Personally Controlled Electronic Health Record Review: Summary of recommendations

Rename the Personally Controlled Electronic Health Record (PCEHR) to My Health Record (MyHR).
Restructure the approach to governance, dissolve NEHTA and replace with the Australian Commission for Electronic Health (ACeH) reporting directly to the Standing Council on Health (SCoH).
Establish a Clinical and Technical Advisory Committee to ACeH.
Establish a Jurisdictional Advisory Committee to ACeH.
Establish a Consumer Advisory Committee to ACeH.
Establish a Privacy and Security Committee to ACeH.
Establish a taskforce to transition arrangements between the current governance structure and the one recommended in this report.
Maintain the Independent Advisory Council (IAC) with an altered reporting line, direct to the Federal Minister for Health.
Commission an external review of the function and roles in the eHealth section of the Department of Health, Department of Human Services (DHS) and NEHTA to assess duplication and alignment with mandates.
Establish a regulatory body that monitors and ensures compliance against eHealth standards that are set and maintained by ACeH.
Centralise the system operation of the MyHR to the Department of Human Services (DHS), under contract from ACeH. DHS should run all MyHR related infrastructure services and maintenance, performance reporting, contact centres, management of NASH, and the Health Identifier service. ACeH to work with DHS to assess which components of the service should be contracted out to private partners, with DHS remaining the overarching government department responsible for service delivery.
Establish a clinical systems capability (group) within the Department of Human Services (DHS) to integrate and coordinate improvement to all health systems and platforms.
Transition to an ‘opt-out’ model for all Australians on their MyHR to be effective from a target date of 1st January 2015. This recommendation is subject to the completion of the minimum composite of records (recommendation 21) and the establishment of clear standards for compliance for clinical users via the Privacy and Security Committee.
Commission a technical assessment and change management plan for an opt-out model to be undertaken in early 2014 in order to determine requirements and identify costs for a model change.
Require an annual report from the Privacy and Security Committee on:
- the number of individuals who have opted out of the MyHR;
- the number of documents that have access controls changed by category; and
- the meaningful use and adoption by the profession
Commission an Information Security Risk Assessment of the end-to-end flow of consumer information to and from the MyHR platform. Findings and mitigation actions to be reviewed and agreed by the Privacy and Security Committee.
Clarify that the MyHR is a supplementary source of information that may, but does not always need to be, used by clinicians in caring for their patients.
Develop and conduct an education campaign for consumers and clinicians about the impact of the change to an opt-out process and the strength of security and privacy in the system.
Expand the existing Australian Medications Terminologies (AMT) data set to include a set of over the counter (OTC) medicines.
Widen the existing National Prescribing and Dispensing Repository (NPDR) to include the expanded set of over the counter (OTC) medicines.
Implement a minimum composite of records to allow transition to an opt-out model by a target date of 1st January 2015 inline with recommendation 13. This will dramatically improve the value proposition for clinicians to regularly turn to the MyHR, which must initially include:
- Demographics;
- Current Medications and Adverse Events;
- Discharge summaries;
- Clinical Measurements.
Work should proceed to allow the integration of diagnostic imaging and pathology into MyHR but their delivery dates should not delay transition to opt-out.
Implement a standardised Secure Messaging platform for the medical industry, prioritising support for standards compliant platforms.
Expand the Secure Messaging strategy to include exchange of secure communication between the medical industry and consumers to facilitate improved communications and workflow efficiencies.
Review the NASH platform with a view to evolving the platform to align with the recommendations for Digital Identity that is included in the Coalition’s Policy for E-Government and the Digital Economy.
Review the current development program for the PCEHR and deliver prioritised usability improvements based on user centred design principles in partnership with industry. The usability improvements to be designed to complement everyday workflows.
Add a flag to the clinical author to identify if their patient has restricted or deleted a document in their MyHR to facilitate a discussion on the clinical impact.
Notify the consumer via an SMS message when their MyHR is opened or used by default. For patients that do not have a mobile number, a message will not be sent, however mobile contact number should be requested as part of the standard information for a customer’s profile.
Enable a single sign-on capability that enables simplified usability as users of the systems are able to seamlessly pass from one system to another.
Evolve education, training and implementation programs to engage industry associations in the design and delivery of programs. This includes implementation of online training tools, including provision of a simulated MyHR environment to support required training volumes.
Immediately update the MyHR strategy to actively enable decentralisation of information across multiple data repositories, with information being linked using the Healthcare Identifier (HI).
Reset the policy standards and frameworks necessary to enable interoperability, in a decentralised model, plus commercial models that ensure providers can generate an acceptable return on the investments made in shared infrastructure.
Prepare a business case that defines appropriate methods of compensation for investment should be investigated that include one-off costs and/or transaction fee services for clinical access to records associated with integration of existing data sets into the MyHR.
Introduce by ACeH Board a new balanced scorecard of metrics that includes primary metrics (e.g. meaningful use metrics) and secondary metrics (e.g. leading indicators) that are aligned with the benefits and goals of the MyHR.
Apply governance principles of transparency of metrics and reporting to build confidence in the clinical relevance of information that is provided.
Change the ePractice Incentive Payment (ePIP) to introduce meaningful use metrics that incent contribution of clinical relevant information to the MyHR, including linking ongoing ePIP funding to actual usage of the MyHR.
Commission a scoping project to identify the options available to encourage further take up of electronic transmission of data by specialist medical and allied health professional practices and private hospitals.