The national e-health record system looks set to shift to an opt-out model, after an evaluation of trials in Queensland and New South Wales concluded an “opt-out approach to increase both individual and healthcare provider participation and use is the preferred option,” with opt-in approaches “unsustainable”.
A 2013 government-commissioned review of the My Health Record system — then named the Personally Controlled Electronic Health Record (PCEHR) — recommended the system shift to an opt-out approach. Under the original design of the system, an e-health record was only created for an individual if they opted in to the system.
An opt-out approach was seen to be a way of boosting take-up of the e-health record.
The federal government in 2015 announced it would trial an opt-out approach in northern Queensland and in the Nepean Blue Mountains region in NSW. The government introduced legislation to facilitate the move to an opt-out approach. The proposed changes drew criticism from some privacy advocates.
An evaluation of the opt-out trials, which was completed last year but released this week by the Department of Health, said that both among individuals and healthcare providers interviewed there was a “high level of support for the automatic creation of My Health Records”.
“For healthcare providers, the burden of assisted registration is seen as a major impost that is not practical without additional funding,” the report states.
“There is also a belief that, even if these additional resources were available, they would be unsustainable in the health system or could be better used for direct health service delivery.
Among individuals, “after automatic creation was explained and the benefits of the My Health Record system were understood, the sentiment was positive,” the evaluation concluded.
“They said the fact that they did not have to do anything to create their My Health Record was a major plus. They expressed the view that they would not have registered for a My Health Record themselves and would have expected that their healthcare providers already would be sharing information with other healthcare providers in this way.”
“Based on data from all sources available to the evaluation, a national opt-out approach is not only acceptable to individuals, healthcare providers, participating health service and health department managers, it is seen by these participants as the only sustainable and scalable approach,” the report states.
More than 970,000 records were created as part of the opt-out trials. This compared to 80,444 additional e-health records created in two areas in Victoria and Western Australia where “innovative opt-in” methods were trialled to see their impact on uptake of the system.
“The opt-out rates of individuals in opt-out trial sites was low (1.9%), which is in line with international experience with opt-out systems for electronic health records,” the report states.