Reference no: EM133035493

The Australian government has developed the Personally Controlled Electronic Health Record System (PCEHR) with the objective of making a patient's medical records accessible online to practitioners, patients and other relevant parties, with patients also able to make comments on their records.

The argument for the e-health system was that it would reduce costs and add efficiency to the health system. Reported estimates of the cost savings potentially available from moving the health records online were in the vicinity of $8 billion over a decade. Additionally, the new system is seen as a means of preventing around 5000 deaths per year. Examinations of the previous system of health record management highlighted the potential to reduce the duplication and fragmentation that existed, as well as potential to afford a higher quality of service to patients being treated. Duplication occurred, for instance, when a patient visits one doctor and then is referred to another or seeks a second opinion (where details of allergies and medications need to be recaptured, as well as prior test results and immunisation status for various diseases), not to mention the additional records that are created when a patient enters hospital or is treated in an emergency admission. Previously, if a patient was admitted to emergency afterhours their existing records may be held in a clinic that is not open, presenting potential challenges for the medical staff on duty treating the admission. While most general practitioners have moved to the electronic age, with computerised prescriptions, health records and scheduling, it was noted that the 'situation in our hospitals is not so good. The likelihood that some of the data stored in your GP's computer can be transmitted to the hospital or a specialist, or vice versa, is close to zero'. The aim of this system was to work towards doctors having relevant information at hand when seeing new patients for the first time, with these doctors also able to access this information in a more timely manner.

The e-health system consists of several parts, one of which is the Personally Controlled Electronic Health Record System. At the federal level, legislation was passed by the parliament in June 2010, with this legislation providing the authority for the government to proceed with the scheme and issue healthcare identifier numbers to all Australians. In 2018 the Australian Government announced the PCEHR would be renamed 'My Health Record' and legislation was introduced to transform the model to an opt-out program.

In order for Australians to have their own unique personal health record that they control, it is necessary for the system to be able to distinguish between and identify each Australian. To achieve this, the healthcare identifier number was created. This unique 16-digit identifier is an example of a primary key and it is used to identify patients and healthcare providers within the e-health system. For patients, this number is linked to their Medicare card. This identifier is linked to data about the individual - name, address and date of birth - and is used to link the government's database to that of healthcare providers. Health records from visits to general practitioners, pathologists, specialists and chemists are stored in other secure locations, along with prescriptions and referrals and encrypted links between doctors and hospitals. The links are used for the communication of test results and X-rays in a secure manner without the risk of them being lost in transit. This data is linked to the government's central database through the client identifier.

In designing the system, the consideration of privacy was obviously of paramount importance. Media reports at the time stated that the e-health system will fall under the coverage of Australia's federal privacy laws, with the responsible Minister commenting that, amongst other measures, the system will update a log each time a person's record is accessed and that penalties of up to $66 000 for unauthorised access will apply. In addition, patients will be able to access their records and determine what details are viewable by other parties. In emergency cases, hospitals may be permitted to search the patient's records.

There were concerns from politicians about getting a critical mass of participants, particularly if healthcare providers chose not to participate. For example, in a previous project in one state in Australia, NSW, the electronic health record failed. The NSW Health Minister commented that 'If you don't engage the clinicians who have to use the system then you're in dire straits . . . [NSW] rolled FirstNet out without proper clinical engagement, without the proper investment in training, software and equipment', with the state's system being blamed by doctors for service outages, as well as reportedly having excessive technical complications.

Financial issues have also been flagged - including the cost of training doctors and health practitioners in the operation of the system, as well as ensuring that they have the appropriate facilities for storing data and accessing the health network.

During discussions about the system there have been some concerns about the fact that people have had health identifier numbers generated without their knowledge. Concern has also been expressed about the use of the system beyond the health dimension, with the flagging of fears about the scope creep of the system and it being used to build potential links, for example, to government welfare data.

The system designers decided on a new 16-digit identifier for patients and providers.

Required:

-Identify the stages of system development where this would have been considered.

-Explain the likely discussion at each stage.