My Health Record

In 2013 it was reported that on average, each Australian has 22 health system interactions annually. This includes General practitioner (GP) visits, specialists, or prescriptions. All of these interactions are held in individual, separate, paper-based records making the entire health picture of an individual difficult to ascertain.[4] It is also reported that up to 10% of hospital admissions are due to adverse drug events, 18% are due to medical errors relating to lack of adequate available patient information,[5] and an estimated 25% of clinicians time is spent collecting information regarding the patient than actually treating them.[6] These facts combined with the ageing Australian population, vast geographic expanse, and ever increasing population, drove the implementation of an electronic health record in an effort to bring the medical record into the 21st century.

As part of the 2010/11 Australian federal budget the Hon. Nicola Roxon (Minister for Health and Ageing) announced the PCEHR as a "key building block of the National Health and Hospitals Network".[7] The system went live on 1 July 2012[8]

The Australian Government had a policy to develop a lifetime electronic health record for all its citizens. PCEHR was the major national EHR initiative in Australia, being delivered through territory, state, and federal governments. This electronic health record was initially deployed in July 2012, and underwent active development and extension by the Australian Digital Health Agency.[9]

It was budgeted to cost $466.7m but had surpassed this to $766m before the actual launch date with the final figure still to be calculated.[10]

In contrast a recent study published by Deloitte[11] projected the PCEHR to save approximately $11.5 billion over the 2010 to 2025 period. This consists of approximately $9.5 billion in net direct benefits to the Australian Government and $2.0 billion in net direct benefits to the private sector.[12]

As of 17 February 2013, 1233 healthcare organisations had registered for the PCEHR with NEHTA CEO Peter Fleming estimating 98% of GP-specific software was PCEHR compatible.[13]

At the 7-month mark 56,761 patients had registered with the 12-month target at 500,000 patients. The target figure was still considered achievable according to the DoHA deputy secretary Rosemary Huxtable who had released this information to a Senate Estimates committee. [14]

The name of PCEHR has changed to My Health Record in 2015 with an opt-out model. The Australian government budgeted around $485million for this system which potentially could save nearly 5,000 lives per year when functional.[15][16][17][18]

The Australian standards organisation, Standards Australia, and federal Department of Health have created an electronic health website, "e-health"[19] relating to information not only about Australia and what is currently going on about EHRs but also globally. Many key stakeholders contribute to the process of integrating EHRs within Australia. They range from each States Departments of Health to Universities around Australia and National E-Health Transition Authority to name a few.

If a consumer registered over the phone, in writing, or in person an identity verification code IVC is issued to enable access to the e-Health record online for the first time. After this first log, or post 30 days from issuance the IVC becomes obsolete. There are four steps in the registration process:

1. Read the essential information
2. Create a new or log into your australia.gov.au account
3. Verify your identity
4. Set up your e-Health record [21]

The Healthcare Identifiers Service (HI Service) was established by the federal, state and territory governments to create unique identifiers for healthcare providers and individuals seeking healthcare. It was designed and implemented by Medicare Australia under the control of the NEHTA. The HI Service allocates three types of Healthcare Identifiers:[22][23]

Individual healthcare identifier (i.e., who received the service)

The Individual Healthcare Identifier (IHI) is a unique 16 digit reference number that is used to identify individuals within the healthcare system.

The healthcare provider can retrieve a registered patients IHI via the Healthcare Identifier Service by entering in the correct name, DOB, and Medicare number which will automatically retrieve the patients unique IHI from the system. This then links the patients with their PCEHR, allowing the healthcare provider to view all the uploaded material.[24]

Health Provider Identifier-Individual (i.e., who provided the service)

The Health Provider Identifier-Individual (HPI-I) is allocated to healthcare providers involved in providing patient care. Healthcare providers belonging to the Australian Health Practitioner Regulation Agency (AHPRA) have automatically been registered for their HPI-I.[25] This unique number allows healthcare providers to access patients PCEHR and also acts as a tracking tool of who has accessed what, what edits were made etc.

Health Provider Identifier-Organisation (i.e., where the service was provided)

The Health Provider Identifier-Organisation (HPI-O) is a unique code for organisations that provide healthcare services. An HPI-O may be linked to several HPI-I's, but an organisation can not have more than one HPI-O.[22]

The eHealth Practice Incentives Program (ePIP) aims to encourage GP's to adopt and embrace the latest technology and developments within the eHealth industry as they occur. GP's are only eligible for ePIP if they are already registered in the Practice Incentives Program (PIP) administered by the Australian Government Department of Human Services (Human Services) on behalf of the Department of Health and Ageing(DoHA).[26] There are five further requirements for this incentive:

1. Integrating Healthcare Identifiers into Electronic Practice Records
2. Secure Messaging Capability
3. Data Records and Coding
4. Electronic Transfer of Prescriptions
5. Personally Controlled Electronic Health (eHealth) Record System[27]

The benefits of participation in this incentive is practices can receive a maximum of $12,500 per quarter, based on $6.50 per Standardised Whole Patient Equivalent (SWPE) per year.

The System Operator is the entity that is responsible for creating and operating the PCEHR. This position was held by the Secretary of the Department of Health and Ageing. The System Operator during their duties must have regard to the advice and recommendations (if any) given by the PCEHR Jurisdictional Advisory Committee and the PCEHR Independent Advisory Council.[28]

National Authentication Service for Health Public Key Infrastructure (PKI) is a certificate that authenticates healthcare professionals accessing the eHealth records system. These certificates can be loaded onto smart cards which are then used in combination with the healthcare professionals HPI-I to log on to patients who have a PCEHR using the patients IHI. This system also facilitates secure electronic communications with other healthcare provider organisations.[29]

The PKI allows users to know:

• who sent the message
• the message hasn't been altered between sending and receiving it.
• the sender can't dispute the message they created and sent
• that only the person the message is directed to can open it[30]

These benefits allow users to securely and confidently relay patient information to trustworthy sources.

For the PKI to work there must be a Chain of Trust on your computer. This Chain of Trust is composed of three certificates, namely:

1. Medicare Australia Root CA
2. Medicare Australia Organisation CA
3. Medicare Australia Organisation CA2[30]

The PKI Certificates are based on the Australian Gatekeeper framework and met the International Organization for Standardization (ISO) Health Informatics-Public Key Infrastructure technical specification (ISO/TS 17090).[31]

The six GP Desktop Vendor Panel members are :-

• Best Practice Software Pty Ltd
• Communicare System
• Genie Solutions
• iSoft
• Medtech Global
• Zedmed[32][33]

The PCEHR Act established the PCEHR Jurisdictional Advisory Committee (PCEHR JAC) to advise the System Operator on matters relating to the interests of the Commonwealth, States and Territories in the PCEHR system. The PCEHR JAC meets at least four times per year, or more frequently as agreed between the System Operator and the Chair. The PCEHR JAC has nine members, a member to represent the Commonwealth and a member to represent each State and Territory.[40]

The PCEHR Independent Advisory Council (PCEHR IAC) was established under the PCEHR Act to advise on the operation and participation in the PCEHR system, clinical, privacy and security matters relating to PCEHR system operations. The PCEHR IAC meets at least four times per year.[40]