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.
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.
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.