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10 Jun 2014

Patients may be required to actively opt-out of having an e-health record under changes being considered by the Federal Government as part of an overhaul of the troubled Personally Controlled Electronic Health Record scheme.

The Federal Government is considering the recommendations of a review it commissioned into the PCEHR, including suggestions it be turned into an opt-out scheme, be re-named MyHR, and include arrangements to make it clear when patients change or withhold information.

The PCEHR, which was commissioned in mid-2012, has met resistance from the medical profession and has failed to elicit widespread interest among patients because of a series of perceived shortcomings.

Doctors, in particular, have been reluctant to use the system because of its limited clinical utility, the additional burden of establishing and maintaining electronic patient records, and unresolved medico-legal issues.

In the early part of this year, little more than one million people had registered for an electronic health record, and a handful of medical practices accounted for a large proportion of the records that had been created.

Former AMA President Dr Steve Hambleton was part of as three-member panel commissioned by Health Minister Peter Dutton to review the PCEHR. The results of the review, which was completed last December, were released by the Government last month.

Among the review’s 38 recommendations, it proposed that participation in the My Health Record (MyHR) system – as it would become – should become an opt-out arrangement from the beginning of next year.

This has been seen as a critical change that would immediately make electronic health records more clinically useful, because knowing every patient had a record would encourage doctors to use the system.

One of the criticisms of the PCEHR was the extent to which patients had control of what appeared in the record, particularly their ability to remove or shield information.

This arrangement undermined the clinical usefulness of the e-health record for doctors, because they could not be confident that it contained all relevant medical information.

To help address this, the review recommended there be a requirement that copies of Medicare items for health assessments, comprehensive assessments, mental health care plans, medication management reviews and chronic disease planning items be uploaded to the MyHR, and to add a flag to alert clinicians if a patient had restricted access to or deleted a document from the record.

The review also recommended that the National E-Health Transition Authority be dissolved and replaced by the Australian Commission for Electronic Health, which would be advised by committees that included clinicians.

The Federal Government has committed $140 million to continue the roll-out of the PCEHR while it considers the findings of the review.

Mr Dutton said the review had provided “crucial advice” on how the PCEHR could be improved, indicating that the existing system was likely to be overhauled.

“The Abbott Government fully supports the concept of a naitoonal e-health record system, but it needs to be effective, functional and easy for all Australians to use, while being clinically relevant to our doctors, nurses and other frontline health care providers,” the Minister said. “It’s clear many of the existing problems with the PCEHR system stem from the rushed early implementation.”

Adrian Rollins

Published: 10 Jun 2014