Far from being “in meltdown” and “plagued with errors”, Australia’s new health identifiers are on track to start appearing in GP systems by January.
According to ehealth expert Dr Chris Pearce, that’s when the work of identifying inevitable hitches in practical application of the system will begin in earnest.
Dr Pearce is research director at Melbourne East GP Network, one of three GP divisions whose substantial experience in ehealth measures will be drawn on initially to shape the national implementation.
Details of further programs for exhanging information through referrals and shared EHRs are still sketchy.
Dr Pearce says the three divisions – like several others that missed selection for the initial program – have each developed a significant skill base in improving data quality, and the implementation and practical application of shared health records. Of about 550 MEGPN GPs, 220 are currently involved in a data quality program. Around 350 are using Argus for secure messaging, and a smaller number are involved in an aged care health record, which began less than six months ago.
“The plan is that these divisions will make the mistakes for the rest of the country. We will learn and others can benefit from that. What we know already is that it’s not so much about technological solutions as it is about human facets. Even the Health Identifiers process we suspect will be quite complex when it comes to rolling it out. it’s not just about putting it into the software. It’s also about things like making sure the patients know what’s happening.
“This piece of the puzzle has been missing up till now. Now we have an implementation agenda, and that’s fantastic.”
In North Brisbane, GPpartners has even more experience in ehealth, having worked for more than a decade on coordinated health care, which led to a shared health record system called HRX (Health Record eXchange) for chronic disease patients. By January this year, the project involved 313 GPs in 70 practices, 278 other clinicians, two major public hospitals, three large private hospitals and 17 allied health and community providers.
Deputy CEO, Brett Silvester, explains how the division assembled expertise and IT from the remnants of co-ordinated healthcare and HealthConnect trials, including a direct-connect shared electronic health record application called RecordPoint, developed by a co-operative research centre at the University of Queensland, which was later spun off to Extensia Health Solutions.
“The way it works is that a patient sees a GP, and the GP opens a patient record. As it is opened it calls the repository to see if the patient is registered. If so it brings up a bubble saying ‘I have a record’.
At the end of the consultation, it bundles up the changes and says ‘I am about to submit this to the central repository’. At that point the patient can choose not to send it. Very few choose not to. It’s an opt-in system, but because these patients are the most sick and vulnerable, it’s quite rare for them not to opt in. Now the record closes and the system sends the information automatically and securely to the repository.
“At the local hospital we have a Web browser viewer with Medicare security to access the record. The major beneficiaries are cases of emergency, where you don’t know someone is coming in, and you need to know current medications and conditions. Not knowing could be life-threatening.”
Silvester describes the divisions who have made significant achievements in a complex and difficult area as “just the practical people who try and make stuff work”.
“We know that ehealth is not a short journey. In other countries they talk about a 10-year journey. Health is a big system, and you have to make sure electronic systems will provide benefits, and that it’s secure. There are a lot of vested interests, and a lot of sensitivities. It’s a massive task.
“We try to stay away from the theoretical debate. Our job is to make a difference to patients. The patients who have real records believe an EHR is the right thing to do. The patients who have records believe everyone else should have one as well.”
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January 2011 is a lot more encouraging than August 2011
Not that you want to rush these things, but the more time for trouble-shooting the better.
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