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Tuesday, May 05, 2009

E-Health back on the agenda- privacy issues to follow

The National Health and Hospitals Reform Commission (NHHRC) has released a paper which outlines the case for person-controlled electronic health records for every Australian by 2012.The Commission says an electronic health record is arguably the single most important enabler of truly person-centred care. “The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care,” the Chair, Dr Christine Bennett said. It would" enable people to take a more active role in managing their health and making informed health care decisions.” Person-controlled Electronic Health Records (PDF 262 KB)

The seven recommendations to make this a reality are:
    • By 2012, every Australian should be able to have a personal electronic health record that will at all times be owned and controlled by that person;
    • The Commonwealth Government must legislate to ensure the privacy of a person’s electronic health data, while enabling secure access to the data by the person’s authorised health providers;
    • The Commonwealth Government must introduce unique personal identifiers for health care by 1 July 2010;
    • The Commonwealth Government must develop and implement an appropriate national social marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health approach; and
    • The Commonwealth Government must mandate that the payment of public and private benefits for all health and aged care services be dependent upon the provision of data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health records.
Karen Deane in The Australian says that the proposed "person-controlled" system really leaves it to the individual to pay for and adopt a commercially available system from Google or Microsoft for their health record, with Government's role to regulate privacy and technical standards. She quotes AushealthIT blogger David More warning that the approach was "unbalanced" as it over-emphasised the role of the personally held record "and fails to recognise the importance of the provider's records". On his blog, Dr More gives a more detailed assessment. While strongly supportive of e-Health, he comments:
"It is simply absurd to propose a national deployment of Personal Health Records without addressing a range of other critical issues.These critical issues in the e-Health domain include governance, funding, leadership, communication, professional and provider education and consumer involvement. I believe the necessary balance was properly and consultatively achieved in the National E-Health Strategy which was developed last year and which I am deeply concerned may not receive the attention and funding it is due because of the release of this new document. The NHHRC needs to absorb two key pieces of information is seems to be ignoring.

First it needs to recognise there is no established benefits case for PHRs (they are essentially too new for the work to have been done) so investment in this area is speculative and not evidence based at preset. (see paper cited above)

Second it must be clear that when it has been talking of EHRs it has been – to date – talking of provider maintained and used EHRs – for which there is a much longer history of use and an overwhelming benefits case – including work done by organisations as diverse as the RAND Corporation and NEHTA.

No-one, just no one, has asked to public if they want their own personal health record to which their health professionals will be financially compelled to contribute. This is a nonsense of a just staggering magnitude. The new NHHRC document is essentially a semantic and definitional con job as it takes evidence of value and success from ‘real’ electronic health records and just assumes the same can be said about PHRs. This is just not true!

Just how the NHHRC proposal fits with this announcement from NSW Health Minister John Della Bosca last week, I have no idea:
"By the end end of next year, every public hospital in NSW will move from paper patient notes to electronic medical records that can be accessed by any health worker, the Government has announced. The Minister for Health, John Della Bosca, said the $100 million project to digitise 250 hospitals will save money by eliminating duplicate diagnostic tests and imaging. It will also improve patient safety by alerting staff to a deteriorating patient and reduce the likelihood of errors."
Is this the fruition of the NSW trial of an e-health record much criticised at the time, that raised all sorts of privacy issues in 2006? Does anyone know if any later reports on the trial surfaced publicly?

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