Seven-day model for PCEHR will make for good practice: CHF

The proposed model of a seven-day delay to upload pathology and diagnostic imaging reports to the PCEHR can be seen as a way of encouraging better communication between consumers and healthcare providers, the Consumer Health Forum (CHF) chief says.

The CHF recently released a special eHealth edition of its Health Voices journal and took the opportunity to give the Royal Australian College of General Practitioners (RACGP) a bit of a serve in the press release accompanying the publication, saying the RACGP was putting doctors' interests before patients' in its criticisms of the seven-day model on alleged safety grounds.

This week, CHF CEO Adam Stankevicius didn't resile from his criticisms, but said that at the time, he took the view that the college wasn't as engaged as it could be in the debate.

“It was an opportunity, with the release of that edition of Health Voices, to make a foray into the space and re-engage the RACGP on a few issues where we have seen blockages between our representatives,” Mr Stankevicius said.

“We’ve had a number of conversations since that time and we are moving towards a much better resolution of those issues.”

Mr Stankevicius said consumer groups were firm in their support for the PCEHR and believed it was essential that consumers were able to see their results, which doesn't always happen in current practice.

“We know that a lot of times the GP will say 'I'll refer you off for these tests and if you don't hear from us, everything is fine'. Consumers are still left waiting weeks later not knowing if the test results have come in, with no signal from their GP surgeries whatsoever about whether they’ve been looked at and how they might have been considered and if everything is indeed fine.

“I think at the moment we’re in a space where consumers just don’t know, and we think the seven-day proposal actually gives a way in which some boundaries can be put around that situation, so the consumers do have some certainty."

Mr Stankevicius said the seven-day proposal for uploading pathology and diagnostic imaging reports, in which the GP can recall the patient if there are abnormal results but otherwise the report will be made available to the patient after a week, could be seen as a way of incentivising good practice.

"It’s a way of ensuring that consumers get the follow-up that’s needed, or they get some kind of indication that there is nothing for them to be worried about," he said. "At the moment we hear a lot of feedback from consumers ... they are not sure that the 'all OK' applies to the test is OK, or the test results haven’t come in yet, or I haven’t done the right thing, I didn’t diet at the right time and I have to go back and do it again.

“There is a whole lot of uncertainty at the moment, which arises from lack of information. The seven-day proposal is about incentivising that good communication practice between GP and consumer within a time period that means that if there are those concerns, there is an opportunity for the practitioners to do a recall of the consumer.”

Mr Stankevicius does not believe that there will be a major problem with consumers potentially misinterpreting their results, arguing that good communication between patient and provider can overcome this. He also said that contrary to the RACGP's argument over safety, the bigger threat to safety is if the results are not made available to other treating clinicians.

“There seems to be this view from some in the industry that the results will be provided absent of any other information,” he said. “That they are just going to be up there and you won’t ever have had a conversation with your practitioner about why you got the test, or what the test might show. I think if there is a good and robust ongoing communication between consumer and practitioner, those questions will have been answered before you even go and have the test.

“We don’t think that the PCEHR is or ever will be a substitute for good and effective ongoing communication between consumer and practitioner, and I don’t think that's anything the college would disagree with.”

Mr Stankevicius said an argument put forward by the chair of the RACGP's national standing committee for health information systems, Nathan Pinskier, in an article in Pulse+IT last week that there were potential privacy issues with other healthcare providers having access to sensitive results, was one that he hadn't heard raised by other doctors' groups.

The RACGP is particularly concerned over the manner in which the majority of consumers were registered for the PCEHR through assisted registration by GPs or, as was more common last year, through Medicare Locals or Aspen Medical. The college argues that many consumers may not have understood the standing consent model or the default access controls built in to the PCEHR.

This, Dr Pinskier argued, could potentially lead to privacy breaches or even adverse events and thus to a loss of confidence in the system by consumers.

Mr Stankevicius argued that in addition to the national privacy principles, healthcare practitioners all had codes of conduct they had to adhere to.

“[Dr Pinskier's] article is the first time that I've seen the potential privacy breach as a concern,” he said. “I think if there’s a question about health practitioners breaching the privacy laws as a result of the PCHER being in place and them having access to diagnostic tests, then that’s a broader legal question and a professional ethics question. It’s not a question about the PCEHR.

“The flip side is that I go and get the test on a Tuesday, the results are up on the PCEHR on the Thursday or the Friday and I’m in a car accident on Sunday, a time when most of my health professionals won't be available, because they work an average day week, those test results may actually be quite important for my treatment in accident and emergency.

“So while there may be some concerns about privacy, I think there a both legal and professional regimes which govern the way in which professionals access and use the PCEHR. The potential offsets are also quite beneficial.”

Mr Stankevicius said he believed most people would favour an opt-out system, as recommended by the Royle review, mainly because most consumers believe information sharing between healthcare providers goes on much more than it actually does.

He also said he was not overly concerned that the momentum in registrations and uploads for the system had stalled somewhat since the new government took the reins.

“We see this when new governments come in all the time and particularly with big ticket items, they like to take a step back and get a feel for the space,” he said. “I think they did that with the Royle review and obviously changes to the board of NEHTA as well. So I think it’s quite reasonable, and particularly if we are seriously looking at moving from opt-in to opt-out, that requires a different kind of momentum and a different kind of campaign.

“There might be some frustrations from some in the industry who have been on a particular track in the software space, for example. I certainly understand those frustrations, but in terms of the government’s commitment, with something as important and significant, it’s quite reasonable that they take a bit of time to think about the way in which they want to take it forward.”

Posted in Australian eHealth

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