Today we are going to have a conversation around the Adoption implementation of eHealth through a Medicare Locals eyes, we will be interpreting some results and going through what workforce training is going to be needed to keep eHealth and the PCEHR moving forward in to the future.

If I may I would like to tell you a little bit about Townsville-Mackay Medicare Local.

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Townsville-Mackay Medicare Local (TMML), covers an area of 240,000 square kilometres and covers everything south of Cardwell, north of St Lawrence and east of Clermont and Richmond including Hamilton Magnetic and Palm Island.

We have 2 major regional offices that are 387km’s apart, 1 in Townsville and 1 in Mackay

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Townsville-Mackay Medicare Local is a regional primary health care coordinating body that works closely with GPs, allied health professionals and community organisations in serving the health care needs of residents across North, North-West and parts of Central Queensland.

Townsville-Mackay Medicare Local is an independent, not-for-profit organisation with its own board, comprising community and health professional representation, as well as business and management expertise.

Townsville-Mackay Medicare Local is the largest primary health care employer in North Queensland with 80 per cent of our staff deployed to support direct service delivery.

Our work focusses on health system integration, mental health service delivery within the primary health care sector through our Clinical services and ATAPS for both Adults and Children, our “Closing the Gap” team works tirelessly with our

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indigenous consumers encouraging aboriginal and Torres Strait people to access quality health care, We are constantly looking for ways to implement quality improvement programs within primary care. We also specialise in delivery of Continuing Professional Development and Practice Staff education that focuses on multidisciplinary approaches to service delivery.

One of our Quality Improvement Programs is what we are going to be talking about today……eHealth

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In 2012 Medicare Locals were recognised as key players in the rollout of the PCEHR as they had a local presence throughout all regions in the country.

In late December 2012 Townsville-Mackay Medicare Local employed 2 eHealth program officers one based in each area with the specific role of being the front-line staff in the rollout of the program.

We were also allocated the role of being the coordinator of a Hub site with Wide Bay, Central Queensland and Central North West Queensland Medicare Locals making up the cluster sites in which information was shared through collaboration with their eHealth teams.

With the development of our initial change and adoption plan we began our journey to deliver eHealth, more specifically the PCEHR, to Primary Care Providers.

TMML’s Health Professionals can be broken down to:

• 102 General Practices

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• 81 Pharmacies

• 14 public Hospitals

• 3 Private Hospitals

• 24 Aged Care Facilities

• 75 Private Specialists

We began by focusing on our General Practices where we would get the most bang for our buck quickly and encourage meaningful use of the PCEHR.

• General practitioners being offered incentive payments through the ePIP (electronic practice incentive payment) program to encourage the uptake of eHealth and the PCEHR. –

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5 requirements were placed on general practices to adopt and implement eHealth. These requirements were

1. Integrating Healthcare Identifiers into Electronic Practice

Records

2. Secure Messaging (SMD) Capability

3. Data Records and Clinical Coding

4. Electronic Transfer of Prescriptions (eTP)

5. Have the ability to upload and view the Personally

Controlled eHealth Record System (PCEHR)

At the same time Medicare Locals were focusing on providers, they were also preparing to sign-up consumers for their own PCEHR. Once the General Practices were eHealth ready, the program was to be rolled out to the general public so that Shared Health and Event Summaries could be uploaded to individual Australian’s personally controlled eHealth records.

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eHealth – having the right information at the right place at the right time.

You would think with that statement it should have been relatively easy for medical professionals to adopt and implement eHealth into their daily workloads. It also sounds like a concept that consumers would embrace and sign-up for without question.

What we found through out our Hub and Cluster contradicts this statement; as all sites encountered numerous barriers to adoption in which was echoed through our sites.

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Reflecting across the Hub and Cluster the barriers we uncounted can be broken in to four key lessons learnt:

Technical Bottle-necks and Challenges

• The registration process for stakeholders was complex and confusing, repetitive forms with same information being asked.

• Application forms that changed without notice and without consultation with applicants, with claims of un-received forms from DHS and they would not accept evidence of sending. This made the whole registration process drawn out and frustrating for stakeholders.

• eHealth website unreliability due to site crashes

• The changes to the eHealth solutions cause the software vendors to be in catch up all the time and there are delays in rolling out new software versions around Australia

• The software vendors delivering eHealth solutions that are at different points of implementation with no “test” software for training

• Medicare staff creating confusion when being contacted by Stakeholders, consumers and even Medicare Locals as they were unable to offer best solutions.

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Provider Challenges

• Opposition within some Health Provider bodies.

• The implementation of eHealth has been gradual and this presents a problem as there is no final solution as yet and change is continual and uncertain

• The change management for Primary Care Providers has been continual and is constantly changing due to new requirements and new programs using eHealth

• Primary Care Providers have struggled to keep up with the changing requirements and implementations, so large effort in keeping up to date, some have fallen behind due to resources or changes to staff

• Medico-legal information not clear from indemnity insurance companies due to being an untried risk assessment area

• The lack of eHealth item numbers through DHS (Department of Health Services) for reimbursement for providers time to upload to the PCEHR

• Peer to peer gossip leading to Health Professionals reluctant to change

• Lack of financial incentives for other Health professionals outside of general practice has led to reluctance to uptake eHealth

• With the OPT IN OPTION, providers can’t see the real value due to not all of their patients would have useful information available during consultations.

• If there had of been an OPT OUT for both consumers and providers there is a belief that this would have created critical mass and meaningful use almost instantaneous.

• Providers have reported that they should have just been given access through their provider numbers rather than Individual identifier numbers

• With Consumers being in control of the record, stakeholders are very reluctant to engage due to the possibility of records missing vital information in which the consumer does not want divulged

• The lack of genuine consultation with clinicians, the eHealth record should enhance workloads not disrupt and create less time to see other patients.

Consumer Challenges

• Awareness of the PCEHR was almost nil and there was no national marketing campaign in place

• Complex registration for consumers

• Conflicting information on registration channels caused confusion for consumers

• Many consumers believed they already had an HER (electronic Health Record)

• The consumers are also having trouble keeping up with the latest information, both by the primary care providers and the DOH (Medicare and DHS)

• The consumers are only seeing a gradual improvement to primary health care due to the time taken for the implementation of eHealth into the programs such as

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Diabetes and Chronic Diseases

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Medicare Local Challenges

• We did not have a transparent road map involved in the program

• eHealth was focused on data and registration numbers

• eHealth rollout sometimes focused on some health professionals when they did not have the functionality to engage.

• Had to develop a new program from scratch with limited resources and experience

• All of our Hub and Cluster sites comprise of a large area within Queensland so travel was time consuming and expensive

• eHealth was new to many providers so some general practices required a lot of support and time

• ML’s had to develop a lot of policies and procedures with limited support from other stakeholders due to limited experience

• Other programs within ML’s were unaware of eHealth and required a lot of training to get cross-program support

• The overabundance of eHealth information available for consumers and stakeholders leading to further confusion.

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Interpretation of results

With Technical issues aside, Medicare Locals in the last 12 months have been driven by data and numbers of registrations from both Stakeholder and consumers rather than being able to focus on Meaningful use of the PCEHR.

If we had not been playing the numbers game our Hub and Cluster could have focused on Meaningful use which would have given the ability for Primary Health Care Providers buying into eHealth and already being comfortable with the use of PCEHR therefore working towards critical mass as the natural course of registrations would have followed due to Primary Health Care Providers recommending to consumers to register themselves.

Very few people – neither providers nor consumers – disagree that the PCEHR is at its base level a very good thing, although we still encounter numerous push backs.

Most push-back has come from the following areas –

The readiness of all stakeholders to roll the PCEHR out in a controlled and efficient manner was not evident.

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The readiness of providers to embrace the PCEHR without pushback did not occur.

The readiness of consumers to sign-up for the PCEHR in large numbers did not occur.

As we all know a lot of investment has gone into the PCEHR starting with NEHTA and the build team right through to the Medicare Locals eHealth teams at the grass root level that have rolled out the program to stakeholders and consumers with in their areas.

In the last few months with Hospitals starting to engage with the PCEHR with discharge summaries now being uploaded, and with some providers in our areas choosing to ignore their peak bodies advice not to register their organisations into eHealth, we are starting to see the consumer registrations increase and meaningful use starting to rise due to being driven by pharmacy registration of consumers therefore the follow on pushing Primary Health Care providers to upload SHS’s for their patients.

Residential Aged Care Facilities are contributing to the overall growth of eHealth and will continue to do so as further enhancements to the PCEHR become available increasing the true value for their residents health needs.

• The best results are coming from the primary care health approach to immunisations, Medication management and allergies being recorded in one place

• children and the aged care the biggest beneficiaries as they cannot always articulate their allergies or immunisations if the care giver is not available

• Children will have a long term eHealth record that will be used during childhood and then later in life, but the information will be kept. The middle years for most are their most healthiest with minimal medical conditions, except for a small percentage where they will be active all the time.

• We are starting to see benefit coming from chronic disease management where multiple primary care providers are able to see the latest non clinical information allowing for them to further plan the management and made more efficient.

• Just having consumer/patient information across primary care programs can save time and effort and reduce the risk of medical errors or hospitalization

• We are now receiving performance data to measure the consumer activity sooner this can allow the change of delivery strategy and implementation of programs for prevention rather than cure

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So what training and awareness is needed to progress the PCEHR program?

• Workforce training needs to be identified and embedded into the young health professionals during their initial curriculum in universities, Tafe and defiantly while they are on clinical placements, this will allow the new breed of professionals to use eHealth as core day to day activities.

• Further training for existing Primary Care providers is required now and will need to be ongoing as the eHealth solutions become further embedded into the workplace and the integration of information across programs means improved patient monitoring and analysis will be able to occur, changing the focus from treatment to prevention.

• The change of focus will mean more workforce training to accommodate “Home Care” rather than GP office, however all diagnosis will still occur at the GP Office, continuing care may not depending on the level of illness, this will free up the GP (Primary Care Provider) to focus on the prevention rather than the treatment.

• Huge effort will be required for training and support of all Primary Care Professionals involved with eHealth and the Medicare Local network will be ideally placed to deliver and coordinate the training for all these providers, not just GP Practices.

• Workforce training will need to occur across all disciplines and workers in the primary health care environment of which there are more than 150,000 across Australia.

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• Last but not least

• Further embedding eHealth into other Medicare Local programs will continue the flow of eHealth in the Primary Care Sector.

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Thank you for listening to me and I invite any questions.

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