Digitalisation of health and Australia: Are we on the right eHealth track?

Digitalisation of health and Australia: Are we on the right eHealth track?

Tech opens up an exciting world of possibilities for most industries and health is no exception.

In Australia the current state of eHealth is a testing topic and rightly so — a system capable of handling and catering to the many needs of an almost 24-million strong population is no easy feat. Regardless, the Australian Government is determined to innovate and break into eHealth with incredible eHealth technology and initiatives currently being developed and implemented -  but more often than not they’re surrounded by complexities.

Let’s take a look at the Australian Government’s Personally Controlled eHealth Record (PCEHR).

Technology to keep records of Australia’s aging population
The PCEHR initiative is an electronic summary of an individual's health records. The individual and their healthcare provider can access it online whenever they need, from wherever they are.

The system was rolled out nationally in July 2012, however due to low take up with the original ‘opt-in’ option the government changed the process to ‘opt-out’ at the start of 2015. This means every single Australian will have an eHealth record unless they ‘opt-out’ electronically and remove their record.

The Government estimates a fully functioning national e-health system has the potential to save taxpayers $2.5 billion per year within a decade, an additional $1.6 billion in annual savings is expected to be passed on to the states.

Issues facing the rollout

As with anything utilising technology privacy is a major concern, especially when it involves electronic data collection. Individually the user enters most of their personal information and physicians enter more specific details about the individual health such as: allergies and adverse reactions; medicines; medical history; etc.

All of this data needs to be kept safe and secure and the Federal Government has taken precautions to ensure this, such as:

  • Requiring password authentication for access;
  • Installing a multi-layered ICT system of firewalls, gateways and portals to ensure only authorised users can access the eHealth record system;
  • Ensuring personal information transmitted or stored will be encrypted to government standards published in the Australian Government Information Security Manual;
  • Continued education and awareness programs to highlight the need for individuals to protect themselves against security threats and other hoaxes or scamming activities;
  • Recording and maintaining a history of access to eHealth records that individuals can view.

To continue to protect and secure this data (especially if the information is requested from an unsecured device), all stakeholders need to keep up to date with security issues and threats, and how best to protect themselves. It’s also imperative that the teams implementing the system go above and beyond to stay on top of new ways to prevent data leaks and breaches and prevent individuals medical and personal records ending up in the wrong hands.

PCEHR adheres to the Commonwealth Privacy Act 1988 and the Australian Privacy Principles (APP). There’s a lot to cover to ensure individual’s data is kept private.  A very interesting functionality with PCEHR is that the individual has the ability to suppress some of the information on their record and control who sees what, but regardless of this functionality in life-threatening situations all information can be accessed by physicians.

PCEHR has done an incredible amount of groundwork to ensure the privacy of the user is adhered to. They have full logs of who, how, what and when someone accesses the information. But to effectively keep individuals details ‘private’, security measures and data encryption need to remain a key focus. The user needs to understand the entire system and exactly who, when and how people have access to their personal information.

Future Direction
The health information supplied in an individual's PCEHR is drawn from both public and private sources, such as existing hospital data repositories, which are registered to participate in the eHealth record system. But what if they’re not? Does that information just go a-miss?

Australia is missing unification on many fronts of it’s eHealth adoption. Capital Markets CRC principal adviser Dr Paul Nicolarakis suggests part of the problem is Australia lacks a vision for healthcare. He said there isn’t one group of individuals working towards a common goal. If we look at PCEHR, at the moment it’s not mandatory for healthcare professionals, hospitals, clinics etc. to sign on to the system. Some state governments have supported the initiative. NSW Health committed millions to rolling out ‘HealtheNet’ - which gives NSW Health clinicians access to a consolidated view of a patient’s clinical information on the state database and national database through a NSW portal. But why would a national system need an individual state-based portal to view the information? It seems counterintuitive.  

Does Denmark have the answer?
Denmark’s eHealth system is world leading. All GPs and all hospitals have electronic medical records (EMRs) and all communication and standards are managed through a central network called MedCom. The ownership is shared between national, regional and local government authorities. Denmark was an early adopter of eHealth, implementing the system as early as 1994. This unified approach between national, regional and local government authorities seems exceptional on the surface, but due to rapidly changing technology fragmentation has become an issue. Despite this, Denmark’s governments at all levels are working together to fix these problems and have a plan to resolve it by the end of 2016.

Having a common goal of the combined governments and working together on all levels appears to be a logical solution to a successful roll out, but it’s not always that simple.Technology adoption for any government department is a challenging task. Change in leadership, budget restraints, old technology and red tape are all factors that deter, slow down and complicate the implementation of technology.