E-health record concept document leaves questions

Welcomed by industry, but the hard work is yet to begin

Industry has welcomed the release of the draft concept of operations for the Federal Government’s $466.7 million Personally Controlled Electronic Health Records (PCEHR), but complete clarity on the project remains lacking.

The 130-page document, released Tuesday by health minister Nicola Roxon, maps out the record’s function, possible information as well as proposed security and privacy settings and how the system will connect with clinical systems. The release of the document, which the Federal Government had previously been reluctant to offer publicly, came as it sought to incite further discussion around the project and iron out potential issues prior to going live on 1 July 2012.

Royal Australian College of General Practitioners (RACGP) e-health spokesperson and former clinical lead at the National E-health Transition Authority (NEHTA), Dr Nathan Pinskier, told Computerworld Australia that while the document was robust it left many questions open.

“Does [the document] answer all the questions? Absolutely not and that’s a process that will become clear over the next 12 months as a result of the lead e-health sites and through further public consultation over the next few months,” Pinskier said.

“I don’t think there’s anything specifically missing but at the end of the day to make a national e-health system work it has to have clinical utility, it has to work for the clinicians on the ground, it also has to be trusted by consumers.”

According to Pinskier, global attempts at national e-health solutions remain immature, with the PCEHR itself leaving questions about methods of access by clinicians and the accuracy of system data.

“There needs to be some more clarity around what information sets consumers will be able to suppress or withhold, there is a model there and it’s been fairly well framed in the discussion paper but it still needs some work over the next three months and over the next 12 months,” he said. “The consent mechanisms and access mechanisms also still need further defining.”

Communication issues between consumers and the industry groups are also yet to be resolved, Pinskier said. However he noted ongoing work within the DoHA and NEHTA to align the ideas of various stakeholder groups through “four-cornered” roundtable discussions.

The project has and will continue to change from its original conception, said Pinskier, however the priorities around creating a shared health summary “by and large” have remained the same.

Prior to the document's public release, NEHTA head of clinical engagement, Mukesh Haikerwal, voiced uncertainty about the content the draft would include, noting opinions around what should be included varied greatly.

"Everyone has a view of what should be in it; that view grows depending on who you talk to and so when you coalesce that you’ve got a massive elephant," he said at the time.

“Because technology and standards and things change, that elephant moves, so to make it successful we’ve got to deliver something that is small; an elephant that is small and tied down.”

The document has also changed significantly since first begun in April 2010, having undergone at least ten revisions in the past year.

According to Pinskier, the draft has provided more clarity around the scope of the project, what should be included and what could be involved by the first cut on 1 July next year.

“Is there enough time? It is an ambitious timeline we’re talking about; 15 months to connect a number of disparate health data silos. I would envisage by the time we go live most of those issues should be sorted out at least at a macro level.”

Pinskier warned against “cumbersome” processes around accessing the e-health record, suggesting the patient demographics targeted for trial use by the government and NEHTA would be unlikely to adopt a system that was ultimately difficult to use.

Commenting on the release, Roxon said patients today should be able to visit their local GP, specialist or emergency department and know their health records are available at a click of a button.

Follow Chloe Herrick on Twitter: @chloe_CW

Follow Computerworld Australia on Twitter: @ComputerworldAU

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Tags e-healthRACGPPersonally Controlled Electronic Health Record (PCEHR)

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