Clinical Safety of the Australian Personally Controlled Electronic Heath Record (PCEHR)

November 29, 2013 § Leave a comment

Like many nations, Australia has begun to develop nation-scale E-health infrastructure. In our case it currently takes the form of a Personally Controlled Electronic Health Record (PCEHR). It is a Federal government created and operated  approach that caches clinical documents including discharge summaries, summary care records that are electively created, uploaded and maintained by a designated general practitioner, and some administrative data including information on medications prescribed and dispensed, as well as claims data from Medicare, our universal public health insurer. It is personally-controlled in that consumers must elect to opt in to the system, and may elect to hide documents or data should they not wish them to be seen – a point that has many clinicians concerned but is equally celebrated by consumer groups.

With ongoing concerns in some sectors about system cost, apparent low levels of adoption and clinical use, as well as a change in government, the PCEHR is now being reviewed to determine its fate. International observers might detect echoes of recent English and Canadian experiences here, and we will all watch with interest to see what unfolds after the Committee reports.

My submission to the PCEHR Review Committee focuses only on the clinical safety of the system, and the governance processes designed to ensure clinical safety. You can read my submission here.

As background to the submission, I have written about clinical safety of IT in health care for several years now, and some of the more relevant papers are collected here:

  1. J. S. Ash, M. Berg, E. Coiera, Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System Related Errors, Journal American Medical Informatics Association, 11(2),104-112, 2004.
  2. Coiera E, Westbrook J, Should clinical software be regulated? Medical Journal of Australia. 2006:184(12);600-1.
  3. Coiera E, Westbrook JI, Wyatt J (2006) The safety and quality of decision support systems, Methods Of Information In Medicine 45: 20-25 Suppl. 1, 2006.
  4. Magrabi F, Coiera E. Quality of prescribing decision support in primary care: still a work in progress. Medical Journal of Australia 2009; 190 (5): 227-228.
  5. Coiera E, Do we need a national electronic summary care record? Medical Journal of Australia 2011; 194(2), 90-2.
  6. [Paywall] Coiera E, Kidd M, Haikerwal M, A call to national e-health clinical safety governance, Med J Aust 2012; 196 (7): 430-431.
  7. Coiera E, Aarts J, Kulikowski K. The Dangerous Decade. Journal of the American Medical Informatics Association, 2012;19(1):2-5.
  8. [Paywall] Magrabi F, Aarts J, Nohr C, et al. A comparative review of patient safety initiatives for national health information technology. International journal of medical informatics 2012;82(5):e139-48.
  9. [Paywall] Coiera E, Why E-health is so hard, Medical Journal of Australia, 2013; 198(4),178-9.

Along with research colleagues I have been working on understanding the nature and extent of likely harms, largely through reviews of reported incidents in Australia, the US and England. A selection of our papers can be found here:

  1. Magrabi F, Ong M, Runciman W, Coiera E. An analysis of computer-related patient safety incidents to inform the development of a classification. Journal of the American Medical Informatics Association 2010;17:663-670.
  2. Magrabi F, Li SYW, Day RO, Coiera E, Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects. Journal of the American Medical Informatics Association 2010 17: 575-583.
  3. Magrabi F, Ong, M, Runciman W, Coiera E, Patient Safety Problems Associated with Healthcare Information Technology: an Analysis of Adverse Events Reported to the US Food and Drug Administration, AMIA 2011 Annual Symposium, Washington DC, October 2011, 853-8.
  4. Magrabi F, Ong MS, Runciman W, Coiera E. Using FDA reports to inform a classification for health information technology safety problems. Journal of the American Medical Informatics Association 2012;19:45-53.
  5. Magrabi, F., M. Baker, I. Sinha, M.S. Ong, S. Harrison, M. R. Kidd, W. B. Runciman and E. Coiera. Clinical safety of England’s national programme for IT: A retrospective analysis of all reported safety events 2005 to 2011. International Journal of Medical Informatics 2015;84(3): 198-206.

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