PCEHR review recommends opt-out model, NEHTA dissolved

Written by Kate McDonald on .

The federal government has released the Royle review into the PCEHR, which recommends the name of the system be changed, that NEHTA be dissolved and the system move to an opt-out model, and that improvements be made to clinical usability.

Health Minister Peter Dutton told the HIMSS conference in Sydney today that the government's response to the review's recommendations was still several months away, but that he strongly agreed with the recommendation that the system be opt-out for consumers, rather than the current opt-in model.

The review, conducted by Uniting Care Queensland executive director Richard Royle, AMA president Steve Hambleton and Australia Post CIO Andrew Walduck, found that there was “overwhelming support” for continuing the path of implementing an electronic health record for all Australians.

However, it made 38 recommendations on how to improve the system, the most controversial being a recommendation to transition to an opt-out model from January 1, 2015.

The panel also recommends changing the name of the system to the My Health Record (MyHR), and that the National E-Health Transition Authority (NEHTA) be dissolved and replaced by an Australian Commission for Electronic Health (ACeH), to report directly to the Standing Council on Health (SCoH).

Pulse+IT understands that part of the $140m allocated in last week's budget towards the system will be used to fund the Commonwealth's obligation towards NEHTA until a decision is made on its future. NEHTA is co-funded by COAG and would need its agreement for the organisation to be disbanded.

To get clinicians using the system, the panel recommends that in addition to usability issues, the government “incent” GPs by changing the eHealth practice incentive payment (ePIP) to link ongoing ePIP funding to actual usage of the MyHR.

It also wants the government to alter the MBS item numbers next year for health assessments, mental health care plans, medication management reviews and chronic disease planning items to require a copy of the information to be uploaded to the MyHR.

Operation of the system should be moved from the Department of Health to the Department of Human Services (DHS), under contract from ACeH, the panel recommends. It also wants to see an expansion of the National Prescription and Dispense Repository (NPDR), which Mr Dutton praised as a worthwhile endeavour in his speech.

The review panel also wants to establish a number of advisory committees to the proposed ACeH, including a clinical and technical committee, a jurisdictional committee, a consumer advisory committee and a privacy and security committee.

Technical changes to make the system more attractive to consumers include a single sign-on capability and a notification system that tells the consumer by SMS when their MyHR is opened or used.

From January 1 next year, the panel wants the system to include a minimum composite of records that would include demographics, current medications and adverse events, discharge summaries and clinical measurements. This, in addition to an opt-out model, would dramatically improve the value proposition for clinicians, the panel said.

It recommended that work proceed on implementing diagnostic imaging and pathology into the system, and also to implement a standardised secure messaging platform. It also wants the secure messaging strategy to include secure communication between the medical industry and consumers themselves.

The National Authentication Service for Health (NASH) should also be reviewed, with a view to aligning the platform with the recommendations for digital identity as part of the government's eGovernment policy.

In terms of submissions to the review panel, the reviewers say that the main concerns were the usability of the system, the lack of education and training modules or an effective test environment for software developers and integrators, and that the governance processes around the PCEHR did not adequately represent the industry and were overly bureaucratic in nature.

To overcome the common complaint about the system from clinicians that personal control means the full record is not available, the panel recommends that a flag be set to indicate that a document has been hidden, which is only visible to the practitioner who authored or uploaded the document.

“The panel noted that no medical records are complete (in either paper or electronic form) and that there are some people who legitimately do not want to share everything,” the report says. “The panel disagrees with the advice from many of the submissions that a flag should be able to be seen by all those who view the record as in the panel’s opinion it would be likely to result in emotional “blackmail” by providers attempting to seek disclosure of the hidden information.”

However, if the flag was visible to the practitioner who authored the document, this would allow a discussion to be had about it, or that an alternative, “clinically appropriate but different” document be put in its place.

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