This editorial appeared last week in the Sydney Morning Herald.
Electronic health records will make it easier to save a life
Date November 11, 2013
EDITORIAL
How could 22 doctors overlook the signs that one man was suffering from a serious drug addiction? Nathan Attard, 34, died alone, in an apartment infested with stray animals and filled with rubbish and drug paraphernalia, a Sydney coroner's court has heard. Doctors had prescribed him an array of medication including Xanax, morphine, Seroquel and Valium.
After the conclusion of the inquest into Attard's death, Deputy State Coroner Carmel Forbes is expected to recommend a statewide computerised system that would allow doctors and pharmacists to share information and detect patients who are prescription shopping. Such a system is overdue. For years health authorities have been calling for an electronic prescription monitoring system, without result.
''Failure to establish an electronic patient record within five years would be an indictment against everyone in the system, including the government," Prime Minister Tony Abbott said in 2003 during his first formal speech as he took over the health portfolio under John Howard's leadership. He failed that time, let's hope his government does not fail again. The former Labor government began introducing an e-health system but like many of its commitments the roll-out was plagued with difficulties. Just before the election several experts charged with rolling out the billion-dollar project quit the program amid claims the Department of Health and Ageing was more concerned with signing people up to the systems than providing a record that could be usefully managed by doctors.
More than 650,000 people have applied for e-health records but GPs have created only about 4000 shared-health summaries for their patients, which list their diagnoses and medications, because there is no clear financial incentive for GPs to spend the time to input all the information into the patient records. The Australian Medical Association has called for the government to overhaul the scheme. AMA president Steve Hambleton fears concerns over privacy have trumped common sense. Under the system being developed, patients will be able to go in and delete records after a doctor has entered them. This means doctor shoppers, especially those who accumulate prescription drugs, could remove records showing their behaviour.
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To allay privacy concerns, patients could have control over who had access to their records. These records should be viewable by patients, but not changeable (to prevent, for example, doctor shoppers deleting multiple prescriptions from different doctors). Privacy concerns are valid, and people should be able to opt-out from e-records, but for the rest of the community privacy concerns should not trump the implementation of an efficient, useful national electronic system.
The full editorial is here:
This is a very interesting editorial marred by an sad error in fact regarding the ability of the patient to alter the medically entered Shared Health Summary - they can’t.
The editorial makes the very powerful and rather sad point that both sides of politics have really failed to deliver a useable national health record system, while sadly failing to point out that the idea of value of a national e-health record is not something that is by any means certain.
While the editorial seems to be of the view that there is intrinsic goodness and value in a national record system I would suggest there may be less risky and cheaper ways to address the issues that the National EHR is intended to target. A boost to the clinical use of IT in all aspects and then some regional health information sharing mechanism could be a better approach.
The need for leadership, governance and a well-considered overall strategy seems often not too be mentioned as well. As well, being really clear as to the business case for action is also vital.
All in all a ‘curate’s egg’ of an editorial but it is good to see some discussion of e-health in the mainstream media. Coverage has been pretty thin in the last year or two!
David.
I suspect the, somewhat ambiguous reference to consumers being able to 'change their records' is referring to the ability to remove a Shared Health Summary (or any Clinical Document), rather than an ability to change the content of the document.
ReplyDeleteIt's rather sad and pathetic that there is such ignorance and confusion about how this health record thingie is supposed to work.
ReplyDeleteIn the case of the asylum seeker boats, the government thinks that no information is good information.
This and the previous government both seem to be of the opinion that the same applies to the health record.
They don't seem to understand that they have been elected to represent us, not dictate to us. My guess is that the present government will either realise the error of their ways - or suffer at the hands of the electorate.
I do hope the mad monk goes for a double dissolution.
I would have thought that via the PBS and medicare number identifier, Medicare already have the data they need to pick up doctor shoppers and serial abusers of drugs of addiction. They could monitor scripts in the same way that banks monitor credit card purchases for fraud.
ReplyDeleteAll they would then need to do is ring the script writers and alert them to the behavior. Alas this would involve the public service taking responsibility for something so it will never happen.
The total failure of government eHealth is marked by public servants failing to take responsibility for anything, especially other peoples money, a billion $$ of it.
While privacy is important one of the big problems here is being able to opt out, or having to opt in in the first place. In the case of an EHR (or PCEHR) this is not going to have any impact on prescription shopping, or merely the uptake - 650,000 applied but only 4000 created?
ReplyDeleteThey could monitor scripts in the same way that banks monitor credit card purchases for fraud.
ReplyDeleteAll they would then need to do is ring the script writers and alert them to the behavior. Alas this would involve the public service taking responsibility for something so it will never happen.
They do. It's called the Prescription Shopping Program. Only difference is they send a letter not call you.
this is not going to have any impact on prescription shopping, or merely the uptake - 650,000 applied but only 4000 created
The NPDR isn't even fully rolled out yet, once it is available it is an automated system that won't require manual creation. The 4000 figure is for Shared Health/Event Summaries