Issue 23 / 27 June 2011

Brave New World of e-health a minefield

WHO owns medical information? Patients, doctors or institutions?

For some time now information technology has been heralded as a potential driver of reform, promising to improve much of the inefficiency and ineffectiveness that besets modern health care.

Indeed, it has generally been acknowledged that PCEHRs (personally controlled electronic health records) will allow timely and extensive information sharing among health care providers.

In the national sphere, federal Health Minister Nicola Roxon has long recognised the potential of e-health records, claiming that they will allow for a “seamless interconnection” and will save health professionals and patients substantial amounts of time. “Implemented properly, electronic health records will reduce inefficiencies between different parts of the health system and lower the potential for mistakes: inadvertent misdiagnosis or treatment”, the Minister is reported as saying.

To this end, hundreds of million dollars have been invested in the National E-Health Transition Authority (NEHTA) to make the idea workable. But like most things pursued by a consultative process, it has fallen victim to accommodating the pressures of powerful vested interests and the framework for the e-health record is in danger of becoming a dog’s breakfast.

The High Court ruled 15 years ago on doctors’ ownership of medical records, which was followed by changes to privacy law, giving patients the obvious and accepted right to access their own health records. But with dual ownership, PCEHRs raise new issues, such as censorship of content and restriction of access to information. In short, consumers would ultimately control what information is stored in their record and who can view the file.

In this event, the utility of such a file to doctors would be compromised and would become largely irrelevant to their practice.

This quandary raises the fundamental question: who owns the medical information? The one who provides care? The one who pays for the care? The institution, where the care is delivered? All of the above? None of the above? Some of the above? Confusion reigns supreme.

Even more crucial, is the question: who is ultimately responsible for the veracity, accuracy and currency of information?

Along with the expansion of electronic health information, there has been a potential commercialisation of patient databases. This begs the question: can patients now selectively authorise commercial access to their e-health records?

Imagine the nightmarish scenario this could unleash, especially if personal DNA information were to be added to patients’ files.

There is no doubt that the question of ownership of medical information will be acutely focused by the proposed PCEHRs, and the issue is bound to become a legal and ethical minefield.

To date, privacy laws and longstanding codes of professional ethics have prevented doctors from conveying medical information without the patient’s permission. And patients who want a paper or electronic copy of their medical records have always received them at a cost.

However, far from expediting an efficient health care system, PCEHRs may well stress established protocols and throw standards into turmoil. Like many other advances in the past, this one will inevitably throw up new questions, which must be addressed.

Before we plunge into the brave new world of PCEHRs, there must be unambiguous, clearly defined rules of ownership and responsibility for the accuracy and quality of content.

Should this not eventuate, doctors will refuse to “opt in” to a flawed and compromised system.

Dr Martin Van Der Weyden is emeritus editor of the MJA.

 

Posted 27 June 2011

6 thoughts on “Martin Van Der Weyden: From the sidelines

  1. Peter Arnold says:

    Well said, Martin!
    Also, what about hackers? Nothing connected to the Internet is sacred; nor is wi-fi transmission inside your own home.
    My long-standing advice to my children applies to our colleagues: “Put nothing on the Internet that you’d be embarrassed to see on the front page of the daily newspaper!”

  2. Retired practitioner says:

    Bring on PCEHRs I say!
    My GP recently moved to a new practice, leaving his previous partners. They required $25 per family member to transfer the records (largely electronic) to my (unchanged) GP.
    I believe such records should be the property of the patient (who paid for their compilation), and that he or she should be able to dictate where they may be kept or sent.
    Let us not be paternalistic about this.

  3. drjohn says:

    Very interesting article. Patients obviously should have access to files but who is the keeper? Duplicated files, one owned by the patient and one on the doctor’s computer could be a nightmare unless unambiguous synchronisation is available. God preserve us from having to rely on patients bringing some form of smartcard to a consultation!!
    Having said that, there are obvious follow-up benefits to continuity of care.
    I can foresee a new department in DOHA or Medicare just to deal with these issues.

  4. John Hunter says:

    Thank you Dr Van Der Weyden, for bringing these issues to attention. If personal experience with the new federal medical board is an indication of the low level of efficiency of the current federal health authority, confusion will indeed reign supreme when the electronic patient record system is introduced, reminiscent of pink batts. A comprehensive electronic record is, like motherhood, a great idea, but Ms Roxon’s plans are likely to miscarry or have severe birth defects without more planning, including consultation with our profession. (I do not use my own name because, being a retired practitioner, my continuing partial registration is not routine but open to individual scrutiny by the board each time I renew)

  5. The Saint from Elsewhere says:

    “Retired practitioner” might like to compare the costs of providing medical records with the charges a lawyer would make for a similar service.
    It has crossed my mind that doctor buy-in, or enthusiasm, for electronic health records might be higher if the systems used in public hospitals did anything but double their work!

  6. Anonymous says:

    Without medical records a doctor has no medicolegal defence. Whatever else is done doctors must at all times be able to freely access records of their treatment of patients.
    I was once denied access to records of my treatment of a public patient by a hospital where the public patient I had treated had a complaint. It’s fair for a public hospital to own records of public patients and it’s fair for patients to have access to them, but a doctor must never be denied access to records of their treatment of patients.

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