Legislation passed by the Senate in November 2015 brings a longstanding work in progress – the national electronic health record – that much closer to completion.
The legislation shifted consumer enrolments in the system to an ‘opt-out’ basis in trials running in Northern Queensland and the Nepean Blue Mountains region of New South Wales. Shifting to an ‘opt-out’ basis as well as changing the system’s name—from PCEHR (‘pecker’) to My Health Record (MHR)—follows recommendations from the 2014 Royle review.
Shifting enrolment from an ‘opt-in’ to ‘opt-out’ basis also reflects more fashionable public policy thinking: the notion of the ‘nudge’ and the application of behavioural economics.i The underlying thinking here is that policymakers can easily influence people by changing the ‘choice architecture’ to make more desirable choices—while still providing the flexibility to choose otherwise.
Pending the outcome of the trial, this ‘nudge’ goes some way to addressing past criticisms of the MHR around low take-up. Yet there are still divergent views about the system. On the one hand, sector stakeholders agree that a national electronic medical record is desirable in principle. But many have been concerned about whether the MHR is ‘the one,’ after estimated expenditure of $1.5 billion and issues around system security, access, control and ownership. What are the key implications of changes around the MHR?
Incentives to get with the programme
A lack of financial incentives for medical practices to use the MHR system has been a core criticism. For many years the Federal Government has used financial incentives to encourage the adoption of digital technologies in medical practices through programmes such as the Practice Incentives Program (PIP). Reworked for the MHR, the PIP eHealth Incentive continues that approach.ii A quarterly payment tied to uploading Shared Health Summary records for 0.5% of patients, the eHealth Incentive, has been effective since 1 May 2016. Practitioners should be taking advantage of this financial incentive to defray costs that may be incurred in using the MHR system, such as upgrading IT infrastructure, staff training as well as for time spent managing records.