How e-Health records could stop mental health treatment
For the very first time I find myself agreeing with Tony Abbott. Not because of his views on climate change, and definitely not because of his views on homosexuality, but simply because he expressed reservations about introducing an e-Health records system.
The national e-Health records system is due to be rolled out in 2012, and would allow health providers to access patient summaries that include conditions, medications, test results allergies, and vaccinations as well as an indexed summary of specific health events and the related practitioner.
One of the obvious benefits of this system is that it will potentially promote consistent care across jurisdictions. But when it comes to the kind of sensitive information exchanged during psychological treatment, this level of transparency is equally undesirable.
Some psychologists worry the introduction of e-Health records will deter already apprehensive Australians from seeking critical psychological help, especially if it eventually becomes tied to claiming Medicare benefits.
If this is the case, e-Health records threaten to undermine the effectiveness of both Labor and the Coalition’s commitments to mental health and suicide prevention.
Dr Alexander Blaszczynski, a practicing psychologist and Professor of Clinical Psychology at the University of Sydney, is convinced that although there are some clear advantages to national e-Health system, its introduction will deter people from seeking psychological treatment for fear that their clinical information won’t remain confidential:
“The key issue is that it will make some people with certain conditions less inclined to seek out and accept treatment. I generally work in the field of impulse control and behavioural disorders, and that sort of patient information is highly sensitive. If you’re treating a politician or a high profile executive who engages in illicit behaviours, gambling or something like bondage they won’t want to risk that coming out in the public domain. They certainly won’t want that information on a server that could potentially be available to general physicians and allied health providers,” he said.
Bondage aside, it’s a sobering thought. It is well known that mental health problems are a risk factor for both self-harm and suicide, and the number of people with untreated mental health issues in Australia is already shamefully high — around 65 per cent of the national population and around 75 per cent of the youth population.
To add a public face to the problem, Opposition finance spokesman Andrew Robb spoke out last year about his own battle with a depressive condition. Robb said it took him decades to confront his condition and seek assistance, partly because of a stigma surrounding mental health issues. “There are millions of people who couldn’t - they probably do what I did and just live with it,” he said.
A national e-Health record system will potentially exacerbate what is an endemic cultural problem by deterring those who are already apprehensive about seeking psychological help. In doing so, the introduction of e-Health records would undermine any efforts made by the government to address mental health and suicide prevention in the next term, regardless of which party wins power.
Since 2007 Australians have been able to claim up to 12 sessions with a registered psychologist under Medicare if referred by their doctor. In addition to this, Labor has promised to provide an additional $22.9m for psychological counselling services for about 12,500 people (each year) who have attempted suicide or were at risk of attempting it. While the Coalition has promised to deliver 60 additional youth Headspace sites and 20 Early Psychosis Intervention Centres.
To varying extents, both policies represent admirable allocations of funding for suicide prevention efforts in Australia. But the simultaneous introduction of e-Health records (an initiative that ultimately has the support of both major parties) is going to undermine the effectiveness of either policy if it drives patients away from seeking help in the first place.
To their credit, in their initial announcement the government outlined that e-Health records will be an opt-in system that won’t be linked to the provision of health care benefits. Laura Ryan, a spokesperson for the Minister for Health and Ageing, confirmed that even if there is a large public take up of the system, “It will remain entirely voluntary.”
Additionally, Ryan was adamant that the Australians “Will be in complete control of the record being established and can choose what is added to the record and what people can see.” If Australians are allowed this level of control over the content of their e-Health records, it would certainly go some way in assuaging public and professional concerns regarding privacy and the confidentiality of psychological treatment.
Looking back, I probably should have asked her to sign something.
According to Dr Blaszczynski, “It would be grossly naive to believe that the department will honour those assurances in the long term.” Looking at the evidence, his cynicism is certainly justified.
The government announced Personally Controlled Electronic Health Records for All Australians (emphasis added) 13 months after the National Health and Hospitals Reform Commission recommended health care providers be able to send and receive patient information by 2012-2013.
The NHHRC also recommended that “The Commonwealth Government must mandate that the payment of public and private benefits for all health and aged care services be dependent upon the provision of data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health record.”
In other words: health rebates should be linked to the practitioner’s ability to send and receive patient information. For patients, this means they’ll need to have an e-Health record to be able to claim Medicare.
But future intentions are always unknowable to an extent, a point made obviously clear in the government’s own e-Health records announcement, which concludes: “Subject to progress in rolling out the core e-Health infrastructure, the Government may consider future investments, as necessary, to expand on the range of functions delivered under an electronic health record system.”
If the plan to introduce e-Health records in 2012 goes ahead it will certainly have a detrimental effect on the confidence of some Australians in the privacy of medical or psychological treatment. The effect of deterrence would only be avoided if the e-Health program remains voluntary and under the complete control of the patient.
Whether that will actually happen, is about as questionable as the burial of Work Choices.
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