A call for national e-health clinical safety governance

To the Editor: Coiera and colleagues’ call for national e-health clinical safety governance1 is timely, given that the proposed rules and regulations for the personally controlled electronic health record (PCEHR) from the Department of Health and Ageing2 neglect this crucial component. The Royal Australasian College of Surgeons (RACS) has called on the Australian Government to provide better clinical governance arrangements for the PCEHR.

In a letter to the Minister and a submission to the Department of Health and Ageing,3 the RACS identified inadequacies in the proposed rules and regulations for the PCEHR2 and recommended a better approach. The RACS pointed out that the original ambition for PCEHR clinical governance4 had been significantly downgraded, and was critical of the absence of a clinical governance body. The proposed independent advisory council, appointed by the Minister, could not be considered clinically focused, independent or indeed a governing body. The RACS has proposed that the Committee of Presidents of Medical Colleges would be better equipped to independently identify suitable members of a clinical governance body.

Lack of clinical engagement is arguably the reason for the failure of e-health implementation in the United Kingdom’s National Health Service. The absence of clinical governance arrangements in the proposed PCEHR rules and regulations represents a significant departure from the National E-health Transition Authority’s clinical engagement strategy and puts clinician ownership of and engagement with e-health at risk.