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The Quarterly 2014

Whither the PCEHR?

The Personally Controlled Electronic Health Record (PCEHR) is being designed and built as the Australian national electronic health record, with the primary aim being to aggregate and store key health summary data on all Australians and to enable the secure sharing of that summary data between patients and health providers. The PCEHR had its initial genesis in a number of reviews conducted in 2008 and 2009.1 While the 2008 National eHealth Strategy had discussed individual electronic health records, it was the June 2009 National Health and Hospital Reform Committee report that recommended that individual electronic health records be pursued as a matter of urgency, with a national system to be implemented by 2012.2

In the May 2010 budget, the Australian Government announced funding of $466.7 million to develop and build the first release of the PCEHR, to go live in 2012.3 The PCEHR was seen as “an important systemic opportunity to enable person-centred care, support informed consumer decision making, improve quality and safety of care, reduce waste and inefficiency, and improve continuity and health outcomes for patients”.4 The system was launched on 01 July 2012, and has been slowly rolled out over the last 2 years.

The first 2 releases only produced limited functionality, with Release 2 in August 2012 adding Medicare and Pharmaceutical Benefits Scheme data, childhood immunisation records and organ donor registry status. This was followed in May 2013 (Release 3) by the addition of some child development records, primarily from NSW and Tasmania, and some viewer access to the National Prescription and Dispense Repository.5 Release 4 (November 2013) saw minor refinements to the general system and enabled connections for aged care event summaries.

0n 03 November 2013, the new Liberal Government announced a review of the PCEHR implementation. Release 5, which was meant to be a large release and has already been delayed, was meant to go live in April 2014, but is likely to be delayed until after the Government announces its decision on the review, possibly prior to the 2014 Federal budget.5

So why the review and what are the current problems with the system?  The review was initiated primarily because the incoming Government was unhappy with the progress of the implementation of the system and the planned scope of the Releases. The current major weakness of the system is the paucity of useable clinical data.  With only small numbers of discharge summaries available and little progress on diagnostic tests, the utility of the system is currently questionable. This was also seen as a failing in the now defunct United Kingdom HealthSpace record.6 In addition, the take up rate under the ‘Opt In’ model has also been slower than ideal, with the detailed and cumbersome application process contributing to limited uptake, which again mirrors the problems with the Healthspace record.6

The review, however, has the potential to refocus the PCEHR in a number of areas, particularly the uploading of more clinically relevant documents, such as diagnostic tests, outpatient and ED summaries, and GP summaries, and moving from an ‘Opt In’ model to an ‘Opt Out’ model, which will increase access, including to those groups most likely to benefit (but less likely to opt in), such as homeless.6 One other opportunity that should be considered, and debated more broadly, is possible secondary uses of PCEHR data for public health and research purposes. Such uses are likely to be supported by many patients.7  

The biggest threat, however, is political, with the future of National eHealth Transition Authority (NEHTA) and, by extension, the PCEHR still under political and financial threat beyond June 2014. While the review is likely to recommend the continuation of PCEHR, this has produced further delays in the roll-outs of the system, including to Release 5 and the merger of Northern Territory’s My eHealth Record (MEHR) into the PCEHR.5 The other threats to implementation are clinician uptake – without proven benefit for both primary care and hospital providers, clinician uptake may continue to languish – and Data quality issues, particularly from health practitioner systems.8,9

As the program has fundamental bi-partisan support,10 and a core of health and patient acceptance, the goals of the PCEHR should be achieved over time, albeit at a slower pace than anyone wants. As a medical administrator, I am keen to see information available to all health practitioners on their patient’s last general practice review, emergency department presentation, hospital discharge, allied health appointment, diagnostic test and current medications. Once these are in place, we can look at further refinements, to mature the system over time. I would be very interested to hear how the PCEHR is working in other parts of the Australian health system and what other medical administrators would like to see from the system.

Finally, is there anything further that Fellows, Members and Candidates want from The Quarterly?  Should we be providing more on-line training? Should we be moving to shorter articles? We would be very keen to have your feedback on how we need to continue to develop The Quarterly over the coming year.
Dr Andy Robertson

1McDonald K. There and back again: A PCEHR Tale. Pulse IT July 2013;36:46-53.
2National Health and Hospitals Reform Commission. A healthier future for all Australians: final report June 2009. Canberra: NHHRC, 2009. http://www. health.gov.au/internet/nhhrc/publishing.nsf/Content/home-1 (accessed Apr 2014).
3Pearce C, Bainbridge M. A personally controlled electronic health record for Australia. J Am Med Inform Assoc 2014 Mar 20. doi: 10.1136/amiajnl-2013-002068. [Epub ahead of print]
4Bennett CC. A healthier future for all Australians: an overview of the final report of the National Health and Hospitals Reform Commission. Med J Aust 2009; 191 (7): 383-387.
5McDonald K. Progress report for the PCEHR. Pulse IT April 2014;41:40-41.
6Greenhalgh T, Hinder S, Stramer K, et al. Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace. BMJ. 2010; 341: c5814.
7Spriggs M, Arnold MV, Pearce CM, Fry C. Ethical questions must be considered for electronic health records. J Med Ethics 2012;38:535-539.
8McCauley V. National e-Health Infrastructure. Pulse IT April 2014;41:36-38.
9Otto K. Barriers to PCEHR uptake on the frontline. Pulse IT April 2014;41:8-11.
10Bennett CC. A new coalition for health reform? Med J Aust 2014; 200(6): 312-313.
11Kruys, Edwin. GP matters: The PCEHR: Moving forward. Medicus 2013; 53(8): 6-7.

The Royal Australasian College of Medical Administrators
Dr Andy Robertson, , p686
www.racma.edu.au /index.php?option=com_content&view=article&id=686&Itemid=386