Andrew Took: Access essential for e-health cards

THE Personally Controlled Electronic Health Record (PCEHR) system to be introduced in Australia from 1 July is consumer-centric in its design.

Not only is it an opt-in model and a completely voluntary scheme, but consumers will be able to access all their health information stored on the PCEHR and, by setting advanced access controls, can exclude parts of their medical history from being accessed by treating practitioners.

Much has been said that unless we adopt an opt-out model, take up rates will be poor and the vision of better health outcomes for Australians will remain illusory.

Ideally, a consumer’s PCEHR will enhance their medical treatment by providing a consolidated summary of his or her health information. It does not — and never will — replace the doctor’s clinical records.

As long as the consumer does not place restrictions on access, the PCEHR will provide the treating practitioner with access to specialist letters, referrals, shared health summary (SHS), prescribing information and discharge summaries at the touch of a button. Further down the implementation track, pathology results and other reports may be included.

The PCEHR will create opportunities for improvements in the continuity of consumer care and, by consolidating information about a consumer’s medications, has the potential to reduce certain adverse events such as the prescription of an antibiotic to a patient with a known allergy.

However, despite Avant’s recommendations, health practitioners reviewing a patient’s PCEHR will not be advised if access to certain health information in a PCEHR has been restricted by the consumer by setting advanced access controls.

While recognising the consumer’s right to privacy, Avant believes it is both desirable and necessary that the system should, at the very least, alert the practitioner to the fact that access has been restricted. The knowledge that certain information has been restricted would enable targeted discussions and warnings to be given by the treating practitioner regarding proposed treatment.

Accordingly, treating practitioners will need to proceed with treatment decisions on the premise that patients may have restricted their access to certain health information.

Health practitioners may also need to consider whether they choose to act in the critical role of an individual’s “nominated provider”, anticipated in the majority of cases to be a GP.

A key aspect of the role of the nominated provider is to create and manage an individual’s SHS. The scope of the nominated provider’s potential legal liability may be increased in a situation where inaccurate or outdated information is unwittingly uploaded and is relied upon by other health providers accessing the SHS. This may be a disincentive to a GP to accept the role of nominated provider.

Avant has recommended that draft PCEHR legislation be amended to include a limited immunity from civil liability for a nominated provider in regard to their role in maintaining a patient’s SHS, provided they have acted in good faith and without gross negligence.

There are also important privacy and security issues for all health practitioners accessing the PCEHR system. Although the data contained within the PCEHR system will be housed in a central repository, medical practices must still comply with national privacy laws.

The draft legislation contains civil penalties for intentional or reckless unauthorised collection, use and disclosure of health information contained in an individual’s PCEHR. For example, failing to change passwords on a regular basis, or neglecting to install antivirus and anti-malware software so your practice computers are vulnerable to unauthorised entry could have serious consequences.

The RACGP has produced guidelines on computer security that may be helpful for a practice in reviewing their current data security measures.

Ultimately, the success of the PCEHR system will rest on the willingness of both consumers and health practitioners to “opt in”, and on consumers making their health information fully available.

Mr Andrew Took is Avant’s national manager, Medico-Legal Advisory Service.

Posted 13 February 2012

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