Options for opt-out revealed in PCEHR discussion paper
The federal Department of Health has released a discussion paper on changes to legislation that will be required to implement the government's preferences for the PCEHR, including options for a move to an opt-out model, the removal of the PCEHR participation agreements seen by many general practices as overly onerous, and the creation of a test environment so software vendors can trial changes before they go live.
Changes to several pieces of legislation are needed to implement the recommendations of the 2013 reviews into the PCEHR and the Healthcare Identifiers (HI) Service, including changing the name of the PCEHR to My Health Record (MyHR).
For example, amendments will need to be made to both the PCEHR Act and the HI Act to set up and run trials of an opt-out model while the current opt-in arrangements remain. The government's preferred option is for two trials to take place along with consideration of other models for increasing participation in the PCEHR under opt-in.
The department will need to consult with the states and territories on how to go about setting up trials for the opt-out model, with the potential for the Health Minister to make a temporary “quarantine zone” for each trial region.
The proposed timing for the opt-out trials includes a two-month period during which individuals can choose to opt out of the system. There would then be a trial registration period of two weeks in which PCEHRs are created for everyone else.
The newly created records would then be available to view by the individual for six weeks in order to set access controls on who they want to allow to see their record, after which healthcare providers will be able to access the PCEHR and start uploading data.
The department hopes that provider access can be open from July 2016, meaning trial sites will need to be chosen this year, legislation passed and an education campaign designed and launched early next year.
The discussion paper emphasises that participation in the system will remain voluntary for healthcare provider organisations.
“Healthcare provider organisations will be encouraged to use the system through revised incentives, and education and training services,” it says.
The discussion paper also broaches a proposal to abolish the participation agreements that healthcare organisations have had to sign before using the system. These have been seen in the past as particularly onerous in terms of red tape for general practices.
It is proposed that requirements in the participation agreements covering copyright and data breach notifications be added to the PCEHR Act instead.
The discussion paper also raises the issue of making payment for Medicare items for health assessments, comprehensive assessments, mental healthcare plans, medication management reviews and chronic disease planning dependent on reports being uploaded to the PCEHR. This will require a change to the Health Insurance Regulations 1975.
One welcome proposal is to add all healthcare organisations to the Healthcare Provider Directory (HPD) by default. Under current arrangements, both organisations and individuals have to consent to having their HPI-O or HPI-I listed on the directory.
While listing HPI-Is will continue to require consent, the idea is to automatically list any HPI-O in the directory, which has the potential to improve other eHealth services dependent on the HPD such as secure messaging.
There are also major changes to the governance arrangements underpinning the system. As recommended in the Royle review, the department proposes to set up an Australian Commission for Electronic Health (AceH), which will assume responsibility for the governance and operation of all national eHealth systems including the PCEHR.
ACeH will be established as a new corporate Commonwealth entity through rules made under the Public Governance, Performance and Accountability Act 2013 (PGPA Act) and the PGPA Rules, the discussion paper says, with a proposed commencement date of July 2016.
Several advisory committees will be abolished, as will NEHTA, with an implementation taskforce established from July this year to oversee and advise on the design, establishment and transition to the new arrangements.
ACeH will take full responsibility for the PCEHR from the department along with broader operations managed by NEHTA, but management of the HI Service will remain with the Department of Human Services/Medicare.
ACeH's board will include IT and clinical experts, and it will be overseen by an independent assurer reporting directly to the minister for health.
The discussion paper also proposes that the system operator make a test environment available to software vendors so they can test how systems operate and interact before they are implemented, a proposal that many in the medical software industry thought should have been implemented from the start.
Changes to the PCEHR Act will also be required for another recommendation of the Royle review, that consumers be notified by SMS or email when their PCEHR is opened or used. An added benefit of allowing the department to collect mobile or email numbers would be improvements to the identity verification process.
There will also be changes made to the regulations for the HI Act so that the Individual Healthcare Identifier (IHI) can be used on government aged care or disability records to ensure these records are associated with the correct individual.
There is also the potential to increase penalties for misuse of the system, including introducing criminal offenses in relation to the PCEHR system for serious breaches, while retaining the ability to impose civil penalties.
The discussion paper is available from www.ehealth.gov.au. Submissions are being requested from interested groups and individuals by June 24, after which legislation is proposed to be introduced by August.
Posted in Australian eHealth