Imagine if any medical practitioner could access your healthcare records at the click of a mouse. The emergency department could treat you more quickly, specialists could compare test results instantly and you wouldn’t have to remember the last time you had a tetanus shot.
Welcome to the world of eHealth, a program the Government has invested $466 million in. Its aim is to create PCEHRs (Personally Controlled Electronic Health Records) that centralise a patient’s healthcare information and, with their permission, present it to registered healthcare providers.
Advocates of the scheme say it will ensure a safer, more efficient healthcare system, but critics raise issues including privacy, access and consent.
"I don’t think privacy has been addressed enough," says Professor Julie Zetler, senior lecturer in the department of marketing and management at Macquarie University, who is researching the ethics of eHealth.
Zetler also has concerns about security – how do you prevent unauthorised use of the records?
- Take a number
The Government’s most heralded line of defence is Healthcare Identifiers (HI).
These 16-digit numbers identify patients, organisations such as hospitals and healthcare providers to ensure only the correct records are accessed by authorised people. And every PCEHR will have an audit log to show activity.
But Professor Zetler says the establishment of HIs has created a separate issue altogether.
"You probably don’t know it, but you’ve already been allocated an HI," she says. "It was going to be voluntary, then Government made it mandatory. And they got all your information by appointing Medicare to run the HI system.
"We’re being told signing up for a PCEHR is a ‘choice’. But look what happened with HI numbers. Will that happen again?"
A spokesperson for NEHTA (the National E-Health Transition Authority, set up by Government to develop the scheme) says the system is subject to the Commonwealth Privacy Act 1988 and will have its own legislation, the PCEHR Bill, which imposes civil penalties for any unauthorised access.
The choice to opt in to the scheme "is cemented in the PCEHR Bill, which states that a consumer ‘may apply’ for registration". But that Bill is only in draft form and legislation can change.
Zetler also questions who is a "healthcare provider". NEHTA says "an individual who is a registered member of a particular health profession".
"But that leaves the definition wide open," Zetler says. “You assume GPs and surgeons. But it also includes naturopaths and acupuncturists.”
Which begs the question – do you want your hypnotherapist to know you’ve got herpes?
-- All in the details
NEHTA says patients will have access to their records and be able to control what information is included.
The Australian Medical Association (AMA) has concerns about the clinical impact of this patient control – how useful can a health summary be if only some information is included?
And where will liability rest if there is a mistake in the data or data has been omitted?
The collection and storage of information is a huge task.
To prepare for the national scheme several eHealth sites are already operating, particularly in the NT, where they’ve proven useful in managing the health of a largely mobile indigenous population over a vast area.
But it’s taken five years to create a workable system for just 50,000 patients.
And there have been teething problems. The software developers have told an inquiry that the July 1 national roll-out should be postponed.
- Who’s in charge?
Zetler worries about where our records will be kept. NEHTA says they will be stored "in state or privately-owned electronic databases that meet strict security requirements".
But the introduction of private industry raises conflict of interest concerns for Zetler.
"This scheme will collate a huge amount of medical information," she says.
"It is inevitable it will be passed on to researchers – that is how medicine improves – but will the patient know? If you give a specialist access to your files, but they’re also involved in research, are you automatically giving them permission to include you in that research?"
NEHTA says information will only be used for research with the consent of the patient. The maximum fine for unauthorised use of the system is $66,000 for a corporate body and $11,000 for an individual.
- Counting the cost
A final grey area is cost. In March Federal Health Minister Tanya Plibersek said the cost of managing a PCEHR would be included under the Medicare category of "taking a patient’s medical history as part of a consultation".
But on April 10 the AMA said no funds had been allocated for consultations set up specifically to create a PCEHR for a patient. It has advised GPs to charge between $53 and $210 for the service.
"GPs are being asked to do more work for no reward," says AMA president Steve Hambleton.
"The system does have benefits," concludes Professor Zetler. "But with the amount of money invested, I can’t see it being a choice forever."
-- Would you want your health records online?
Jenny Goodacre, 36, Sydney, NSW
"I’m happy to have my records online. It makes managing them much easier, especially these days when people rarely stay with one GP. I have concerns about internet security generally, but they’re mainly based on perception rather than fact. A sensible approach would be for an individual to manage their records by managing access."
Ryan Sage, 28, Darwin, NT
"It would help me – I never remember my medical history. But only people who are taking something from you, such as blood, or giving something to you, such as medication, should have access. I wouldn’t be happy to pay for it, and I’d be worried about privacy. What if the GP’s receptionist sees your file and gossips about you?"
Natalie DeBona, 29, Brisbane, Qld
"It would be beneficial to have my records readily available in one place rather than me having to vaguely remember them. But I would expect strict privacy regulations. I wouldn’t want an old school friend who is now a nutritionist being able to log on and see my medical history. Only GPs and surgeons should have access."
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Autor(en)/Author(s): Leanne Hudson
Quelle/Source: Herald Sun, 28.04.2012
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