Experts warn that patient safety can be in jeopardy under the proposed Australian electronic health records system. The electronic health record scheme, due to start on July 1, is yet to provide safeguards to prevent mistakes with doctors software.
Three experts including Chief clinical adviser to the e-health transition agency Mukesh Haikerwal warn the lack of a national clinical safety system to deal with computer glitches, and electronic devices means that “it is not yet possible to make any definitive statement about whether the personally controlled electronic health record is safe or not.”
The new system has been subject to growing criticism on concerns of privacy and security attributable to the unreliable performance of the National e-Health Transition Agency NEHTA, responsible for the e-Health rollout. Complaints have come 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.” This comes from an analysis by the Parliamentary Library.
A reliance on patient details transmitted from elsewhere by doctors and others, errors in readings could have life and death implications said, Dr Haikerwal. Experts write in the Medical Journal of Australia today, “There is no guarantee that harm events will be rapidly identified or remediated when it is in operation.”
“The handful of local studies on e-health safety all point to clear evidence of past harms and future risks,” says Enrico Coiera, director of the University of NSW's Centre for Health Informatics, along with co-authors executive dean of Flinders University's Faculty of Health Sciences Michael Kidd and National E-Health Transition Authority clinical lead Mukesh Haikerwal. “Given the systemic nature of national e-health, harm events will not be confined to individuals, and may affect large groups of patients.”
Dr Haikerwal, lead clinical adviser to the agency, says the need for a robust monitoring regime 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 such as psychologists. He denies the failure to make arrangements yet for the oversight of software and other gadgetry served by the e-health system is an oversight, as he said e-health would take time to roll out.
Likening national e-health programs to the airline industry, Professor Coiera and his co-authors say preventive action to “avoid an e-health 'air crash' now is a far better option than picking up the pieces after the event”. “Oversight is needed to manage the tasks of monitoring, detection, investigation and remedial action,” they warn.
E-health will deliver a growing battery of patient information meaning that increasingly doctors would depend on the reliability of the information “that my software that is bringing that information has gone through a rigorous process”. The authors raise the risk of wider patient safety problems under the national e-health system, such as if drug allergies were incorrectly uploaded or if medication names and doses were incorrectly displayed. They say the Therapeutic Goods Administration (TGA), which does have regulatory power, considered clinical software beyond its scope.
NEHTA chief executive Peter Fleming rejected the MSIA's concerns, and promised to provide copies of clinical safety documents requested by the Senate inquiry into the PCEHR Bills and related matters.