Report urges electronic health records by 2012

Australians can expect to have access to an electronic record of their health history by 2012, should the Federal and State Governments adhere to a key recommendation made in the final report of the National Health and Hospital Reforms Commission (NHHRC) today.

The NHHRC, charged with developing a long-term health plan for Australia, spent the better part of an entire chapter of its long-awaited blueprint espousing the need to urgently advance the ICT systems within Australia's healthcare industry.

"Our recommendation is that, by 2012, every Australian should be able to have a person-controlled electronic health record," the report said.

Such an electronic health record would give citizens access to their health-related information, controls around which medical practitioners this information can be shared with, and choices around "how their health record will be stored, backed-up and retrieved."

The report also recommended that entries into such records be "verifiable" and "auditable."

It "needs to be clear about who has entered data (the provenance of this data) so that a clinician viewing the record, with the patient's consent, can rely upon the information in caring for that patient," the report said.

Equally, "if the patient authorises health professionals to access their record, the patient will also be able to see an audit trail indicating who has added to or viewed the record."

Roadblocks

The concept of a unified health record, acquiring and sharing health information across all levels of Government, public and private practitioners and different types of health care ('primary' care at the GP and 'acute' care at hospitals, aged care etc), has long been discussed but rarely acted upon in Australia.

One barrier has been the views of private health practitioners, who view  patient or "customer" records as competitive information.

"We know that the concept of patients controlling access to their own health information may be confronting to some health practitioners," the report said.

The NHHRC argued, however, that patients "have always had the right to choose whether or not to share some or all of their information with [the] health professionals they consult," whether they be in the online or offline world."

Another major barrier has been privacy concerns from citizens worried about how such information might be used or misused.

In tandem with its eHealth Record recommendation, the report recommended the Federal Government "legislate to ensure the confidentiality and privacy of a person's electronic health data, while enabling secure access to that data by health practitioners (who have been authorised by the person to view relevant data on the record)."

The report said a lack of standards is hampering the ability of health institutions to share information.

 "Much like the state and private railways of the 19th century, Australia runs the risk of unlinked electronic health infrastructure," the report said.

"We can't even identify that a set of data is actually that of one person or another, as there are often many different identifiers for an individual in each service that they are treated.

"Hence, we have recommended the introduction of unique personal identifiers and a set of nationally agreed and implemented standards that would address the need for one system to talk to the other and provide information about the patient, whichever system is chosen to access and record their treatment on."

The report requested the Federal Government take "a leadership role in clearly stipulating the required 'architecture' for electronic health records (including unique identifiers for patients, health professions and health service organisations, authentication systems, and rules to optimise interoperability of systems)."

While the report "recognises and acknowledges" the efforts made by the National E-Health Transition Authority (NEHTA) to develop uniform eHealth standards, it also noted "increasing frustration and mounting cynicism with the pace of action on implementing a national e-health platform.

"The lack of visible utility at the point of care has resulted in calls to stop the 'talkfest' and get on with setting a dedicated budget and definite delivery date with clear responsive and responsible governance for electronically enabling the health system," the report said.

The report also recommended Government investment in 'eHealth teaching, training and change management" - including an increase in the number of graduates studying health informatics.

Finally, the report acknowledged that the Federal Government needs to sell the benefits of unified electronic health records to the public via a "national social marketing strategy" to talk up the "benefits and safeguards."

"The need to build understanding and achieve 'buy-in' from consumers, health professionals and health system managers must be a priority and is a matter of winning 'hearts and minds'," the report said.