By Julian Bajkowski

Australia’s long and troubled efforts to create a functioning national system of electronic health and medical records system is once more close to collapse.

The Australian Medical Association has expressed serious concerns over clinician input into the project following the shock resignation of highly respected clinical representative Dr Mukesh Haikerwal from the National eHealth Transition Authority (NeHTA) this week.

Other crucial clinical advisors, including Dr Nathan Pinksier and other clinical leads are also understood to have quit signalling a severe breakdown in relations between doctors and Department of Health and Ageing.

A loss of confidence by doctors in either DoHA or or NeHTA would, in practical terms, shut-off political life support for the circa $1 billion Personally Controlled Electronic Health Record (PCEHR) project because the scheme cannot work unless doctors voluntarily agree to use it.

The urgent warning from the AMA in the wake of the clinicians’ walk out now puts substantial pressure on DoHA’s high profile secretary, Jane Halton, to personally intervene to get the project back on-track.

Questions are already swirling around Canberra as to how DoHA managed to shatter the support of medical lobby on a project that has bi-partisan support during the delicate pre-election caretaker period.

One possible trigger for the breakdown is what appears to be a bureaucratic power grab by DoHA in a ham fisted bid to gain central control over the complex and difficult eHealth project.

It has been reported that a DoHA spokesperson issued a statement that said the department would be “taking the lead” from NeHTA in dealing with medical and health technology interests and would take “a fresh look at the design of the PCEHR system.”

However AMA president Dr Steve Hambleton said he still had confidence in Ms Halton, but called for swift action.

“Jane’s got some good credentials on the board over her time in [DoHA]   but she may have to make this a personal focus of hers,” Dr Hambleton told Government News.

Even with support, Dr Hambleton is not mincing words about how much support from doctors has evaporated.

“It’s really undermining confidence in the profession that one of our senior leaders can’t continue,” Dr Hambleton said of Dr Haikerwal’s resignation.

One sign of the scale of differences in thinking between DoHA and doctors is the fact that the normally effusive Dr Haikerwal – himself a former AMA president   is flatly refusing to talk while his professional organisation re-evaluates its role in the eHealth scheme.

“It’s been a decade that we’ve had Mukesh leading the profession and trying to assist the government in making an outcome that is going to work,” Dr Hambleton said.

Dr Hambleton said the AMA now had to redouble its call for a “clinical advisory panel to advise on the next steps.”

One of those will be getting the eHealth system functionally up and running.

“Having 600,000 blank records is not an achievement [especially] when it is not being used by anybody,” Dr Hambleton said.

As with many complex government and health IT projects, the usability of the system has become a critical issue.

Dr Hambleton said that a “lack of clinical utility” on the PCEHR was preventing take-up.

“If it has clinical utility everyone will want to be part of it,” he said.

That clearly hasn’t happened yet, with pathology, medical imagery, medication, allergies and basic conditions all cited as areas that still needed to come good in terms of their usefulness on the PECHR.

Doctors have repeatedly said that they want a system that provides a complete and accurate electronic picture of care and treatment components for patients – or none at all because of the inherent dangers of relying on an incomplete picture.

“Adding functionality that adds to information chaos is not going to make anyone use it,” Dr Hambleton said.

Earlier this year NeHTA confirmed that it had settled legal differences with accident prone multinational IT vendor IBM, whose role in the eHealth project had been to build the authentication layer of the national system – until its contract was terminated.

In August the Queensland government banned IBM from securing new business in the state after the vendor managed to exclude itself from any financial liability in relation to the epic $1.2 billion Queensland Health payroll which it was supposed to build using software from German company SAP.

IBM is also an IT infrastructure services provider to DoHA, where the quality of the company’s services came under scrutiny following an outage that heavily impacted department staff and prompted a terse email from Ms Halton.