Issue 2 / 29 January 2013

DOCTORS as a rule are a rather sceptical bunch. This is not a criticism; in fact, such a temperament is likely to have a collective and individual overall benefit.

It means we are less likely to be overly enthusiastic about new treatments and management choices, preferring to hold off until more evidence emerges to support or refute benefits to our patients.

Most clinicians are aware of the nature and variability of the quality of sources and protocols used to generate insight into new aspects of health care. We are encouraged as part of our continuing professional development to acquire and maintain the skills, knowledge and attitudes that allow us to form critically defensible rationale for our choices in the care of our patients.

It is likely that these skills, knowledge and attitudes are reflected in the medical profession’s suspicion of the personally controlled electronic health record (PCEHR), even though mainstream and medical media have been, on the whole, cautiously supportive of the PCEHR.

As part of the rollout of the PCEHR by the National E-Health Transition Authority, I travelled across Australia last year visiting more than 20 metropolitan and regional training hospitals in an awareness-raising campaign addressing e-health.

The campaign involved more than 300 medical practitioners, mostly doctors-in-training, and they overwhelmingly reflected this generally sceptical perspective in their approach to medicine.

However, at busy hospitals where most doctors are already using e-health solutions in their daily workflow, I noted that hyperbole about the contentious aspects of the PCEHR was absent but questions and uncertainties underlying much of the public criticism of the system were pervasive.

The campaign explored these questions and uncertainties by communicating three core themes — perspective, relevance and salience. To achieve this we created a 3-minute video that shifted the emphasis from “How will it affect me?” to a deeper and more motivating question based on why doctors choose this profession — “How will this impact on my patient?”

Doctors who took part in the campaign were given detailed information on the infrastructure and evidence from Australia and overseas on how best to transition to e-health and the benefits already realised in communities where e-health was accepted and used.

Question and answer sessions highlighted that most doctors’ concerns related to accessibility, privacy, security and possible impacts on the patient–doctor relationship — just the sort of questions I hoped doctors would ask.

The effectiveness of the campaign was confirmed with feedback from attendees, many of whom reported an increased understanding of, and willingness to engage with, the PCEHR.

What I did not hear during this campaign — not even once — was that this extraordinary investment in changing the way we connect and share information with patients, each other and other health professionals was a waste of resources.

The campaign helped to remind clinicians of the salient opportunities e-health offers and what their role will be in helping patients integrate e-health into their health care.

Medical scepticism is not something we needed to “overcome” in this campaign. By recognising its value and cultural influence, we were able to create a project that managed expectations and inspired confidence in the critical role clinicians are playing in the design and rollout of the PCEHR.

The campaign confirmed that medical professionals only want to ensure that any change in how they provide care will, ultimately, benefit the most vulnerable person in any health care encounter — our patient.

Dr Kieran Le Plastrier is the principal director of Cor Mentes, a health industry consultancy contracted by NETHA to roll out a national education program on the national e-health system. He is a Sydney-based psychiatrist-in-training and is undertaking a PhD on factors affecting medical practitioner performance at the University of Western Sydney. He has created and presented programs on optimal medical professionalism.

Posted 29 January 2013

10 thoughts on “Kieran Le Plastrier: Ending e-health doubts

  1. Brisbane GP says:

    I see absolutely no benefit in something which patients can alter at will, opt in or out of on a consultation basis,and requires large effort on my part to set up. To no beneficial purpose.

    Patients may hide what they wish, include what they wish, and generally do the same for anyone they see.

    All doctors a patient sees are designed to have a complete record of the patient electronically. This also doesn’t encourage continuity of care.

    I have no interest in such an arbitrary system as this.

  2. Rob.the.Physician says:

    Pardon my scepticism,but how is it to the patient’s advantage when ‘the patient’ controls his/her own records?
    ie; they (the patient) can add to OR delete from their own records at ant time!

  3. Dr Nemo says:

    NEHTA might have been better placed to have directed its efforts to formulating s core database where diagnoses and other important details can only be recorded by registered medical practitioners and interns. The author of any such items could be recorded by core provider number. In essence, such a dataset might be a useful plugin for clinical software if there was any form of standardisation but that bird has long since flown (two flights and counting!)

  4. Experienced GP says:

    Hippocrates made the following observation:

    “It is more important to know what sort of person has a disease than to know what sort of disease a person has”.

    e-Health may be a collection of details and figures about a patient at a particular time.
    But bodies and minds never remain static and the information is soon out-of-date.

    As well, it takes a human being, not technology, to understand a human being.

    We run the risk of documenting the least relevant aspects of a patient. The most important
    are recorded in the files of the doctor and too private for public consumption.

    It looks like we are about to succumb to the latest “fix”.
    Hippocrates would have known better.

  5. chee says:

    Kieran, you’ve got to be kidding. You don’t see the real issues here, do you? The professional is not holding back because it’s unknown or because it’s new or because we don’t much about it. The profession is holding back because there are problems with accuracy, currency, authenticity, reliability, liability and the profession is worried because no one paying us for the time and resources to get the process of PCEHR up and running, maintain its integrity, reliability and accuracy etc.

    For now and for some time in the foreseeable future, we are unlikely to find PCEHR useful to any of us. Most important of all, we are annoyed that the whole thing was rammed down our throat without consultation with real doctors whatsoever. They then have the hide to get “consultants” like you to sell the product to us using all sorts of forums possible.

  6. Sue Ieraci says:

    chee is spot on – doctors are accustomed to taking on new technology – when it benefits patients or the work process. If your task is to convince the profession that the current form of NEHTA is a good product, perhaps don’t open the conversation with “Doctors as a rule are a rather sceptical bunch.” Maybe convince them with evidence, which you suggest they respond to. And if the evidence isn’t there – the product may not be ready yet.

  7. Edwin Kruys says:

    Privacy breaches can happen on a larger scale than ever before and the PCEHR is a much more interesting target for cyber criminals than individual practices.
    Patient privacy risks are often being waved away with arguments like: “You do your banking online, so why not share your medical record online?” The difference is: you can insure your money, but what if your confidential health information goes viral? This can cause serious damage – Read my blog post: “What the Government didn’t tell you about the PCEHR”

  8. Sue says:

    Another thought: we’re often told that some form of EHR is essential in reducing duplication and error. My question: what evidence is there of this? I’ve worked in Emergency Medicine for thirty years, an area where one might consider this type of error to be most crucial. And yet, I can’t think of many examples where an eHR would have made much difference to a patient’s safety. Do other people have examples?

  9. Anonymous says:

    Dr Le Plastrier’s cohort of mostly public doctors-in-training are a group with no experience of the costs of running a practice and little understanding of the legal implications of relying on a patient controlled record. He does not seem to have addressed the real problem of the PCEHR which is not the electronic nature of the beast but the unfettered patient control which renders the record to being a potentially tampered and inaccurate record subject to the whim of the patient!

  10. Greg the Physician says:

    I completely agree with the earlier posts which raise very valid criticisms of the PCEHR. It’s about time that the AMA and Colleges drew a line in the sand on such issues. I will not use the PCEHR while it includes an element of patient control, and will decline to accept any referrals which are conditional on the use of the PCEHR.

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