With less than a year until the launch of the much-vaunted personally controlled electronic health record, government and industry have questioned how they might convince Australians to want an identifiable record of medical histories, prescriptions, allergies and discharge summaries.
Where July 1 2012 had once been seen as the coming of a technology some viewed as greater than the telephone for healthcare, talk at two informatics conferences this week turned instead to what the day would foreshadow, rather than what it would bring.
Rome wasn't built in a day, after all.
Australians will be able to register for their own personally controlled electronic health records (PECHR) under an opt-in proces that is expected to bring control over the minutiae of how much data one's doctor or hospital can access and in what context.
A national system will bring together the data repositories and efforts of 12 e-health implementation sites and the Federal Government's lead e-health body, NEHTA.
Yet how many Australians will actually opt in to the record - and how that will be promoted - remains unclear.
Unlike the telehealth rebates scheme, the Department of Health has so far failed to provide detailed key performance indicators of how fast take-up would occur from the records' launch date. Instead, it only indicates expectations that 500,000 Australians will have registered records ahead of official launch next year.
Unfortunately that target, made up largely from trial users at the implementation sites and including a large amount of the 90,000 record users in a single NSW-based e-health site, is little comfort to those keen to adopt a potentially life-saving technology but without knowledge of the true cost.
"People don't think about signing or opting on to a health record until they get sick, by which time it's too late," according to Alan Forrester, director of the emergency services at Hastings Macleay Network in norther NSW.
"It's something the public need to understand - if it's going to be useful to them."
To its credit, the Department has implemented communications strategies and appointed a consortium of consultants, public relations companies and support outsourcers to undertake the mammoth change management task at hand.
An informatics conference in Sydney this week was geared toward the shared services staff of NSW Health but became a sales pitch for the effect electronic medical records (eMR) in the state.
Despite problems increasingly identified in the state's own system, eMRs had been rolled out to 80 percent of NSW Health beds to date, allowing some 75,000 clinicians to deliver 143,000 patient charts and place 101,000 orders daily.
The program had been such a success, Sydney attendees heard, that clinicians in hospitals stuck with hybrid records had become impatient with the compete transition. Queensland hospitals, too, were set to follow suit.
NSW Health chief information officer, Greg Wells, used his presentation to industry to sell his home state as the place a national e-health proposal could be put through the fire.
"If you want to prove e-health at scale, come into NSW and we'll make this work," he told the conference.
Yet not all are sure the statistics are so clear at telling the whole say.
"Let's not underestimate - this is going to be tough gig," said Michael Edwards, the chief executive of the Nepean Division of General Practice, and one of three members sitting on an advisory panel to Wells for the Greater Western Sydney e-health implementation site.
"It's going to be driven ultimately by the consumer, through the GP, back up the chain," he said.
Healthelink - the opt-out record being migrated this year to a PCEHR-compliant model - suffers from poor use by consumers, despite inflated take-up rates.
It was, according to Edwards, a parallel to Britain's ailing health IT system, an $11 billion expenditure that this week faced the axe.
Those at an informatics conference in Brisbane similarly lacked confidence, to the point that a panel urged the nation to focus more on telehealth, due to its geographic spread, than becoming a world leader in the e-health arena.
But with a Federal Government proposal going ahead, clinicians have increasingly called for communication to begin now - before all the contracts are signed and well before a due date the government hopes will prove popular enough to justify its expenditure.
"The question is what message are we really giving to the community?" asked clinical professor Steven Boyages, chief executive of the Clinical Education and Training Institute.
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