Wednesday, October 21, 2009

I Am Really Trying to Give This Up!

Posted to encourage some professionals to respond.

Should every Australian have their own, portable e-health record?

5:02pm, 20 Oct 2009 by Ross - yourHealth Team

The idea of having personal electronic health records, controlled by each individual, has been recommended by the National Health and Hospitals Reform Commission.

In its report A Healthier Future for All Australians , the Commission said, “Much like the state and private railways of the 19th century, Australia runs the risk of un-linked electronic health infrastructure.

“From remote communities to metropolitan hospitals, governments, private companies and clinicians have implemented dozens of innovative e-health projects.

“But much more can be gained by taking advantage of synergies and committing to a truly national effort to optimise the system.”

Each individual’s e-health record would be designed to give them better access to and more control over their own health information.

With an individual’s approval, health care providers and carers could instantly access the same, up-to-date patient information - avoiding asking them the same questions and manually re-entering patient data.

The Commission believes this approach would help reduce waste and inefficiency in the creation and use of health information and lead to better, safer care and improved health outcomes.


What do you think?

More here:

My view is that they are asking the wrong question and that there is a Government agreed strategy about what is needed that they should be implementing!

Go for it - comments I mean!.



Anonymous said...

I've made these comments before, but they are worth repeating.

A patient controlled, on-line healthcare professional managed electronic health record - YES.

A patient managed, portable (USB/smartcard/etc.) electronic health record - NO.

1. The proposed solution will disenfranchise those who need the most healthcare management - the elderly, most of the chronically ill, indigenous Australians and the poor.
2. Of the remaining population, very few will have a long term commitment to maintaining a comprehensive health record - until they get sick (by which time it will be often too late).
3. Infants and children, particularly those from families identified in Point 1, will also miss out.
4. Patient managed health records are likely to be incomplete and patchy.
5. Clinicians will have far less confidence in a patient-managed health record than they would in a healthcare professional managed health record.
6. Practices will therefore continue to focus on trying to maintain their own copies of a comprehensive health record for each patient - we will have achieved nothing.
7. Who will pay for a patient-managed solution? Who will get paid? The patients???
8. Do you trust Microsoft or Google to participate in the management of your health records? Neither do I.
9. Portable devices will frequently get lost, misplaced, left at home - back to every practice keeping copies again.
10. Portable devices will become technologically outdated. Where would I be today if my health records were on a 3.5 inch floppy disk? Health records need to last a life-time.

This is one reform that health does not need. It is utter rubbish.

Anonymous said...

I would have to agree with Anonymous - very well put !

Anonymous said...

To the 9 points add
10. Inability for researchers to review effectiveness of treatment(s) with a view to develop the most effective and potentially cost effective treatment regimens.

Anonymous said...

I agree with all of the points raised so far. However, I'd like to add a slightly different perspective to the discussion.

My opinion, based on what I have read so far, is that the push toward a patient controlled electronic health record is ill conceived. It seems to be a solution which sounds plausible but is unlikely to work in reality for most of us.

A patient controlled record will put the responsibility of ensuring the record is complete on the patient or whoever is responsible for their day to day wellbeing. Hence, it is likely to be incomplete as many patients will not be able or willing to invest the time and effort required to fill any gaps in the record (or ensure the gaps are filled by others). I suspect that it will be considered, by most people, as enjoyable as filling in their tax return and they will put it off as long as possible.

From what I have seen so far, the need for individual health service providers to maintain their own records, for their patients, will remain.

Anonymous said...

I agree with Anonymous (22 Oct 10:55:00 AM). We have a medical record at our GP or other. If the existing system can be enhanced (patient controlled identifier, online health services and professionals, secure and private) to ensure that our existing medical record is up to date, and if we can authorise access to a limited subset of that record in a safe and secure manner - well we will have solved the most important part of the riddle.

Dr David More MB, PhD, FACHI said...

This is all good - but unless we have high quality, reliable EMRs in the hands of clinicians and feeding systems from labs, radiology etc (and the secure links between all these) then there is no valid, trusted information for the patient or their agent to access.

That has to be step 1!


netspaced said...

It seems to me that patients don't want to control their own health record any more than they want to control the maintenance records of their car.

Governments want patients to control their own health records so that the governments can cut costs. A premise of this is to reduce medical services to interchangeable commodity items. A premise of that is to destroy the relationship that Australians have been used to with their GP. When that goes, so does the trust that had resided in the relationship.

The quality of EMRs in the hands of GPs is one of the factors in the trust. That GP EMR is the jewel in the crown of electronic health information.

Anonymous said...

I have been maintaining a PHR for myself and my family on an Excel spreadsheet on my home computer for a few years now. Despite the fact that it contains unstructured and summary information only, it has become immensely useful. This is because I seem to always forget past illnesses (seems to be those over a year ago) despite how much I thought about them at the time! Now when I or my kids display symptoms the first thing I do is check the PHR e.g. a child is breaking out in spots, can't be chickenpox, they've had that, could be hives again (which they've had twice before), no need to visit the GP, go straight to the pharmacy and get antihistamines. The health system saves money and we save money and time.

Bring on patient-controlled PHRs (secure online ones, not Excel spreadsheets or portable ones)! If the government can't get their act together, let the (regulated) private sector do it! Government should steer, not row, and why not give the cost and risk to the private sector if they want it (and they will be sure to get privacy/security right as it could kill their brands and potentially their businesses overnight if they get it wrong!).

Anonymous said...

I might be wrong, but I think there is a bit of a muddle going on through this discussion, confusing consumer controlled record *access*, and consumer controlled content.

Folks are rightly I think worried about a world in which the PHR is king, and there are no decent clinical feeder systems into it. Its a world in which somehow patient content keeps everything together, and is just plain silly, for all the reasons outlined above. Call that the PHR-centric national model.

What I (think) I hear from NEHTA and the Feds is something different. It sounds to me like a model where we integrate disparate clinical EHRs using health exchange technologies (as is done in the US). The patient controlled bit essentially relates to ACCESS not content ie I think they are saying that patients control to whom access is allowed to their records.

And yes, you could have a PHR added into the mix, and you could even in your PHR set consent permissions to your records I guess (although that is not what I have heard advocated by NEHTA - again correct me if I am wrong). Adding an PHR harms no one and helps many. But its not for everyone.

Are we not then grabbing at ghosts here? I think NEHTA and the minister are making a big mistake in using ambiguous terminology which allows this substantial misinterpretation, and if the highly informed readers here make that mistake, then the situation is wide open for widespread public misperception.

It could very easily be clarified - NEHTA: Are you advocating the national system is all about patient controlled content or access?