Tuesday, May 19, 2015

The Federal Parliamentary Library Provides Some Commentary On The Government My Health Record initiative. A Good Summary Of The Views and Well Worth A Read.

This appeared a few days ago.

E health

Budget Review 2015–16 Index
Dr Rhonda Jolly
E health makes use of developments in computer technology and telecommunications to deliver health information and services more effectively and efficiently. The e health funding provided in this Budget represents the Government’s response to recommendations made in a 2013 review into its predecessor’s Personally Controlled Electronic Health Record (PCEHR) system.[1]
Prior to Budget night, Health Minister Sussan Ley announced that the Government would provide $485 million over four years to restructure the current system.[2] The Minister suggested that this funding would deliver ‘a fully functioning national e-health system’ that could save taxpayers $2.5 billion per year within a decade, and an additional $1.6 billion in annual savings for the states and territories.[3]
There are to be a number of major changes to current arrangements under the restructured system. These include a name change—the PCEHR will become the myHealth Record. Unlike the PCEHR, responsibility for myHealth is to be situated within a new body, the Australian Commission for eHealth. This body, which is to be established by July 2016, will take over from the National E-Health Transition Authority (NEHTA).
In response to criticisms of the model adopted under the PCEHR that required patients to request that an e health record be set up, the revamped system will trial a system that will automatically create an e health record for participants. It will be necessary for patients to request that they are not included in the system—that is, they will have to ‘opt out’. Commenting on the proposed model, a Government spokesperson maintained that rather than changing directly to the new system, the trial will be necessary ‘to ensure public confidence in the system is maintained’ and to ‘assist in evaluating the effectiveness of associated public awareness and information dissemination and education and training for healthcare providers’.[4]
Many stakeholders appear to be pleased with the decision to trial the opt out model. Leanne Wells, from the Consumer Health Forum (CHF), for example, has stated that the approach ‘will require active leadership from the Minister, an open and transparent process and a public education campaign to ensure community and clinician confidence in the security and reliability of the scheme’.[5] The Australian Medical Association (AMA) appears supportive of the proposed revision and the Royal Australian College of General Practitioners (RACGP) considers it would help to ensure future policy could be based on evidence. RACGP president Frank Jones has added, however, that the organisation considered it crucial that the trial was directed by medical practitioners, not bureaucrats.[6]
The RACGP has observed also that it would closely examine details of the revised system as they emerge, since it is eager to see where funding is to be allocated and whether training in its use will be provided to general practitioners. Moreover, the RACGP is keen to see if, and how medico-legal issues associated with the new model will be resolved, whether arrangements for governance for the new e health commission will be appropriate and whether those arrangements will include stakeholder representation.[7]
Not everyone is satisfied that the Government’s approach will deliver a well-functioning solution. E health analyst, Steve Wilson, believes it is simply not possible to switch from opt in to opt out records unless the fundamental architecture of the system is redesigned to include a ‘privacy by design’ function which is attuned to the new model. Wilson contends:
... you simply cannot invert the consent model as if it's a switch in the software.
The privacy approach is deep in the DNA of the system. Not only must PCEHR security be demonstrably better than experience suggests, but it must be properly built in, not retrofitted.[8]
Academic Dr David Glance has commented also that while changes may increase the general usage of the e health record system, the system itself ‘remains fundamentally flawed’ because there is no guarantee that all health professionals involved in patient care will participate and supply information, nor is there a guarantee that information supplied will be complete.[9] In addition, the system will continue to allow patients to withhold information so that records may not be complete—and acting on such a record ‘becomes a significant clinical risk’ for health professionals.[10] Dr Glance considers that there are other models that may work better than that proposed by this, and the previous government, and that some alternative models have the benefit of not needing centralised infrastructure, and as a result, not needing government involvement.[11]
In a variation of Glance’s proposition, former Senator Amanda Vanstone has declared that perhaps it is time to say with regards to e health projects in general that ‘enough is enough’ and to ‘outsource the job to the private sector’.[12] Bernard Keane, from the online journal Crikey, is similarly unimpressed with the proposed changes to e health records. Keane declares the Budget simply ‘warms over’ a ‘dud’ Labor idea, which he labels ‘one of the most spectacular wastes of money of recent decades after War on Terror funding’.[13]
Lots more here (including my comments)
It is very good to see the Government is hearing that there are a wide range of choices other than just steaming down some idea invented five years ago that does not seem to have worked and which has cost a bucket!


Anonymous said...

I'm from the GUVMINT and I'm here to help. It will take another 5 years at least to work out if we can make the new system work because we haven't designed it yet but there are some big companies offering their software that they say will do the job for us. So that might be a better option. We've got plenty of money earmarked to put their way if their system looks good. First however we have to get some people on board who know what they are doing and we can't do that until we start unwinding NEHTA which will be a slow process. First we have to progressively make the NEHTA people redundant because their jobs will be going away and we will have to pay them quite a lot of redundancy money because some of them have been there a long time. Then we have to interview them to see if they have the expertise to do the job we need done in the new eHealth organisation we are starting up in place of NEHTA. Of course there is no guarantee those people will join if we don't offer them at least what they were earning at NEHTA and a bit more for the inconvenience of taking a redundancy and changing over to a new job to do what they have always been doing. The Health Minister seems to think this is the right way to go so at least we have made it to first base. It should be plain sailing from hereon if she doesn't change her mind and divert our half a billion dollars somewhere else where it might be more useful.

Anonymous said...

National Commission for eHealth? Seems somewhat odd. Why don't we have a national commission for E-Education or E-Human Services or E-Defence or E-Sport. Or we could roll them all up into a National Commission for E-Things.
I suppose the idea is to separate the E-stuff away from the cumbersomeness of the business of health per se.
E-Health for E-Health's sake?
It would be useful to know what the mission, objectives and performance measures of the new Commission are to be? One of the failings of NEHTA has been that it was never clear what their actual role was.