The Medical Software Industry Association (MSIA) has detailed an alternative rollout schedule for the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project, following claims the system will be not even be close to completion by 1 July.
MSIA president, Jon Hughes, told a Senate committee examining the PCEHR Bill 2011 a reduction in the complexity and scope of the e-health program was required for the program to go live on 1 July.
Hughes outlined a plan for simplified records by 1 July in the form of PDFs or letters, with the more complex data filled records to come by 1 July 2013.
“A much simpler release one program could still deliver an effective valuable solution to the health sector by 1 July but only if the scope of that program is reduced significantly,” Hughes said.
“That is, if it is completed without many of the components that are currently included in that program, an essential element of that strategy would be a new 12-month timetable for the development of our standing functionality as release two of the PCEHR program with supporting funding and a delivery scheduled for the 1 July 2013.”
According to Hughes, the implementation for 1 July is packed with complex data defined in the clinical documents which healthcare providers are expected to exchange and share under the PCEHR.
“A feasible solution for the 1st of July could simply contain images of the reports currently generated by various health systems,” he said. “Discharge summaries, referrals and the like are currently generated in a lot of systems as letters or as a PDF and those documents would work fine in a simple initial [PCEHR] without needing to get to the stage of detail of atomic, discrete individual bits of data which have to be consumed electronically and understood and interpreted by computer systems.”
“It’s the use of that detailed data which is where the risk is introduced and where there are complexities which have not yet been solved and could well wait until the next iteration of the solution.”
Letters or PDFs are documents used by clinicians now, Hughes said, and are shared via email or fax and would work well within the PCEHR, rather than “a represented interpretation of that data in a structured document that depends being able to interpret data electronically”.
Hughes provided the example of a discharge summary, which would contain information including medications a patient is on at the time they left hospital, details about diagnostic tests the patient received while in hospital and the results, information about the conditions the patient was diagnosed with and the procedures the patient underwent. Under the current PCEHR rollout, this would be stored using coding systems and structured terminology and very detailed data which would be interpreted and decoded by the system.
“But that interpretation is dependent on a high degree of standardisation and conformance with that standard and all the various systems effectively talking the same language,” he said. “All that information can also be encapsulated in an image of a report, the same page you might get now when you leave hospital on a piece of paper, it can still appear electronically within a health record but the doctor would read the report online on his computer just like he would read a fax.”
MSIA treasurer, Dr Vince McCauley, also noted the importance of the Australian Medicine Terminology (AMT), a national terminology to identify medicines used in Australia using unique codes to provide unambiguous, standardised names for branded and generic medication.
AMT is crucial in the PCEHR to avoid misinterpretation and duplicated medication.
“The [AMT] has been a work item for NeHTA [National e-Health Transition Authority] for years from when it was first set up,” McCauley said. “However that terminology still has serious issues due to changes in the NEHTA process around its correctness and its utility.
“We already have medicines terminologies in the system provided by companies… and they’ve said, 'Why would we change from using a medicines terminology that we understand and is proven in safety and quality for another that is of unknown quality, unknown safety and introduces a whole range of new issues?'”
According to McCauley, the terminology has been trialled in one system, but is not used across the sector and is not generally available.
“The transition from the current usage of diverse terminology to a single terminology is a very substantial piece of work which is not going to occur before the 1 July.”
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