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Major e-health record re-think underway

30 Sep 2014

A major re-think of the use of e-health is underway that would see a shift away from a single, national electronic health record scheme to a network of smaller systems through which vital clinical information can be shared.

University of Western Sydney computing expert, Adjunct Associate Professor George Margelis, is among those urging a new approach that seeks to harness existing e-health systems, which are often organised around a hospital, geographic region or specialty, by developing ways that can communicate with other and allow for clinical information to be shared nationwide.

The ability to securely deliver reliable clinical information was “the ultimate end point,” A/Professor Margelis said, “but we need to get there by evolution rather than revolution”.

The UWS academic will be among a number of speakers to address the e-health Interoperability Conference to be held in Sydney in late October, at which ideas on how to link existing e-health systems to create a virtual national network through which patient and clinical information can be shared.

The new direction in thought is being developed as the Abbott Government ponders how to proceed following the damning findings of a review it commissioned into the previous Government’s $1 billion Personally Controlled Electronic Health Record (PCEHR) scheme.

The design of the Scheme has been heavily criticised by clinicians worried that the ability of patients to delete or modify information without notification seriously compromised the reliability and clinical usefulness of the record. Very few medical practices have signed up to the scheme.

The review panel, which included former AMA President Dr Steve Hambleton, recommended that the PCEHR be turned into an opt-out scheme, be re-named MyHR, and include arrangements to make it clear when patients changed or withheld information.

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

A/Professor Margelis said there were many e-health systems already up and running around the country, though mostly they were small and self-contained.

He cited as an example the system set up by St Vincent’s & Mater Health Sydney that enabled patient electronic records to be shared between St Vincent's Hospital, St Vincent's Private Hospital, St Vincent's Clinic and local GPs and specialists.

A/Professor Margelis said such systems were often well-suited to the particular characteristics of the area, including the needs of patients, but it meant the e-health landscape was “very fragmented”.

He said it made more sense to develop ways to enable these systems to securely communicate with each other rather than to impose an overarching national system.

“The system that works well in inner-metro Sydney is not necessarily the system that will work well in rural WA,” A/Professor Margelis said. “We need to remember that most health is local.”

He likened the idea of creating a national electronic health record system from scratch to “going from nought to 100 overnight”, and a better way was to help connections and networks to evolve with the active involvement of clinicians.

A/Professor Margelis said input from clinicians was critical in order to ensure e-health records developed in ways that were clinically useful and appropriate.

For this reason he thought the appointment of Dr Hambleton to head NeHTA was “exciting” because “he understands the need for clinical engagement at the grass roots”.

He said e-health needed to be part of the medical school curriculum so that doctors we familiar enough with the concepts to be able to convey their needs to those designing e-health systems.

The e-health Interoperability Conference is being held at the Parkroyal Darling Harbour, Sydney, on 28 and 29 October.

Adrian Rollins

Published: 30 Sep 2014