Patient access to diagnostic test results: the RACGP’s view

The Royal Australian College of General Practitioners (RACGP) has long been an advocate for the personally controlled electronic health record (PCEHR), recognising the significant benefits a national electronic health record could bring to patient healthcare outcomes, and in improving safety and quality.

The imminent implementation of diagnostic imaging, pathology and other diagnostic results into the PCEHR will provide healthcare consumers and other healthcare providers with access to their information and may afford significant benefits if delivered judiciously.

This implementation needs to be based on a model that leverages current clinical workflows, has been assessed to be clinically viable and safe, meet national privacy requirements and consumer expectations, and provide standardised and consistent views across all services.

Any process for uploading reports into the PCEHR needs to ensure that there are not any potentially new, foreseeable risks or unintended consequences for healthcare consumers or clinicians. The RACGP stands firm on its position that the referring doctor retains the primary responsibility to review results and action any further healthcare needs in collaboration with the patient.

The RACGP acknowledges and appreciates that the PCEHR record is owned by the individual and patients have an absolute right to access and manage their personal health information. However, there is a need to balance this against the significant priorities of patient privacy and clinical safety.

Under the proposed direct upload model in conjunction with the existing default PCEHR consumer standing consent model and settings, there is a risk that any person in any organisation that has access to the PCEHR could potentially access patient’s test reports.

Given the manner in which most Australians have been registered via assisted registration, it is highly likely that few would be aware that the default setting is to “allow any provider involved in my healthcare (whether it be a dentist, GP, physiotherapist, etc.) to access my PCEHR”. This setting alone presents two major concerns:

The first significant privacy breach or unintended data exposure or clinical adverse event has the potential to result in major embarrassment and a significant loss of confidence in the system.

There is a risk that patients may misinterpret test reports with the potential to result in a failure to seek follow-up care or advice. This could be partly attributed to the fact that current report terminology is aimed at healthcare providers and may not always be easy to interpret even for a trained clinician.

Results viewed in the absence of a broader clinical context or experience have the potential to create adverse impacts. Healthcare, like any other industry, has its own brand of jargon and nuances that require experience to interpret and establish the ensuing course of action.

A recent topic review describes several situations where patients with glioblastomas who were only provided online access to their MRI scan or report or had only partial results in their health record, misinterpreted the information prior to expert clinical interpretation and medical review resulting in unnecessary patient distress and prolonged uncertainty. [1]

Test results represent just one of the many factors that are considered to reach a clinical diagnosis and to plan any ongoing treatment or management. Age and gender, current and past medical conditions, family and social history, medicines, occupation, ethnicity, genetics, diet and lifestyle all contribute to the overall interpretation of results, which require a broad set of clinical skills that GPs have been trained to provide.

The patient’s treating practitioner is therefore usually the most appropriate and qualified person to explain and discuss diagnostic results.

It is the ongoing GP-patient relationship that facilitates the provision of contextual and ensuing advice, assisting patients to comprehend their individual test results and be well supported through any future necessary healthcare needs. This is a core component of continuity of care, and a concept the RACGP advocates strongly for.

As an alternative approach towards greater information transparency some organisations provide access for patients to directly view their doctor’s notes after the consultation event. The Open Notes study involved 20,000 healthcare consumers across three sites in the United States and over 100 primary healthcare providers. [2]

The participating healthcare providers discussed the notes with their patients as part of the consultation, providing the contextual knowledge required for the consumers to understand the delivered information. Patients were subsequently provided online access to their notes in the healthcare provider’s local clinical information system.

The broader benefits of the study were clear and included increased trust for both healthcare consumers and clinicians. Patients could confirm that their provider truly understood their goals and priorities and healthcare providers could have confidence healthcare consumers used information appropriately, recognising that knowledgeable healthcare consumers often achieve better health outcomes.

The collaborative approach taken in the Open Notes study clearly demonstrates the value of patients being better informed and provided with context when dealing with medical information. Good communication is a fundamental component of effective healthcare and great value is placed on the transparency and availability of information.

Ensuring patients have the appropriate level of health literacy is also vitally important. This can be achieved through relevant healthcare patient education. Patients must be appropriately informed about their medical care including understanding what their test results reveal as part of a holistic approach, rather than simply as a set of numbers available online.

Education requirements for healthcare consumers should include:

As a pathologist colleague indicated to me recently, government and consumers should be more focused on developing processes to strengthen systems to ensure that all requesters (especially those within the tertiary sector) are reviewing the results of tests ordered and following up accordingly.

There has been little to no focus on this requirement at a national eHealth level, which one might consider to be a core requirement and duty of care (call it the primary use case).

Direct uploading of volumes of human un-curated diagnostic reports to the PCEHR will not in itself solve the issue of tests that are not followed up and will create a new medico-legal concern in that providers will have no immediate visibility regarding which test reports have been reviewed and followed up.

Put simply: big data, big workflow, big risks.

Dr Nathan Pinskier is chair of the RACGP’s National Standing Committee – Health Information Systems.

References

     

  1. Cahill JE, Gilbert MR, Armstrong TS. Personal health records as portal to the electronic medical record. Journal of neuro-oncology. 2014;117(1):1-6.
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  3. Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, et al. Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead. Annals of internal medicine. 2012;157(7):461-70.

APHS invests in Flamingo to develop personal cloud platform

Epic Pharmacy, the pharmacy services company formerly known as APHS, has invested $1.5 million in software firm Flamingo to create a healthcare technology platform aimed initially at health insurers and hospitals.

Epic Pharmacy is perhaps best known for its pharmaceutical packaging arm APHS Packaging, which supplies aged care facilities with medication sachets, manufactures dose administration aids (DAA) for community pharmacies and distributes the Medido monitored compliance device.

Sydney-based Flamingo is a start-up firm headed by Catriona Wallace that is active in the customer relationship management (CRM) and vendor relationship management (VRM) fields. It has developed a ‘co-creation’, analytics and personal cloud solution that aims to allow businesses to co-create solutions with individual customers to personalise the way they communicate and interact.

Flamingo will use Epic Pharmacy’s funding to develop customer-directed healthcare solutions initially with healthcare insurers, and then with any healthcare service provider from hospitals to aged care facilities.

“Customised healthcare is of growing interest and concern to the majority of Australians,” Dr Wallace said. “With this new funding, Australians for the first time will be able to co-create a personalised experience with a health service provider to meet their own individual requirements, beyond just the product.”

Earlier this year, Flamingo partnered with the Respect Network, a cloud network provider which has developed a standard and protocol for personal cloud providers. A personal cloud is described as a customised offering that provides a way to store, manage and provide permissions to personal data as well as preferences for how the consumer interacts with an organisation.

The idea is to allow customers to control their own personal cloud of information and grant access to it, rather than encouraging companies to maintain their own data stores.

Customers are invited to review and personalise their relationship with the organisation, including selecting their preferred communication channel and decide the particular product and service mix that best suits their requirements.

A personal cloud for healthcare data will be developed as part of new venture, Dr Wallace said.

“Flamingo already has clients in the financial services, professional services and digital business sectors and this funding now allows us to provide the platform to healthcare providers initially in Australia and by June 2015 to the North American market,” she said.

Epic Pharmacy managing partner and founder Cathie Reid will join the Flamingo board, which also has private investors including Paul Hunyor, founder of One Big Switch, and Doc Searls a fellow at the Center for Information Technology & Society (CITS) at the University of California, Santa Barbara, and senior editor of the Linux Journal.

In addition to its medicines packaging arm, Epic Pharmacy provides specialised hospital, oncology and aged care pharmacy services. For hospitals, it provides daily dispensary management and auditing systems, as well as clinical review and supply management and consulting services through its staff of hospital pharmacists.

For oncology, it provides a comprehensive chemotherapy dispensing and reconstituting service for public hospitals, private hospitals and day oncology units across Australia.

In aged care, it is a leading provider of specialised medication management services for residential aged care facilities. In addition to its sachet system, it provides an electronic medication chart.

Health technology firms score high on BRW innovators’ list

Health IT firms, health insurers and iconic Australian firm Hills have all scored highly on BRW magazine’s list of 50 most innovative companies.

While Kiwi cloud-based accounting software firm Xero took first place for its payroll module, there were a number of healthcare companies and healthcare-related technologies in the top 50, including online appointment booking and directory service HealthEngine at number 22, and pharmacy IT specialist Fred IT at number 23.

HealthEngine was cited for the overhaul of the site and its functionality over the last 12 months, which has seen a mobile version of the platform launched and appointment numbers increasing by 57 per cent. HealthEngine says its iPhone app is consistently in the top 20 medical app downloads in Australia and has seen more than 25 per cent of bookings now being made via a mobile device.

Fred IT is the market leader in dispensing systems in Australia and also owns the eRx electronic script exchange, also the market leader. It has also launched the eRx Express app, which is integrated with Fred and allows patients to order their prescription drugs and set a time to pick them up.

The company is now set to launch Fred NXT, the first full function, cloud-based software as a service (SaaS) offering for Australian pharmacies. Fred NXT is an integrated system for dispense, point of sale, professional services and retail management, hosted in the cloud with some locally installed proprietary and third-party software.

Fred CEO Paul Naismith said the company was born out of the vision of innovating as a means of making things easier for pharmacy.

“Investing in and nurturing innovation is the key to finding better ways for health professionals and their patients to connect,” Mr Naismith said. “For pharmacy, this means freeing pharmacists up to spend more time with their patients, rather than trying to become IT experts.”

Health solution provider UHG was named at number 15 for its medEbridge information exchange, which is integrated into MedicalDirector and Best Practice and enables the extraction of patient data from the clinical software for secure transfer to insurance companies so they can assess claims faster and more efficiently.

Online private health insurance firm health.com.au was named at number 11 on the list. It has done away with the traditional shopfront and conducts all of its customer processes online, from application to support. health.com.au claims to have passed 20 insurance companies in market share, and is currently providing health coverage to more than 80,000 Australians.

Hills, which over the last few years has divested itself of its heavy manufacturing background and entered new markets in home security systems and healthcare delivery technology, was named at number 20.

Hills is currently putting together a portfolio of solutions for the healthcare industry, including IP and wireless nurse call systems, patient infotainment systems and aged care home monitoring solutions. It was cited for the development of the Hills Innovation Centre in Adelaide, which is currently developing a nurse call handset for aged care residents with arthritis in association with the University of South Australia.

Pharma company AbbVie Australia, which was spun out of Abbott Pharmaceuticals last year, secured the 21st spot for the development of OnTrack, a patient adherence program for people with Crohn’s disease using one of its injectable biologics.

OnTrack is run in two phases over a 12-month period. For the first four months, patients are provided with in-home and over the phone nursing support and then a pharmacy liaison service for a further eight months. The pharmacy liaison service allows script pick-up data to be collected and reported via an online portal.

Product development firm Planet Innovation scored highly at number 3 on the list for the development of a new incubator for IVF, while Bayer ANZ rounded out the top 50 for a radiology contrast media dosage algorithm and associated Protocol Assistance Tool Support (PATS) it has developed. The software provides a recommended dosage to achieve the best image resolution and can be used by non-medically qualified technicians.

Information management missing from PCEHR review

The Health Information Management Association of Australia (HIMAA) has urged the federal government to include people with skills in health information management and clinical coding in implementing the recommendations of the PCEHR review.

HIMAA CEO Richard Lawrance said his organisation was concerned about the lack of health information management expertise in plans to implement the report’s recommendations. Health information managers and clinical coders are experts in managing the vast volume of data that is expected to result from better sharing of information, and are also experts in making sense of that data.

In a letter to the Department of Health regarding its current round of consultations on the review’s implementation, Mr Lawrance said that if the PCEHR was not functional as a health information management system, its impact upon the quality of care improvements expected of eHealth and in curtailing spiralling health care costs to the community will be severely impaired.

“The PCEHR review report mentions ‘information’ 235 times,” Mr Lawrance said. “It is most commonly qualified as ‘clinical’, next as ‘health’. ‘Health information professionals’ are mentioned just once in appendices, and ‘health’, ‘information’ and ‘management’ do not occur together at all, even the name of the Health Information Management Association of Australia, which is omitted from the list of 86 other contributors to the review.”

Mr Lawrance said he was concerned that the review’s report was being taken as read, and consultations were focused on the practicalities of the implementation of its 38 recommendations.

“HIMAA is largely supportive of the recommendations, but collectively they fail to address the need for a longer term and systemic plan for the management of the volume of information the PCEHR will store over time, such that the relevant information is actually accessible to point of care clinical decision making, both to clinicians and their patients,” Mr Lawrance said.

“The PCEHR also needs an adequate classification system that renders it meaningful for population health management and research, and the application of its data as information for funders.”

He said that the absence of health information management as a central organising concept was even more worrying in that it was also missing from the recent Health Information Workforce (HIW) report from Health Workforce Australia.

“The HIW report places a more informatics-focused chief information officer as the ICT coordinator of a range of clinically oriented CIOs – nursing, medical, clinical,” Mr Lawrance said. “Information management expertise is completely absent from the report’s future configuration of health information at the executive level.”

“It would be disturbing if the exclusion of health information management from eHealth development represents a trend in government thinking.”

HIC 2014: Preaching to the unconverted on eHealth

The private hospital sector will need to be presented with a sound business case that improves either the bottom line or patient safety before it will contemplate participating in the national eHealth system, the Health Informatics Conference (HIC) in Melbourne has heard.

Paul Williams, CIO of private hospital and pathology services provider Healthscope, told the conference that few people in his organisation had even heard of the PCEHR and that it will be a hard sell to get the organisation involved if there is no obvious benefit either to patients or doctors.

Asked by the ABC’s Q&A host Tony Jones how to go about persuading those unconverted to the benefits of eHealth to take part, Mr Williams said his managing director was one of those who was unconverted and that “it’s a tough gig”.

“In our environment, with 44 hospitals and we deal with about 70,000 specialists who would come into our hospitals over a year, they have each got their own bespoke systems, they have each got their own way of working, they are not going to change to conform to a Healthscope way,” Mr Williams said.

“In fact, we bend over backwards so they come back again. It’s a bit different in our pathology business – pathology has historically been a leader in eHealth … But it is unlikely that there will be a big bang approach at Healthscope, certainly on the hospital side, to it.”

While Healthscope’s 47 medical centres use PCEHR-compliant software and it announced its GPs would begin promoting the PCEHR to patients in July last year, the acute and secondary care sector is another matter, he said.

Mr Williams said a lack of interoperability between GPs, specialists, allied health, pathology, radiology and hospitals was the major barrier to eHealth in Australia. It was not a problem of scepticism about the national system, he said, because most in his organisation had not even heard of the PCEHR.

“Even if you’ve got a will and a desire, trying to make a business case for a private entity that is publicly listed, that’s got to show a bottom line return for every dollar that you spend, becomes tough,” he said.

“There needs to be a realisation that today, there’s not an obvious economic return. We do things when we can obviously make a buck, or save a buck, or there is significant patient quality issues.

“We’re very heavy on that within Healthscope, so we believe if there’s a quality initiative [that] reduces risks or … we get good outcomes for our patients, those are the things that would obviously drive our organisation.”

GPs must lead eHealth debate: RACGP president-elect

Promoting the status of the expert-generalist and leading the debate on eHealth are two of the main missions for the next president of the Royal Australian College of General Practitioners, WA-based GP and adjunct associate professor Frank Jones.

Dr Jones was announced as the president-elect today following a competitive month-long election, in which he vied with four other GPs to take over from Liz Marles when she completes her term in October.

Dr Jones is a full-time GP of 30 years’ standing with appointments as senior lecturer in general practice at the University of Western Australia and adjunct associate professor in general practice at the University of Notre Dame.

He is the owner practice principal of Murray Medical Group in Mandurah, south of Perth, which he describes as a progressive, multi-disciplinary, non-corporate private practice of 21 GPs with a multitude of allied health professionals working from
the same site. He was a procedural GP obstetrician for 25 years and still has visiting rights at his local hospital.

In his candidate statement, Dr Jones highlighted the role of the expert-generalist, the need to promote and refine “brand GP” and “brand RACGP”, and the central role that general practice must play in eHealth.

“Information technology must be at the heart of any discussion around quality 21st century general practice,” he said. “High quality patient records are fundamental to good patient care, and eHealth records, telehealth and telemedicine is pivotal college business: we must lead this debate.”

He also highlighted the wealth of information collected by practice systems and how this needs to be better used for research purposes. “Academia needs to reflect front-line GP needs,” he said.

In a statement to Pulse+IT outlining his thoughts on eHealth and health IT, Dr Jones said GPs have “a wealth of untapped clinical information within their systems which have the potential to completely alter the way we practice.”

“GP based research emanating from our IT records will enable the profession to show government and our communities what a cost efficient and quality outcomes based speciality we really are.”

He characterised GP clinical information systems as being “years ahead” of hospital systems and that the limited interaction between primary and acute care IT needed to be fixed before a shared electronic record could work.

He said he was supportive of the RACGP’s submission to the federal government’s review of the PCEHR, calling it a “sensible, reasoned and reflective response”, but he was critical of the PCEHR roll-out, saying that because there was no general agreement on its design, the project had failed.

“Even though there was clinical passion for a system, too many other players with different agendas impeded progress,” he said.

“As an example, as a practicing physician seeing a patient after hours I need critical clinical information which will guide me to deliver the best outcome for my patient. Let’s get that bit right first! I do think an opt out system would be better. I have uploaded a few summaries but to no advantage to anyone at this stage.”

IT has revolutionised the way he is able to practice medicine, he said. “Having up to date progress notes, full summaries, recall systems and immediate access to pathology and radiology is now an accepted norm. However, as usual it’s the quality of information input that is most important: ‘rubbish in-rubbish-out’ scenario!

“Most medical software is very user friendly; it really then behoves the efficient and caring medic to input correctly.”

Dr Jones’ views on eHealth in full can be seen here, and his candidate statement on the RACGP website (PDF).

Budget 2014: paperless claiming for PBS meds in hospitals

The federal government has allocated $16.5 million over five years in the budget to allow the supply and claiming of PBS medicines from medication charts in all public and private hospitals.

Similar to a scheme being rolled out in residential aged care facilities, the initiative will mean that the medication chart can serve as a prescription for most medications, meaning pharmacists can supply and claim PBS medicines with the chart itself as the record of supply.

In RACFs, doctors will only need to complete the medication chart and will no longer have to write a separate PBS form, except for certain medications such as schedule 8 drugs. Nursing staff are also able to administer medications directly from the chart.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) has been developing the National Residential Medications Chart (NRMC) for several years and started rolling it out in pilot trials in association with the Department of Health and aged care facilities last year.

It follows work co-ordinated by the commission and the jurisdictions on creating standardised medication charts, including the National Inpatient Medication Chart. Software vendors are working to add them to their clinical information systems.

These charts can be both paper-based or electronic, but by acting as the prescription or the record of supply, the aim is to reduce workflow burdens on doctors, nurses and pharmacists, as well as increase patient safety by reducing the risk of dispensing errors during the transcription of data from medication charts.

The roll-out will take some time as state legislation must be amended to allow for this manner of prescribing and dispensing. According to the budget papers, the measure is expected to deliver at least $40 million per year worth of red tape reductions.

“This initiative will deliver medication safety benefits to patients, improving the quality use of medicines and health outcomes through reductions in transcription errors,” the budget paper says. “It will both complement and harness the useability of the eHealth record in the primary and acute care setting.”

Also announced in the budget, the government has provided $2.1 million over two years to the Pharmacy Guild to administer the payment functions of professional pharmacy programs under the Fifth Community Pharmacy Agreement (5CPA), which were previously administered by the Department of Human Services.

The Guild said the funding was directed towards the cost of establishing and implementing online registration and claiming of a range of 5CPA programs.

These include the Home Medicines Review Program, Residential Medication Management Review Program, Diabetes Medication Management Service, Medicines Use Review, Rural Pharmacy Maintenance Allowance, Section 100 Support Allowance, and the Pharmacy Practice Incentives Program. The 5CPA expires in July next year.

As widely reported, co-payments for the PBS have risen in this year’s budget, by $5 for general patients and 80c for concessional patients. PBS safety net thresholds will also increase each year for four years from next January.

This is in addition to the existing annual indexation of co-payments and safety net thresholds in line with the Consumer Price Index. The measure is expected to save $1.3 billion over four years.

In a statement, the Guild said is disappointed that despite these savings, the government had not seen fit to ameliorate any of the pre-election changes to price disclosure, which it said were announced without consultation and in breach of the 5CPA.

“The Guild will continue its fight for this unfair impost to be redressed, including in the negotiation of the next Community Pharmacy Agreement,” it said.

Budget 2014: confusion still reigns on PCEHR

Health Minister Peter Dutton has refused to commit to a timetable for a decision on the future of the PCEHR despite funding its operation for an extra year, leaving one software vendor to call a halt to its PCEHR compliance work.

The government yesterday committed $140.6 million in the budget to support the operation of the system for another 12 months, but Mr Dutton said the government would continue to consider the recommendations of the Royle review over the coming months before making a decision on its future.

Confusion also surrounds the future of the National E-Health Transition Authority (NEHTA), funding for which runs out on June 30. NEHTA, which has received extra funding from the federal government since the PCEHR scheme was announced in 2010, is co-funded by the states and territories and any decision on its future would need to be decided at COAG.

In a message to members, Australasian College of Health Informatics (ACHI) president Chris Pearce said he understood that NEHTA will continue, “but with what role and what degree of funding is undefined”.

“Future progress is likely to involve the states more,” Dr Pearce said.

The lack of clarity on the future of the PCEHR is expected to have an effect on the development plans of many clinical software vendors. The founder of allied health software specialist myPractice, Glen Germaine, said he had decided to release the next version of the software without PCEHR integration enabled.

“The $140.6 million for one year in itself offers little solace to us,” Mr Germaine said. “Without the release of the review and clear answers from the Minister and his department on the future vision and direction of the PCEHR, we are essentially in the same position as we have been for the past six to eight months.”

myPractice has completed a lot of the work required to become compliant with the system, at great cost, but Mr Germaine called a halt to further work last November following a reduction in activity by the Department of Health and NEHTA due to the election.

He said at the time that he would not be proceeding with the HI Service testing until the path for allied health was made clear. Following yesterday’s budget, Mr Germaine said there was still no clarity on the system and what it will mean to allied health.

“The general consensus from allied health providers we have spoken to in the past six months is that they have no clear need for it,” he said.

“We’ve decided that we can’t wait any longer before releasing our next version. We are going ahead and it will not include the PCEHR integration work we have done. It’s there in the product, but it is not complete and will not be enabled.

“There’s no point spending time and money on it until the case is made for it by the Minister.”

In a statement, Mr Dutton said the government would continue to consider the recommendations of the Royle review over the coming months “to understand the issues, their implications and the best ways to deliver on the intended outcomes”.

The review, which was conducted last November and December and a report handed to Mr Dutton just before Christmas, has not been released publicly and Mr Dutton’s office refuses to answer questions on when it planned to do so.

The Department of Health has also refused to release the report and has denied Pulse+IT’s FOI request, which we have appealed.

In his statement, Mr Dutton said implementation issues had “plagued the PCEHR from day one” and that he wanted to get it “back on track so that it provides real benefits to patients and health professionals alike”.

“Most clinicians are not using the system,” Mr Dutton said. “The government will need to make it effective, functional and easy for all Australians to use, and clinically relevant to health providers.”

He said the PCEHR review team had made some significant recommendations to improve the system, but he did not explain what they were.

“Careful planning and consultation are required to ensure that the government’s response to the recommendations and future investment in the eHealth system provide the best results possible for the Australian people,” he said.

Louise Schaper, CEO of the Health Informatics Society of Australia (HISA), said the $140m in funding provided the opportunity for ongoing consultation to get the system right.

“We welcome the government’s clear statement in the budget of their commitment to shared electronic health records for patients,” Dr Schaper said.

“The adoption of an innovation such as this is a long-term change management project and we are pleased the government is taking the time to make the right decision for patients and for healthcare providers. This is a good opportunity for ongoing consultation to make sure we get this right.”

Dr Schaper also said HISA welcomed the government’s ongoing support for primary care, but said the new Primary Care Networks “must continue the good work done by Medicare Locals”.

“Primary care professionals need localised change and adoption support, like that provided by the Medicare Locals,” she said. “This will continue to be essential, not just for implementation, but most importantly for use.”

Dutton “committed” to electronic health record

Health Minister Peter Dutton has told the Standing Council on Health (SCoH) meeting of state and territory health ministers that the federal government is “committed” to an electronic health record and “will be working with the states and territories to implement it properly”.

The statement – issued as part of an official communique from the SCoH on Friday – is the clearest indication yet that while the government may not keep the PCEHR in its present form, it does not plan to cancel the $700 million project.

According to the communique, Mr Dutton told the meeting that there were “a number of concerns identified” in the report compiled by the Royle review into the system and handed to Mr Dutton before Christmas last year.

Both Mr Dutton’s office and the Department of Health have refused to release a copy of the report.

Mr Dutton told the meeting that the concerns included clinician engagement, and that the government “is working through the issues”.

The communique states that all health ministers “supported the concept of the PCEHR but agreed that there was work to be done on making this a much better system that is properly coordinated and really works”.

Funding for the operation of the system runs out on June 30. DoH figures show that the national infrastructure partner, Accenture, was paid $87.7 million for operational services for the PCEHR between June 26, 2012 and June 30, 2014.

Accenture was also paid $47.8 million in 2011 to build the system in association with Oracle and Orion Health, which received $11 million and $17.8 million respectively.

A DoH spokeswoman said Accenture had also done additional work such as designing the Child eHealth Record and the standalone assisted registration tool (ART), bringing the total value of the contract to $154.3m.

Additional funding from the states through NEHTA and commonwealth funding for eHealth uptake activity through Medicare Locals is estimated to have brought the total cost of the project to $1 billion.

The health ministers also agreed to work together to improve the consistency of reporting of hospital in- and outpatient service capacity, including the ability to capture data on services such as hospital in the home, same-day dialysis and chemotherapy chairs, capacity contracted from the private sector and ambulatory care services.

Increased sharing of information and data between jurisdictions was also identified as a way to improve integrated care.

Update to privacy info for PCEHR assisted registration

The Department of Health has issued an update of the eHealth privacy document given to patients when they are signed up to the PCEHR through assisted registration.

The document, Essential information about assisted registration and your privacy in the eHealth record system, has been updated in line with the new privacy principles that came into force last month.

The document is for use with the Assisted Registration Tool (ART), a standalone piece of software that allows users to sign patients up at the point of care, and with software that has integrated assisted registration functionality.

The latter includes general and specialist practice software packages from Best Practice, Communicare, Genie, Medtech 32, practiX and Zedmed, with Medical Director due to include the functionality in its next release.

Aged care software providers Leecare (Platinum 5.0), AutumnCare and Comcare also have integrated assisted registration, as do pharmacy packages Fred Dispense and Simple’s Aquarius.

The latest update of the standalone ART, version 2.2, is available from the federal government’s eHealth site. Copies of the new document have been emailed to current ART users.