In the shadow of the carbon tax, Australia’s e-health records scheme rolled out on July 1 with what can only be described as a very soft launch. Unlike the carbon tax, the e-health records scheme is voluntary and it seems few doctors and patients have signed up.
Some doctors fear they may be held liable if the patient-controlled records aren’t kept up-to-date. And consumers remain concerned about the privacy of their medical information. So, what are the realities of these risks?
New e-health records
Most GPs already have their own electronic records system. The new Personally Controlled E-Health Record (PECHR) is different because it places a patient’s record on a nationally linked database, so all current and future health-care providers could, with the patient’s consent, have access to the same information where and when they need it.
The record will include the patient’s prescribed medication, test results, care plans, immunisations and health alerts such as allergies. Having this information readily available would be invaluable in an emergency.
It’s also hoped the new system will reduce the high rate of medical errors (18%) that occur from inadequate patient information, reduce unnecessary hospital admissions, and save doctors from collecting a full medical history each time they see a new patient.
Information and choice
The Personally Controlled E-Health Record, as its name suggests, was designed to give patients greater control over the information contained in their health-care record. This is consistent with legal and ethical principles of a patient’s right to autonomy, which underpins the modern provision of health care.
Patients can choose what goes into the record and what is omitted, via a summary page in the health care record. But some doctors are nervous that information will be missing from the record and as a result they’ll be (a) unable to provide efficient, safe and high-quality care; and (b) held liable if something goes wrong because of the lack of information in the record.
Medical indemnity
We know many patients choose to disclose only some medical information to their doctor, while keeping other details to themselves, whether they use a paper based or e-record system. But doctors cannot be held responsible for something that is outside their control. They can only do what is reasonable – and the law supports this.
True patient control rights should come with associated responsibilities. If a patient signs onto the e-health system and exercises their right to withhold information, knowing that to do so may impact on their care, the patient should be held responsible for any mishap arising from a lack of information. This should be made clear at the sign-up stage.
But medical defence organisations have also advised doctors that it’s not reasonable to rely on the PCEHR alone. Doctors must examine and assess the patient as they’ve always done, noting this information in their own records.
Privacy
In 2011, the government commissioned a privacy impact assessment report of the proposed e-health system. The authors made 112 recommendations for changes to ensure the integrity of the system, of which the government agreed to 103. One important recommendation was for the government to clearly explain the privacy control settings to consumers, including their limitations, before they decided to register for a PCEHR.
Irrespective of the government’s promise that the e-health system will have “bank tight” security, it’s likely that patients will continue to keep information to themselves. They may be concerned about the potential for information to be used against them by future employers, health insurers, life insurers or even other doctors, who aren’t immune to forming biased opinions about their patients based on a view someone before them has formed.
The government must acknowledge that true patient control over their medical record supports patients omitting information and this may undermine the very purpose of the system itself – to improve efficiencies by not having doctors spending time on tasks that they still have an obligation to perform. So expected efficiencies may be limited.
Will the new system work?
For the A$467 million that has been spent launching the system, its success in large part depends on buy-in. It’s currently an opt-in system, with both doctors and patients having a choice to sign up. This is in part to allow the government to skirt the section 51 (xxiiiA) constitutional requirement for the government not to civilly conscript medical services by compelling doctors to use a government-prescribed system.
Instead, the government has offered incentive payments to practices that take up the scheme before February 2013, to encourage as many users as possible to join the system. But the Australian Medical Association has voiced concern that the incentive program doesn’t run for long enough to allow all members to get on board or be properly remunerated to join, set up and administer the new system. The incentives program is currently under review.
Experience tell us that a successful e-health system is dependent on the confidence of the stakeholders. It would be wise, therefore, for the government to invest more time and money to reassure and educate both health practitioners and patients about the integrity of the system, the importance of sharing health information and explicitly note who is responsible for what.
Until then, the system’s biggest advantage is to serve as a memory aid for patients.
Richard Ure
logged in via Facebook
It is encouraging that the Opposition has supported/not opposed PECHR.
If the Opposition had been true to form as with the NBN, perhaps the measure would have got more attention and possibly half the population would have signed up by now.
Having said that, I am hoping in the long run the forthcoming debate will start asking and sensibly answering the question: “Why is mental illness treated differently from other illnesses?” In the meantime journalists will no doubt suggest mental illness episodes are an example of the type of information patients will prefer to hide. After all it is what journalists have always done in the past.
john Killally
retired
I agree with Richard,
And then I would like to add, that the E-health records would work on a confidential basis between GP's and patients. But when you introduce a third party then the confidentiality and Privacy can break down.
I would like too add, that we had an occassion recently to be concerned about privacy of Government records. We were approached by a public servant about whether we had changed our address from one to another. This was on the guise that returned mail had come back…
Read morejohn Killally
retired
There is a lot of this article missing, Question what happened to the rest?
Coco Coco
logged in via email @hotmail.com
There is a range of reason why people are not signing up. I am one who has made a positive decision not to sign up for e-health. Why? Because I consult Drs after I assess their level of competence and seriousness of my health issue and costs.
Read moreFrankly, I do not want the private GP discovering this. I consult her for more difficult things. I do not want to piss her off. I do not want her knowing I don't consult her for all matters and eject me from her patient list. In a lot of non-metropolitan areas…
Peter Fox
Peter Fox is a Friend of The Conversation.
Medical doctor
Thanks Coco. The group who will most benefit from e-health are patients with complex, chronic medical conditions. These patients often have multiple specialists, inpatient admissions, with their GP at the centre of the care. When e-health is fully rolled out, these patients will have vastly improved care with significantly less duplication, and improved communication. The decreased duplication will save the public health system $$$
From your description, you don't really sound like the main target audience.
Also, I don't think GPs are as fragile as you suggest. They're so busy, they couldn't care less if you went to a medical centre to get your contraceptive pill prescription.
Richard Ure
logged in via Facebook
Peter,
I guess I would benefit to MY satisfaction if I was not administered a drug to which I was seriously allergic when I was not able to discourage the administrator of that drug that I would rather not have it thank you.
Coco Coco
logged in via email @hotmail.com
Peter - I guess I just must not fit your assumed definition of not having sufficiently "complex" enough health problems to be suitable for e-health.
Read moreBTW - I have cancer [breast - it has spread], an aneurysm, femoral hernia, two other hernias, high blood pressure, tachycardia, asthma, late onset inherited form of anaphylaxis.
Oh - and as for your condescending comment about my birth control pills - like every Dr I have ever consulted throughout my life the automatic assumption is of heterosexuality…
James Wookey
Paramedic
Coco Coco
I'm confused as to why your GP isn't your first port of call for medical matters? Shouldn't your GP logically be the one you have the most trust in to help you manage your conditions? If your not happy with your GP no one is going to blame you for finding another one. Also I can't see any reasonable Private GP holding it against you if you visited a public medical center now and then for a minor complaint because you could afford or get an appointment at the usual practice.
Your…
Read morePeter Fox
Peter Fox is a Friend of The Conversation.
Medical doctor
Coco, my apologies for making assumptions. I was generalising for the sake of argument.
I'm sorry that you have to deal with that list of medical conditions. I would argue that this additional information suggests you would have a substantial amount to gain from e-health. For example, if you were brought into hospital with altered consciousness from anaphylaxis, or a complication of your breast cancer treatment - the doctors would be able to give you superior care if they have all of your medical details to hand. Particularly, after hours when your GP is closed, finding this information is often very difficult (although it does sound like you're very organised with keeping a copy of all your results!)
I agree with James that the benefits are likely to outweigh the negatives. However, your decision to not participate is absolutely your choice.
Coco Coco
logged in via email @hotmail.com
James - not sure where you reside! It must be somewhere where there is an endless supply of competent to reasonably competent GP's on hand, so that when you decide Dr X is not okay, you move smoothly on to Dr Y or Z. That is most certainly not my area.
I live in an area where even half way competent GP's have CLOSED patient books and because of under supply of GPs versus demand, actively seek out opportunities for culling patients from their books. Even local specialists throw a wobbly eg…
Read moreKatrina Bramstedt
Associate Professor, Medical Ethics at Bond University
I used e-health for many years in USA and loved it. I found it a great way to have quick and readable access to my medical records, including immunizations and prescriptions. Even now I can quickly get my info through the iPhone app that links to my charts. As a medical ethicist I am well aware of the issues of privacy and data control. There are always risks with technology but there are benefits as well.
Tracy Soh
Addiction Medicine Physician
One of the key concerns that the medical profession has is that the Governments own draft regulations put an unreasonable legal responsibility on the medical profession. When the Government initially released the draft regulations, they proposed to place all responsibility on the quality and security of the information held on to the medical practitioners, even though the medical practitioners did not hold the data, nor did they have full control over the contents.
The regulations have seen been reviewed, but consultation has been held with only a few key groups and little detail has been available to medical practitioners in general. The profession is somewhat wary of what legal exposure they will have under the new e-health system.