Tuesday, July 05, 2011

I Wonder How Much Of This Has Actually Been Thought Through? The Next Version of the PCEHR ConOps Needs to Allay these Concerns?

The following article came out a little while ago.

Fight over medical files

Source: The Daily Telegraph

DOCTORS warn they will boycott the Federal Government's multi-million-dollar plan to roll out electronic health records if patients can edit or withhold their medical history.

It is feared patients will withhold embarrassing information when they start accessing and monitoring their medical files for the first time from July next year.

Incoming Australian Medical Association president Steve Hambleton said he supported electronic health records, which would be shared with other medical professionals to provide better health outcomes, but serious concerns remained.

More than $466 million will be spent on developing personally controlled electronic health records, which is one of the Gillard Government's key health reforms.

The Federal Health Department said the system would be trialled before being rolled out.

Patients will be able to decide what is recorded on their files and which medical professional can access their health records.

It is proposed that a teenager at 14 years will be able to control their own records and after 18 years a parent will not be able to access their files.

Dr Hambleton said doctors were uncomfortable with some of the proposals.

"What's the indemnity cost if it's not updated and it's two weeks out of date (and there's an adverse outcome)?" Mr Hambleton said.

"If they can hide and/or delete (information), it's not going to be accurate and doctors won't use it.

"Consumers can delete what kind of drugs they are on."

More here:


Last week we had the following from the Editor Emeritus of the Medical Journal of Australia.

Martin Van Der Weyden: From the sidelines

Brave New World of e-health a minefield

WHO owns medical information? Patients, doctors or institutions?

For some time now information technology has been heralded as a potential driver of reform, promising to improve much of the inefficiency and ineffectiveness that besets modern health care.

Indeed, it has generally been acknowledged that PCEHRs (personally controlled electronic health records) will allow timely and extensive information sharing among health care providers.

In the national sphere, federal Health Minister Nicola Roxon has long recognised the potential of e-health records, claiming that they will allow for a “seamless interconnection” and will save health professionals and patients substantial amounts of time. “Implemented properly, electronic health records will reduce inefficiencies between different parts of the health system and lower the potential for mistakes: inadvertent misdiagnosis or treatment”, the Minister is reported as saying.

To this end, hundreds of million dollars have been invested in the National E-Health Transition Authority (NEHTA) to make the idea workable. But like most things pursued by a consultative process, it has fallen victim to accommodating the pressures of powerful vested interests and the framework for the e-health record is in danger of becoming a dog’s breakfast.

The High Court ruled 15 years ago on doctors’ ownership of medical records, which was followed by changes to privacy law, giving patients the obvious and accepted right to access their own health records. But with dual ownership, PCEHRs raise new issues, such as censorship of content and restriction of access to information. In short, consumers would ultimately control what information is stored in their record and who can view the file.

In this event, the utility of such a file to doctors would be compromised and would become largely irrelevant to their practice.

This quandary raises the fundamental question: who owns the medical information? The one who provides care? The one who pays for the care? The institution, where the care is delivered? All of the above? None of the above? Some of the above? Confusion reigns supreme.

Even more crucial, is the question: who is ultimately responsible for the veracity, accuracy and currency of information?

Along with the expansion of electronic health information, there has been a potential commercialisation of patient databases. This begs the question: can patients now selectively authorise commercial access to their e-health records?

Imagine the nightmarish scenario this could unleash, especially if personal DNA information were to be added to patients’ files.

There is no doubt that the question of ownership of medical information will be acutely focused by the proposed PCEHRs, and the issue is bound to become a legal and ethical minefield.


Dr Martin Van Der Weyden is emeritus editor of the MJA.

Posted 27 June 2011

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While I am sure the PCEHR proponents will be claiming this is all just a medical ‘winge’, I believe there are some very serious issues contained here that will need to be properly addressed if the nation’s clinicians are to be any way persuaded to come on board the program.

Clarity of responsibility, and appropriate remuneration, for those accepting professional risk will be absolutely crucial. If, as I suspect, it proves impossible to blend patient control and professional accountability then the only way the PCEHR program will be able to remain viable will be via a total re-design of how the system will operate.


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