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02 Dec 2013

There needs to be a “fundamental change” in the Commonwealth’s troubled electronic health record system to reduce patient control if it is to be used and adopted by doctors, the AMA has warned.

In a blunt assessment of the failings of the Personally Controlled Electronic Health Record (PCEHR), the AMA said that the overriding emphasis on patient control in the present system had come at the expense of clinical utility, with doctors wary of relying on health records where information may be hidden or incomplete.

Since the system went live in mid-2012, little more than one million people have registered for a PCEHR, and barely 11,000 shared health summaries have been uploaded by doctors, fuelling concerns that it is in danger of becoming a very expensive failure.

Last month, AMA President Dr Steve Hambleton was appointed by the Abbott Government to a three-member panel to review the system and advise on changes to improve its usefulness and encourage greater adoption by patients and the medical profession.

In its submission to the review, which is due to report to Health Minister Peter Dutton by the middle of this month, the AMA warned the system risks being rejected outright by many doctors unless the emphasis on patient control is scaled back and the integrity of information contained in the record is assured.

“We support people taking greater responsibility for their own health, and the PCEHR has the potential to assist with this,” AMA Vice President Professor Geoffrey Dobb said. “But patient control should not mean that the PCEHR cannot be relied upon as a trusted source of key clinical information.”

The AMA’s overriding concern is that patients have the ability to remove or restrict access to information in the PCEHR, meaning that it cannot be relied upon as a comprehensive and accurate source of clinical information.

“The current PCEHR arrangements allow patients to restrict access to information, and patients can remove documents without trace,” Professor Dobb said, warning this was a fundamental flaw in current arrangements that undermined the system’s clinical usefulness.

“To encourage use of the PCEHR, GPs, community specialists and emergency department specialists must be confident that it contains accurate, up-to-date information,” he said. “Without a fundamental change to increase clinical confidence, the PCEHR does not serve the best interests of patients. As a result, it would be rejected by many doctors and would fail.”

The AMA Vice President said less patient control would not compromise privacy, because there were already strong safeguards in the enabling legislation to prevent third parties having access to electronic records without a valid reason, and there were heavy penalties for any breaches.

In its submission, the AMA also recommended that the PCEHR be an opt-out rather than opt-in system, as this would ensure a high degree of consumer participation and encourage doctors to commit to using the system.

“Doctors would be much more likely to fully embrace the new system if a majority of their patients had a PCEHR,” Professor Dobb said.

Among other improvements, the AMA has recommended increased assistance for medical specialties and health care organisations in developing the capability to view and upload documents to the PCEHR; ensuring that medical software provides seamless access to the system, as well as ease in uploading documents and information; and making sure that any new functions added to the PCEHR fit within the existing workflow and do not create additional work for clinicians.

Adrian Rollins

Published: 02 Dec 2013