I am fortunate to be using the Kimberley Internet Electronic Record as a General Practitioner in Remote Communities. There are many advantages. A key one is when I am on call. I can be a thousand kilometers from a patient yet I can go to their record and provide advice that is based on a clear understanding of their health problems and their medication. That information can save lives when you are giving phone advice. More than that I can do it on an ipad whilst in the shopping centre.
Many of my patients have serious renal disease, a complex health problem that requires specialist care. I can send a secure email to the renal specialist, they can check the record, results and medication and provide useful assistance and advice within a few minutes. Together we work as a team with the record system the communication tool. This is also true when I work with the diabetic team, the obstetric team or any other specialist group helping to look after the patients for whom I have the primary care responsibility.
I have a number of health workers who have their own records on the system. It has been an eye opener to see how useful it is for patients to see and monitor their own health records. I look forward to the soon to be released Patient access version of Mmex. It will allow me to assist my patients to take real responsibility for their health. That will be a true health revolution.

I've cut my leg deeply and need it patched up. So I jump on line to book an appointment at my local medical centre in 10 minutes.

The GP patches me up. Do I need a tetanus boost? Crikey, I can't remember when I last had one. No probs! The GP checks my record to find that I'm due for a boost.

Apparently I'd better have some penicillin to protect against infection so the medic enters that onto my record. Off I hobble to the pharmacy who swipes my Medicare care card to find my penicillin prescription and dispenses the pills accordingly.

This probably wouldn't improve my health (I promise to be more careful in future) but it would make the exercise so much more convenient. So for that reason alone I wish the various health bodies ('system', ha!) would hurry up and digitise some of these basic processes that involve patients, especially careless ones like me.

It will be exactly the same as the UK. Clinicians in the UK produced a 600 page report as to the benefits of eHealth and they said there were many....only if we could actually make it work, and this was after £20billion or so of expenditure. A report by Sydney University dived into the inadequacies of the new system in NSW Health. It is an understatement to say that these systems do not effectively support the clinical 'value chain'. The politicians answer is to throw more money at the problem. A problem that cannot be solved using existing technologies. The same technologies are being used in Australia as in the UK so I don't expect a different outcome and in fact some States have closed down or terminated expenditures on 'e' health projects.

The current model of IT development is of limited use and also the design paradigm used for health is wrong. Hospitals are not 'manufacturing facilities'. The 'ERP' type systems being imposed are driven from an administrative perspective and do not effectively support the health 'value chain' which in turn supports clinicians. The imposition of these systems is, I believe, forcing clinicians to abandon exiting practices and also 'green' and 'black' screen systems they developed and so valuable knowledge is being lost.

The emergence of Broadband and Mobile Internet offers the opportunity to completely rethink the way we design, build and deploy information system. The system we need would be a 'utility' and designed manage the 'patient project' (the health value chain). It would need to be real time, 'person centric' and would recognise each individual's rights as a clinician, nurse, patient, administrator, etc, and make the appropriate information and artifacts available at the time as the patient passes through the system. Due to the design there would only be a single patient record in such as system - the record would be integral to the system updated in near real as the patient entered the system at a number of points - hospital, clinic, GP Practise, etc. The system could be deployed as a national system utilising the emerging Broadband infrastructure of the NBN. Suffice to say to build this you would not use a traditional IT development approach and the system would have to be designed with the full involvement of clinicians.

The means to do the above exists today.

I am 67 years old, intelligent, educated and have a whole range of health conditions. Therefore I deal with my GP, public hospitals, private specialists (gastroenterology, vascular, endocrinology etc.), various public and private radiology and pathology. These services keep me healthy but they cannot all share my health records. I am the conduit between them all - ensuring that blood tests and scans and other results are known to the range of health care providers and hopefully therefore ensuring they are making informed decisions about my care. These means I have to cart bundles of records around with me to surgeries, services and hospitals. Some are linked, most are not. How wonderful would it be just to give each health practitioner permission to access all or some of my history. As I get older, this history becomes longer and, although I have moved my health records from GP to GP throughout my life, I am the only one with the real knowledge. To have that electronically would be wonderful. To date I have managed to become a very informed conduit of information to and between all my health care providers. What about when I get older and cannot remember where the records are or what I had done? So don't knock any attempt at coordinated electronic healthcare information. I welcome it.

I agree with the worth of an electronic health system, however, I do have a couple of qualms. <br>
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- Security is my main concern. We live in an era of hacking. Just this afternoon, I have read an about Anonymous and their plans to bring down the internet & about a voting system in the USA which if trusted, whould have installed Bender as the Mayor of Washington, DC. Additionally, I work at a university in Darwin, where in the past two weeks, we have had increasing connection problems resulting not only from the start of semester, as well as a Telstra line issue. <br>
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An electonic health system should not be dependant on either internet providers or world wide web. Let it be hosted in Australia and available on an internally secure system as I assume would be possible using the NBN. <br>
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- My next concern is access. Personally, I would prefer to hold control over my information, with the control such that when I go to a health care provider, it is up to me to log-in so that they can see my records. I would then be able to allow them access to my records either for a limited time - such as the duration of the appointment, or between set dates - or permanently. <br>
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In the case of an emergency, however, I do not see any problem with the emergency workers (a defined selection with clearance) having immediate access to my records - records in which I see it as entirely possible that my DNA might be recorded.<br>
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Other than this, I see my medical records as belonging to me, and any one else should get a court order. <br>
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The last concern, and ultimately, the more important, is the question of how such a system would be implemented. I have lived in Melbourne, where the automating ticketing system for public transport is a constant joke. Not so many years ago, there was a fuss about insulation, and between times, the funding of schools has caused much political havoc. I look at government implementation and can do naught but sigh. <br>
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Surely we can find a system which has been implemented somewhere else in the world, and bring experts in - with fore-knowledge of all the glitches - to implement our own health record system. If their system were put in place by a certain company, then let us go directly to that company and employ them not just in the implementation phase but also for system support thereafter. In my experience, and observation, relying on local employees who have neither the experience in the system, nor the professional history in dealing with issues involved, is inevitable bound to fail.<br>
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I believe in the values and goals of an e-health system, yet worry about the construction, control and structure of the end product. Hopefully we can do more than muddle through.

The legislative framework that has been announced for the PCEHR allows for a person to hide or remove items from the record without any tracking that an alteration has been made. This means that a health professional will not be able to confidently assume that the information in the record is complete. It therefore becomes quite useless.

The Inquiry report into the ehealth PCEHR Bill has now been released:
http://www.aph.gov.au/Parliamentary_Business/Committees/Senate_Committees?url=clac_ctte/pers_cont_elect_health_rec_11/report/index.htm

'Meaningful purpose' and 'meaningful use' should always have been the highest priority for ehealth; but this founding principle has been missing from the very beginning, and I am at a complete loss to understand why so many 'influential' people over such a long period of time have ignored or refused to discuss 'meaningful purpose and use'.

The Greens were the only party to even touch on a meaningful purpose for ehealth with their Recommendation 4.

This is what every logical, thinking person would expect of a national ehealth system, that is; the capacity to discreetly and securely collect and use (analyse) the widest possible range of health information in a meaningful way for the purpose of improving health outcomes for all - to secure a better health future for all Australians - to shore up this
nation's economic capacity to continue to provide quality healthcare for all well into the future - to create a continuous cycle of healthcare improvement.

This is critical, so that in Australia's future we are not economically forced to go down the same track as the USA - where responsibility for public healthcare was long ago abandoned and transferred to employer private health insurance schemes - where the unemployed must fend for themselves - they cannot afford to see a doctor, cannot afford tests, cannot afford to fill prescriptions, cannot afford necessary procedures, cannot afford hospital care.

Recent News: 'EHRs should include patient-reported data', National Cancer Institute, Harvard University and the University of North Carolina at Chapel Hill, March 2012: 'Adding The Patient Perspective To Comparative Effectiveness Research', March 2012
http://content.healthaffairs.org/content/29/10/1863.abstract?sid=18618fe7-d37f-45f7-be1b-77306039f54f

Not a single 'influential' person, not a single 'influential' politician, not a single 'influential' journalist, not a single so-called 'influential' consumer/patient representative body has, during this entire period, supported meaningful use or patients' rights to self-report their health outcomes so they can make a meaningful contribution to 'meaningful use'.

My sincere thanks to the Greens for at least raising this in their section of the report:

Greens Recommendation 4:
1.4 That the bill be amended to make explicit reference to the use of anonymised, aggregate data from the PCEHR system
for research and public health purposes.