So far, PCEHR an empty record
By Associate Professor David Glance, Director of the Centre for Software Practice, University of Western Australia
This article was first published in The Conversation on 3 July 2013, and can be viewed at: http://theconversation.com/is-the-governments-missed-health-record-target-meaningful-15558
The government has failed to meet a self-set target of 500,000 registrations of its Personally Controlled Electronic Health Record (PCEHR) by 1 July.
As at 30 June, the Department of Health and Ageing said that total number of users was 397,745. The majority of these registrations resulted from a recent push by DoHA using consultants to sign people up at public hospitals and at e-health roadshows.
Still, even if the government had met the target of 500,000, it would have been a meaningless gesture. The vast majority of those who have signed up, if they ever get around to logging in, will be greeted with an empty record.
Given the lack of active participation on the part of GPs, as well as the lack of public hospital systems to integrate with PCEHR, there’s little evidence to suggest that this is going to change any time soon.
So far, only 4,805 individual providers have signed up to access the PCEHR portal. This is despite the fact that the government provides incentives to GPs to connect to the system by paying them the Practice Incentive Payments for eHealth (ePIP).
Despite these payments, GPs still struggle to see the benefit of spending time curating shared records when the legal liabilities are still unknown but are potentially severe.
The cost of the ongoing maintenance of these largely empty records is about AUS$80m a year. And that’s just the baseline. It’s clear that a great deal more funding will be needed to try and lift the level of meaningful use of PCEHR.
The problem for governments is that increasing spending on a system becomes progressively harder the longer it remains largely unused. What’s more, the devolved nature of the Australian health system makes it extremely unlikely that we’ll ever see true and meaningful use of the system.
What we will continue to see however, are reports of increasing numbers of registrations, data about the number of people who accessed the system and how much administrative data has been added.
The latter figure, in particular, is an easy one for the government. All Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data gets added automatically. This shows when individuals have claimed anything on MBS or filled out a script at the pharmacist.
Again, this data is clinically meaningless and of marginal benefit to an individual. Its only use is for, perhaps, reminding people when they last saw their doctor.
In the United States, President Barack Obama initiated a program to provide physicians with incentives to adopt electronic health records. By May this year, 55 per cent of eligible office-based providers (291,325) had received nearly US$5.9 billion in payments for adopting electronic health records.
But even there, only 27 per cent of doctors having a electronic health record actually met the core objectives of meaningful use criteria for the system. At least the criteria for defining what meaningful use means are far more stringent in the United States than the simple user registration count being used by the Australian Department of Health and Ageing for PCEHR.
As I have argued before, it’s possible that we will see some benefits come from infrastructure that has been developed as part of PCEHR. Things such as individual health identifiers, for example, may eventually make identifying patient test results less prone to error.
In the meantime, we are a considerable way off seeing any clinical benefits from PCEHR. Indeed, we could question whether there are not better things within the health system that the nearly AUS$1 billion spent so far on PCEHR could have been spent on.
For the time being however, empty PCEHR records like my own will stand as testament that getting through the registration for the record is as devoid of meaning as its content.