PCEHR

**Recent articles:**
www.computerworld.com.au/article/377960/nehta_anticipates_e-health_record_clarity/ Australian Doctor: www.australiandoctor.com.au/articles/77/0c06f677.asp NEHTA: www.nehta.gov.au/ehealth-implementation/what-is-a-pcher

The Australian:  [|www.theaustralian.com.au/australian-it/it-business/roxon-sells-her-vision-of-handing-power-to-the-patients/story-e6frganx-1226037346609] www.theaustralian.com.au/australian-it/draft-plan-for-e-health-disappoints-500m-records-system-to-be-voluntary/story-e6frgakx-1226037456206 [|www.theaustralian.com.au/australian-it/e-health-vision-has-roxon-revved-up/story-e6frgakx-1226037451911]

Comment Pages:
Please click on these links and edit your comments on the following pages:
 * Consent Model Privacy Model Information Architecture (eg indexing services etc)   Clinician Workflow **
 * Patient Workflow **
 * Standards **
 * Implementation Considerations **
 * Governance**
 * Benefits**
 * Sustainability**

DM I developed a 9 page submission which has been submitted to DoHA. Any text or points that are useful can be used in this submission.

It is on the web here (just cut and paste as needed)

[]

**Comments:**
Despite a number of announcements and a number of draft versions distributed under non-disclosure, NEHTA has not publicly published the "PCEHR Concept of Operations"....

Using the NEHTA defintion of the PCEHR I composed the following text in the hope that it helps.

==What is a PCEHR? == ==[] ==

// A Personally Controlled Electronic Health Record (PCEHR) is a secure, electronic record of your medical history, stored and shared in a network of connected systems. The PCEHR will bring key health information from a number of different systems together and present it in a single view. // // Information in a PCEHR will be able to be accessed by you and your authorised healthcare providers. With this information available to them, healthcare providers will be able to make better decisions about your health and treatment advice. Over time you will be able to contribute to your own information and add to the recorded information stored in your PCEHR. // //. In the future, as the PCEHR becomes more widely available, you will be able to access your own health information anytime you need it and from anywhere in Australia. // Discussion on this definition.  · __ Secure: __ Currently Australia does not have and there is little unified agreement on what will make the PCEHR secure. This is despite the existence of systems that have been functioning as e-Health systems since the 1970s that store the e-records on more than 2 million patients across multiple care institutions (RMRS/HELP/BID/Brighams and Womens/BAZIZ/OpenMRS). Why can we not use these know security techniques as national standards. We also know that the greatest threat to security of patient records is by those in the health system who have no rights of access to individual records. This is a human factor and often requires legislation with the e-security tracking within the e-health system. An excellent example is the Beth Israel Deaconess security technologies.  · __ Stored and shared in a network of connected systems: __ in the current Australian health system there are no such systems and we know that local silos on nested non-communicating e-Health systems are permitted to be implemented with no unity with national standards, Tasmania is a very good example. All these implementations will have to be undone if/when we have legislated national network communication standards. As Paul Clayton decreed in HELP and New York Presbyterian institutions NO health application was permitted to be evaluated if it was no HL7 Standardises and met other core data standards.  · __ Bring key health information from a number of different systems together and present it in a single view. __ This is not possible without the requirements stated above. We know it can be done as was shown in the 1995 review of e-health systems in International Journal of Medical Informatics 54 (1999) 155–156.  · __ Accessibility: __ Within current and emerging technologies this can be managed based on the clinical environment where the application is installed.  · __ To contribute to your own information and add to the recorded information stored in your PCEHR//.// __ This is a complex and currently not fully resolved issue of data and information capture as was highlighted by Slack in the January 2011 issue of JAMIA. I believe an even greater problem for recording information is that by clinicians as has been shown by Bates and others in their commentary on CPOE. Tierney also points out that those recording clinical information should be those who require it the most, that is clinicians (includes patients).  · __The PCEHR will not hold all the information held in your doctor's records but will complement it by highlighting key information__//.// In the care of the patient ALL information is required what is required are the rights of access and ‘user defined formats’ relevant to each clinical scenario-Summarisation (Coiera/ Fries / Whiting-OKeefe/ Kriplani). Historically it is interesting to note the variations in Summarisation that have been successful (OCIS/RMRS/OpenMRS/e-Chasqui) and also the similarities.

There is an animated description of the PCEHR created by DoHA [|here]

04/04/2011-1342 hrs-In recent searching I have found this on NEHTA and the Concept of Operations: [] I am presuming it will be markedly different from the version we are all wating for. Terry Hannan