Dr Rhonda Jolly
E health makes use of developments in computer technology
and telecommunications to deliver health information and services more
effectively and efficiently. The e health funding provided in this Budget
represents the Government’s response to recommendations made in a 2013 review
into its predecessor’s Personally Controlled Electronic Health Record (PCEHR)
system.[1]
Prior to Budget night, Health Minister Sussan Ley announced
that the Government would provide $485 million over four years to
restructure the current system.[2] The Minister suggested
that this funding would deliver ‘a fully functioning national e-health system’
that could save taxpayers $2.5 billion per year within a decade, and an
additional $1.6 billion in annual savings for the states and territories.[3]
There are to be a number of major changes to current
arrangements under the restructured system. These include a name change—the
PCEHR will become the myHealth Record. Unlike the PCEHR, responsibility
for myHealth is to be situated within a new body, the Australian Commission
for eHealth. This body, which is to be established by July 2016, will take over
from the National E-Health Transition Authority (NEHTA).
In response to criticisms of the model
adopted under the PCEHR that required patients to request that an e health
record be set up, the revamped system will trial a system that will
automatically create an e health record for participants. It will be
necessary for patients to request that they are not included in the system—that
is, they will have to ‘opt out’. Commenting on the proposed model, a Government
spokesperson maintained that rather than changing directly to the new system, the
trial will be necessary ‘to ensure public confidence in the system is
maintained’ and to ‘assist in evaluating the effectiveness of associated public
awareness and information dissemination and education and training for
healthcare providers’.[4]
Many stakeholders appear to be pleased with
the decision to trial the opt out model. Leanne Wells, from the Consumer Health
Forum (CHF), for example, has stated that the approach ‘will require
active leadership from the Minister, an open and transparent process and a
public education campaign to ensure community and clinician confidence in the
security and reliability of the scheme’.[5] The
Australian Medical Association (AMA) appears supportive of the proposed revision
and the Royal Australian College of General Practitioners (RACGP) considers it
would help to ensure future policy could be based on evidence. RACGP president
Frank Jones has added, however, that the organisation considered it crucial
that the trial was directed by medical practitioners, not bureaucrats.[6]
The RACGP has observed also that it would
closely examine details of the revised system as they emerge, since it is eager
to see where funding is to be allocated and whether training in its use will be
provided to general practitioners. Moreover, the RACGP is keen to see if, and
how medico-legal issues associated with the new model will be resolved, whether
arrangements for governance for the new e health commission will be appropriate
and whether those arrangements will include stakeholder representation.[7]
Not everyone is satisfied that the Government’s approach will
deliver a well-functioning solution. E health analyst, Steve Wilson,
believes it is simply not possible to switch from opt in to opt out records unless
the fundamental architecture of the system is redesigned to include a ‘privacy
by design’ function which is attuned to the new model. Wilson contends:
... you simply cannot invert the consent model as if it's a
switch in the software.
The privacy approach is deep in the DNA of the system. Not
only must PCEHR security be demonstrably better than experience suggests, but
it must be properly built in, not retrofitted.[8]
Academic Dr David Glance has commented also that while
changes may increase the general usage of the e health record system, the
system itself ‘remains fundamentally flawed’ because there is no guarantee that
all health professionals involved in patient care will participate and supply
information, nor is there a guarantee that information supplied will be
complete.[9]
In addition, the system will continue to allow patients to withhold information
so that records may not be complete—and acting on such a record ‘becomes a
significant clinical risk’ for health professionals.[10]
Dr Glance considers that there are other models that may work better than that
proposed by this, and the previous government, and that some alternative models
have the benefit of not needing centralised infrastructure, and as a result,
not needing government involvement.[11]
In a variation of Glance’s proposition, former Senator
Amanda Vanstone has declared that perhaps it is time to say with regards to e
health projects in general that ‘enough is enough’ and to ‘outsource the job to
the private sector’.[12] Bernard Keane, from the
online journal Crikey, is similarly unimpressed with the proposed
changes to e health records. Keane declares the Budget simply ‘warms over’ a
‘dud’ Labor idea, which he labels ‘one of the most spectacular wastes of money of recent decades after
War on Terror funding’.[13]
Regardless of the legitimacy of these types of criticisms,
it is most likely too much to expect any government to abandon the PCEHR in its
entirety, given the substantial investment in the e health project made by
various federal governments since the 1990s. And as Steve Hambleton, the former
AMA President and current chair of NEHTA has remarked, while the PCEHR could
have been more efficient, the foundations of the e health record system are in
place.[14] So it may be impractical
to abandon work already accomplished. Nevertheless, at the very least,
technical issues such as those raised by Wilson would seem worthy of further
investigation. So too is the idea that the opt out trials should not only
include advice from health practitioners, but also the expertise of medical health
information technicians.
It may be that the suggestion from long-time critic of the
current e health record system, Dr David More is pertinent—the funding in this Budget
represents ‘a holding action’; that is, a prelude to the development of what Dr
More thinks will be a ‘new’ strategy for e health.[15]
It is more likely that the new strategy will actually be a variant of the old
strategy, simply because it is too costly and difficult to replace existing e
health architecture. At the same time, it will be
interesting to see how the opt out model contributes to a new or improved or
revised strategy, and to what extent the suggestion of more inclusive system
development, which has accompanied the myHealth announcement, is
realised to the satisfaction of government, health practitioners, medical
software and other industry stakeholders and patients.
[1].
Department of Health, Review
of the Personally Controlled Electronic Health Record (Royale
report), December 2013.
[2].
S Ley (Minister for Health), Patients
to get new myHealth Record: $485m ‘rescue’ package to reboot Labor’s e-health
failures, media release 10 May 2015.
[3].
Ibid.
[4].
K McDonald, ‘Budget 2015: money for PCEHR reboot is to last four years’, Pulse+IT, 11 May 2015.
[5].
Consumers Health Forum, Online
health records trial a big step forward, media release, 19 May 2015.
[6].
Australian Medical Association (AMA), Spectre
of 2014 Budget overshadows modest measures in 2015 health budget, media
release, 12 May 2015 and McDonald, op. cit.
[7].
McDonald, op. cit.
[8].
S Wilson, Why
the Govt can't simply go opt-out for e-health, itNews, 11 May 2015.
[9].
D Glance, New name and opt-out policy won’t save the personal health record, The Conversation, 11 May 2015.
[10].
Ibid.
[11].
Ibid.
[12].
A Vanstone, ‘Increased
taxes a sure loser’, Canberra Times, 11 May 2015, p. 4.
[13].
B Keane, Deficit, schmeficit: Hockey focuses on the short term, Crikey, 13 May 2015.
[14].
A Gartrell, Budget to revive health scheme on life support, Sun Herald, 3 May 2015, p. 10.
[15].
D More, ‘Here
are the main details of the e-health area of the Budget for 2015-16. Very, very
interesting!’, Australian Health Information Technology blog, 13 May 2015.
[15].
A Gartrell, Budget to revive health scheme on life support, Sun Herald, 3 May 2015, p. 10.
[15]. D
More, ‘op. cit.
All online articles accessed May 2015.
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