Submission to the Commonwealth Department of Health and Aged Care: The Better Medication Management System (BMMS): Draft Exposure Legislation: July 2001.

Background

The BMMS Legislation seeks to establish an individual electronic medication record for patients. The object is to provide patients and their doctors with improved access to medicines information to reduce adverse outcomes and to decrease hospitalisation as a consequence of such outcomes. The participants in the system will be patients, doctors, pharmacists and the Government. Participation will be on the basis of consent. On registering to participate patients will also be given the option of consenting to the use of their personal medication information for other purposes, including research. Doctors and pharmacists will have access to the patient record only on the basis of patient consent. The BMMS Board established under the legislation will have the power to make decisions on the release of patients' de-identified and identifiable health data for a range of purposes under guidelines to be determined by the Board. The Board, once established by the legislation, will also make a range of decisions on privacy issues. The consultation period for the exposure draft of the legislation was 28 May until 9 July.

The AMA's Stand

The AMA supports e-health initiatives that provide opportunities to significantly improve health outcomes for patients while at the same time protecting the privacy of the patient's health information. The AMA's view is that the BMMS legislation:

• Does not offer patients or doctors confidence that the privacy of patient medication information will be protected and;
• Does not establish the means to achieve stated health outcome objectives

The AMA's view is that while the BMMS concept is of value this legislation must be shelved. Achievement of the stated BMMS objective is based on assumed outcomes from a complex combination of policy, process and technical features.

The AMA's view is that development and implementation of a significant pilot project using multiple sites is a way forward. Such a pilot would inform development of policies, processes and technical issues that contribute to comprehensive legislation.

The AMA is not convinced that such a pilot requires enabling legislation. In terms of privacy issues the Privacy Legislation is likely to provide "adequate" coverage for undertaking a pilot.

The AMA's Concerns

The AMA's concerns with the draft BMMS legislation are that it:

• Establishes a BMMS Board whose independence is potentially compromised in the selection process;
• Delegates key patient privacy protections to the Board for determination instead of including these in the legislation;
• Permits the option of private sector management and operation of the individual patient health information database;
• Imposes onerous burdens on GPs and subjects them to excessive punishment for non-compliance;
• Potentially establishes something akin to a licensing system for doctors and pharmacists to participate;
• Potentially compels GPs or pharmacists who do not wish to participate in BMMS, to do so;
• Creates extensive new liabilities, responsibilities, workloads and costs that outweigh the marginal benefit to patients of an unreliable medication record.

Action Taken by the AMA

The AMA has been actively engaged in all consultation processes related to the development of the BMMS, including representation on the BMMS Development Group, Technical Working Group and Privacy Sub Group.

In March 2001 the AMA convened a non-government stakeholders meeting. The objectives of this meeting were to establish a clear objective and develop an agreed development plan for BMMS.

AMA submission to Government of 5 July2001, provides detailed comment on the draft legislation.