already been committed to NETHA until June 30, 2012 for national services supporting the PCEHR.

It will be interesting to see if the budget reveals specific funding for e-health in areas that will encourage more uptake of the PCEHR for people who need it the most.

Brett Avery is e-health programme manager at Webstercare and has spent the past seven years researching and prototyping software for the health sector. He is also a member of the CIO Executive Council’s Pathways Leadership Development Program.

Copyright © 2013 IDG Communications, Inc.

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