Concept of Operations: Relating to the introduction of a Personally Controlled Electronic Health Record System
The concept of representation is particularly relevant to health service delivery. Individuals are often supported by other people when accessing healthcare services and it is important that the provisions put in place are flexible enough to support the types of arrangements that might be needed.
For the purposes of managing an individual’s PCEHR, an individual may also be represented by an authorised representative or assisted by a nominated representative. These relationships will be recorded in an individual’s PCEHR.
Authorised representativesIt is important that everyone in Australia has the option of having a PCEHR. There are, however, individuals who have limited or no capacity to make decisions about their healthcare and healthcare information. These individuals may not be able to create and manage a PCEHR on their own behalf. The PCEHR System therefore allows participation through an authorised representative.
The Commonwealth, states and territories each have legislation that provides for a person to be authorised by law to represent another person for healthcare purposes, such as through powers of attorney provisions or guardianship orders. The PCEHR System will leverage this existing framework so that a person who is authorised by the law of any jurisdiction to be able to act on behalf of an individual for healthcare purposes will be recognised by the PCEHR System as an authorised representative.
The PCEHR System will need to verify the legal authority. This can either be done electronically using the Proof of Record Ownership Service (see Section 6.5.1) or by presenting the appropriate documentary evidence of their authority to an authorised registration agent.
Once the individual is registered for a PCEHR, the authorised representative will be given the same access and controls as the individual. There may be more than one authorised representative for an individual.
There is continuing investigation into whether other authorisation mechanisms can also be leveraged to enable individuals without formal authorised representatives to participate in the PCEHR System. The key consideration in this exercise is maximising access to the PCEHR System by vulnerable members of the community, without compromising proper protection of their information.
Nominated representativesAn individual or authorised representative may nominate other persons (such as carers5 and family members) to access their PCEHR.
Arrangements for nominated representatives differ from the arrangements for authorised representatives since a nominated representative is not recognised by the PCEHR System as having legal authority to act on behalf of the individual.
A nominated representative may view the individual’s PCEHR, but will not be able to manage the individual’s access controls, contribute to information in an individual’s PCEHR or provide consent for a healthcare provider to obtain access to the individual’s PCEHR.
It is proposed that there are no age restrictions on nominated representatives and a minor can be a nominated representative.
An individual can elect to have more than one nominated representative.
When an individual nominates a representative, they will be able to select whether the nominated representative has access to the audit trail (see Section 5.7) or ‘limited access’ information (see Section 5.5.3).