GPs need funding for e-health data quality

The Royal Australian College of General Practitioners (RACGP) has recommended that GPs be allocated more funding from Medicare to balance out extra time they will need to spend managing a patient's electronic health record.

The government hopes to have personally controlled electronic health records (PCEHR) up and running by mid next year. Different medical providers will contribute to the record, which will not be stored together, but use indices to link information.

The college warned in a submission to a Concept of Operations for the scheme that as the record will draw on data from multiple sources, contradictions or incorrect information could make its way into the record.

The college suggested that all professions that were able to contribute to a patient's consolidated view should have to undergo a "formal clinical safety assessment" conducted by an approved authority, such as the Australian Commission on Safety and Quality in Health Care.

However, the college also said it was important that a healthcare organisation ensured the accuracy of the information in the patient's e-health consolidated view and shared health summary, which should be carried out by the patient's nominated provider. It said that the GP was the "best-placed health professional to assume the role of nominated provider", and indeed believed that unless the patient said otherwise, their usual GP should be the default nominated provider.

The work required to complete this task "must not be underestimated", according to the college.

"IT is the RACGP's belief that the nominated healthcare provider will be burdened with substantial risk and considerable time spent on validating and updating the information in the Shared Health Summary," it said.

RACGP hoped the government would recognise the need for funding to GPs to manage the record, and not just to implement it, with funding required for training and education and a quality assurance process. In addition, the benefits of the record will flow to other health professionals more than to GPs, the college said.

"Accordingly, the RACGP would urge that government consider appropriate amendments to the Medicare Benefits Schedule to recognise the additional work general practitioners will undertake in consultations initiating and maintaining the patient's shared health summary and PCEHR," it said.

It believed that unless this occurred, there was a risk that providers would refuse to participate in the process.

The college also expressed concern about the complexity of access controls, saying that patients will require education to understand the controls, or they won't use them.

The Australian Medical Association (AMA) had also drawn attention to the record's complexity in its submission to the Concept of Operations, saying that "disproportionate emphasis has been given to the concerns of an extreme minority who will wish to mask details of their health record".

"Most of the unacceptable complexities that are proposed seem to be the result of struggling to meet the demands of an unrepresentative and vocal few," it said.

It suggested that making the record opt-out would have been simpler, where consumers with privacy concerns could make the choice not to participate.

The opt-in proposal meant that if medical practitioners searched for an electronic health record, they would often not find one for a patient, the AMA said. The limiting of the distribution of certain information also meant that doctors would not be able to rely on the record to be complete.

The AMA also expressed concerns about the administrative costs that medical practitioners will incur to implement the record.

Both organisations have expressed concerns around the medico-legal issues that arise from the record, given how loosely many obligations have been defined under the concept of operations.