RACGP raises governance, liability concerns over PCEHR

Problems with governance, the administrative burden on general practice, and professional and financial risk need to be resolved in order for general practitioners to have full confidence in the proposed PCEHR, the Royal Australian College of General Practitioners (RACGP) says.

In its submission to the Senate Committee on the Personally Controlled Electronic Health Records Bill, the college said issues needed to be addressed including the provision of a clear governance structure to oversee the system operator of the PCEHR, the proposed repository system, and potential secondary use of PCEHR data.

It also raised questions as to the administrative burden of the system and professional and financial risks associated with an unintended breach.

“The PCEHR system is managed by the System Operator and the specific entity of the Service Operator is not clearly defined,” the submission states.

“Further, there are references to operational matters that again are not defined and without which the provisions in the legislation cannot be judged.”

In terms of the national repository system and its associated portals, which will be operated by a mix of private and public sector organisations, the RACGP has queried who exactly is the true custodian of the data held within these repositories, and how the various federal and state privacy laws will apply.

“The RACGP is concerned about the preservation and availability of data when a repository operator unregisters or ceases to exist as an entity,” the submission states.

It also wants clarification on the secondary use of PCEHR data. The RACGP, which provides the secretariat for the General Practice Data Governance Council, supports an appropriate information sharing environment for secondary use of general practice data in order to improve patient and population health outcomes, and to support research.

However, the RACGP said it was concerned that the revised Concept of Operations suggest that the de-identified PCEHR data may be used for secondary purposes without appropriate regulation.

It says the legislation only deals with this issue under Clause 66, Collection use and disclosure with consumer’s consent.

“However, at the time of consent a PCEHR is created, the potential uses for research are not specifically known, and hence the consumer cannot give fully informed consent for this,” the submission states.

“In addition, the legislation makes no reference to decision-making in this area in regard to access to PCEHR data for research purposes and other secondary uses. The RACGP believes this to be an omission in the legislation and leaves the use of the PCEHR for research or other purposes unclear.”

It also raised questions about the further burden of administration on general practices, particularly concerning the reliance on individual healthcare providers to know if there are any changes to the eligibility of employees or the organisation.

“The design of appropriately tested and proven IT systems must reflect the additional administrative workload and provide intuitive solutions to ensure that healthcare providers and the organisations that they work within are protected.”

The submission raises the prospect of general practitioners being wary of participating if unintended breaches occur, resulting in financial or professional penalties.

Dr John Bennett, chair of the RACGP national standing committee on eHealth, said GPs will need to be confident that the PCEHR system and the legislation that supports it will be robust, secure and function as designed.

“The RACGP is committed to the uptake of eHealth initiatives within the health sector and we continue to strongly support the PCEHR and the foundations of electronic communications,” he said.

“However, the PCEHR must meet the needs of clinicians and patients. GPs must have confidence in the PCEHR system for it to be successful. Currently, there are still a number of issues that we would like to see addressed in regards to the legislation including the consequential amendments.”

Posted in Australian eHealth

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