Submission to the
Australian Government Department of
Health
Electronic Health Records
and Healthcare Identifiers Legislation
Discussion Paper
June, 2015
Contacts: David L Stokes
Principal Advisor
Dr Louise Roufeil
Executive Manager (Professional Practice)
The Australian Psychological Society (APS) would like to thank the Australian
Government Department of Health for the opportunity to comment on the
Electronic Health Records and Healthcare Identifiers: Legislation Discussion
Paper.
The APS is the national professional association for psychology, with over 22,000
members. Psychologists are the third largest health profession in Australia and
are employed in all sectors of health care. The APS has interacted extensively
with various government agencies and departments in relation to the
development and implementation of the Personally Controlled Electronic Health
Record (PCEHR). The Society‟s lengthy involvement with electronic health
records and healthcare identifiers in Australia informs this submission.
Executive Summary
The Australian Psychological Society (APS) largely endorses the findings of the
review of the Personally Controlled Electronic Health Record (PCEHR) and the
proposed legislative changes emanating from that Review. It particularly
applauds the suggested removal of inconsistencies in legislative and terminology
processes, the continuing protection of privacy and confidentiality, the ambition
to increase ease of access and usability, the adoption of the title My Health
Record and the trial of the opt-out process.
The APS continues to raise concerns regarding the over focus on „medical‟
clinicians and urges the greater recognition of allied health, medical specialists
and nurses as health service providers who can ensure the much greater
relevance and breadth of the electronic health record. The Society also directs
attention to the damaging nature of some of the decisions and processes
followed in recent years that impeded the success of the eHealth program and
urges greater flexibility, collaboration and breadth of thinking with regard to the
electronic health record.
1. Benefits of the Proposed Legislation Changes
The Discussion Paper identifies a number of significant proposals involving
changes to legislation that the APS feels are positive and beneficial to the whole
eHealth program. These benefits are described below.
1. The proposed changes to terminology and legislation that have been identified
through administrative and operational experience in the health space make
excellent sense. For instance, the clarification of the term “health care” and
“health service provider” will be of importance across the various legislative and
operational procedures. In addition, the notion of implementing these changes to
ensure consistency throughout the various legislative components will be of
considerable assistance.
2. The stakeholder consultation that was conducted as part of the PCEHR review
was a very productive and encouraging exercise. The recognition that, despite
considerable efforts in communication and engagement, the knowledge and
understanding was “patchy at best across all stakeholder groups” is an important
finding. This finding is consistent with the results of a recent survey of APS
members. When asked if their practice management software was able to
interface with the PCEHR, 95 per cent of private practitioners responded that
they either “didn‟t know” or “no it didn‟t”. However, it is encouraging that a
number of studies1, as well as the consultation referred to above, found
considerable goodwill and readiness to move in this space once understanding
and knowledge were provided.
3. Both the consultation and the set of proposals have gone to considerable
lengths to reassure stakeholders that the privacy and confidentiality mechanisms
put in place for the PCEHR are to be largely retained in the revised version. This
is of particular importance and relevance to the APS whose members, and their
clients, are very concerned about privacy and confidentiality. Many clients who
are seeing a psychologist experience significant mental health, relationship or
other sensitive health issues and therefore require the protection of privacy and
confidentiality carefully engineered for the original PCEHR.
4. Both the consultation and the set of proposals contained in the Discussion
Paper have recognised some of the barriers to access and usability of the current
electronic health record and the health identifiers (HI) service. Somewhat
gratifying was the reference to “allied health practitioners” particularly with
regard to accessibility and access to compliant software. In the context of a very
medically-focused prior history with regard to the PCEHR, and the persistent
disinclination to make the Provider Portal more than a view-only system, this is
not only progress but evidence of genuine review.
5. The abandonment of the PCEHR as the title of the electronic health record and
its replacement by “My Health Record” is to be applauded. The new title
maintains the concept of a personal patient/client record.
6. The freeing up of the notion of the HI Service Operator is also a sensible and
practical change.
7. Despite some hesitation about losing the qualities of self-initiation and selfmanagement associated with the opt-in system, the APS feels that the opt-out
notion is more practical and realistic. The sensible utilisation of trial sites is also
to be applauded and should ensure that any major hitches or unforeseen
procedural problems are identified and addressed before national
implementation. It is anticipated that the trial will also provide an opportunity for
broader inclusiveness and engagement of allied health practitioners in the trial.
8. The issue of consent is complicated by the notion of opt-out. This is
recognised by the Discussion Paper and some provisions proposed. However, it
will be vital for extensive education and information promulgation to ensure that
people who seriously wish to opt out, can do so and that all people understand
the implications of this type of procedure.
9. The notion that the System Operator will be further empowered to notify
individuals when their electronic health record is opened or used is a positive
development.
10.The relationship between the electronic health record and the Australian
Health Practitioner Regulation Agency (AHPRA) has been rather blunt and the
improvement of the information flow will be very welcome. Very few people
registered with AHPRA were aware that their HPI–I was both allocated and
available within their registration database. The improvement of the relationship
between the two bodies may significantly enhance the knowledge base of
registered health practitioners.
11. Finally, the issue of whether to maintain criminal penalties as well as civil
penalties for violations of privacy/ confidentiality is well aired in the Discussion
Paper. There are two reasons why the APS would endorse the maintenance of
both forms of penalty: the first, is to ensure that serious disincentives for
violation of privacy/ confidentiality are in place; secondly, and even more
importantly, to those whose clients/patients may have very sensitive information
in their record comes the need for confidence that people are prevented from
violating that process. The unfortunate fact is that information and knowledge
regarding mental health or relationship issues – commonly experienced by the
clients of APS members – cannot be retrieved once released or shared.
Therefore, the consequences of breaches for the clients of psychologists can be
immense and that impact should be matched by the significance of the penalty.
2. Issues of Continuing Concern
The APS has listed a number of positive elements set out in the Discussion
Paper. However, there are also a number continuing issues that have not been
satisfactorily resolved by the Discussion Paper. These are set out below:
1. The current lack of knowledge and understanding of the PCEHR system,
including the low uptake of individual health records and the lack of engagement
by service providers, is disappointing. However, this low level of understanding
and uptake is not entirely the failure of community members, service providers
or stakeholders. It needs to be recognised that after the launch of the eHealth
initiative in July 2012, there was a significant hiatus in the rollout of the
program. The transfer of major responsibilities and initiatives from the National
eHealth Transition Authority (NEHTA) to the Department of Health not only
disrupted the momentum of the rollout but also resulted in a huge loss of human
resources (i.e., knowledge and experience) that is yet to be adequately
recouped. Furthermore, the transfer resulted in a significant loss of confidence
among the champions and professional supporters of the initiative. 2. There
continues to be a tendency in the Discussion Paper to view the term “clinician”
as solely referring to a medical practitioner. There are many instances in the
Discussion Paper where the use of the term “clinician” primarily refers to a
medical clinician. It is vital for the success of the electronic health record that it
fully recognises all health practitioners; this is essential in order for the records
of services offered by allied health practitioners, medical specialists and nurses
are encouraged and facilitated to become part of a patient/clients electronic
health record. If this fails to occur, My Health Record will be no more than
general practitioners (GPs) talking to GPs, or occasionally to pathologists/
radiologists and possibly pharmacists. An electronic system that only includes
part of a patient/clients health record will fail to meet the objectives of My
Health Record.
3. Section 3.4.6, Obligations to use PCEHR system, requires clarification. This
section indicates that Medicare benefits for “health assessments, comprehensive
assessments, mental health care plans, medication management reviews” will
only be paid to the patients of providers who upload appropriate reports to the
PCEHR. It is not clear to the APS if this statement is referring solely to GP and
pharmacist items or all Medicare items, including those which apply to services
delivered by allied health professionals. It would be extremely concerning to the
APS if patients of allied health professionals (who currently cannot upload to the
PCEHR and are not supported to utilise the electronic health record) might be
excluded from receiving rebates.
4. There are still significant barriers to both access and utilisability of the
electronic health record for many health providers. As set out in the Discussion
Paper, this centres on a complex registration process, inflexibility of the HI
service, the unavailability of uploading options (e.g., Provider Portal) and the
lack of affordability of appropriate clinical practice management software. It will
continue to be a source of resistance that there is generous support available to
GPs to make clinical software part of their practice but no similar support is
available to specialists, nurses and allied health practitioners.
5. It is critical that the trials of the opt-out process also extend their inclusivity
to recruit allied health into the eHealth program. While some allied health
professionals have had informal discussions with the Department of Health about
this issue, it is important that there be formal representations regarding this
issue and that documentation regarding the trial sites and the implementation of
the trials carefullydocument both the concept and procedures that will be
followed to achieve this end.
6. The Healthcare Provider Directory is another example where greater
flexibility, initiative and coordination between various agencies involved in
eHealth would have made for much greater success. The concept of a health
provider directory was absolutely central and vital for the success of interprofessional communication and the support of patient access to appropriate
services. An example of how inflexibility in the HI system produced a ridiculous
anomaly was the fact that the consent for a provider to be registered on one of
the versions of the HPD was enabled when the provider completed the
application form for an HPI-I. Sadly, this was irrelevant for most registered
health practitioners who were provided with their HPI-I by AHPRA and had no
reason to complete the application form. Despite repeated representations to the
Department of Human Services to do something to resolve this anomaly, nothing
was done.
- oOo –
The APS looks forward to the process of consultative and collaborative development of revised
legislation and improved initiatives. The Society continues to support the absolute centrality of the
electronic health record to the improvement of clinical management and patient care. With some of
the reservations expressed above, the APS wholly endorses the progress suggested by the Discussion
Paper and looks forward to the launch of a revitalised and focused electronic health record.