Tuesday, July 7, 2015

Call me naive but an eHealth record shouldn't be hard

The Federal Government is about to attempt to revive the originally dubbed the personally controlled electronic health record (PCEHR) now rebadged myHealth Record.

The bottom line is that clinicians are reluctant to use the system - they don't see enough benefit compared to the cost. They also have very real concerns about putting too much of their own diagnostic and consultation detail on line as they see that as their "intellectual property" - and a reason why the patient will come back to them.

And that is quite valid, the health system would be better off if everyone had a good relationship with a GP. The problem is that is easier to do as you get older. The solution to it may lie in differential Medicare rebate rates - if the patient declares a practice as their primary GP then they get a higher rebate for that GP visit.

But the Government does control the purse strings for a lot of health care, and once the system becomes opt-out there is Government data that can and should be entered. The obvious ones are:

1. The fact of any visit to a doctor and the attendant item number included in the Medicare claim.
2. The details of any script filled. This can be captured by pharmacies and almost certainly is already captured.
3. The details of any pathology tests ordered.
4. Focus on the providers of practice management software to build the appropriate APIs for interfacing between the myHealth Record and the practitioner system.
5. The date and purpose of any hospitalisation in a public hospital.
5. The fact of any imaging from the medicare claim. Build APIs for the myHealth Record to access images held in practice records (subject to data limits).

The issue isn't about training, it is about forcing some of the data onto the system. This won't capture historic data (though the Medicare records might) - and I can't see GPs ever loading historic data. But as time goes on it becomes increasingly rich.

The really good value will come from capturing the referral letters and replies relating to specialist consultations. The easiest way to capture those is by myHealth Record being a convenient and secure means of communicating between practitioners.

The data set obtained is not only useful for the purposes of accurate history taking, but also as data sets in big data studies on health issues.  Two contributors reporting on a workshop convened by Australia's Chief Scientist Ian Chubb identified this "big data" analysis as a critical pathway to making the health system more efficient and equitable.

Sally Redman wrote "Australia’s excellent and world-leading big health data sets – including large, long-term research cohorts and routinely collected information such as hospital and Medicare data records – will be central to this effort."

James McCluskey wrote "There is an agreed need for electronic medical records across the nation to simplify patient interactions with the health system and drive new research. Indeed, 'Big Data' in health needs to be better harnessed to inform public health policy and practice"

Jane Gunn wrote "Clinical data should be used to inform efforts to improve the system. Currently we have no standardised system for recording diagnoses and management across separate health care settings. This makes it extremely difficult to keep track of what is happening to people as they interact with the health care system."

The benefits of these health records are so great we need to stop pussy-footing around on "permission" and wherever possible make data capture the default.

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