The Department of Health and Ageing (DoHA) has defended its role as the System Operator of the PCEHR, saying it was the most legally sound of the governance options considered.
The decision has been criticised by some in the industry, including the Medical Software Industry Association (MSIA), due to a perceived conflict of interest.
The MSIA said in its submission to the inquiry that it disagreed with the power vested in DoHA as system operator, funder and a board member of NEHTA, which meant it was “impossibly conflicted”.
DoHA deputy secretary Rosemary Huxtable told today's Senate committee hearing into the PCEHR that there were three main options concerning the governance and operation of the PCEHR system.
“The first was to establish governance using a company like NEHTA, under the Corporations Act,” Ms Huxtable said.
“Number two is a statutory authority ... and the middle option was to vest the system operation within the Commonwealth.
“There were fairly strong views in consultations that where there is the capacity to hold and provide governance over private health information, the view was that the responsibility should be held within the government, not a private company.”
Ms Huxtable said the legislation does not rule out the possibly of moving to a statutory body governance structure eventually, and that it requires the structure to be reviewed in two years.
“The value of responsibility invested within the department is that it is subject to Commonwealth law,” she said. “It is not a function that is unknown.”
Questions have also been raised about the potentially conflicted role of the secretary of the department, Jane Halton, who also sits on the board of NEHTA.
“The reality is that the secretary has vested in her a number of powers such as those governing therapeutic goods and nursing homes,” Ms Huxtable said.
“It is not a strange thing. There are mechanisms put in place to ensure transparency of governance, including requirements for annual reports and answering to ministerial councils involving the states and territories. It is difficult to have effective eHealth solutions without full engagement with the states and territories.”
Fionna Granger, first assistant secretary of the eHealth division at DoHA, answered a series of questions about patient and practitioner access to the PCEHR, raised earlier in the hearing by Carol Bennett of the Consumers Health Forum.
Ms Bennett had queried the decision to no longer allow “no access” functionality in the PCEHR – where consumers could ensure a particular document is not available to any other individual – while at the same time allowing the consumer to delete documents.
Ms Granger said there were several levels of access, including general access where the consumer gives consent to health professionals viewing all data on the individual's PCEHR; limited access to certain health professionals, which can be overriden by emergency personnel; and the ability of consumers to delete certain health documents.
“There were medico-legal issues and the best idea was the ability of consumers to be able to remove documents but the original healthcare provider would still have their own record, as is current now,” she said.
Adding no access functionality to certain documents would make the PCEHR more complex and consultations with consumer groups had shown they wanted more simplicity, she said.
“It is important to understand that the information that is being put in is the clinical information and it can't be edited by a non-clinician,” she said.
“There is a place for consumers to add notes and have a diary – and one of the Wave 2 sites is building a consumer health diary – but in terms of clinical information, it can't be edited by the consumer. They can remove documents but they can't change them.”