I snapped this shot as the truck removed the eHealth computer kiosk machine from its former owner – a Medicare Local. The image is apt. Moments before this photo I was consulting with the hardworking manager of a group home. The home is operated by the State and houses half a dozen ageing intellectually disabled persons. I have been privileged to be their GP for over a decade. Their parents, those which remain alive, and contactable, are elderly themselves and have no need for computers and “silly what not”. Some months back I spoke with the manager of the advantages the eHealth record might hold. It is a no brainer, a health summary may assist everyone if one of these persons is unwell and transported by ambulance to the emergency department.

So, why the image? Well, after a multitude of phone calls it appears the intellectually disabled persons cannot give consent. If they cannot give consent, then they cannot have a eHealth record initiated. The solution is easy – “have their legal representative draw up the powers of attorney” and then lodge this with eHealth.

It seems to escape attention that the house manager has responsibility for these persons finances, communication, transport, medications, State departmental health records, clothing , and food. But the manager cannot even initiate the eHealth record. Clearly a mistake has been made.

The case is not an isolated “error”. I have a second example. A gentleman’s wife attempted to register her dementing husband for a eHealth record. I supplied a letter indicating my knowledge of the couple and the need to have Mr Jones registered. Mrs Jones ended up paying the family solicitor for the necessary additional documents.

Ironically it seems that for a billion dollars worth of eHealth each Australian who has a dubious consent capacity is required to personally organise their solicitor! I think we can understand the issues of privacy – the need to scrutinise who can SEE the content of the file. However in this circumstance, who is protected by also obstructing the creation of the eHealth record? The creation of the file allows the information to be available to medicos treating the intellectually disabled.

A very stark contrast arises. If I, as a competent adult initiate my file creation, what protection is there that an employer or insurer cannot see the file? Medicare Locally are enthusiastic to sign people on, going as far as incentives and GP staff training to request I “consent”. But it remains unclear – will my employer or insurer have their doctor accessing my file? Of course this cannot happen, unless, I “consent”. Can I be asked to “consent” that the employer’s doctor view my eHealth record as a part of a pre employment medical? I can decline without prejudice, can’t I?

Dr Craig Barnett
B Med (Hons) B App Sci FRACGP

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