The federal government is set to spend A$485 million to rescue Australia’s failed personalised electronic health record project. All Australians will be set up with a record and can opt out, in contrast to the previous system where patients opted in.
The new system, called myHealth Records, will be revised according to the recommendations of a report commissioned by the former health minister Peter Dutton in 2013. The report had 38 recommendations to improve the existing Personally Controlled Electronic Health Record system (PCEHR). The very first was to change the name from the less-than-catchy PCEHR (pronounced “pecker”) to the only slightly more acceptable myHealth Record.
Other recommendations included the dissolution of the National E-Health Transition Authority (NEHTA), the organisation widely blamed for the overly complicated and unusable system that resulted from nearly A$1 billion in funding. In its place will be an oversight organisation called the Australian Commission for e-Health that will have a variety of sub-committees reporting into it.
The report also tried to address another criticism of the system by tackling the incentivisation of GPs to actually spend time uploading data to their patients’ personal records. The recommendation here was to tie cash incentives to uploading data and that billing for GP management plans require these plans to be uploaded to the patient’s myHealth record.
Probably the biggest change from a political perspective is the default creation of a record for every Australian, then allowing people to opt out. This would certainly address the low take-up rate of the PCEHR. After three years, only two million people have registered for a record so far, with the majority of these records being empty of any meaningful data.
The PCEHR review report showed that even by December 2013, consumer access to the system was dropping rapidly and provider access stayed flat, despite increasing amounts of content being put into the system.
While some of the changes proposed for the personal record may increase general usage of the system, it still remains fundamentally flawed.
The first problem is that the system still represents a “scrapbook” approach to a clinical record. There is no guarantee that all the health professionals involved in the care of a patient will participate and supply information, nor that the information supplied will be complete.
Couple that with the ability of the patient to hide aspects of their record and the final picture is not only incomplete, but acting on it becomes a significant clinical risk. UNSW Australia researcher Professor Enrico Coiera has detailed the extensive clinical risks inherent in a personal record here.
Using the record in clinical practice is extremely difficult. In fact, the Australian Medical Association’s own guidelines details that the personal record is only a “memory prompt” for the patient and that “remains the treating medical practitioner’s responsibility to take a clinical history from their patient”. In other words, a doctor can not rely on the personal record to make clinical decisions.