The financial pinch on GPs is clearly sharpening interest in electronic health records
The financial pinch on GPs is clearly sharpening interest in electronic health records.
According to the latest figures, 1085 general practices uploaded health summaries to the My Health Record system in the week to 19 June, more than 2.5 times the weekly average of 400 a week during April.
In the same period, the number of health summaries uploaded has jumped from 2000-3000 per week to more than 8000, while the number of views by healthcare providers has shown a similar increase from around 400 per week to almost 1100.
The spurt in activity is clearly linked to the threatened loss of the eHealth Incentive PIP for practices that fail to upload a quota of shared health summaries under new rules adopted on 15 May.
“Following the implementation of these changes to the eHealth Incentive, use of the system by general practitioners has increased significantly,” a Health Department spokeswoman said.
Some doctors are unhappy about the use of financial incentives to promote the system, saying privately the rule could amount to coercion of GPs who are strapped financially by the four-year freeze on Medicare rebates.
But others see a lot more carrot than stick in adopting the new system, which is an “opt-out” model for patients which replaces the failed “opt-in” Personally Controlled Electronic Health Record.
“From my personal point of view I can only see the advantages,” says Dr Chris Goodall, a GP in Cairns, part of the north Queensland PHN area where one of the two MHR trials is getting under way.
In the tropical city, with a large itinerant population, the ability to share and view patients’ health records will save huge amounts of time and avoid duplication of tests, he says.
“At this time of year, 10 to 20% of our business is travellers and holidaymakers,” Dr Goodall told The Medical Republic. “There are lots of grey nomads and people escaping the southern winter, and all of them are on a white tablet with a line down the middle and they can’t remember the name of it.
“It will be massive for us that we don’t have to send faxes down to their local GPs asking for a fax back with their medication summaries and that sort of thing. It will save us a lot of time. That’s the principal reason why I am interested.”
Dr Goodall, an early user of the PCEHR, said colleagues who had had concerns about the system tended to be less well informed.
“A lot of my colleagues probably weren’t aware of what was going on and were quite worried. I think they’re now starting to see the advantages. Once you know what you are doing, uploading takes three clicks of a mouse. You click on the health summary and upload what you want.”
Another Cairns GP, Dr Peter Vanrietvelde, says he is very positive about the concept but is concerned about the heavy cost of the e-health system development while rebates remain frozen and the advantages remain far in the future.
“We help a diverse range of patients including refugees, ACFI patients, the elderly, and people with severe mental illnesses. This type of practice can benefit from a shared electronic record system, but only if everyone is using it,” Dr Vanrietvelde said.
“The local emergency department is starting to use it. I have seen a benefit once or twice so far, but that’s about it. The other difficulty is, it’s embryonic in what it can and can’t do.”
Groundwork already done for the PCEHR meant only a handful of his patients were not signed up when the My Health Record trial became active for patients to enter information in mid-June.
The new rules, requiring uploads of at least 0.5% of a practice’s standardised whole patient equivalent per quarter, take effect on 15 July. The date coincides with the start of the trials in northern Queensland and the Nepean Blue Mountains PHN area west of Sydney.
The health department says that will amount on average to just five uploads per full-time GP per quarter, but the adjustment will be a burden for some.
Dr Kumar Praveen, the principal of Your Family Doctors @ Kirwan in suburban Townsville, says his large 24-hour bulk-billing clinic will struggle to comply because of a large list of 60,000 active patients.
“It’s going to be tough for us to maintain it with our numbers. We have already upgraded our server twice, and that’s something all practices will need to do to handle that type of load. For a big bulk-biller like me, it is very difficult,” Dr Praveen says.
The opt-out rate for patients across the two trial sites of just 1.9% is seen as a positive sign, although patients can opt out at any time.
In the Nepean-Blue Mountains area, Dr Louise McDonnell says a few of her patients opted out of My Health Record because they mistakenly believed their clinical records would be revealed.
“That was a misconception. The clinical notes can go up, but there’s no real point in putting them up. You can vet with the patient what goes up,” the Hazelbrook GP said.
“I will always sit down with the patient in a consult and show them what I am going to upload, but there’s no obligation for a GP to do that. They can upload anything without the patient being in the room. As a matter of principle, I am going to seek consent.
“With the pressure for GPs to get the PIP item numbers, someone could sit down and do 30 in a day, and that could be a problem if the patients are not aware. Perhaps there is a need for education of GPs around that. I think I’d like to know my records are going up.”
Dr McDonnell is prioritising uploads for patients who have complex medical histories and medications.
“Most of them are very happy for this to go ahead. I’d say the majority are very keen,” she says.
The as-yet unknown factors are whether hospital staff will actively look for a My Health Record when admitting a patient and whether a discharge summary will come back to the GP.
“But unless we embrace it, we can’t improve on it, and nothing is going to change,” Dr McDonnell says.
“In time, hopefully a short time, the pathology and radiology will be on it and the real benefit of that will be avoiding duplication. The cost savings could be huge.
“Specialists need to be educated to look, and hospitals need to look, because our pathology and Advance Care Directives will be there.”
