In this post I want to make a simple suggestion. That is that Mr Hockey should reward those people who register for their Access Card with the capability – rather than store health information on the card itself – for citizens to enter information on their health in a standardised form on a national Personal Health Record server access to which is provided by provision of the card.
The standard format to be used can be a matter of discussion but the basic elements of the contents could be as follows. Note: All content would be optional for each individual patient as would be use of the record as a whole be totally optional.
1. Very basic demographics (derived from the card record) – Name, Age, Sex, Current Address and a Date Last Reviewed by Patient, Pharmacist or GP.
2. Ordinary Regular GP with phone number etc
3. Allergies (simple record of what substance, what reaction and had a doctor confirmed the validity of the allergy (Y/N).
4. Important Family Medical History if individual wants to record it (e.g. heart attacks run in family etc).
5. Known Chronic Illnesses (e.g. diabetes, epilepsy, arthritis etc) and important past surgery.
6. Listing of Current Medications and Dosage and Frequency.
7. Results of Tests and Investigations – these would be sourced from the GP or specialist and placed on the record for the patient – and marked with the contact details of the source of the information
8. A recurrent simple record where the individual could record a date, time and measurement (e.g. a blood pressure reading, spirometry or patient measured blood sugar levels)
9. A place for notes of information such as appointments, immunisations etc as free text.
10. The capacity to store important health related documents in any of the standard formats as an attachment if needed for any specific reason.
The record would be only accessible if the card owner placed the card in a reader in the presence of an appropriate health professional – for initial creation or updating – or via the use of a secure one-time validated web site log-on. (e.g. you enter your ID, your e-mail or SMS phone number is already stored on the Access Card database – and that is used to send you back a one time usable password that expires in say one hour.).
Anyone trying to wrongly access your account needs to know your ID Number, your phone number or e-mail (not on the card) and to be expecting the password to arrive. This would be more secure than current internet banking which millions of people use daily.
I would envisage Medicare would provide an annual payment in the form of a standard Medicare benefit for your GP to review and update your record on an annual basis. A small fee could also be provided to pharmacists to update the medication record.
The advantages of this proposal are:
1. The user owns and is responsible for the record – but the record can be flagged as having been medically reviewed on a particular date.
2. Slightly more technical information is provided by the GP for the patient and again this process provides more review.
3. The system is totally voluntary and indeed other providers may be able to set up similar services (e.g. health funds, banks) (it would be important the format be standardised properly – perhaps NEHTA could own that problem).
4. A lot of the benefits potential of HealthConnect like proposals could be realised quite cheaply.
5. The proposal, intrinsically, ensures those with complex health issues are those who would set up such a record and it is those who we need the most information available for in emergent and multi health provider (team) situations.
6. The record is totally voluntary and avoids any privacy concerns – with a Government or other provider guarantee of strict security enforcement.
7. The system could make a real contribution to continuity of care of patients within the community.
8. It would be very easy to design the record to be downloadable to GP computing systems to provide very useful background information when a patient changes practice or location. Also has the benefit of providing an off-line backup of possibly important records.
It should be noted that this proposal would provide a very useful testbed for shared EHR possibilities, infrastructure and utility and, if sensibly designed, permit migration to a more clinically orientated system over time. There is also the possibility that an interested consortium could undertake the entire project with funding from a range of sources possible (Health Insurers, Users, Government or a mix of some or all.).
I wonder will the policy gurus give the idea a careful review. I hope so.
David.
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