Personally Controlled Electronic Health Record (PCEHR) – patient-centred care; clinician-centred design

by

ehealth

ehealth initiative: http://www.ehealth.gov.au

The Australian federal government introduced the Personally Controlled Electronic Health Record (PCEHR) to much fanfare in July 2012, hailing it as revolutionary and paradigm shifting.

This opt-in system collects individual medical records from an individual’s multiple providers and makes them accessible to all health care providers and the patient at the click of a button. Costing $A466.2 million, it will save a staggering $A11.5 billion in the first 10 years of use by avoiding unnecessary hospital admissions and ordering of multiple repeat investigations, as well as increasing continuity of care.

However, those who will be utilizing the records the most are not happy. The Australian Medical Association (AMA) and Royal Australian College of General Practitioners (RACGP) have raised increasing concerns about the current design and roll-out of PCEHR from a medical practitioner’s perspective.

(image from digitalqatar.qa)

The lackluster design and marketing effort by the government has resulted in a poor uptake by Australian citizens (only 15% of the government’s target benchmark had been reached by July 2013). By creating an opt-in system, patients have minimal incentive to enroll for the new system due to its clumsiness and non-user friendly interface.

Instead, general practitioners (GPs) or family care physicians, who act as the “gatekeepers” for patient care are tasked with the time-consuming process of enrolling their patients – and are not even compensated for their additional effort by Medicare. To cap things off, there are ongoing debates around security, legality and accessibility plaguing the PCEHR roll-out.

There is no sure-fire solution to the current mess – but a multi-pronged approach is paramount. The most pressing decisions include changing PCEHR to an opt-out system. This is particularly important for patients with complex medical problems who frequent healthcare facilities who would benefit the most from the system. Furthermore, doctors should be given financial incentives or reimbursements for creating shared health summaries for their patients. This could be processed through the Medicare system currently used for funding of primary health care visits and procedures.

After these initial steps are taken, attention can then be turned to addressing accessibility issues, improving user-friendliness, and better marketing to encourage enrollment.

Ultimately, better patient-centered care (the whole reason the system was designed!) requires clinician-centered e-health systems; the PCEHR is no different.

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5 Responses to “Personally Controlled Electronic Health Record (PCEHR) – patient-centred care; clinician-centred design”

  1. anthonypoggy1985 Says:

    Have to agree with the design falls. I’m 28 and computer savvy yet still find it difficult to navigate around the site. I do like the idea of the system but feel for the older generation who would really struggle with such “ideas” and the advertising is non existent! Thanks for the read!

  2. htamada2013 Says:

    Thanks for interesting story. There is preceding small but interesting service in Italy developed by MSD Italy known as Doctor plus (http://www.msd-italia.it/servizi/doctor_plus.asp) which capture diabetic patients biometric data remotely. This seems to be another patients centered electronic health record at home care setting.

  3. omsdeux Says:

    Thanks for the very interesting entry – there is also much debate in the U.S. about how to construct such a program. Patient privacy, and fear that health related issues might be used to discriminate have been key issues. Interesting to have a policy that is driven at the individual level – perhaps a good policy idea a bit idea ahead of its time and lacking a strong implementation plan?

  4. amishra2013 Says:

    This is an interesting post, given that in the US something similar is being stated by the ACA. Concept of electronics health records (EHRs) and accountable care organizations (ACOs) aim to achieve some what similar goals. These provisions in general aim at improving the quality of health care system and making it more efficient. More information can be found here:
    http://www.foley.com/ppaca-emphasizes-use-of-health-information-technology-05-13-2010/
    http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/Health%20Reform%20Issues%20Briefs/US_CHS_ValueBasedPurchasing_031811.pdf

  5. likobayashi Says:

    Definitely agree that this could be a great tool, if properly built and implemented. However, I agree that there are definitely some things to be worked out. I did also visit the site but couldn’t even really figure out how it would help me, if I were a patient. It looked like just an advertisement webpage and had far too many words and sections for me to be able to easily find where I would see my information. Health literacy is a huge issue now and this website would not be helping with that at all.

    I do like your suggestion of changing PCEHR to an opt-out system, though am not sure about the feasibility (or legality, as someone mentioned above) of this. I wonder how this would work technically if different EHRs are used. I don’t know how the Australian health system works, but I know that here in the US, there are a ton of different EHR systems which don’t necessarily interface very well. Still, making this system an automatic place where health information is stored would be a good place to start, as you suggested, and once it is mandatory, companies would have more incentive and reason to make technical updates as the usage would be greatly increased. I do know there have been studies done showing that even if a patient has access to their health information, they may not act on or view it (especially if there is no campaign to increase awareness about the benefits), but this tool could be hugely helpful to practitioners who need to access information for patients. Thanks for your post!

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