Case study to watch: how to improve ehealth record take-up

By David Donaldson

Tuesday October 6, 2015

Australia’s progress towards a widely subscribed national ehealth system remains slow, with only around 10% of the population enrolled with the government’s opt-in My Health Record system and low uptake by health practitioners.

Paul Madden
Paul Madden

Due to low engagement rates following its creation as an opt-in system in 2012, the Health Department plans to recommend the government adopt an opt-out policy from 2017, Department of Health deputy secretary and strategic health systems and information management special adviser Paul Madden told a Committee for the Economic Development of Australia event last week.

Madden said that the government would be advised to go for a national opt-out system in line with prior recommendations subject to the results of regional trials to take place in 2016. Transferring to opt-out was recommended by a December 2013 review into the Personally Controlled Electronic Health Record (PCEHR) system.

PCEHR — which is being rebranded by the Coalition government as the My Health Record system — allows doctors, hospitals, and other healthcare providers to view and share an individual’s health information to assist in their care. This will facilitate access to records for patients no matter where they go to the doctor and should especially assist those who visit multiple providers for the same problem — potentially reaping significant benefits given the increasing chronic health challenges faced by the community.

He revealed that there are 5139 GP practices, 250 hospitals, 144 aged care residences and 1158 retail pharmacies registered with My Health, but low patient participation is discouraging health providers from making the effort to use the system. While over 5000 GP practices are registered, “we’ve got less than 1000 GPs actually using it,” Madden said.

Despite awareness-raising, the low profile of the system, combined with the opt-in mechanism, means that subscriptions have remained low. Nearly two years after the government’s review, only around one in 10, or 2.4 million, Australians have elected to join the system.

“Anyone who wants to be in the system needs to take the time to understand, number one, what it is, what they might get from it and how to register and prove their identity,” he observed. It’s not just difficult getting providers on board at the beginning — convincing customers of the value proposition of signing up while relatively few records are online is also a challenge.

But it is hoped that if the majority of patients are enrolled thanks to a switch to an opt-out mechanism, “then healthcare providers will engage with the system,” Madden explained. The first part of the move will involve regional trials in perhaps four locations with a total population of around one million people.

In line with the review’s recommendations, the National E-Health Transition Authority will also be replaced with the Australian Commission for eHealth from July 2016, and a transition taskforce will be established to manage that process.

The government has been in contact with the states and territories to discuss locations for the trials, which will involve training for general practices, pharmacies, aged care, allied, private hospitals and specialists.

But progress remains slow. While the review recommended opt-out be introduced from the beginning of this year, legislation allowing for the regional trials and eventual national transition was only introduced to the parliament last month.

Nonetheless, although it “needs some tweaking” and usability changes, “the good news for our government is they’re not up for a really big system build,” said Madden. “The system exists, it’s been there for three years.”

And it’s been improved from where it began. Whereas the prospective customer needed to endure clicking through 17 screens to prove their identity when it was first created, the system is now down to two.

It is expected that putting records online could save the Commonwealth $2.5 billion per year within a decade by reducing inefficiencies, with an additional $1.6 billion in annual savings also delivered to the states, according to the government.

Four factors will help improve the health bottom line: increasing efficiency of access to information, enabling better coordination; moderating demand for services by giving patients information required to enable them to participate more actively in self-care; improving access to information and services to the vulnerable; and providing care providers with the tools and information required to make improved treatment decisions and to reduce the incidence of adverse events and unnecessary or duplicated services.

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