Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Monday, July 08, 2013

Weekly Australian Health IT Links – 8th July, 2013.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

A really amazingly rich week - with a lot of reading and some very interesting discussions.
Having missed the NEHRS adoption target in FY 2013, it is important to remember the FY 2014 target it to add an additional 1.5Million. The only way that will happen will be a lot of money being spent on promotion. We can all wait and see.
Last but not least we can all be pleased to see the Qld Government saying it will learn from Qld Health Payroll debacle and like fiascos. I hope so.
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Labor comes up short on personally controlled e-health plan

THE government has failed to deliver on its 500,000 target for the personally controlled e-health record system, coming up short by about 100,000 consumers.
According to a Health Department spokeswoman, the total number of PCEHR users was 397,745 as at June 30. She could not reveal the average number of logins for last month.
That represents a whopping increase of 313,196 registrations last month alone, compared with 84,549 at the end of May.
The government set a goal of half a million registrations by June 30 this year before the PCEHR went live 12 months ago.
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3 July 2013, 6.52am EST

Is the government’s missed health record target meaningful?

TThe government has failed to meet a self-set target of 500,000 registrations of its Personally Controlled Electronic Health Record (PCEHR) by July 1. As at June 30, the Department of Health and Ageing said that total number of users was 397,745. The majority of these registrations resulted from a recent…
The government has failed to meet a self-set target of 500,000 registrations of its Personally Controlled Electronic Health Record (PCEHR) by July 1.
As at June 30, the Department of Health and Ageing said that total number of users was 397,745. The majority of these registrations resulted from a recent push by DoHA using consultants to sign people up at public hospitals and at eHealth roadshows.
Still, even if the government had met the target of 500,000, it would have been a meaningless gesture. The vast majority of those who have signed up, if they ever get around to logging in, will be greeted with an empty record.
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E-record patient sign-ups miss target

4 July, 2013 Huseyin Sami
The Federal Government has fallen short of its goal of having 500,000 patients signed up for personally controlled electronic health records (PCEHRs) by 30 June - but not by as much as feared.
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Call for pharmacists to get e-health incentives

4 July, 2013 Nick O'Donoghue
Pharmacists should be given the same incentives that GPs receive to boost the uptake of the Federal Government’s Personally Controlled Electronic Health Record, a pharmacy IT expert believes.
Paul Naismith, CEO of the Fred IT Group, told The Australian that a significant amount of work was needed to be done to boost uptake of the PCEHR, and that pharmacists were in a position to increase the number of people setting up e-health records.
“There is no doubt... that in the longer term the PCEHR will deliver real improvements in patient care,” he said.
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Apps user ready to share medical history

KAT Roberts is a savvy digital user and frequently uses all four fitness apps on her smartphone but she's never heard of the government's personally controlled e-health record system.
One year since the PCEHR was unveiled subscriber numbers have been steadily increasing. By early last week it had passed the 320,000 mark.
Roberts, a Melbourne-based marketing executive, says she has no qualms sharing her medical information with doctors and backs the idea of an e-health record system.
"I think it's (e-health record) really good. I've moved a few times in the last couple of years and tend to go to different doctors.
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E-health patient sign-up misses target

2 July, 2013 Antonio Bradley
The Federal Government has fallen short of its goal of having 500,000 personally controlled e-health records  (PCEHRs) by June 30, missing the mark by about 100,000 patients.
By the end of June, 397,745 patients had registered for a PCEHR, and that number was only reached after a huge surge in sign-ups during the month, according to figures obtained by The Australian.
A staggering 313,196 patients registered in June, adding to the total of only 84,549 patients who had registered before the month began.
The government had held out hope of reaching the target right up until the last month, with Health Deputy Secretary Rosemary Huxtable telling a budget estimates hearing last month that the target was "still in sight".
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Incentives not enough to entice doctors: Guild

5 July, 2013 Nick O'Donoghue  
Generous incentive payments being offered to doctors are not enough to encourage patients to sign up to the Personally Controlled Electronic Health Record (PCEHR), according to the Pharmacy Guild of Australia.
The Guild’s comments followed the publication of a survey which found one-in-six Australian doctors did not believe patients should have any access to their individual health record.
The survey of 3700 doctors in eight different countries, carried out by Accenture, found that Australian doctors were the second most resistant to patients being able to view their health record, Leigh Donoghue, managing director of Accenture’s health business in Australia and New Zealand, said.
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No more IT debacles, hopes Minister

Date July 5, 2013 - 4:41PM

Sylvia Pennington

The Queensland Government has unveiled a raft of measures it claims will prevent technology debacles, such as the failed Queensland Health payroll project, from occurring on its watch.
Risky and high value ICT projects will be scrutinised by a council of directors-general and overseen by Minister for Information Technology Ian Walker and his departmental head Andrew Garner.
A former lead government business partner at Ernst and Young, Mr Garner assumed the mantle of whole-of-government CIO in May.
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eHealth could ease end-of-life choices

Dr Terry Flynn, a health economist who is a Senior Research Fellow at the Centre for the Study of Choice at the University of Technology, Sydney, has found that the majority of older Australians he surveyed didn’t want medical intervention at the end of their lives.
However, because Advance Care Directives remain relatively uncommon and are not always shared with decision-makers in time, most people could not make their wishes known.
Around 110,000 people a year need some form of end-of-life care and more than half of all deaths occur in hospitals, despite most Australians indicating a preference to die in their own home.
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The difficult birth of online medical records

Sunday 7 July 2013 9:05AM
It sounds like a fantastic idea. No matter where you are your healthcare provider can access your complete medical history online.
The federal government wants all of us to give permission for our medical records to be available in this way.
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eHealth: The good, bad and ugly

Technology should make our lives easier. However, in health-IT a good idea can easily go bad. But the opportunities are mind-boggling and we’ve got exciting years ahead of us. Let’s have a look at the good, bad and ugly in eHealth, including cyber insurance, liability issues, telehealth, mobile apps, social media and of course the PCEHR.
PCEHR
The PCEHR has gone ugly. Sidelining doctors and clinical leads didn’t do the project any good. A basic requirement of a successful project is effective stakeholder management. Healthcare evolves around GPs, and if the main stakeholders are not on board for 200%, the project will fail. Meanwhile, the government has started data-mining our patient’s eHealth records. A colleague recently said on an IT forum:
I demand legislation that simply states something like: Information stored in the PCEHR can exclusively be accessed by health professionals directly involved in the patient’s treatment and exempt from access by any other third-party including by means of subpoena
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Do vendors like standards or not?

Posted on July 4, 2013 by Grahame Grieve
Quoting from discussion on David More’s blog:
“[Vendors] basically saw the standards as having the potential to erode the significant barriers to entry they had put around their little proprietary walled gardens”
This is something I hear a lot, but the reality is much more nuanced than that.
To illustrate, consider the example of a service provider who makes a living by selling the provision of a service. The actual service doesn’t matter – it could be selling software that manages a clinical data repository (i.e. EHR), selling communications (Vodafone etc), or a surgeon who does open heart surgery.
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Federal and State Governments Agree to Fund e-Health after July Next Year

As per reports, current funding for PCEHR is given by the federal government and the National e-Health Transition Authority (NEHTA) is funded jointly. The funding will expire on June 30 next year.
In a memorandum of understanding (MOU) dated November 9, 2012, which was sanctioned officially last month, the federal, state and territory governments have agreed to provide funding for e-Health from July 2014.
Official sanction to the MOU was given by Federal Health Minister Tanya Plibersek on June 25 this year. It was signed by Queensland, SA and the ACT by the end of 2013 while WA signed it in February, NSW in May and Victoria and Tasmania in June.
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Australian doctors give patients less control over their e-health records: survey

More than three-quarters of doctors surveyed say sharing electronic health records has reduced errors
Doctors in Australia are more resistant to giving patients’ control over electronic health records than doctors in other countries, according to an Accenture survey.
Accenture surveyed 3700 doctors in eight countries, including 500 doctors in Australia. The survey was conducted during November to December 2012.
Australia’s personally controlled electronic health record (PCEHR) scheme has had a slow start despite support by government and prominent healthcare CIOs.
Most of the Australian doctors surveyed support limiting patients' ability to update their electronic health records. Only 18 per cent said patients should have full access to their own records.
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The facts add up to good health

BIG data is being used to drive improvements in the delivery of health services at a local level and may prove crucial to efforts to make the system more sustainable.
The National Health Performance Authority was established to analyse and report on the performance of public and private healthcare organisations across nearly 50 indicators set by the Council of Australian Governments.
The use of data is not new in healthcare - it is used for everything from recording drug side-effects and adverse events to tracking infectious diseases - but the work of the authority is different in that it allows nationally consistent data on service delivery to be reported at a local or peer-group level.
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Data breach hot potato to bounce back

Date July 4, 2013 - 4:51PM

Mahesh Sharma

The data breach notification bill is not dead in the water, observers say, despite being a casualty of a politically-charged final parliamentary sitting week.
The bill, which requires organisations to notify the Federal Privacy Commissioner and affected consumers of a security breach that affects personal data, was due to be debated by the Senate last week after being approved by the House of Representatives in early June. However, the Labor leadership spill that reinstalled Kevin Rudd as Prime Minister pushed the new notification rules off the agenda.
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Productivity: creating a government of 'doers' not 'gunnas'

Too much time is spent on discussing, researching and strategising projects and not enough emphasis is placed on implementation. Peter Fritz explains how it’s time to incentivise project completion.
Decide faster, implement faster, monitor better, develop the right incentives to drive the process, that’s what’s needed to ensure Australia is productive.
…..
Besides the obvious silos that are called departments, such as those of Finance, Innovation, Environment, Health and so on, our organisations are further divided into sections and units, few of which are co-ordinated for the single purpose.
An example of how this plays out is the introduction of electronic health records. First committed to in 1991, today after spending several billion dollars, Australia still does not have a fully functioning online health records system. Only 109,000 people have registered out of a target of 500,000 by June 2013. It should not have taken 22 years to get the project off the ground. This is just one of the many examples where our lack of productivity is failing us. It is not the billions of dollars spent that are the largest cost to the country and the community, but the opportunity costs a whole generation has missed out on.
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Western Health administers backup remedy

Health provider implements Veeam software to protect data
Melbourne based health provider, Western Health, is set to deploy new backup software in order to improve the data protection and disaster recovery capabilities of its virtualized infrastructure.
The organisation employs 6000 staff across three acute care hospitals, two aged care facilities and a day hospital facility.
Western Health manager of systems and software solutions, Cameron McBride, told Computerworld Australia that it had experienced limitations with its previous backup tool.
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Australian among first to have Wi-Fi cardiac checkups

3rd Jul 2013
AN AUSTRALIAN now living in South Africa is among the first cardiac patients to use Wi-Fi technology for checkups with her Brisbane cardiologist.
The St Jude Medical Merlin@home transmitter, approved for use in Australia in May, allows pacemakers, implantable cardioverter-defibrillators (ICDs) and cardiac resynchronisation therapy defibrillators to be monitored wirelessly over the internet.
Dawn Butler, 69, was diagnosed with cardiomyopathy four years ago and fitted with an ICD before moving to South Africa two years ago. 
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3D printers help create bionic ears

  • From: AP
  • July 04, 2013 8:01AM
WITH a 3D printer, a petri dish and some cells from a cow, US researchers are growing synthetic ears that can receive and transmit sound.
Instead of printing with hard plastics, the Princeton University scientists send bovine cells mixed in a liquid gel through the printer, followed by tiny particles of silver.
The printer is programmed to shape the material into a "bionic ear" and forms the silver particles into a coiled antenna. Like any antenna, this one can pick up radio signals that the ear will interpret as sound.
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InterSystems to Showcase Advanced Technologies for Breakthroughs in Patient Care at Australia’s Health Informatics Conference

Demonstrations Will Include Real-Time Analytics and Strategic Interoperability;
Booth Visitors Can Get Vital Signs Measured and See Medical Device Integration in Action
SYDNEY -- July 2, 2013 -- InterSystems, a global leader in software for connected healthcare, will show the latest versions of the InterSystems TrakCare® unified healthcare information system and InterSystems HealthShare® strategic informatics platform at HIC 2013, Australia's Health Informatics Conference, and participate in a practical interoperability demonstration at the IHE Australia Showcase.
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New electronic health processing set to speed up visa applications

by Ray Clancy on July 2, 2013
Collaboration between Australia and Canada has resulted in more than 100 countries now having access to eMedical, the Department of Immigration and Citizenship’s new electronic health processing system that enables more efficient and cost effective visa processing.
A DIAC spokesman said that eMedical is an updated and improved version of the former eHealth system used to record online the health examination results of visa applicants who complete their examinations for both DIAC and Citizenship and Immigration Canada (CIC). ‘Increased use of eMedical will result in substantial benefits to DIAC and our clients, including improved client service, enhanced integrity and significant financial savings,’ the spokesman explained.
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Global IT spending forecast slashed

  • From: AFP
  • July 03, 2013 8:19AM
MARKET tracker Gartner has slashed its forecast of how much global businesses would spend this year on information technology.
The huge cut in estimated spending to $4.05 trillion ($US3.7 trillion) comes as less expensive tablets displace PCs at the workplace.
Gartner cited fluctuations in the value of the US dollar along with reduced outlay for traditional personal computers as the main reasons it cut to $3.7 trillion its Worldwide IT Spending Forecast for 2013.
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Most of us still not ready for video-link diagnosis

THE elderly are most likely to want to visit their doctor or GP for medical care whereas their children are open to using a video link, according to the latest Newspoll.
The Newspoll, conducted for the Path to Prosperity series, showed a slight drop in the confidence of Australians in the health system and their ability to afford the necessary care - 86 per cent are still content with levels of quality and safety.
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Time now for a bold plan to make telehealth a reality

THE unprecedented growth of the aged population in developed western economies has led to intense interest in the potential of telehealth and telecare services to help manage chronic disease at home and in the community.
The increasing number of aged people will place unsustainable stress on established healthcare services and will result in increasing deficits in clinical human resources, the expansion of disease management programs and patient demand for greater self-management.
Despite a significant focus and investment on developing ehealth standards and infrastructure, very little policy work has been done in Australia to deploy telehealth as a solution to the increasing demands and costs of managing chronic disease. In contrast, the first report from Britain's Department of Health on this subject was published in 2000. This since has been followed by many other studies such as their Preventative Technology Grant of 2006-08 which provided £80 million ($132.4m) to local authorities and their partners for investment in assistive technology and, most recently, £31m of funding for a Whole System Demonstrator program which noted telehealth as integral for the management of long-term conditions.
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NBN Co hits June 30 rollout target, but many users 'not serviceable'

THE NBN Co has hit its politically crucial June 30 rollout target, passing more than 207,000 homes and businesses. But more than one quarter of those are unable to order a service on the superfast fibre network.
The NBN Co has revealed that as of June 30, it had passed 163,500 existing homes and businesses and 44,000 new housing estates with the National Broadband Network.
But of those passed by the fibre footprint only 33,600 homes and businesses, or 16 per cent of premises, have signed up to a service.
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NASA's Voyager 1 approaches outer limit of solar system

Date June 28, 2013
Washington: The Voyager 1 spacecraft is approaching the outer limit of the solar system but remains months or even years away from the farthest reach of the sun's magnetic pull, NASA said on Thursday.
In the meantime, the US space agency's pioneering craft launched in 1977 is sending back a wealth of data on the final frontier of the solar bubble — or heliosphere — which scientists have dubbed the magnetic highway.
"This strange, last region before interstellar space is coming into focus, thanks to Voyager 1, humankind's most distant scout," said Ed Stone, Voyager project scientist at the California Institute of Technology in Pasadena.
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Enjoy!
David.

Sunday, July 07, 2013

I Have To Say This Is Hardly A Surprise - Enrolment in The NEHRS / PCEHR Falls Short. Lots Of Commentary This Week.

The following appeared a few days ago.

Labor comes up short on personally controlled e-health plan

Source: The Australian
THE government has failed to deliver on its 500,000 target for the personally controlled e-health record system, coming up short by about 100,000 consumers.
According to a Health Department spokeswoman, the total number of PCEHR users was 397,745 as at June 30. She could not reveal the average number of logins for last month.
That represents a whopping increase of 313,196 registrations last month alone, compared with 84,549 at the end of May.
The government set a goal of half a million registrations by June 30 this year before the PCEHR went live 12 months ago.
At a budget estimates hearing last month, Health Deputy Secretary Rosemary Huxtable said the target was "still in sight" after getting 10,000 registrations - the highest number in a single day - on June 4. She later said 500,000 "may be a stretch".
More here:
This was followed by some really good commentary on The Conversation from Prof. David Glance.
3 July 2013, 6.52am EST

Is the government’s missed health record target meaningful?

David Glance
Director, Centre for Software Practice at University of Western Australia
The government has failed to meet a self-set target of 500,000 registrations of its Personally Controlled Electronic Health Record (PCEHR) by July 1.
As at June 30, the Department of Health and Ageing said that total number of users was 397,745. The majority of these registrations resulted from a recent push by DoHA using consultants to sign people up at public hospitals and at eHealth roadshows.
Still, even if the government had met the target of 500,000, it would have been a meaningless gesture. The vast majority of those who have signed up, if they ever get around to logging in, will be greeted with an empty record.
Given the lack of active participation on the part of GPs, as well as the lack of public hospital systems to integrate with PCEHR, there’s little evidence to suggest that this is going to change any time soon.
So far, only 4,805 individual providers have signed up to access the PCEHR portal. This is despite the fact that the government provides incentives to GPs to connect to the system by paying them the Practice Incentive Payments for eHealth (ePIP).
Despite these payments, GPs still struggle to see the benefit of spending time curating shared records when the legal liabilities are still unknown but are potentially severe.
The cost of the ongoing maintenance of these largely empty records is about AUS$80m a year. And that’s just the baseline. It’s clear that a great deal more funding will be needed to try and lift the level of meaningful use of PCEHR.
The problem for governments is that increasing spending on a system becomes progressively harder the longer it remains largely unused. What’s more, the devolved nature of the Australian health system makes it extremely unlikely that we’ll ever see true and meaningful use of the system.
What we will continue to see however, are reports of increasing numbers of registrations, data about the number of people who accessed the system and how much administrative data has been added.
The latter figure, in particular, is an easy one for the government. All Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data gets added automatically. This shows when individuals have claimed anything on MBS or filled out a script at the pharmacist.
Again, this data is clinically meaningless and of marginal benefit to an individual. Its only use is for, perhaps, reminding people when they last saw their doctor.
We also had some pretty grumpy comment from the a libertarian commentator pointing out an possible agenda for the whole program!
Wednesday, 3rd July 2013
Melbourne, Australia
One of the big topics I discuss in my new investment advisory service - Revolutionary Tech Investor - is regenerative and personalised medicine.
These two hot trends fit perfectly into the philosophy of this newsletter too - the idea that you should be positive about and look forward to the future.
That is of course in stark contrast to most of the things you see in the mainstream about the future.
You know what we mean - the irrational fear that rising oceans will drown everyone...that we'll run out of food in some sort of Malthusian Hell...and that robots will kill everyone, just for kicks.
Of course, people have feared the future for thousands of years, so this kind of reaction isn't surprising. But for those 'hoping' for the end of the world, we've some bad news: it ain't happening...
Just one note.
I've seen the government's Medicare eHealth record system promoted as 'personalised medicine'.
Let's get one thing straight. It is not 'personalised medicine'. Or not in the way I and most others in the technology sector think of it.
The Medicare eHealth system is just a sneaky way for the federal government to get you to voluntarily submit your private information to a government database.
Like all government schemes, that's not how they promote it. They promote it as a useful way for you to keep your health info in a safe and secure database...so that doctors and other healthcare professionals can quickly find out your health history and the medication you're taking or have taken.
The reality is that the government is simply getting the kind of information that it would otherwise try to get through the intrusive and compulsory Census questionnaires.
My tip is to avoid the eHealth program at all costs. As always when the government gets involved with anything, it's simply the thin end of the wedge. The government's ultimate goal is to create a UK-style 'Death Pathway'.
Because the National Health Service is so costly to the UK government, it has to set parameters on who, when and for how long hospitals can treat patients.
If the beancounters' spreadsheet says a patient has a low chance of survival from a treatment or that the treatment won't necessarily lengthen the patient's life, the hospital guide the patient towards an early 'exit'.
And by 'exit' I don't mean leaving the hospital to go home. I mean leaving in a box.
I'm afraid that's the result of socialised medicine for you.
As for real personalised medicine, well, that's something completely different...
Lots more on real personalised medicine here:
And to top it all off the ABC’s Sunday Extra weighed in with an almost 20 minute program with Mukesh Haikerwal and David Glance asking what has gone wrong.

The difficult birth of online medical records

Sunday 7 July 2013 9:05AM
It sounds like a fantastic idea. No matter where you are your healthcare provider can access your complete medical history online.
The federal government wants all of us to give permission for our medical records to be available in this way.
But as of 30 June 2013, a paltry 397,000 Australians have registered for one of these 'Personally Controlled E Health Records'.
So, why aren't we biting?
Links to audio and so on are found here:
All in all with advertising in full flight and the commentary collected here there is a lot going on. I have to say I am not sure the whole program is still not as flawed in design as it has always been - with even the NEHTA Clinical Lead saying the whole thing needs more clinical engagement and work!
Docs still do not seem to be happy:
Witness the results of this poll from Australian Doctor:
Are you taking part in the national e-health scheme and writing health summaries for PCEHRs?
- Yes, I am taking part in the scheme and have already written health summaries for PCEHRs. 6.62% (19 votes)  
- Yes, I will be taking part in the scheme, but have yet to write a PCEHR health summary. 29.62% (85 votes)  
- No, I am not personally taking part, but colleagues in my practice are who I can refer patients to. 7.67% (22 votes)  
- No, I will never take part in the scheme and will not be promoting its use to patients.  56%  (161 votes)  
Total Votes: 287
We also have this report:

Australian doctors give patients less control over their e-health records: survey

More than three-quarters of doctors surveyed say sharing electronic health records has reduced errors
Doctors in Australia are more resistant to giving patients’ control over electronic health records than doctors in other countries, according to an Accenture survey.
Accenture surveyed 3700 doctors in eight countries, including 500 doctors in Australia. The survey was conducted during November to December 2012.
Australia’s personally controlled electronic health record (PCEHR) scheme has had a slow start despite support by government and prominent healthcare CIOs.
Most of the Australian doctors surveyed support limiting patients' ability to update their electronic health records. Only 18 per cent said patients should have full access to their own records.
The survey also found 77 per cent of Australian doctors surveyed said that sharing health records electronically reduced medical errors last year. Also, 83 per cent said they actively used electronic medical records and about 70 per cent reported improved quality of diagnostic and treatment decisions by using shared electronic records.
Lots more here:
And of course this blog:

eHealth: The good, bad and ugly

We’ve come a long way with technology in general practice. Technology should make our lives easier. However, in health-IT a good idea can easily go bad. But the opportunities are mind-boggling and we’ve got exciting years ahead of us. Let’s have a look at the good, bad and ugly in eHealth, including cyber insurance, liability issues, telehealth, mobile apps, social media and of course the PCEHR.
PCEHR
The PCEHR has gone ugly. Sidelining doctors and clinical leads didn’t do the project any good. A basic requirement of a successful project is effective stakeholder management. Healthcare evolves around GPs, and if the main stakeholders are not on board for 200%, the project will fail. Meanwhile, the government has started data-mining our patient’s eHealth records. A colleague recently said on an IT forum:
“I demand legislation that simply states something like: Information stored in the PCEHR can exclusively be accessed by health professionals directly involved in the patient’s treatment and exempt from access by any other third-party including by means of subpoena”
I’m not holding my breath here but it’s a clear message, shared by many GPs. By failing to listen to doctors the PCEHR will be added to the already impressive global scrap heap of major health IT fiascos. But the good news is: there are alternatives. Instead of wasting more tax dollars, we should adopt one of the already fully functioning, cheaper Australian shared record systems, like RecordPoint from Extensia.
Lots more here:
As I said there is a lot going on. Meanwhile the system remains its lumbering self.
David.

Commentary On The PCEHR On Now On Radio National.

The difficult birth of online medical records

Sunday 7 July 2013 9:05AM

It sounds like a fantastic idea. No matter where you are your healthcare provider can access your complete medical history online.
The federal government wants all of us to give permission for our medical records to be available in this way.

See here:

http://www.abc.net.au/radionational/programs/sundayextra/ehealth-records/4801862

David