The PCEHR Review, and the "Minimum Composite of Records"

May 20, 2014

So the PCEHR review has finally been released, and I’ve been reading with considerable interest. I’m going to stick to analysing the technical recommendations that they make, starting with a group of recommendations they call the “Minimum Composite of Records”:

  1. Expand the existing Australian Medications Terminologies (AMT) data set to include a set of over the counter (OTC) medicines.
  2. Widen the existing National Prescribing and Dispensing Repository (NPDR) to include the expanded set of over the counter (OTC) medicines.
  3. Implement a minimum composite of records to allow transition to an opt-out model by a target date of 1st January 2015 inline with recommendation 13. This will dramatically improve the value proposition for clinicians to regularly turn to the MyHR, which must initially include:
    • Demographics
    • Current Medications and Adverse Events
    • Discharge summaries
    • Clinical Measurements

The section that explains these starts with the following paragraph:

A common theme in the consultation process was the need for a minimum data set to make up a viable clinical record. Many of the submissions also pointed out that it was imperative for the data standards to be widely and universally adopted to allow the MyHR to function. The more clinically relevant material that was present within the MyHR the faster the rate of adoption and therefore the faster the return on investment will be

I’m really pleased to see the question of wide and universal adoption of standards mentioned - that’s what I would have said to the panel if I’d made my own submission. From these general comments at the introduction, the review seems to get rather distracted by medications coding issues, before suddenly coming back to the question of “minimum composite of records”. So, what does that mean?

  • Demographics- I cannot imagine what this means beyond what is already in place? The documents include demographics - my consistent feedback from clinicians is that they contain too much of them, and I couldn’t figure out from the text what they thought this meant.
  • Current Medications and Adverse Events- well, that’s consistently been a focus of what we’ve already done, but the section indicates that this is about the medications coding. So more on that in the next post
  • Discharge summaries- again, this is something that has already been prioritised, but the section points out that this doesn’t apply to private hospitals. And, in fact, private hospitals aren’t really a good fit for the current discharge summary because of the way their business works, so the basic discharge specification may need to be reviewed to make it a better fit for that use
  • Clinical Measurements- the section says “capture vital signs to prevent avoidable hospitalisation and demonstrate meaningful use of PCEHR.” - uh? How will capturing vital signs - data of relevance today during an admission - will “prevent avoidable hospitalisation”? That was submission from the Aged Care industry, so perhaps they’re saying, if the PCEHR contained a record of the patients baseline vital signs, then we can know whether they’re actually significantly impaired if they have an emergency admission outside their normal facility? - it seems like a super narrow use for me

They say: “All other functionality … should be deprioritised while these data sets are configured” - but what other functionality is that? It’s not obvious to me.

So, the Minimum composite of records actually means:

  • Improve medications coding
  • Cater for discharge summaries from private hospitals
  • Add support for vital signs
  • Continue to focus on implementation activities in support of these things

Have I read that right? Comments welcome…

I’ll take up the question of medications coding (recommendations #19 and #20) in the next post.