'Opt-in' will undermine e-health records: AMA

Government must issue data to support the "opt-in" model

The Australian Medical Association (AMA) has continued to lobby the government to change its $466.7 million e-health record system to an “opt-out” model, arguing that the current “opt-in” model will undermine the system’s health improvement objectives.

In its submission (PDF) to the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, the industry body’s president, Steve Hambleton, maintained the current “opt-in” design will undermine the goals of the system, “to reduce the occurrence of adverse medical events and duplication of treatment”.

“In the early days we are concerned that if medical practitioners search for a PCEHR they will often not find one for their patient,” the submission reads. “This may deter future attempts by medical practitioners and consequently lead to a very low uptake of the proposed PCEHR by medical professionals.

“We predict it will be many years before the PCEHR becomes ubiquitous in health care.”

Former health minister, Nicola Roxon, released information on the number of medical errors and unnecessary tests conducted in hospitals, but the government has not revealed the rate of uptake of the PCEHR by consumers required to reduce such errors, the submission argues.

“To our knowledge, the Government has not presented any supportive data to justify that the opt-in design of the system will deliver an appropriate level of participation,” said the submission states. “A much simpler and more effective design would have been achieved by making the record opt-out.

“The vast majority of patients want their doctors to have access to their critical medical information so they can receive the best possible care. Consumers with serious concerns about privacy, or an objection to their medical and health information being shared could actively make the choice not to participate in an opt-out system.”

According to Hambleton, those patients that are in need of e-health records, such as the elderly, could then benefit from the system without having to participate to the extent the current system model requires.

The submission also noted the AMA’s concern about the possibility of the PCEHR adding to the “information chaos” already experienced by clinicians due to the significant administrative tasks it requires.

“If doctors have to interrupt their clinical workflow to check if a patient has a PCEHR, and then could find that the information they need is not accessible, this will make it more difficult to deliver quality patient care, not less."

“To date no data has been made available measuring the impact of using the PCEHR on clinical workflows,” Hambleton argued in the submission. “No information has been released from the lead implementation ‘wave’ sites to show how the system is working in practice.

“This information is critical to assisting medical practices and other healthcare organisations to integrate the use of the PCEHR into their everyday practice.”

Added to this are the numerous disincentives for clinicians to participate in the PCEHR, including the added risk, cost and time spent for doctors to create a shared patient summary for free.

“It is essential that provision is included for the nominated provider to be remunerated for their important work creating shared health summaries.”

In its submission to the legislation, the National e-Health Transition Authority (NeHTA), the body charged with the roll out of the PCEHR, acknowledged the ongoing concerns about consumer control of information in the record, but said it would not change the system’s design.

“Some medical professionals have raised concerns that if consumers are able to restrict access to information in their PCEHR, this will create clinical risk because healthcare providers will be basing their decisions on only part of the story,” the submission read.

Follow Chloe Herrick on Twitter: @chloe_CW

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