Thursday, August 18, 2011

The Consent Model For the PCEHR Needs To Be Sorted Out Correctly. We See Some Odd Allies on A Different View.

The Government really has a difficult to choice to make with the consent model to be applied to the PCEHR.

In the last few weeks we have had a number of contributions to this debate.

First (most recently) here:

Guild backs AMA call for e-health rethink

Plans to introduce an opt-in, personally controlled health record system in Australia next year are doomed to failure, according to the Australian Medical Association (AMA).

Dr Steve Hambleton, AMA national president, said the Federal Government should make the system opt-out to maximize uptake, otherwise her feared elderly patients and those who are not technically savvy may miss out.

In Auckland just 91 of one million people opted out of a similar electronic health record when it was introduced there, Dr Hambleton told Sydney’s Sun Herald newspaper.

Tim Logan, acting national president of the Pharmacy Guild of Australia supported the AMA’s position and described the opt-out proposal as the “more sensible option”.

“The PCEHR has the potential to be a technological breakthrough in health management, but it’s so easy to get this wrong,” he said.

Dr Hambleton’s comments echo claims by Kos Sclavos, Guild national president, who said the opt-in system offered no incentive for patients to sign up to the electronic health, earlier this year.

More here:

http://www.pharmacynews.com.au/news/guild-backs-ama-call-for-e-health-rethink

Here is the older report covering the AMA view.

Online health records face uphill battle

Jim O'Rourke

August 7, 2011

A NEW online medical records system is doomed to failure because not enough people will sign up for it, the Australian Medical Association has warned.

From July 1 next year, patients will have to volunteer to ''opt in'' to the system, which stores all their health details, including test results and prescriptions, in a national database. It's the first time patients will be able to access their medical information.

The AMA believes inclusion in the federal government's Personally Controlled Electronic Health Record system should be automatic unless patients choose to ''opt out''. Otherwise, many patients in nursing homes, the elderly or others who are not ''technically savvy'' will miss out, the group's national president, Steve Hambleton, said.

Mr Hambleton said the medical profession supported the concept of having a one-stop source of medical information ''but people should be asked if they want to leave the scheme, not if they want to join''.

''When they did this in Auckland, where they had a million people, only 91 people opted out,'' he said.

John Bennett, chair of the e-health national standing committee at the Royal Australian College of General Practice, said the opt-in issue would be challenging.

''Unless you get enough people taking part in the system, that's healthcare providers and the community, it's hard to have enough information available to make it useful,'' he said.

http://www.smh.com.au/national/online-health-records-face-uphill-battle-20110806-1igfk.html

Also we have had a piece of commentary from Accenture who have experience with a number of health systems all over the world.

EHR Systems—Opt In or Opt Out?

It’s a Question of Information Governance

The short position paper is found here:

http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture_Health_OptInOptOut.pdf

The bottom line from all this seems to me to be that if you want rapid adoption and use of whatever comes from the PCEHR program then opt-out makes some sense. However, unless there can be a high degree of confidence that there will be a level of ‘information governance’ will be adequate to virtually guarantee personal information security and privacy, such a position is really difficult to support.

We have some reassurance from the success of Medicare Australia in protecting their personal information, however their record is not totally unblemished. See here for a link to that material.

http://aushealthit.blogspot.com/2010/03/confirmation-that-medicare-australia.html

There seems to be no doubt that if opt-in is chosen that adoption will indeed be very slow indeed.

At the very least, before opt-out is considered, there does need to be the proper infrastructure, including NASH, in place and the education of users of all sorts needs to be fully implemented and delivered.

From the Government's perspective this really is a 'wicked problem'. Go opt-in and really risk a white elephant or go opt-out and wind up in a political bun-fight.

Views on this issue are more than welcome!

David.

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