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19 Oct 2015

The Health Department has released a discussion paper on proposed changes to the eHealth Incentive under the Practice Incentive Program (PIP).

Despite advice to the contrary from the AMA and other key GP stakeholders, the Department is determined to revise the eHealth Incentive requirements to include a measure demonstrating ‘active and meaningful use’. They plan to implement the changes on 1 February 2016. 

Member feedback confirms that this will discourage GP involvement with the My Health Record (MyHR) rather than promote its active and meaningful use.

One proposal outlined in the paper is for PIP practices to be required to upload a target number of Shared Health Summaries (SHS) to demonstrate active and meaningful use. The proposal for a practice payment ignores the work involved for individual GPs and, alone, will not motivate individual GP engagement with the MyHR. A Service Incentive Payment (SIP) and MBS item that recognises this would be more appropriate and effective.

The Department is pushing these policies in an attempt to implement Recommendation 36 of the Review of the Personally Controlled Electronic Health Record – December 2013 (PCEHR Review). The problem is that they are attempting to implement meaningful use metrics before the most important recommendation has been implemented – making the health record an opt-out arrangement.

The target date for moving to an ‘opt-out’ model was originally meant to be 1 January 2015, and a trial was to have been undertaken in early 2014. This is now behind schedule - trials are only now about to commence, and the outcomes are unlikely to be known before late 2016.

There are also a number of other recommendations from the PCHER Review that relate to the clinical utility of the MyHR. These must be implemented before revising the eHealth Incentive requirements.

The eHealth Incentive has been successful in encouraging PIP registered general practices to become MyHR ready – 85 per cent of PIP practices now claim it. However, imposing new eligibility criteria ahead of recommended improvements to clinical functionality and ease of use poses a real risk that GPs will just wash their hands of the incentive, and the record itself. As one of my colleagues recently said, “If GPs thought it was a goer, we would have jumped on it to help care for our patients.”

GPs have been slow to engage with the record because, in its current form, there is no value proposition. Less than 10 per cent of the population have signed up for a record, and the reliability of the information in the record cannot be trusted because of the capacity of patients to remove information from view.

There are also complicated legislative requirements backed by severe penalties for breaches, as well as concerns around privacy and security. Combined with the lack of system integration, low take up by hospitals and poor participation by other specialists and other health providers, it is not hard to see why the MyHR and its predecessor has been a failure.  

We understand that the Government wants to gets some runs on the board with the MyHR and there is no doubt that, done properly, the MyHR has the potential to improve patient care. However, if clinician advice is ignored and unrealistic timeframes continue to be pursued, then it is hard to see us doing anything but repeating the mistakes of the past.

The AMA’s submission on the PIP eHealth Incentive is available from the General Practice page on the AMA website. In short, it recommends:

  • delaying the implementation of a revised eHealth Incentive from 1 February 2016 until such time as the MyHR is easy to use, clinically relevant, reliable and interoperable;
  • implementing a SIP and MBS item to support active and meaningful use;
  • giving further consideration to redesigning the incentive to support ongoing eHealth capacity and use; and
  • retaining quarterly payments rather than moving to an annual payment.

Published: 19 Oct 2015