More Magical Thinking from the RACGP on NEHTA’s E-Health Delivery.

We have had NEHTA publish yet another sponsored advertorial from the Royal Australian College of General Practice (RACGP) this week.

E-Health to assist treating mental health

16 April 2010. Continuity of care for patients suffering mental health issues could be greatly improved with the introduction of e-health according to the Royal Australian College of General Practitioners.

The potential future individual electronic health record (IEHR) will give healthcare providers better access to patient information and improve information-sharing among different health care professionals, leading to better quality care for patients.

Typically, mental health patients visit a number of healthcare providers and it is possible for a patient to have a GP, psychologist and psychiatrist and also deal with other health professionals, pharmacists and even rehabilitation programs, who all need accurate and up to date information about the patient’s care and medication.

The impact of mental health within the Australian population is substantial with twenty per cent of Australian adults affected by some form of mental disorder every year and GPs are often the first point of contact.

Dr Chris Mitchell, RACGP President and GP in northern New South Wales said that the process of linking information back to the GP is critically important.

“There needs to be a shared understanding of the treatments undertaken for a patient, particularly in relation to medications prescribed and the value of that information for the GP is critical in “closing the loop”.

“A consolidated medicine summary, as will be provided with the e-health system, will allow the GP to see when medication has been changed and lead to a better outcome for the patient with all healthcare providers having access to the same information,” he said.

“Patients with mental health illnesses are part of a vulnerable “at-risk” group and we believe their quality of care can be improved with the introduction of a national e-health infrastructure.

“Individual healthcare identifiers are the key that will unlock e-health for Australians.

“Every person in Australia should receive care that is informed by an electronic health summary. The passage of the Healthcare Identifiers Bill 2010 is an essential step to enable e-health innovation and efficiency,” said Dr Mitchell.

To ensure that GPs can deliver the highest standard of care to their patients, the RACGP is ensuring that the National E-Health Transition Authority (NEHTA) is informed of what is reasonable, workable and useful for GPs when leading the progression of e-health in Australia. NEHTA is the lead organisation supporting the national vision for e-health in Australia.

Dr Caroline Johnson, who is a member of the RACGP National Standing Committee -Quality Care, the RACGP representative on the Mental Health Professionals' Association (MHPA) and a GP, said that patient confidentiality is a very sensitive issue in the area of mental health.

“Awareness of consumer and carer issues is crucial. RACGP members are very aware of the particular sensitivities related to the use of and access to diagnostic labels in this area.

“Mental health patients often already feel stigmatised, so we want to be sure that the information used and shared via e-health is always for their benefit. The whole issue of trust and confidentiality is one to be looked at very closely and quality collaboration between health professionals is a vital part of patient care.

“In situations where the patient is highly distressed or confused, for example, hospital emergency settings, getting accurate information quickly about a patient through e-health could potentially result in better outcomes,” said Dr Johnson.

RACGP

The Royal Australian College of General Practitioners is the professional organisation that sets and maintains the standards for quality clinical practice, education, training and research in Australian general practice and represents Australia’s urban and rural general practitioners.

The release is found here:

http://www.nehta.gov.au/media-centre/nehta-news/626-eheath-mental-health

The astonishing thing about this release is that it targets a group of patients (those with chronic mental health problems) who are one of the most likely groups to want to avoid losing control of their personal health information – second possibly behind those who live with HIV – to some nebulous shared EHR system.

It is even more amazing that they clearly recognise the problem – last 2 paragraphs:

“Mental health patients often already feel stigmatised, so we want to be sure that the information used and shared via e-health is always for their benefit. The whole issue of trust and confidentiality is one to be looked at very closely and quality collaboration between health professionals is a vital part of patient care.

“In situations where the patient is highly distressed or confused, for example, hospital emergency settings, getting accurate information quickly about a patient through e-health could potentially result in better outcomes,” said Dr Johnson.”

But they must know NEHTA is yet to convincingly show they have solid ideas about how to protect such critically sensitive information – going to the extent of wondering whether item level access controls are possible and worth the effort.

The official NEHTA site on privacy is here:

http://www.nehta.gov.au/connecting-australia/privacy

There has not been a new publication added to that area of the site since November, 2008.

What they presently saying is as follows:

Privacy

The protection of our privacy is one of the key priorities leading up to the widespread adoption of e-health in Australia.

A Privacy Management Framework has been developed to ensure that privacy is integrated across NEHTA's work program into the design, management and policy development associated with our range of e-health initiatives.

Relevant requirements in privacy law were met to determine what privacy standards apply. However, this approach does extend beyond compliance with the legislation, to ensure community expectations around privacy protection are also met, including thorough regular consultation with stakeholders and the broader community.

----- End Quote.

So what we have is a priority area with no update in 17 months and a collection of platitudes as an apparent policy position. They also fail to mention the that the totality of Privacy Law and nationally consistent implementation is still under review – and that there is not yet a clear detailed government view on Health Information Privacy.

You can read the Australian Law Reform Commission Submissions and views here:

http://www.austlii.edu.au/au/other/alrc/publications/reports/108/61.html#Heading64

The government has partially responded – but we still do not have a uniform national privacy code.

See here:

http://www.dpmc.gov.au/privacy/alrc.cfm

The first part report is here:

http://www.dpmc.gov.au/privacy/alrc_docs/stage1_aus_govt_response.pdf

Page 13 covers the Health Information Aspects and has yet to be legislated – the report only being finalised late in 2009.

Here it is:

Part H – Health Services and Research The ALRC made a number of recommendations to clarify definitions and address a range of health privacy issues, while retaining core provisions in line with confidentiality obligations and professional ethics. The Government will amend the Privacy Principles to:

• enact new rights for individuals to have their health records transferred between health service providers (reasonable fees may apply), and to be told what will happen to their health record if their provider closes down or changes hands;

• clarify that providers can share health information that is necessary for healthcare and is within the individual’s reasonable expectations, promoting appropriate information flows in the sector; and

• strengthen options for access through an ‘intermediary’, with a tailored option if direct access to health information seriously threatens life, health or safety.

The Government will also work with other jurisdictions and health ministers to progress national consistency in the public and private health sectors.

The Government’s response also supports two central proposals to facilitate research in the public interest, simplify regulation, and protect community expectations of personal privacy:

• a harmonised set of rules for Government and private sector researchers will replace the two sets of binding guidelines on non-consensual handling of personal information; and

• the research provisions will be expanded to allow such handling for any research in the public interest, not just for health and medical research.

Two important parameters of the current regime will also be maintained:

• the public interest in research must ‘substantially outweigh’ the protection of privacy – requiring a clear choice in favour of the research; and

• the National Health & Medical Research Council and the Privacy Commissioner will retain primary responsibility for issuing and approving the research rules.

---- End Extract

On the basis of what I have read here from NEHTA and in the ALRC response there seems little understanding of the complexity of these issues for some individuals.

The second bullet point above would seem to be open to all sorts of interpretation and possible abuse that was against a patient’s wishes.

Spruiking of the unalloyed benefits of e-Health from the RACGP certainly does not encourage careful consideration of these issues.

David.