Sunday, July 17, 2011

Here Is A Relatively New Document Describing NEHTA’s View of the Current PCEHR ConOps. Interesting Stuff!

The .pdf file is dated 5th July, 2011.

Key points

Draft Concept of Operations: Relating to the introduction of a personally controlled electronic health record (PCEHR) system.

This document is a summary of key points. You can find the full Draft Concept of Operations: Relating to the introduction of a PCEHR at:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/pcehr-document

1. Overview

eHealth is an important part of the Australian Government’s health reform agenda which aims to deliver a better deal for patients and secure the long-term sustainability of Australia’s health system.

To provide better access to health information, the Australian Government is developing the Personally Controlled Electronic Health Record (PCEHR). This system will enable the secure sharing of health information between an individual’s healthcare providers, while giving the individual control over who can access their ehealth record.

The Government has invested $466.7 million to develop the basic functionality required to establish the PCEHR System that will grow over time. This first release will give all Australians from July 2012 the option to sign up for a PCEHR.

The PCEHR System will build on the foundation laid by the introduction of the National Healthcare Identifiers for individuals, healthcare providers and healthcare organisations as well as the National Authentication Service for Health, standard clinical terminologies and methods for communicating health information between healthcare providers such as discharge summaries and electronic referrals.

1.1 The need for a PCEHR System

One of the many challenges faced by the Australian health system is that health information is held in dispersed records across the country. In many healthcare situations, quick access to key health information about an individual is not always possible. Limited access to health information at the point of care results in:

  • A greater risk to patient safety.
  • Increased costs of care and time wasted in collecting or finding information.
  • Unnecessary or duplicated treatment activities.
  • Additional pressure on the health workforce.
  • Reduced participation by individuals in their own healthcare information management.

The PCEHR System will enable better access to important health information, allowing individuals to view their important health information when and where they need it. They will also be able to share this information securely to healthcare providers involved in their care.

This will result in:

  • Improved continuity of care for individuals accessing multiple healthcare providers by enabling key health information to be available where and when it is needed.
  • Access to consolidated information about an individual’s medicines, leading to safer and more effective medication management and reductions in avoidable medication-related adverse events.
  • Enabling individuals to participate more actively in their healthcare by improved access to their health information.
  • Improved diagnostic and treatment capabilities through better access to health information.
  • Improved care coordination for individuals with chronic or complex conditions by enabling the individual’s healthcare team to make better-informed decisions at the point of care.

1.2 The PCEHR System

The PCEHR System aims to place the individual at the centre of their own healthcare by enabling access to important health information when and where it is needed by individuals and their healthcare providers. Individuals will be able to choose whether or not to have a PCEHR, and if they choose to participate, they will be able to set their own access controls. With the individual’s permission, key pieces of health information may be viewed by participating healthcare providers across different locations and healthcare settings.

1.3 Participation

1.3.1 Individuals

Individuals will be able to register for a PCEHR from July 2012. Those who choose to participate will have the opportunity to experience the following benefits:

  • Access to their health information
  • Receive improved healthcare
  • Be more informed about their healthcare choices

Individuals may also nominate representatives (such as family members and carers) to help manage their PCEHR. Authorised representatives (such as parents and guardians), will also be able to register individuals in their care and access their PCEHR. Additional processes will be put into place to manage access when the child becomes older and is able to manage their own PCEHR.

Individuals will be able to withdraw at any time from the PCEHR System. A PCEHR is not mandatory for receiving healthcare services.

1.3.2 Healthcare providers and organisations

Healthcare organisations will be able to access the PCEHR System from July 2012. Healthcare organisations that choose to participate will have the opportunity to:

  • Access health information more efficiently
  • Ensure safer healthcare
  • Deliver more effective healthcare

1.4 Personal control

Central to the PCEHR System is the concept of personal control. Participating individuals can have control over their PCEHR in the following ways:

  • Decide whether or not to have an active PCEHR: The PCEHR System operates on an opt-in model, where individuals elect to register and create a PCEHR. At the point of registration, individuals establish their PCEHR by consenting to the terms and conditions of the PCEHR and set their access controls. Individuals may de-activate their PCEHR at any time.
  • Access information in their PCEHR: Individuals will be able to view any health information contained in their PCEHR.
  • Set controls around healthcare provider access: Individuals can determine and change settings around access to their PCEHR to participating healthcare organisations involved in their healthcare. Individuals may choose from a range of approaches to setting and managing these controls. Where the individual requires emergency care access controls may be overridden.
  • Authorise others to access their PCEHR: Individuals can nominate other persons (such as carers and family members) to access health information in their PCEHR.
  • Choose which information is published to and accessible through their PCEHR: Individuals can request healthcare providers to not send information to their PCEHR. There will be optional advanced mechanisms to more closely manage access to certain information.
  • View an activity history for their PCEHR: The PCEHR System will provide an audit trail where individuals can view a history of actions on their PCEHR.
  • Make enquiries and complaints: Individuals can make enquiries and complaints in relation to the management of personal information in their PCEHR and the PCEHR System.

1.5 Privacy and security

Health information within the PCEHR System will be protected through a combination of legislation, governance arrangements and security and technology measures. Some of the technical and non-technical controls include:

· Accurate authentication of users accessing the PCEHR System.

· Robust audit trails.

· Proactive monitoring of access to the PCEHR System to detect suspicious and inappropriate behaviour.

· Rigorous security testing, to be conducted both before and after the implementation of the PCEHR.

· Education and training of users of the system.

· Requirements that healthcare providers and organisations comply with specific PCEHR System business rules and other relevant legislation.

Individuals will be able to make enquiries and lodge complaints regarding suspicious or unauthorised access to their PCEHR.

1.6 Governance

There will be the establishment of appropriate governance structures and mechanisms to manage the national PCEHR program and its operation. During the PCEHR planning phase to June 2012, the primary accountability for the PCEHR system is with the Minister for Health and Ageing. Planning responsibility for the PCEHR system’s implementation into the broader health sector, and its strategic fit with state and territory health policies, is with the Australian Health Ministers’ Conference.

More information on the eHealth agenda

Please visit our new eHealth Information site at: http://www.ehealthinfo.gov.au/ . This website provides information on the PCEHR, healthcare identifiers, eHealth sites, as well as more general ehealth information through the form of text, interactive diagrams and videos. It is a resource which we will be updating regularly.

You can also find relevant video links below:

http://www.youtube.com/watch?v=3IOoUMwSGMI&feature=relmfu

http://www.youtube.com/watch?v=usTGPRQVZ0A&NR=1

----- End Document.

I find this a useful summary of just what NEHTA is thinking and to possibly get a handle on what is coming down the pike. The key points to me are:

1. While the need for the PCEHR (Section 1.1) identifies all sorts of substantive issues with the present situation it really does not show just how the PCEHR (as proposed) will actually solve the problem of easy access to point of care information for the clinical decision makers. There is also no reference provided to anything in the way of evidence that the PCEHR would make any form of clinical or outcome diference.

2. Section 1.3 on Participation really does not provide much in the way of ‘how’ to the bullet points provided. Mainly I suspect because it has not been worked out yet.

3. Section 1.4 on Personal Control really just ensures that no clinician would be bothered using the PCEHR as a resource for the reason that its completeness is dubious and anyway it has not been designed for them as I pointed out yesterday.

4. The provided authentication controls have really neither been developed or finalised (given NASH is not operational yet) to what is said in Section 1.5 is just motherhood blurb at this point.

4.Section 1.6 shows Governance is still a work in progress.

Overall a flawed idea that is not really much advanced and probably never will be.

David.

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