Duplication nation

The roll out of e-health records present unique opportunities, and challenges, for aged care providers. Beverley Head reports.

The Federal Government has released a draft concept of operations document regarding the use of personally controlled electronic health records (PCEHR) in Australia, which are being touted as a cornerstone of national e-health programs that could revolutionise the way aged care is provided.

The Minister for Health and Ageing, Nicola Roxon, has said that the PCEHR initiative means “patients will no longer have to remember every immunisation, every medical test, every prescription as they move from doctor to doctor”.

This national blueprint, and the consultation and development that will follow, will help to develop e-health records for all Australians who want one from 1 July 2012, she said.

“In the 21st century, patients should be able to visit their local GP, their specialist or emergency department and know their health records are available at a click of a button, if they want them to be,” according to the minister.

For aged care providers, particularly those working in a community setting rather than in residential facilities, the PCEHR will be particularly important, according to Rod Young, CEO of the Aged Care Association of Australia (ACAA).

“In a community setting the PCEHR would act as a real benefit,” he said, given its active support for integrated health records, which he believed would improve care outcomes.

While the majority (100,000 of the 170,000) of older Australians living in residential aged care were already covered by some form of electronic care management systems, Young said the PCEHR might make it easier for residents and their families to access their health records.

He said that, at present, records generally can’t be made available to the family “because they are two inches thick or there is a large file and they are not accessible to anyone but skilled health professionals”.

Moving to an electronic health record might improve access to health records, he said.
According to Dr Mukesh Haikerwal, a GP and the national clinical lead for Nehta (the National Electronic Health Transition Authority), aged care had been identified as an area that would benefit significantly from using PCEHRs. He said that given older Australians often saw a range of different health professionals and specialists, the PCEHR would be a useful tool for providing a single consolidated view of their health records.

Speaking at a recent e-health event organised by the Australian Information Industry Association, David Roffe, the chief information officer for St Vincent’s and Mater Hospital in Sydney, claimed that the overwhelming benefit of the PCEHR would he that it would stop people from “falling between the cracks” of the health system.

For aged care providers who have to send residents to hospital it can be very hard to know on the resident’s return what treatment they have had, and what medication they have used. The PCEHR would fill in the gaps.

Roffe believed that the PCEHR would help deliver high quality information, of particular benefit to people who saw multiple health professionals. “The biggest costs are associated with those people who have a chronic disease and go between different specialists, that’s where we will get the bang for the buck (from the PCEHR).”

To date the Government has allocated $467 million for e-health projects, which will also fund a series of PCEHR trials. According to Nehta, the Cradle Coast, North-West Area Health Service Project is intended to “provide end-of-life policy lessons for the PCEHR system. The project targets aged and palliative care patients and their families, palliative care medical specialists and clinical nurse consultants. The project will use off-the-shelf care planning software to share the advance care directives until the national PCEHR infrastructure is in place.”

One of the key benefits of the PCEHR system is that people visiting multiple care providers would, if they opt into the system, be able to have access to a consolidated record of their treatment. They would also be able to make that available to anyone they wanted – including aged care providers or family members.

That though is where the PCEHR has one wrinkle – it is an opt in rather than mandatory system, and that could pose a problem for aged care providers. It may be that some older Australians prefer not to have a PCEHR, meaning service providers will have to develop parallel procedures to deal with people with a PCEHR and people without.

While civil libertarians may applaud the approach, it could lead to challenges for aged care providers. Even if a patient opts into the system initially, they can opt out at any stage.

Clearly the government is hoping that the 12 lead PCEHR trial sites, which are intended to enrol 500,000 Australians for what amounts to a stress test of the PCEHR system, will encourage other people to sign up for the program. As it stands, according to the concept of operations draft notes: “Individuals will be able to choose whether or not to have a PCEHR and if they choose to participate they will be able to set their own access controls,” and also withdraw from the program whenever they like.

According to Young: “In chronic disease I would think it would be in most people’s interest to have the record available to all treating professionals.”

But he acknowledged that by giving people more control you are asking them to be more actively involved in their care management, and this is a radical departure as we have largely left this to professionals.

“You are explicitly saying that you are being brought into be more actively engaged.” He believed that the PCEHR would deliver significant benefits, particularly to older Australians receiving community care, and that it would be embraced within the sector.

Lisa Pettigrew, CSC’s national director for health services, said that the Government had already acknowledged that the aged care sector needed additional focus in terms of the national e-health initiatives.

She said that it was also important to consider integrating management of the PCEHR with power of attorney information. This, she said, was imperative in an aged care setting where it may be necessary for a family member with power of attorney to be able to take over the control of a PCEHR for a relative suffering dementia or having an operation, for example.

“That has got to be a part of the consent model,” she stressed.

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