Today’s correspondent takes us back to the issue of the Queensland medical records viewer (see QAS paramedics accessing patient information via ‘The Viewer’ for ‘follow up’. (October 20, 2023)).  They say:

I am a paramedic with 20 years’ experience in an extended care role. I am really concerned about the use of The Viewer by paramedics. What I am finding is most paramedics, mainly the younger generation, now ask our communications staff for patient details to look up The Viewer prior to arriving on scene.  I have huge problems with this; firstly often they get diverted to another case therefor they have just accessed information for a patient they have no contact or business with. Secondly it creates a bias, and I am seeing many, many bad decisions being made based on their poor understanding. 

For example, a close friend who lives in my street with a lot of issues had attempted to take her life. I was off duty but providing care when the paramedic arrived, and I began giving a handover. She put her hand up and said, “It’s ok, don’t worry, I know what is going on I read The Viewer”, therefore missing critical information about this episode.  Second example a patient with long history of AF presents with chest pain and ECG changes typical of an AMI. The paramedic, having read The Viewer says that because other episodes did not end up being an AMI this would not be.

I feel they must be breaching legislation in some form. Do patients have some recourse if it is found under FOI that a paramedic accessed their record without actually ending up having attended the patient?

I rarely ever feel the need to use it as a paramedic there are some very few limited times where I have attended a complex presentation that I was not transporting and used it for risk mitigation but always explaining why to the patient not just acting like it’s my information to do as I please.

These are difficult questions. On first glance, it would seem looking up The Viewer before arriving would make good sense to inform the paramedics. Patients may be annoyed at having to relay information that could have been accessed prior to arrival.  But what does the legislation say?

In my earlier post I concluded that the terms of use say, in effect:

You may access and use the Application, to view, use and display the Content for your professional use when necessary, in accordance with the care or treatment of an individual by a Prescribed Health Practitioner acting in that capacity and in accordance with section 161C(2)(a) of the Hospital and Health Boards Act 2011 (Qld). You must not access or use the Application for any other purpose.

Section 161C(2) of the Hospital and Health Boards Act 2011 says:

A prescribed health professional must not access information contained in a prescribed information system unless—

(a) the information is necessary for the prescribed health professional to facilitate the care or treatment of an individual;

It cannot be the case that a practitioner can only access The Viewer where ‘the information is necessary for the prescribed health professional to facilitate the care or treatment of an individual’.  Taken literally that would mean a practitioner has breached the terms of access if they look to The Viewer and discover that there is no information necessary for the treatment of the patient, even though they thought there would, or might, be relevant information. (Of course, even finding no information relevant to the treatment of the patient’s current condition may be helpful).  I would infer that it must be appropriate to access The Viewer if the practitioner has reason to believe that access the information may facilitate the care or treatment of the patient.  But does that extend to a possible patient?

A paramedic proceeding en route would have reasonable grounds to believe that he or she will be called upon to treat the patient and informing themselves before they get there (subject to the examples given above) may improve their ability to treat the patient. On the other hand, the patient is not yet ‘their’ patient, and they are not engaged in caring for the patient. For all they know the patient may refuse treatment or transport or the information may be quite irrelevant. For example, if the patient is in cardiac arrest, or suffering life threatening trauma, is there past medical history relevant for the care that needs to be provided there and then?

It would be consistent with good paramedic practice to ask the patient if they are happy for the paramedic to look up the record and to discuss with the patient what the record shows and what it may mean for their care (see Paramedicine Board Code of Conduct Part 4: Working with Patients and in particular[4.1] Partnership and [4.2] Informed Consent). Where a patient has an ongoing relationship with their GP there may be a clear understanding that the GP is accessing the information. But an ambulance patient has never met the paramedic before so it would be more respectful to engage with them and to seek permission before accessing their record, even if some patients may be annoyed that the paramedics do not already have information that is available for that purpose.

I can see the argument that provided the practitioner has reasonable grounds to believe that they are going to be involved in the treatment of the patient and that access to the information is reasonable in anticipation of that then access is permissible. But, on balance, I think accessing The Viewer before accessing the patient and entering into a health care relationship with them is inconsistent with both the Code of Conduct and the terms of access.  Regardless of the merits, the legislation and the terms of access refer to accessing the information to treat a patient, and until the paramedic meets the patient there is no health care/patient relationship, they are not involved in the care of the patient and cannot form a view of whether access to the record ‘is necessary … to facilitate the care or treatment of [the] individual’ who is before them.

As for access affecting the care of the patient, paramedics need to remember that good paramedic practice requires them to (Paramedicine Board, Code of Conduct [1.1(a)], emphasis added):

assess the patient, taking into account their history, views and an appropriate physical examination where relevant. The history includes relevant psychological, social and cultural aspects, and available electronic records such as My Health Record.

Access to information on The Viewer may be relevant in the circumstances but cannot replace the need to assess the patient as they present.  A paramedic who fails to hear from the patient or those involved in their care, or to make their own clinical judgement of the patient’s current condition, informed but not guided by, the patient’s history may well fail to provide ‘reasonable care’ with the all the implications that may bring. 

If a paramedic does access the record, and if the patient is aggrieved about that, I suggest the remedy is not under FOI law. Improper access to The Viewer is a criminal offence (Hospital and Health Boards Act 2011 (Qld) s 161C) though I’m sure no-one would want to prosecute in the circumstances described.  A complaint to the ambulance service or the Health Ombudsman would probably be sufficient to make the point.

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.