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NHHRC Backs Person-Controlled Electronic Health Records

Dr David More
From a Medical IT Perspective

Issue 82: May 2009
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Editor's Note: Dr David More is recognised as one of the health informatics industry experts and we are pleased to carry his column in i2P.
For this month we have selected his comments in regard to a report prepared after the National Health and Hospitals Reform Commission (NHHRC) released a supplementary paper to its Interim Report, which outlines the Commissionís support for person-controlled electronic health records for every Australian.
As he says, " I am vitally interested in making a difference to the quality and safety of Health Care in Australia through the use of information technology.
There is no choice.. it has to be made to work!

NHHRC Chair, Dr Christine Bennett, said today that the supplementary paper spells out the Commission’s position that an electronic health record is arguably the single most important enabler of truly person-centred care.

“The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care,” Dr Bennett said.

“A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.”

According to recent research commissioned by the National Electronic Health Transition Authority (NEHTA), 82 per cent of consumers in Australia support the establishment of an electronic health record.

The Commission has made seven recommendations to make person-controlled electronic health records a reality. These include:

* By 2012, every Australian should be able to have a personal electronic health record that will at all times be owned and controlled by that person;
* The Commonwealth Government must legislate to ensure the privacy of a person’s electronic health data, while enabling secure access to the data by the person’s authorised health providers;
* The Commonwealth Government must introduce unique personal identifiers for health care by 1 July 2010;
* The Commonwealth Government must develop and implement an appropriate national social marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health approach; and
* The Commonwealth Government must mandate that the payment of public and private benefits for all health and aged care services be dependent upon the provision of data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health record.

The NHHRC supplementary paper, Person-controlled Electronic Health Records, is available on the NHHRC website at www.nhhrc.org.au under Interim Report of the NHHRC. Feedback can be sent to talkhealth@nhhrc.org.au but must be received by Friday 8 May.

----- End Release

Comments on Document Welcome.

I was given access to a late draft.

My comments (as provided to the NHHRC) are as follows:

I am very keen on the PHR concept and I am very supportive of the need for these records.

I have 4 main issues with the present draft which I would like to see addressed.

1. Balance of EMR and other Source Systems and the PEHR

I believe this approach is unbalanced in that it over-emphasises the role of the personally held record and does not properly recognise the place and importance of the provider held record. (Remember it is these records which will contribute a large part of the information held in the PEHR)

In my view the personally held record needs to be adjunctive to the record, and the systems, used by each health professional to optimise the care they deliver.

The care deliverer needs information of known provenance and trustworthiness from external sources (labs, referrers etc) and needs to have decision support and knowledge available at the point of clinical decision making. This proposal does not permit / facilitate the proper exchange of professionally validated information in the way I see as crucial.

The benefits case for Health IT rests on clinical decision support provided at the point of care and that is not recognised clearly enough in this document I believe.

2. Vocational and tertiary training

There is a clearly identified need to ensure sufficient numbers of skilled health IT resources as this is looming as a critical barrier to the successful implementation of a national E-Health work program. The building of Australia’s E-Health skills capacity and capability will require the national coordination of changes to vocational and tertiary training programs. The emphasis of these changes should be to strengthen the understanding of the importance and use of health IT as part of care provider training programs and to increase the number of specifically trained Australian health informatics practitioners. This last action should involve consideration of the establishment of nationally recognised tertiary qualifications in health informatics in a similar manner to countries such as the United States.

3. Governance.

I believe the Commission does need to properly consider the issue of governance of the e-Health domain. NEHTA is ill equipped to do this at the strategic level and clear leadership is needed if any progress is going to be made.

4. A Patient and Professional Information Portal for Health Information and Knowledge.

This was recommended at the 2020 Summit and is not an expensive thing to do, but has been proven by Australian research to improve the quality of care.

I also have some concerns that having this document, the National E-Health Strategy and the Booz document may lead to policy confusion and inactivity.

I understand there will be a more complete plan included in the final report (due in June). So there is very little time to comment. Get to it!


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