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Concern for patient safety with e-records

Date

Mark Metherell

The electronic health record scheme is due to start on July 1.

The electronic health record scheme is due to start on July 1. Photo: Andrew Quilty

Patient safety under the proposed electronic health records system cannot be guaranteed less than three months before it is scheduled to start.

Safeguards to prevent and correct snafus with doctors' software, such as medication mistakes, have yet to be provided for in the national e-health scheme beginning on July 1.

The warning has come from three experts, including Mukesh Haikerwal, chief clinical adviser to the e-health transition agency.

They warn that the lack of a national clinical safety system to deal with glitches in doctors' desktop computers and electronic devices such as iPhones and iPads means that "it is not yet possible to make any definitive statement about whether the personally controlled electronic health record is safe or not".

"There is no guarantee that harm events will be rapidly identified or remediated when it is in operation," they write in an editorial, published in the Medical Journal of Australia today.

Their warning is the latest challenge to confront the e-health plan, which has attracted growing criticism about security and privacy concerns spurred by the uncertain performance of the body responsible for the e-health rollout, the National e-Health Transition Agency.

E-health has been the subject of complaints from industry "ranging from accusations of ineffective oversight and failure of administrators to acknowledge design flaws, to warnings that the system will not succeed because its implementation has been ill-considered and rushed", an analysis by the Parliamentary Library has stated.

Dr Haikerwal, the lead clinical adviser to the agency, says the need for robust monitoring will become more important as the system users grow along with the delivery of more complex patient data to a wider circle of health practitioners, including doctors, hospitals and other professionals.

He denies the failure to make arrangements yet for the oversight of software and other gadgetry served by the system is an oversight and that e-health would take time to roll out.

Dr Haikerwal, who also chairs the World Medical Association, says that as doctors and others rely on patient details transmitted from elsewhere, an error in blood pressure readings, for instance, could prompt a drug dose error with life and death implications.

The Medical Journal editorial, whose other authors are Enrico Coiera, the director of the Centre for Health Informatics, and Michael Kidd, executive dean of the faculty of health sciences at the University of NSW, says the benefits of the technology should not be overshadowed by avoidable patient harm.

The authors raise the risk of wider patient safety problems, such as if medication names and doses were incorrectly displayed.

14 comments so far

  • Delay its implementation until proper safeguards are in. And what about malicious tampering by hackers? If the American Defense Department, with its massive funding and access to the bery best and brightest in the world on security is regularly beaten by hackers, what hope this system? Whole damn thisng is a stupid geeks wet dream.

    Commenter
    Luddite
    Date and time
    April 16, 2012, 10:01AM
    • Having worked for many years in both health and IT, I am afraid I have to agree with 'Luddite'...I have friends working in this 'space' and there are NO security protocols/policies available to date...I for one, will NOT be joining ehealth till ALL safeguards are in place to ensure my records are only available to registered practitioners...be afwaid people...berry, berry afwaid.

      Commenter
      JAS
      Location
      ACT
      Date and time
      April 16, 2012, 3:36PM
  • Surely any system that prevents some deaths is better than what we have now. Arguing to prevent that system unless it is perfect will condemn many to needlessly die - it nearly happened to me.

    In the last 2 weeks, I was referred by my GP to Emergency. The GP didn't have my current medications, even though I asked him to update the list - most were prescribed elsewhere. I tried to tell the hospital that the medications were wrong and was ignored. I was then given a simple pain relief medication, which had I taken would have caused kidney failure.

    Delaying this project (or stopping it) because it isn't perfect could well end up killing me and many many others.

    Commenter
    a patient
    Location
    sydney
    Date and time
    April 16, 2012, 10:50AM
    • The real question is "will an eHealth system be better than the system we currently have?"
      Waiting for a 100% secure and reliable system will guarantee we never get electronic health records. In that case, be prepared to accept the current situation: avoidable errors, mis-medications, misdiagnoses, and deaths from our antiquated, manual human systems.
      For too long we have delayed a better system because of unrealistic expectations.
      Tell me why we expect computers to be infallible and then we tacitly accept inferior human systems?

      Commenter
      Realist
      Date and time
      April 16, 2012, 11:30AM
      • I was watching an interesting documentary on the Titanic last night. All the many little things that seemed like nothing at the time until after the event. Real eye-opener.

        Commenter
        Unsinkable
        Location
        100 Year Anniversary
        Date and time
        April 16, 2012, 12:36PM
    • Nothing to fear. Nehta has never produced anything useful in the past, and there is no indication that it will in the future. As the minister said recently, EHealth is a journey, not a destination. No system = no risk, privacy or otherwise.

      Commenter
      T.
      Date and time
      April 16, 2012, 11:39AM
      • Is this an ALP initiative? If so I have every confidence it will go as smoothly as everything else these clowns have implemented.

        Commenter
        Jay Mann
        Date and time
        April 16, 2012, 12:09PM
        • Ehealth should never be seen as something that substitutes for good patient care. I am a strong advocate of using these technologies to underpin good clinical practice, but first and foremost patient safety and confidentiality needs to be assured.

          Commenter
          Doctor
          Date and time
          April 16, 2012, 12:39PM
          • Doctors will be able to know the patient history to save lives. Thailand has implemented a similar systems well before 1975.

            Commenter
            Ken
            Location
            Sydney
            Date and time
            April 16, 2012, 12:45PM
            • I would rather 'take my chances' with a less than perfect e-system than none at all. What if you suddenly collapsed in the street and had to be whisked to hospital - do you wait for a relative to be contacted, or wait for tests to be carried out, or have your records available to the hospital?
              Many patients are already using electronic forms of assessment and treatment by downloading insulin or pacemaker information electronically, it going to a doctor who sends back treatment advice. And the Magellan machine is blazing a trail for operations being able to be carried out remotely.
              Electronic health records have to start sometime and if you wait for the perfect system nothing will happen - there might be some unfortunate mistakes early on, but there are unfortunate mistakes now. I don't think the e-health system is compulsory either - you have to opt in and give access - so if you don't want it don't use it.

              Commenter
              Dee2
              Date and time
              April 16, 2012, 1:44PM

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