Issue 5 / 18 February 2013

THE absence of compulsory basic standards for electronic health records in general practice is an “unacceptable” situation and its resolution is very much overdue, according to two experts involved in collecting GP data.

In an editorial in this week’s MJA, two senior members of the Bettering the Evaluation and Care of Health (BEACH) program, which collects information about clinical activities in general practice, have called for the urgent development of “nationally agreed standards for the electronic health record (EHR)”. (1)

“We now have a variety of EHR systems with inconsistent structures, data elements and terminologies”, Associate Professor Helena Britt and Associate Professor Graeme Miller, director and medical director of the Family Medicine Research Centre, wrote.

They listed three negative effects caused by the absence of compulsory basic standards.

“First, it makes it extremely difficult to transfer patient data to other general practices and health providers”, they wrote.

“Second, it makes it hard for practices to change to a different EHR system because transfer of patient data to a new system, with different data structures and coding systems, is unreliable.

“Last, it makes it impossible to obtain reliable national information about the care provided to individuals and the population through passive data collection from GPs’ computers.”

Professor Britt and Professor Miller said this was “unacceptable when in 2011–2012 there were 125 million GP services provided at a cost to government of about $5 billion”.

However, some GPs involved in health informatics say that change is happening.

Dr Chris Mitchell, a GP in northern NSW, told MJA InSight that significant steps had been taken to use EHRs to improve patient care.

Dr Mitchell’s practice was part of eCollaborative, a project of the National E-Health Transition Authority (NEHTA) and the Improvement Foundation, in which 60 practices across Australia are using the personally controlled electronic health record (PCEHR) to try to improve patient care. (2)

“There have been some really significant steps taken”, Dr Mitchell said. “The introduction of new ePIP [practice incentive program] requirements [this month] is driving GPs to coding diagnoses in language which is already available.

“The coded data is then sent up to the PCEHR and the record is able to hold that code.

“In relation to the data quality, there is a lot of effort being made by GPs and by groups like eCollaborative”, Dr Mitchell said.

“We’re improving data quality, particularly in terms of curated summaries, workflow processes and data capture.”

Dr Mitchell said the points highlighted in the MJA editorial were well made, but he did not agree that “top-down legislation” was the right way to go.

“We need to get the data codeable and then the [practice software] vendors can compete in ways that are meaningful. The trick is to get it into their language.

“Important changes are taking place.”

Dr John Bennett, chair of the Royal Australian College of General Practitioners’ National Standing Committee e-Health, said the standardisation process could take 2 to 3 years.

He agreed that the interface in most practice software where GPs captured information about patients with more than one problem was “not very good”.

“If the system were capable of capturing information in a more granular fashion it could then be reused within the clinical system”, Dr Bennett said.

“The fact that you can pick apart the data gives it greater value.”

Professor Britt and Professor Miller said so much more could be done.

“So much more could be achieved if standards and minimum datasets were finalised and mandated — so that we could collect reliable, high-quality, longitudinal patient-based data from GP EHRs”, they wrote.

“How much longer do we have to wait?”

– Cate Swannell

1.    MJA 2013; 198: 125-126
2. Improvement Foundation: eCollaborative — 21st century patient care and self management

Posted 18 February 2013

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