to be complete and accurate (not just the relatively small amount of information viewable by the patient). How do we ensure that Australia’s PCEHR initiative enters a virtuous cycle? We need to address the fundamental
issue of getting our basic patient information into good shape. In particular that means focusing hard on the quality and usability of pathology and radiology information, discharge summaries and specialist reports. These have to be robust enough to become the basic building blocks of a health records architecture. At the moment, over 30 million sets
of pathology tests are created throughout Australia each year.2
Unfortunately their
format is not standardised, they have no uniform coding and their basic structure differs from laboratory to laboratory. Until this information can be reliably, seamlessly aggregated, and is able to be re-used and combined with other health record information, the concept of a shared record (of any kind) remains a pipe dream. Despite a number of commentators
remarking upon the primitive level of standardisation and coding within the basic clinical messaging across Australia, very little has been done to address this fundamental issue. So, what is behind this problem? Why is there no progress
in addressing it when making the health system more efficient is regarded by all as a matter of urgency? I can only assume that NEHTA has insufficient understanding of the issue and for that reason is totally dismissive of it. Any more Machiavellian assumptions as to why this is so would probably be inappropriate at this juncture. To propel the Australian PCEHR
initiative forward into a virtuous cycle, whereby patients can begin to see value in gaining access to their health records, we must ensure that all stakeholders in the system can be confident that the information within those records is complete, accurate and capable of being aggregated and reused. Success depends entirely upon removal of any risk. In order to achieve the level of integrity required, it is essential that we grasp the nettle now and focus upon clinical record standardisation at all levels. The likelihood of whether or not
the PCEHR will be a huge success or a multi-million dollar flop is dependent upon whether we can take the Kaiser approach (highly relevant, completely dependable information, improved upon over time) or the NHS approach (based on information yielded from a system that no one trusts nor particularly wants to support). To ‘create a new order of things’, it is
important to identify the key stakeholders whose information is needed to form the building blocks of a shared health record system. We need to work with these source system owners to get the quality of their information output up to a satisfactory level. In order to ‘encourage’ these parties to change the way they store and distribute core record information, we need to understand what they need to do to change and why they appear to be so reluctant to do so of their own accord, and then we need to find the ways in which we can ‘persuade them to support the cause’. After all is said and done, very few of us are happy with the poor level of automation evident in the Australian health system. As Niccolo Machiavelli said: “I’m
not interested in preserving the status quo; I want to overthrow it.” We need to make the guardians of the status quo throw down their weapons, and we need to do that quickly. Failure to do so will unquestionably mean an ignominious end for the PCEHR.
References 1.
https://www.ucl.ac.uk/news/ scriefullreport.pdf 2.
http://www.aapp.asn.au/images/ document/DOD%20paper%20+%20 append.pdf
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