When sharing by default comes to primary care, as it surely will, how will clinicians deal with the sharing of their interpersonal correspondence?
As the Department of Health, Disability and Ageing contemplates introducing primary care to the concept of sharing by default, GPs and non-GP specialists must consider the possibility their one-to-one referral letters could be shared with their patients.
At the AIDH’s HIC2025 conference this week, Daniel McCabe, the DoHDA’s first assistant secretary for Medicare and digital health, flagged the possibility.
“If a GP writes a chronic condition management plan with a patient, the patient has that plan, but also their allied health professions that support them have that plan and they can contribute to it,” said Mr McCabe.
“The same conversation needs to happen in the specialist sector as well.
“We talk about specialist letters. Maybe we get those shared. Maybe we don’t. I think we probably want to think about, what’s useful for both the patient and the referring GP that should be shared so that patient has a longitudinal history.
“We have levers.
“Where we’re probably heading now is thinking about, how do we use other levers that we have in the system?
“One of the things that we did with the legislation that we put through the parliament around sharing by default is to require data to be shared as part of paying the MBS rebate.
“Now, we might have to consider what the MBS rebate is, to support that and make sure that we take that into account as we build this policy out and roll it out into more settings.
“But I think we want to start to use the financing that we already provide into the system to require sharing.”
Private health insurers were already having the same conversations with the department in terms of what they would like to see done with the information shared.
“That’s going to be a much more tricky conversation as we start to think about how are they using that data in terms of assessing premiums for individuals,” said Mr McCabe.
“But it’s really important.”
Panel moderator Dr Norman Swan pointed out that private health funds had much data that was not shared with anyone else, including the government.
“They’ve got incredibly valuable data,” Dr Swan told Mr McCabe. “If you want to know a surgeon with a high 30-day readmission rate, they know. You don’t.”
“That’s right, and that’s part of the reform that we want to get to, which is, how do we both know that?” replied Mr McCabe.
“How do we share information with consumers about their consultations, about their procedures?”
Dr Danielle McMullen, president of the AMA said that would be a difficult conversation to have with doctors.
“What if things like your letters had to be shared? That’s a really tough conversation for our profession, that hasn’t happened yet,” she said.
“We’re quite protective about interpersonal [communication].
“How do we engage our profession in that conversation – recognise what are your concerns and why? Traditionally, we’ve written those letters one-to-one, but if it’s in the public domain, it’s [about] how do you protect the professional identity and safety and accountability of everyone involved, but also recognise we do need better information sharing.”
Mr McCabe agreed there was work to be done.
“It’s a conversation that we need to work through quite carefully to make sure that we do protect some of the professional concerns that Danielle has talked about,” he said.
“But we’re not starting back where we were 10 years ago.
“We’re actually starting at a point where the expectation of to share is there. Now we just need to work through systematically how we do that.”
HIC2025 was held in Melbourne from 18-20 August.
