In response to the Royal Australian College of GP suggestion that additional financial incentives would be needed to compensate for the additional costs in time and effort there was an amazing response as far as I am concerned.
I discussed the statement from the College identifying the requirement here:
This prompted a response from the Office of the Minister (among a fair few others):
Spokesperson, Office of the Hon Nicola Roxon MP Minister for Health and Ageing
21 October 2011 at 9:13
The RACGP's media release ignores many of the facts and underlying principles of personally controlled eHealth records. GPs are heavily involved in the development of eHealth records, and we are confident our system will help provide better care, save lives and save money.
On consultation with GPs: Over a third of the health professionals advising the development of eHealth records are GPs. This recognises our commitment to consult extensively with GPs. Significantly, the head of the eHealth Clinical Leaders group is Dr Mukesh Haikerwal, a GP, and past president of the AMA. Joining Dr Haikerwal in the group, is Dr Chris Mitchell, a past President of the RACGP.
On GP additional workload: The Government already has incentives in place to encourage GPs to keep up to date with the latest developments in eHealth. Our eHealth Practice Incentives Program provides up to $50,000 per year to practices and we would expect these funds to assist with their adoption of the PCEHR.
On education and adoption: The Government is well aware of the need to encourage patient uptake of eHealth records and, in particular, older Australians, Aboriginal People and Torres Strait Islanders, and mother and their new-born children. That's why many of our eHealth implementation sites focus on these groups. Further, we are investing almost $30 million to encourage the adoption and uptake of eHealth records by the public and the healthcare sector. See this release for further details: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr138.htm
On personal control: The Government does not apologise for creating a personally controlled ehealth system. Right now, it is completely up to a patient what they tell their doctor and this will continue with eHealth records. Importantly, only clinicians will be able to create or alter eHealth records.
The initial article and this and all the other comments are found here:
While there are potential issues with all these 4 points it is point 2 about the PIP being a source of funds to compensate for the time and effort to maintain the PCEHR that deserves a little scrutiny.
The eHealth Incentive Guidelines - found on the Medicare Web Site - and dated August 2011 explains what the PIP payment is for:
“To be eligible for the PIP eHealth Incentive, practices must:
1. have a secure messaging capability, which is provided by an eligible supplier as listed on the NEHTA website
2. have (or have applied for) a location/site Public Key Infrastructure (PKI) certificate for the practice and each practice branch, and make sure that each practice GP has (or has applied for) an individual PKI certificate (excluding locums)
3. provide practice GPs with access to a range of key electronic clinical resources.”
Further detail is provided in the short document which is found here:
Note that there is no mention of the PCEHR at all. These payments are for getting a secure messaging capable GP system in place (you don’t seem to have to be using it!)
All you need is to have a system from the list which was last updated 18 months ago!
The list is here:
Equally you need to have - but not necessarily be using PKI certificates (not NASH provided ones).
The electronic resources are easily available and integrated into at least some GP systems.
The payment is approximately $6,500 for a solo General Practice a quarter and capped at a maximum of twice that no matter the size of the practice.
For a 5 man practice (40% of all practices) this amounts to $10,000 per practitioner per annum which, while reasonable is not a huge amount.
Compare this with the impact of spending 2 minutes of each consultation on ensuring PCEHR currency and reliability. The average GP probably sees six patients per working hour or say 40 patients per day. If we assume say a conservative 30 minutes per day on PCEHR related activities (consent, checking, uploading, reviewing) we are looking at a net loss of say 3 patient consultations per day. Doing the math that is say $300 / week in lost income - i.e. approx. $15,000 a year (very conservatively) in lost income.
Thus - unless there are real productivity and workflow benefit from the PCEHR this is a real looser for the GPs.
Be assured it is maths like this the AMA and the RACGP are doing that has them alarmed and resistant. They know this is going to cost them and they are not happy!
What the DoHA spokesperson is saying just makes no economic sense as does a good deal else in the overall PCEHR proposal despite all the claims to the contrary!
David.
