Where is the personal control in the PCEHR?

Like many GPs I have been watching the development of Australia’s personally controlled electronic health record (PCEHR) with interest, especially as the key implementation date of 1 July 2012 approaches.

This has been a frustratingly long time coming for general practice. GPs successfully implemented clinical computer use over a decade ago and have been waiting for much of the rest of the nation’s health systems to catch up so we can realise the benefits for our patients of safe, secure sharing of health information.  

In 2001–2004, I chaired the Australian government’s MediConnect project that investigated the implementation of electronic transmission of prescriptions from general practice to pharmacy. An important element of MediConnect is that it was underpinned by a sound evaluation process. This allowed us to identify what did and did not work and to measure improvements in clinical care.  

The MediConnect system was allocated $122 million in federal funding and was trialled in Launceston and Ballarat. The evaluation showed that it was highly successful, with strong support from GPs and pharmacists and high levels of adoption, especially by older people with chronic health concerns taking multiple medications.

The evaluation also demonstrated that two major rate-limiting steps were software readiness and a failure of policy makers to understand that GPs were not prepared to bear all the legal liability for any errors that arose due to the implementation of the new electronic system. Incentive payments were provided to allow the time needed to register patients in the program. These are lessons that need to be remembered as the PCEHR rolls out.

The Australian government did not proceed with a national rollout of MediConnect. This was sad for the many Australians who have suffered as a result of medication errors that might have been prevented through the use of the system. It is only now that we are seeing the implementation of widespread electronic transmission of prescriptions.  

I was recently an inpatient at my local hospital and received an invitation to enrol in their PCEHR pilot project. I was keen to do this until I read the fine print. This is not a PCEHR. Although I am invited to opt in and I can advise at the time of a consultation that I don’t want the details included in my record, I have no ability to view my electronic health record (except if my GP allows me to view the version on his or her computer) and I have no right to have any of my details corrected if I identify errors. Put simply, this is a shared electronic health record but without patient control.

I guess this reflects the realities of our national program.  This is a very complex innovation and its implementation is going to be staged and somewhat patchy at first. But when it begins, it will put Australia at the forefront of international efforts to create shared electronic health records for all members of a country’s population. And that’s exciting.

I’m pleased Australia is adopting an initial opt-in approach. It means each Australian can decide when they join in, based on individual levels of comfort with the system. I anticipate that the initial uptake will be slow as confidence increases. Slow uptake will be positive as it will allow problems to be ironed out before large-scale implementation occurs. 

The initial rollout will uncover new risks to patient safety related to the use of this new technology. It is important that such risks are identified promptly.

I hope the PCEHR is also underpinned by a sound evaluation process to allow us to identify what works, what doesn’t and how the investment in this new technology will lead to improvements in the quality and safety of Australian health care.