Patients may have to foot e-health bill

By: Karen Dearne

PATIENTS may have to pay for their own electronic health records, with the key healthcare reform body urging the federal Government to mandate "person-controlled" systems commercially available from providers like Microsoft and Google.
"We believe that the rapid development of new IT applications required across the health sector to give people the opportunity to have an electronic health record is best undertaken by commercial IT developers in an open competitive market," the National Health and Hospitals Reform Commission (NHHRC) said in a supplementary paper released today. While tech-savvy patients are increasingly keen to manage their own medical records, public agencies worldwide have opted to maintain control over health information-sharing systems to ensure confidentiality, technical security and data quality. But in an unexpected turnaround, the NHHRC said "every Australian should be able to choose where and how their personal e-health record will be stored, backed-up and retrieved", and that the record should be "at all times owned and controlled by that person". Instead of providing a national health IT infrastructure, the Government's role should be "to regulate privacy and technical standards", and allow the market to come up with products that suit both consumers and healthcare providers "By 2012, every Australian should be able to have a personal e-health record," said NHHRC chair Christine Bennett. "The Government must legislate to ensure the privacy of a person's e-health data, while enabling secure access to the data by the person's authorised health providers." To thwart likely objections from doctors over sharing information contained in their patients' records, the NHHRC wants the payment of public and private benefits to health and aged care services "to be dependent upon the provision of data to patients, their authorised carers and other health providers, in a format that can be integrated into a personal e-health record". Microsoft has previously told the NHHRC it was feasible to establish an affordable, consumer-controlled e-health record nationwide within one year. Its HealthVault web-based platform has been designed to allow people to collect, store and share their own medical information with doctors and family members. The commission's interim blueprint, released late last year, has been criticised for its failure to put information technologies at the heart of planned health sector reform. While today's paper said the nationwide adoption of individual e-health records would return between $7-$9 billion in economic benefits from increased productivity and reduced adverse events over 10 years, the federal and state governments have baulked at providing the necessary funding. But the NHHRC believes there is no need to finance patients for the creation and maintenance of their own e-health records. Instead, it calls for public funding for "an appropriate social marketing strategy" to inform consumers and health professionals about the significant benefits and safeguards of the proposed new approach to e-health. It also calls for significant funding and resources to help doctors move to the new arrangements. "Engaging private and public healthcare providers to invest in IT systems and infrastructure, change work practices and participate in personal e-health records will be critical to success," the NHHRC said. "Vendors must ensure their systems are compliant with national standards and can receive and send data with patient consent and appropriate authentication." AushealthIT blogger David More warned that the NHHRC approach was "unbalanced" as it over-emphasised the role of the personally held record "and fails to recognise the importance of the provider's records". "In my view, the person's own record needs to be adjunctive to the records, and systems, used by each health professional to optimise the care they deliver," Dr More said. "The care provider needs information of known provenance and trustworthiness from external sources such as referring doctors and labs. "As well, the benefits case for health IT rests on clinical decision support provided at the point of care, and that is not recognised clearly enough in this approach."