No matter which side of politics you support, and to the many in the "neither" camp, it is fair to say that the Federal government has had some unfortunate outcomes with the delivery and implementation of, what many see to have been, meritorious policies and ideas. The implementation of the pink bats and school halls schemes were marked by numerous controversies and, on occasions, subject to the processes of trial and error.
Most people seem to agree that the introduction of electronic health records (EHR) is both a good idea and good policy. People may argue about whether consumers should opt out rather than in, and its cost. But its stated objective of overcoming the fragmentation of health information, improving the availability and quality of health information, reducing the occurrence of adverse medical events and improving the coordination and quality of health care provided by different health care providers is difficult to criticise.
Effective delivery and implementation of the EHR scheme is non negotiable. Government and others simply can't afford to get things wrong. People's health and well being is the very subject matter of the system. This is one of the conclusions reached by the US Institute of Medicine (IOM) in a report entitled "Health IT And Patient Safety – Building Safer Systems For Better Care" released on 8 November 2011. The transition to electronical medical records in the US is in full swing. The report was commissioned at the request of the US government department responsible for coordinating the development of the National Health IT infrastructure.
The IOM is all in favour of the shift to electronic records and says in its report:-
"When designed and used appropriately, health IT is expected to help improve the performance of health professionals, reduce operational and administrative costs and enhance public safety."
However, the report also refers to studies which suggest that fully designed Health IT can create new hazards in the already complex delivery of medical care. The study committee refers to dosing errors, failure to detect life threatening illnesses, delay in pending treatment and loss of data as risks associated with electronic health records which may lead to serious injury and sometimes death. Such errors and delay might be caused by poor human-computer interaction, computer crashes, quirky systems and technology that doesn't communicate with a rival company's version.
Closer to home, Graham Ingram, General Manger at AusCert recently delivered a paper on what he saw to be serious security concerns that he had with the proposed EHR system. He queried the ability of the government to protect such records from external attack. In fact Mr Ingram said that such assurances could not be given.
"You can secure the back-end systems, absolutely . . . what they haven't realised is that if you allow insecure end points to connect with that system, it is no longer secure.
If I can access my electronic health record from the Qantas Club or internet café, we have a problem. If we can't secure the machines, we can't secure the records."
Mr Ingram suggests that personally controlled electronic health records be accessible at secured terminals installed at health care facilities, Medicare offices or other institutions where access can be logged and controlled.
The people responsible for developing Australia's EHR system are leaders in their field. It is safe to say that they will address the concerns set out in the IOM Report. Those raised by Mr Ingram will also demand some careful consideration. Whatever the process, the outcome must be as close as the government can get to a seamless transition from paper to paperless for those who opt in to the scheme.
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