PCEHR positives shock

by Charles Wright on July 17, 2012

Here’s a real shock: a professional health journal has actually found something positive to say about the PCEHR!

According to Pharmacy News, “ehealth record trials show there will be some real practical advantages for pharmacists”, as the national electronic record  is bedded down and information begins to flow.

How can this be? Have they too given up reading Karen Dearne’s uniquely destructive, somewhat fiction-oriented sub-set of journalism which I and some of my colleagues have dubbed “Dearne-alism”?

I know it’s mind-boggling, but Pharmacy News seems to have interviewed people who have actually used the PCEHR, rather than those people who claim it can’t be used; cost half a billion dollars more than the government thinks it actually spent; doesn’t do what it was never supposed to do; will somehow carry an inferior brand of pathology report, etc., etc.

Pharmacy News, for instance, spoke to Linda Dew, manager of Soul Pattinson’s Pharmacy at Geelong, which participated in the Medview trial.

She told them, “We had one gentleman,  a regular patient, come in to the pharmacy and he swore black and blue that a doctor he had seen at the hospital a few days ago had changed his medication. We were able to look up his records from the hospital on the spot, and show him immediately that the script at the hospital was the same as the one he had from his GP and that’s what we were filling.

“It was really reassuring for him and it saved us a lot of chasing up.”

According to Ms Dew, pharmacists [SHOCK, HORROR] actually asked every new patient whether they would like to sign up to the PCEHR, and, would you believe it, only one refused. He just happened to be … a doctor.

The trial seems to have been embraced by Geelong pharmacists, and while some reported the sign-up rate was lower – at around 50-50 – at Barwon Heads, pharmacist Bernard Napthine reported that people he talked to about enrolling didn’t find the concept at all threatening. He was quite surprised by the level of acceptance, and puts it down to the fact that “”Most people had assumed that their records from the pharmacy were already accessible by their GP or at the hospital”.

According to Napthine, “These days people assume that everyone’s data is connected and available across different agencies.” It won’t be, of course. Not without the PCEHR.

{ 4 comments }

Keith July 17, 2012 at 8:10 pm

Hold on! Isn’t Geelong one of the wave sites? And haven’t NEHTA and DoHA spokesmen been at pains to point out the signing up for a wave site is NOT the same as signing up for a PCEHR? And is Medview outside the scope of the PCEHR? To claim that people in the wave sites are “people who have actually used the PCEHR” seems to be stretching the truth somewhat. In fact the folk taking part in the trial in Geelong will benefit from a share of the extra $51 million to help them make the transition. Back in the real world the specification for Electronic Transfer or Prescriptions (on which the PCEHR and other systems will rely) is labelled “For Information Only” and is awaiting important revisions that are targetted for sometime in the second half of this year. When a working specification is achieved work can resume on conforming implementations.

The last para implies that with the PCEHR everyone’s data WILL be connected and available across different agancies. Well it won’t happen until a lot of progress is made on foundation technologies such as ETP (mentioned above), NASH, ELS, SMD etc. The PCEHR is NOT a communication system, it will at some future time have the ability to store a copy of various documents that are generated and transmitted by other systems. That will only happen if those systems are 1) specified, and 2) implemented, and 3) adopted, and 4) used.

Charles Wright July 18, 2012 at 12:04 pm

But hold on Keith, wasn’t the whole point of the wave sites to pilot functionality, refine national specifications and demonstrate that point-to-share systems (e.g. the PCEHR) are of benefit to patients and health professionals?

The experience in Barwon has revealed that a shared repository of scripts and dispense records can be of benefit.

Presumably, the job now is to reflect on the lessons learned, and incorporate such a system into the PCEHR, capitalising on the knowledge gained from the project.

That would seem to me to be a much more productive outcome than this constant whining that it’s not right. It might not be completely right yet, but that doesn’t mean that it can’t and won’t be put right.

And it’s surely not surprising that it isn’t yet being well-used … yet. The pharmacists involved in the trial indicated a willingness to use it, and – what a rare thing in the current environment – to acknowledge its potential.

Anon July 18, 2012 at 9:16 pm

My reading of the story is that pharmacists are saying that registration may not prove to be a significant hurdle and that consumers are by and large ready to engage and that benefits can be readily defined. Yes Geelong and the other wave sites were pilots and are not the national deliverable and yes Medview in its current form may be problematic but there were some lessons learned and hopefully these will pave the way for the national system.

Other comments:

Hold on! Isn’t Geelong one of the wave sites?

Correct

And haven’t NEHTA and DoHA spokesmen been at pains to point out the signing up for a wave site is NOT the same as signing up for a PCEHR?

Correct again

And is Medview outside the scope of the PCEHR?

It was but is now being transitioned into the National medicines Repository

To claim that people in the wave sites are “people who have actually used the PCEHR” seems to be stretching the truth somewhat. In fact the folk taking part in the trial in Geelong will benefit from a share of the extra $51 million to help them make the transition. Back in the real world the specification for Electronic Transfer or Prescriptions (on which the PCEHR and other systems will rely) is labelled “For Information Only” and is awaiting important revisions that are targetted for sometime in the second half of this year. When a working specification is achieved work can resume on conforming implementations.

I guess what you are trying to say is that the current implementation of Medview in Geelong is based on propriety specifications. Correct. The working specification known as ETP 1.2 will eventually work its way through Standards Australia and become a reality hopefully before the end of the year. It a complex piece of work which requires signoff by multiple stakeholders but it will be delivered.

The last para implies that with the PCEHR everyone’s data WILL be connected and available across different agancies.
Clinical data will not be made available across different government agencies. It will be available top providers subject to the consumer’s access control settings.

Well it won’t happen until a lot of progress is made on foundation technologies such as ETP (mentioned above), NASH, ELS, SMD etc. The PCEHR is NOT a communication system, it will at some future time have the ability to store a copy of various documents that are generated and transmitted by other systems. That will only happen if those systems are 1) specified, and 2) implemented, and 3) adopted, and 4) used.

Agree but point out that development and build activity is well underway with some components being more advanced than others. Adoption, well, that’s a whole other story and to that extent it requires adequate resourcing, change management and winning hearts and minds of both clinicians and consumers over time. That’s probably the bigger change than the technology per se.

Keith July 19, 2012 at 10:26 pm

Thank you Charles and Anon (July 18, 2012 at 9:16 pm) for your responses to my comment. Make no mistake, I think ePrescribing and its extension to a Medications Repository such as Medview is a really important and positive thing. It’s the tendency to see everything through the lens of the PCEHR which I object to. Let me take a comment of Charles’ to illustrate what I mean: “Presumably, the job now is to reflect on the lessons learned, and incorporate such a system into the PCEHR, capitalising on the knowledge gained from the project.” I agree with the sentence except that we must incorporate such a system “into our (e)health systems” not just into the PCEHR. With all of this emphasis on PCEHR there is a real danger that we miss the important stuff which is the secure electronic transfer of the Prescription between Prescriber and Dispenser, and of the Dispense Record back from Dispenser to Prescriber (via the relevant script exchange). Sending copies to a repository (Medview or NMR) adds even more value. The PCEHR has nothing to say about these transactions (with the exception that the ConOps allows for a prescribing and dispensing repository). This is what eRx and Medview were designed to do, and much of the work was done well before the PCEHR was even heard of. We can put a PCEHR interface onto Medview and make it part of the PCEHR system, but that won’t give us a functioning ePrescribing system which I believe is where much of the value lies.

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