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Test results loaded on shaky e-health foundations

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The Federal Government is pushing ahead with the roll-out of extra functions for electronic health records despite concerns that it is yet to get the system’s fundamental design right.

In the face of calls from the AMA for it to focus on refining the basic functions of the Personally Controlled Electronic Health Record to improve its clinical usefulness, the Government has announced the allocation of $8 million to enable patients to upload pathology and diagnostic imaging test results to their shared health summaries.

Announcing the move – which has been a long-standing element in the rollout of the e-health record system – Health Minister Tanya Plibersek said it was the “landmark next step” in the evolution of the PCEHR.

“We expect both doctors and patients will find the new functionality useful, as it will reduce the need for them to chase down results or duplicate tests,” Ms Plibersek said. “In an emergency, having this kind of information on a patient’s e-health record could save lives.” 

The AMA said that although pathology and diagnostic imaging test results were important inclusions in electronic health records, the Government was yet to address fundamental problems in the design of the PCEHR that undermine its clinical usefulness.

The Association has consistently raised concerns that, as currently framed, the PECHR allows patients to remove or restrict access to information, meaning treating doctors cannot rely on it as a comprehensive and accurate source.

The AMA has called for the establishment of a clinical advisory group to review the system’s design and recommend changes to make it a much more useful and valuable resource for doctors and their patients.

AMA President Dr Steve Hambleton said such a review and overhaul was urgently needed, before any more resources were poured into developing and adding new features to a record that will not be used by clinicians when treating patients.

Dr Hambleton told the National Press Club on 17 July that the AMA was a “strong supporter” of the concept of a shared electronic health record, and the inclusion of critical information like pathology and diagnostic imaging test results was fundamental if they were to be clinically useful.

“The roll-out of the PCEHR has been slow and patchy across the country,” Dr Hambleton said. “The AMA is not surprised. The design means that its use is limited for doctors in terms of accessibility, content, accuracy and the comprehensiveness of information.”

But Ms Plibersek rejected criticisms of the system, including the rate of take up by doctors and patients.

The Minister told the Health Informatics Conference in Adelaide on 17 July that around 520,000 patients had registered for a PCEHR, as had nearly 5000 GP practices, hospitals and other health organisations, while more than 16 million health documents – mostly Medicare Benefits Schedule billing information – had been uploaded to the system.

“We’ve built the e-health superhighway, and I’m proud to say we’ve had a lot of drivers join it already,” she said.

But Dr Hambleton said that the addition of MBS billing information to the health record was, of itself, not very useful for doctors in making decisions about the treatment of their patients.

He said that simply seeing that a patient had received a Medicare rebate for a colonoscopy was not particularly informative, and that what a doctor needed to know was the result of that procedure.

“We need to direct efforts towards the adoption of the PCEHR by all medical practitioners, now that there has been good sign up by general practices,” Dr Hambleton said. “As the AMA has consistently said, there is very little need for general practice to ’e-health with itself’.  Essential clinical information needs to be shared between general practitioners and all other medical specialists.

“As the PCEHR has rolled out and clinical practice software has become more integrated, we are seeing significant constraints on the clinical usefulness and usability of the health record, flowing from its design,” the AMA President said.

“We need to make the system easier to use, to get all medical practitioners using the current system in a meaningful way.

“To do this, they will need to be confident that the PCEHR will have the information they need, that it is reliable, and that they can get access to it.”

Dr Hambleton said this should be the focus of the design and implementation of the pathology and diagnostic imaging information that will be added to the electronic health record.

Adrian Rollins