Vice President's Message

By Professor Geoffrey DobbWith less than two months to go before the personally controlled electronic health record (PCEHR) is scheduled to go live, it looks set for a soft opening. I think it’s true to say that those with past experience with e-health projects in Australia, and those with an eye to the roll out of similar projects in the UK and elsewhere, have anticipated that resolution of technical issues would create difficulties during implementation. Indeed, many of our colleagues are still providing advice on how these may be overcome.

The practice of medicine is information rich and, in the twenty first century, electronic information management is the normal standard. Pathology providers and general practice have lead the way in shifting their records to computer-based platforms - with radiology practices and some specialist practices following. Regrettably, the public hospital sector, with just a few exceptions, has lagged behind the shift to electronic health records. Nevertheless, the potential advantages of linking this information within a shared health record seems clear in terms of providing access to health information, especially when a patient needs to see a medical practitioner other than their usual general practitioner – perhaps as a fly-in-fly-out worker, a ‘grey nomad’ journeying around Australia, or when a medical or surgical emergency makes a visit to a hospital emergency department imperative.

For these reasons the AMA has supported the concept of an electronic health record.

The reality of what will be available from July 1 falls well short of the AMA’s vision for an electronic health record. The ‘Personally Controlled’ part will make it difficult for medical practitioners to rely on the information as a complete record. The ‘opt in’ system means that, at least at the outset, it is likely only a small minority of patients will have a PCEHR. This is fortunate because it will give an opportunity for significant problems to be resolved before the number of records is large.

It also gives time for the implications of the PCEHR’s existence to be worked through. For example, will there be a duty of care for medical practitioners to try to access information that might be in a shared health summary? And to what extent should they rely on this information?

The AMA has assisted the roll out of the PCEHR by drafting a Code of Practice under the expert leadership of our Chairman of Council, Roderick McRae. But doubts remain. A recent article for the Medical Journal of Australia by Professor Coiera and colleagues raised issues about the safety of relying on the PCEHR. They asked, “What would happen, for example, if drug allergies were incorrectly uploaded from clinical systems or if medication names and doses were somehow incorrectly imported and displayed?”. So who is responsible for the veracity of the information and what governance arrangements will be applied?

Clearly there is a huge task of awareness and education for medical practitioners, other health professionals and the community in general to make the PCEHR functional. This is going to take a lot of time, effort and resources.

Other bumps remain to be smoothed out. The draft proposals for GPs wanting to take part in the PCEHR required them to sign a contract that, among other things, would allow the Department of Health and Ageing to, “…. access your premises, access your information technology systems, require the provision by you of records and information [etc]”. While there has been further comment that a revised draft contract is being developed, and will be released for consultation in response to the AMA’s advice that the original draft contract was unacceptable, it was not a good starting point.

Finally, despite the obligations on medical practitioners, and especially general practitioners, if the PCEHR is to fly, Government support for the work involved seems minimal or absent. The AMA has already published a scale of indicative fees for preparation and maintenance of a shared health summary, but current feedback suggests such items are unlikely to attract Medicare rebates for our patients.

Comment from the Department of Health and Ageing seems to make it clear that GP attendance items can’t be used either, because the current item descriptors will continue to apply. Advice from the Department of Health and Ageing is that there is no new money.

In the absence of Government support are people prepared to pay for preparation and maintenance of their shared health summary? Or are GPs going to do this work for nothing?

These constraints seem likely to limit uptake of the PCEHR after July 1. Over $467 million has been invested in the project. In an era when achieving a budget surplus is the priority it would be easy to kill it off, but it’s too important for that. Instead, it needs further real investment so that it can be developed and modified to ensure as many Australians as possible have an electronic health record. It will be an investment for the future.