The national personally controlled electronic health record will receive a new name, a new governing authority, usability reforms and revised incentive payments for GPs if the federal government sticks by its intention to act on the majority of recommendations made public yesterday in its review of the scheme.
The three man PCEHR review panel, led by UnitingHealth chief Richard Royle with the Australian Medical Association’s Steve Hambleton and AusPost CIO Andrew Walduck, found that while an electronic health record remains a critical part of the future health infrastructure for Australia, it requires “intervention and correction”.
Their re-imagining of the PCEHR - now likely to be known as My Health Record, or MyHR for short - includes the absence of the National eHealth Transition Authority (NEHTA) and a potential operation independent of the Commonwealth purse.
The major recommendations include:
Health record by default
The most significant recommendation made by the review team was to change the approach to user registration for health records from an opt-in model, which has suffered under slow take-up rates, to a default opt-out mechanism.
Health Minister Peter Dutton has already expressed his support for the option, but plans to consult with the public before making his stance formal.
If the transformation is adopted, anyone who hasn’t already signed up for a health record by 1 July 2015 will have a profile created for them by default, which will not yet contain any clinical data.
At this point, consumers would have the option of opting-out and removing any information from view by any clinical practitioners, as well as the ability to switch it back on again and retrieve all of their data.
For those who do not opt-out, there will be an assigned "assumption of standing consent”, which means any interaction with a doctor or hospital will automatically be uploaded to a user's shared health summary.
The similar UK experience, however, suggests that actual opt-out rates will be very low. The National Health Service had only 1.4 percent of nearly 46 million people reject its version.
But the recommendation is almost certain to cause a stir amongst privacy advocates and some members of the public - as already flagged by outgoing information commissioner John McMillan.
To assuage some of these concerns - while doing their best to maintain clinical demand for accurate, un-tampered-with data - the panel proposed a system of alerts that will flag the removal of a document by the patient, which can only been seen by the clinician who uploaded it in the first place.
The rationale is that the marker will trigger a dialogue between the doctor and patient about the removal, its risks and the replacement of the document with something potentially less invasive.
The panel also recommended a system which would automatically send SMS messages to patients when their records are opened and used.
Getting doctors on board
The leap to opt-out is expected to drastically boost the number of consumer profiles in action, but unless doctors are actually using the information, this improvement is just about meaningless, the clinical community told the review panel.
In its submission to the review, the Australian Medical Association said the key to getting clinicians enthusiastic about turning to health records was to make sure they are full of helpful information, and not sporadic and incomplete like at present.
As such, the panel suggested a target data set to be achieved by the 1 July opt-out switchover, which would see demographics, current medications and allergies, discharge summaries and clinical measurements available for all consumers as a minimum.
Usability issues are also central to the mission to sign-up clinicians. In particular, the panel said it received a “large volume of feedback” about the complexity of the National Authentication System for Health (NASH), and the number of security certificates clinicians need to supply before they can start uploading information.
Once inside, the PCEHR itself has been described as “a ‘dumping ground’ for information” which makes it “difficult to find and locate information required”.
The review team has recommended that both be redesigned with usability in mind.
It also proposed an overhaul of the financial incentives offered to GPs to modernise their practices, such as the ePractice Incentive Payment (ePIP) which can be worth up to $12,500 every quarter to eligible medical businesses.
The panel said it would like to see this payment linked to “meaningful use metrics” that reward actual usage of health records as well as the rate of contribution patient data.
If the Government adops the recommendations, the entity leading the PCEHR project, the National eHealth Transition Authority (NEHTA), will be dissolved and transformed into a new entity led by clinicians and software vendors alongside bureaucrats.
The review found NEHTA was notorious amongst its stakeholders for a perceived tin ear.
The panel said a perception that NEHTA had been seeking but not listening to advice from the clinical community had resulted in a reduction in confidence of the private sector "to invest in product development and evolution”.
In response, NEHTA said a governing board made up of state health bureaucrats did not have "the confidence of the industry or audience that it is attempting to represent”.
The review recommended that NEHTA be replaced by a new body called the Australian Commission for Electronic Health (ACeH), whose board will represent a balance between care provider and consumer interests.
It will fill a number of specific experience criteria in terms of background, such as government representatives, GPs, pharmacists and health software providers.
The panel also called for overall responsibility for operating the system to be transferred to the Department of Human Services and its already mammoth IT shop.