In this cybernetic age, where electronic messaging has become as instantaneous as it is ubiquitous, the widescale introduction of electronic health records seems inevitable.

The push by health providers to get rid of the 'paper chain' has led to debate about whether an electronic system will compromise the protection of personal information.

NSW Health intends to rollout Electronic Health Records (EHR) by 2002 and has recently released a report on the Internet for public discussion on the privacy implications of the new system.

NSW EHRs will provide GPs, specialists, public and private hospitals, community health centres and other health providers with access to relevant information about a patient's medical history - with the patient's consent.

The report, "Panacea or Placebo? Linked Electronic Health Records and Improvements in Health Outcomes" was submitted by the NSW Ministerial Advisory Committee on Privacy and Health Information, chaired by NSW Privacy Commissioner Chris Puplick.

Privacy promise
"Individual concerns needn't be great providing the system ensure nothing can be done without the patient's consent," Puplick told ZDNet.

"I would not support any system that did not have central that right of the patient."

The report recommends that under the EHR system only patients who actively agree will have an electronic health record. They will also have to give their consent about the type of information made available and what data is transferable.

-Of course, patients will have ultimate control. They can ask for the service, they can stop the service. To ensure the integrity of the system, patients will be able to get information about who has accessed their health records and when," NSW Minister for Health Craig Knowles said.

Legislative review
The report also recommends that the EHR system be governed by a separate and specific piece of state legislation, which it calls the Health Records and Information Privacy Act.

This legislation would bring together privacy aspects of other legislation that deal with confidentiality issues and would vest in the NSW Privacy Commissioner the power to investigate complaints and made under the Act.

"The Minister has shown some interest in getting a piece of legislation in NSW Parliament in the first Parliament session," Puplick said, adding that the 2002 target to implement EHRs in NSW was "fairly realisitic".

Education campaign
The privacy report also recommends that Health Records and Information Privacy Act must be accompanied by a comprehensive education campaign directed at general public and health care providers, which must be monitored and evaluated by the Privacy Commissioner on an on-going basis.

The report also calls for the piloted, staged, progressive implementation of the statewide system.

The pilot stage would consist of adopting an established model - such as the internal EHR system used by Central Sydney and Hunter Area Health Services - and seeing if it would fit easily into the new paradigm, according to Puplick.

The pilot would also have to be carried out in non-metropolitan NSW to determine whether or not the technology could work efficiently in areas not so well placed.

Puplick's report recommends that the EHR system incorporate unique patient identifiers (UPI) that would prove the identity of the patient.

-Health record privacy is our top priority. A unique identifier system will help ensure access is strictly limited to authorised medical staff only," the Health Minister said.

The Minister has called for public comments by the end of March.

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