Lack of EHR standards a massive fail: report

The failure of successive governments to implement standardised GP electronic health records (EHR) has been slammed by the principal investigators of the nation’s largest study into general practice activity.

In their introduction to General Practice Activity in Australia 2011–12 released this week, Associate Professors Helena Britt and Graeme Miller decried the need to rely on paper-based information for what they claim is the “only continuous, national, representative study of GP activity in the world that links management actions with morbidity.”

The study, which aims to provide the information necessary for the general practice profession to assess its strengths and weaknesses and see changes in practice over time, is the latest of the Bettering the Evaluation and Care of Health annual studies published by Sydney University Press.

“The barriers to reliable electronic measurement of GP clinical activity remain large”, say the authors. “We still have no mandated standards for EHR structure, data elements, definitions, terminologies and classification systems, and no minimum data set required about the patient, their past history, family history and their encounter.”

They described successive failed attempts to see GP EHR standards implemented, beginning with specifications developed in the 1990s for computerised data recording and collation. “These
were regarded as a major achievement by the independent reviewers of the project. However, no-one took up these specifications and Government decided not to proceed … we assume these specifications remain in someone’s drawer.”

Internationally recommended specifications coming out of collaborative work in 2003 between commercial industry and the federally funded General Practice Computer Group (GPCG) also received a mention. “Sadly, this again failed to become an enforced standard,” the authors stated.

The next step was the establishment of the National eHealth Transition Authority (NEHTA) in 2005, when government funding for the GPCG ended and "was effectively shut down", resulting in the "cessation of dedicated government funded GP IT development.”

The authors noted “NeHTA has subsequently concentrated on developing the Personally Controlled Electronic Health Record (PCEHR). The RACGP is currently reviewing GP EHR standards, but without substantial funding support this work is likely to be protracted.”

The authors summarised the results of these government decisions as leading to a situation where “currently we have multiple EHR systems with different structures, data
elements and terminologies … and has ensured that national data collection programs cannot rely on passive data collection from GP desktops to provide a reliable picture of the care provided to the population.”

They concluded by noting the lack of data standards “is amazing in a country with 125 million GP services claimed through Medicare in the 2011–12 financial year, at a cost to government of about $5 billion dollars.”