The database, dubbed ObstetriX, is being developed by the NSW Department of HealthObstet Consortium in conjunction with Microsoft and Meridian Health Informatics. It will replace a host of local hospital databases, and will track and manage detailed maternal and neo-natal information from the initial stages of pregnancy through to birth. Microsoft, which is providing its .NET framework and SQL Server 2000 software for the database, said that the database "acts as a repository for antenatal screening information, patient and family history together with birth outcomes".
Obstet Consortium chairman Dr Michael Nicholl said the system "provides relevant and timely information and operates much faster than the old system. ObstetriX generates tailored reports, enabling hospitals and NSW Health to meet their statutory reporting requirements electronically."
However privacy advocates have expressed concern to ZDNet Australia about several aspects of the database, particularly the ability of general practitioners (GPs) to access patient data over a secure Web site. Speaking on the subject this afternoon, Nicholl attempted to allay fears that the system would be misused by saying that GPs would "only have access to certain parts of the database, they will only be able to access those parts that require direct clinical care". Furthermore, before being considered for access, GPs would have to be involved in a hospital's shared-care program and accreditation process.
Also, GPs would only be "given limited privileges to certain areas for read-only access, and then extremely limited access in terms of write". The write-access areas would primarily related to routine ante-natal visits. Family history information would be quarantined. Nicholl made the restrictions very clear, saying:"we're not going to allow access to sensitive areas in any way, shape or form".
According to Meridian Health Informatics managing director David Ashton, however, "GP access really hasn't been implemented. It's a ways off - 12 months away." Ashton went on to say while technically "anyone within an area health service" would be able to gain access to patient data, in practice access rights would be "generally confined to the actual hospital". There are nine wider health areas in NSW. Furthermore the system would be well integrated into the existing NSW Health Point of Care Clinical System (POCCS).
With respect to data sharing between health services, Australian Privacy Foundation Chair Anna Johnston told ZDNet Australia that, according to the NSW Health Records & Information Privacy Act 2002, "the sharing of identified health records across more than one organisation (such as between area health services) in NSW requires express consent of the patient." According to Nicholl, patients will be able to give or withhold their consent when they "first make contact with the service for their pregnancy".
Additionally, the current system where patients are given summary copies of their data when they are discharged will be continued, and patients will be able to have their data removed from the database upon request to their local hospital. As per the Act, any data made available for research purposes will be 'de-identified' - that is, no names or other identifying information will be used. Nicholl also said: "All research requests go through the data custodian, and the data sponsor for each of the sites. The data custodian is someone who has intimate knowledge of the database itself, and the sponsor is someone who is senior, and makes a management decision."
In general, researchers "have to be members of the organisations to which the hospital belongs, so for example if it was Auburn Hospital, the researcher would have to be attached to Auburn Hospital. If it was going to be area-wide research, then it would have to be someone at each of the hospitals in the area who are participating in the research."
ObstetriX has already gone live at the Nepean, Hawkesbury Private and Blue Mountains district hospitals. According to Microsoft, "Currently 50 percent of all babies in NSW are recorded in Obstet [the previous hospital-specific system]. It is hoped through the implementation of ObstetriX that this will increase to over 80 percent of all NSW babies."
This is a good initiative, IMHO.
Shared care between hospitals and GPs is increasingly important because obstetricians are vastyl expensive (partly because they are being driven out of business by high insurance premiums which run into the hundreds of thousands of dollars per year.)
Anything that makes it easier to deliver and receive shared care should be applauded.