Electronic Health Records

As Aussies struggle with e-health, is meaningful use that bad?

Occasionally, it’s helpful to raise our noses from the grindstone and look around at how the world is progressing around us.  When it comes to EHR implementation and health information exchange (HIE), the United States isn’t the only one facing some serious issues.  This week, Australian Health Minister Peter Dutton announced an inquiry into the sluggish uptake of the country’s Personally Controlled eHealth Record System (PCEHR), which has cost AU$1 billion so far while attracting only a fraction of the providers and patients expected.  Can Australia’s EHR woes teach us a little something about the effectiveness of meaningful use?

Since 2010, Australia has been developing the PCEHR system as a national, all-in-one health information exchange.  Intended to hold up-to-date, interoperable clinical summaries in the HL7 format, the PCEHR uses a unique individual healthcare identifier to tag patient records across a network of connected systems.  Officials hoped to have 500,000 patients using the system by the end of June 2013, but as of October, the system has fallen short by 100,000 opt-in sign ups, and only a few hundred providers have actually uploaded and shared fewer than 5000 documents in the country of 22 million residents.

“On those numbers it runs out at about $200,000 a patient in terms of investment,” noted Dutton.  “We want to make sure for argument’s sake that we get good numbers around the electronic health record because we think there can be savings if people have their records coordinated at accessible emergency departments or general practice.”

Unlike the American EHR Incentive Program, Australia’s PCEHR provides no financial incentive for adoption, nor does it institute penalties for non-use.  A lack of participation in meaningful use will cost US providers up to 3% of their Medicare reimbursements by 2017.  While 98% of general practice EHR software in Australia is compatible with the PCEHR system, a clear advantage over the fragmented EHR landscape in the United States, the lack of a business case for PCEHR could be its downfall.

Australian Medical Association (AMA) President Steve Hambleton acknowledged the problem with the system’s “strategic direction” in an interview with ABC Radio. Hambleton has been appointed to the three-person inquiry panel to review the PCEHR in the coming months.  “We need to refocus this on efficiency, to simplify everybody’s lives,” he said. “At the moment the focus has been on adding on products to the PCEHR, none of which is going to drive people to use it. If we can decrease the search time for information that will make people interested. If we can make it easy to interface with it, with the right software … we can help with the efficiency of the health system and that’s the real driver. We absolutely need to get this right.”

That will probably sound pretty familiar to opponents of cumbersome EHRs and skeptics of the ambitious timeline of meaningful use.  And while some criticize the $30 billion set aside for EHR adoption in the United States while simultaneously lamenting that the incentives don’t cover the majority of EHR adoption costs, the numbers make it clear that it’s working.  EHR adoption has risen measurably due to meaningful use criteria, in large part because of the financial implications of opting out.

This might not be much of a comfort to individual providers still struggling to shoulder the budgetary burdens of EHR adoption, but whatever its shortfalls, meaningful use has succeeded in driving home the business case for health IT on a national scale.

The PCEHR inquiry panel will do its best to identify solutions to the desultory interest in the system, including the possibility of adding some kind of incentives to increase usage.  The private sector may get involved in the government-funded project, and could be helpful in targeting workflow issues and usability problems that have prevented large-scale uptake for patients and providers alike.  The panel expects to deliver its results to Dutton by the middle of December, and will be taking comments from the public and from clinical organizations to aid their investigation.

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