Health plays down e-health record metrics

The Department of Health and Ageing has played down internal take-up estimates for the personally controlled electronic health record (PCEHR) by Australian consumers as a meaningful metric of the initiative's success.

The opt-in health summary and record has attracted 4500 registrations in the 30 days since its launch on July 1, according to Peter Fleming, chief executive of lead e-health agency NEHTA.

Fleming said the initial figure was based on a system that had not been heavily advertised and was undergoing a "staged rollout" of features and transition from the 12 record pilot sites.

The figure falls short of internal expectations at Health. Budget papers for the department include a "key performance indicator" for the e-health record, with indicated it should reach 500,000 registrations by June 30 2013 and a further million registrations the year after.

At current take-up rates, the department would slightly exceed 10 percent of those expectations.

Health secretary Jane Halton argued the figures were useful to determine the record's operating budget in future, but not as a measure of success itself.

"I think it's actually silly to be talking about targets," she told iTnews.

"There are a number of people who have made projections. To say we've got a target, this isn't the sort of thing that you can say, 'Well I have to have this many' — what does it denote?

"I think people did estimate where we thought we might be but whether or not that ends up
being the first priority, whether we actually put more energy into point-to-point communication; all those are things we have to work out in the next couple of months, and a lot of that depends on our work with the wave [pilot] sites."

Greater uptake of the records is expected to occur later this year when NEHTA begins transitioning the 12 pilot sites to the final record.

Simon Carr, e-health services manager at the Metro North Brisbane Medicare Local — one of the pilot sites — told a health informatics conference this week that the program had seen 14,000 individuals in the area show an interest in participating with the trial program and ultimately the final record.

A NEHTA spokeswoman confirmed approximately 105,000 total consumers in total had registered to participate in the local wave sites.

"The focus of the lead sites is raising awareness of the PCEHR with consumers, and supporting providers to get ready for the PCEHR including registration and deployment of conformant software when available," she told iTnews.

Halton said further additions of features or consumer registrations to the record would be done in a "methodical and deliberate and careful way" to ensure the system was capable of scaling up to meet national scale requirements.

The infrastructure underpinning the PCEHR, built by an Accenture-led consortium, was reportedly completed only days before the launch of the record on July 1, and some elements — such as discharge summaries for GPs — will not be available until later this year.

IBM, a core contractor to the PCEHR, also missed its deadline to deliver the secure messaging platform allowing connections and clinical interaction with the record.

An interim system developed and maintained by Medicare Australia is now being used, which Halton said was capable of scaling up for the foreseeable future.

Halton said the Health department would not begin pushing the record to the public until such elements were proven.

"We won't push mass take-up until we have that technology available to us and we're confident about it, until we've actually worked through with the wave sites the experience of bringing larger numbers of people on," she said.

"We need to understand all of those lessons. We need to be in a position where we will understand full well what it actually takes to deploy.

"There is no line across each of the wave sites that says, 'This is the go-date for everybody' and all the race cars start."

NBN-enabled e-health 'on steroids'

Halton told conference attendees this week that the capacity and bandwidth promised by the National Broadband Network would ultimately underpin many of the future applications and services envisioned for the healthcare sector.

"The NBN certainly can stick it on steroids," she said.

"You can do anything without the NBN but you probably can't do it as well or as fast.

"If you think about the world that we're talking about — where you will shunt large images around the countryside, you will have an X-Ray read by somebody on the other side of the country, on the other side of the world."

She said the PCEHR — which offers a central database of health information summaries for patients who have opted in — would catalyse those future services.

"As this information speeds up, as the volume of it — and we all know that once you develop this capability the volume of information just expands exponentially — for that you do need capability of the type they're talking about with the NBN."