NACCHO Aboriginal Health and #MyHealthRecords : Download Evaluation of Participation Trials Report

 ” The report on the evaluation of the opt-out trials for My Health Record showed that the approach would help ensure the full health benefits of a shared electronic health record could be realised.

CHF has been calling for an opt-out system backed by strong community engagement and education and the findings of this report endorse that position

  Consumer Health Forum CEO Leanne Wells Press release below

The Guild has long supported an opt-out model for My Health Record as the clearest path to meaningful use of a national digital health record system .

“Community pharmacy, as the most accessible community health care destination, has always been at the forefront of digital innovation and an opt-out model for the operation of My Health Record will enable community pharmacies to enhance their patient care.

It will also foster better health professional collaboration between care settings and provide key clinical data at important points of care across a patient’s journey through the health care system.”

National President of the Pharmacy Guild, George Tambassis. See Full Press Release below

Download the 354 Page report here

Evaluation-of-the-My-Health-Record-Participation-Trials-Report

Read NACCHO E Health My Health Record articles over the past 5 years

Update From the Department of Health website

In July 2012, My Health Record (then called Personally Controlled Electronic Health Record) was launched.

This is a secure online summary of a person’s medications, diagnosed illnesses, treatments, allergies and tests.

Each person can control what goes onto their My Health Record, and who is allowed to see it.

For healthcare providers, knowing more about a patient’s medical history can lead to a better understanding of what is happening, and result in better treatment decisions.

In most parts of Australia individuals need to actively register for a My Health Record. From March to October 2016, trials of different participation arrangements were run.

The trials were of opt out arrangements in Northern Queensland and the Nepean Blue Mountains of New South Wales area, and innovative approaches to opt in in Western Australia and Ballarat.

The aim of the trials was to understand consumer reaction to different participation arrangements, as well as healthcare provider usage and upload of clinical information to the patients’ records, when most of their patients have a My Health Record.

These trials were conducted as a collaboration between the Department of Health (the Department), Primary Health Networks, the state health departments and relevant hospital and health services.

An independent evaluation of the trials commissioned by the Department of Health was conducted by Siggins Miller Consultants to look at the outcomes from these trials.

The Evaluation of the Participation Trials for the My Health Record is available below.

It will be used to inform future recommendations to the Government about the participation arrangements to best bring forward the benefits of the system to healthcare in Australia.

Consumer Health Forum CEO Leanne Wells Press release

Making My Health Record Work for Everyone

“We support a national opt-out roll out and support the report’s recommendation that this should be done in one national step. This would ensure a nationally consistent campaign would be rolled out and built on.”

“It is no surprise to us that once people have the benefits explained to them and their concerns around privacy and confidentiality addressed that they are happy to have and use the My Health Record. It is good to see that people not only do not opt out of the record but have started to use it” said Ms Wells.

“People are using their My Health Record because they recognise benefits of information bring shared, care being connected and duplicate tests bring avoided “

“The report shows that more work need to be done to raise awareness of the benefits of electronic health records. We support the report’s call for a comprehensive nationally driven but locally supported communication strategy that is targeted at consumers and health care providers. “

“This needs to be properly resourced and should be developed with consumer and health care provider input. It also needs to involve local community leaders who can be strong agents for change and champions of the roll-out.”

“We need to anticipate and avoid roadblocks to use of this vital new piece of our health care system future. We welcome the report’s acknowledgement that there is a need to streamline and improve access because consumers in the pilots found this to be a barrier.  Whether this is through improving My Gov or moving away from it completely, the important issue is that it makes it easier for consumers to use.”

For a national roll out to be successful  we need the Government to  commit  to further investment in their consumer facing infrastructure so that the system is reliable, accessible and resourced appropriately into the future” said Ms Wells ‘

We believe that if implemented the report’s 31 recommendations would deliver a world class system. It is important to remember that this is the first stage and the system will evolve.”

“Such major, deeply needed, change cannot be done on the cheap. To this end we reiterate our call that the government move away from the current budgetary requirement for all new health expenditure to be offset by savings in the health portfolio.”

My Health Record should be opt out, says the Guild

The Pharmacy Guild of Australia has welcomed the success of the My Health Record trials which it says have confirmed the overwhelming benefits of the ‘opt out’ model involving automatic creation of patient records.

The formal evaluation of the trials, published today, has recommended that the Federal Government proceed to a national opt-out approach – a recommendation which the Guild says it fully supports.

The evaluation report says in part: “Taking all the data into consideration we can see no reason not to proceed with an opt-out approach in one national step rather than any progressive staged approach.”

The opt-out trials were conducted in the Northern Queensland PHN, and in the Nepean Blue Mountains PHN, with the final report on the trials completed in November last year. The opt-out trials included community pharmacists among the healthcare providers who took part.

When compared with two opt-in trials conducted in Ballarat and Perth, the opt-out trials achieved better outcomes in terms of participation, understanding and some aspects of use of the My Health Record system.

“The Guild has long supported an opt-out model for My Health Record as the clearest path to meaningful use of a national digital health record system,” said National President of the Pharmacy Guild, George Tambassis.

“Community pharmacy, as the most accessible community health care destination, has always been at the forefront of digital innovation and an opt-out model for the operation of My Health Record will enable community pharmacies to enhance their patient care.

“It will also foster better health professional collaboration between care settings and provide key clinical data at important points of care across a patient’s journey through the health care system.

“An opt-out model with also provide a greater opportunity to further realise community pharmacies’ digital health potential within the patient-centric care model,” Mr Tambassis said.

The Pharmacy Guild has been working with the Australian Digital Health Agency to explore ways to maximise the utilisation of community pharmacy as a vital component in the My Health Record system.

The My Health Record Participation Trials Evaluation Report is available on the health

Press Release AHHA  : Trial shows ‘opt-out’ model favoured for My Health Record

We are supportive of the “opt out” model for My Health Record, but with some important provisos’, says Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association (AHHA).

Ms Verhoeven was commenting on today’s release by the Australian Government Department of Health of a government-commissioned evaluation of participation trials for My Health Record, involving ‘opt-in’ as well as ‘opt-out’ regimes.

My Health Record is a way of securely sharing an individual’s health information between registered healthcare providers involved in a person’s care. Currently, both individuals and healthcare providers have to opt in, that is, register to participate.

‘The report released today comes down overwhelmingly in favour of the opt-out method’, Ms Verhoeven said. ‘Under this model, a My Health Record is automatically created for individuals.

For individuals, not having to do anything to create the record was seen as a major plus, while for healthcare providers, assisting in creating My Health Records, which would have been needed for some patients under the ‘opt-in’ model, was seen as impractical without additional funding and ultimately would be unsustainable.

‘Once the system and its benefits were explained, individuals had minimal confidentiality or security concerns. ‘And, interestingly, most consumers were strongly of the opinion that healthcare providers should not be able to opt out of the system. ‘We support the opt-out model, while acknowledging that the government has no obligation to take on what has been recommended in the report released today.

‘We are however concerned that the existing infrastructure may not have the appropriate capacity to support the recommended change—anecdotal evidence indicates that the current system is already operating at close to capacity and will need to be significantly upgraded to effectively manage the millions of additional records.

‘It would therefore not be wise to rush into this if we want to get this important change right. ‘Given a national rollout is likely to require support by the PHNs, they must be afforded adequate time to undertake collaborative planning, local mapping of digital capacity and capability and the flexibility to respond to local issues and contexts. The phase-in should be well-planned, with comprehensive training and a very strong communications strategy—both to consumers and healthcare providers. ‘Communications cannot be emphasised strongly enough.

The report found that there was very low awareness in the community of the current My Health Record arrangements, and very low awareness among all types of healthcare providers of the online training available for the current My Health Record system.’

 

NACCHO Aboriginal Health : Delivery to @DaveGillespie of #RuralHealthConf priority delegate recommendations

 

 ” Rural and regional Australians have higher rates of major diseases including heart disease and stroke, chronic lung conditions, diabetes, asthma, and arthritis.

We also have a persistent and disturbingly large gap in health outcomes and life expectancy, between Indigenous and non-Indigenous Australians “

Minister Gillespie said Australia’s long life expectancy and good average health outcomes disguised unacceptable differences between population groups and communities, particularly in rural Australia : See Full Response press release from Minister below

After four action-packed days, the 14th National Rural Health Conference with its theme of ‘A World of Rural Health’, has concluded with the delivery of the priority recommendations to emerge from the event to Assistant Minister for Health, David Gillespie.

According to CEO of the NRHA, David Butt, “the Conference provided an excellent opportunity for learning and sharing the evidence of what works in rural and remote health.

“People who live and work in rural and remote Australia have the knowledge about what works and what needs to change to improve health and wellbeing.

“Very importantly, through the conference they have identified key recommendations for health systems reform, to improve the health and wellbeing of the seven million people who live in rural and remote Australia,” Mr Butt said.

Download a PDF Copy of all recommendations

Recommendations14NRHC

Aboriginal and Torres Strait Islander Health

Digital Health

Workforce

AUSTRALIA LEADS IN INNOVATION FOR RURAL HEALTH

Press Release

The Coalition Government’s innovative reforms to improve the health of rural, regional and remote communities were today showcased to the 14th World Rural Health Conference.

In his opening address to the conference in Cairns, Assistant Minister for Health, Dr David Gillespie, outlined a series of major changes to improve rural health which will start or bed down over the coming year.

These included:

  •  legislation to establish the first independent National Rural Health Commissioner;
  •  pathways to recognise rural GPs as “Rural Generalists”;
  •  Primary Health Networks across Australia commission health services to ensure that local health needs are met;
  •  federally funded mental health services including suicide prevention and drug and alcohol rehabilitation now managed at the regional level by PHNs;
  •  200 general practices and Aboriginal Community Controlled Health Services will soon start providing Health Care Home services, to coordinate care for people with chronic conditions.

Minister Gillespie said Australia’s long life expectancy and good average health outcomes disguised unacceptable differences between population groups and communities, particularly in rural Australia.

Rural and regional Australians have higher rates of major diseases including heart disease and stroke, chronic lung conditions, diabetes, asthma, and arthritis.

“We also have a persistent and disturbingly large gap in health outcomes and life expectancy, between Indigenous and non-Indigenous Australians,” he said.

Minister Gillespie also represented the Prime Minister, Malcolm Turnbull, at the National Rural Health Alliance Conference held as part of the World of Rural Health event.

“I know that it takes determination, resilience and flexibility to provide the care that your patients need, without the resources available to your counterparts in the cities,” Minister Gillespie said.

“The Prime Minister shares my passion – your passion – for rural Australia.

“Like you, and me, he believes that Australians have a right to high quality, affordable and accessible health care, wherever they live and whatever their circumstances.

“Meeting the needs of rural families and communities is one of the top priorities in the long term national health plan.”

Smile: $11m reduces gap in rural and remote dental services

Press Release 2

People living and working in rural and remote Australia will now have access to dental services that were previously unavailable.

Assistant Minister for Health, Dr David Gillespie, said today that the Coalition Government is providing $11 million to the Royal Flying Doctor Service (RFDS) to provide dental services.

“The Royal Flying Doctor Service is well-placed to provide these essential mobile outreach dental services in rural and remote Australia,” Minister Gillespie said.

“Where there is an identified market failure and there are gaps in services, it is important that the Government steps in to provide assistance. Today we deliver on our election commitment to ensure people outside our major cities have better access to high quality dental services.”

The Government provides funding to the RFDS under the RFDS Program, which aims to ensure access to essential emergency aeromedical and other primary health care services in rural and remote areas of Australia.

“The Flying Doctor welcomes this new funding for dental services in rural and remote Australia,” RFDS of Australia CEO, Martin Laverty, said.

“There are only one third the dentists in remote areas, with 72 dentists per 100,000 people in major cities, and less than 23 per 100,000 people in remote areas.”

“The research statistics are compelling, with more than one-third of remote area residents living with untreated decay. Essentially, when people from remote areas visit the dentist, they are more likely to require acute intervention – 1 in 3 had a tooth extraction in a year, compared with less than 1 in 10 in metropolitan areas.”

“This funding from the Federal Government will enable the Flying Doctor to expand its dental outreach program to start tackling the disparity that exists between city and the bush – and for that we are very, very thankful”.

On 28 June 2016, the Government announced it would continue to support the RFDS by extending its contract for continued delivery of aeromedical services until 30 June 2020.

The announcement included a commitment of an additional $11 million over two years for the RFDS to expand its existing non-Commonwealth funded dental services for the period 1 April 2017 to 31 March 2019.

Labor Party Response

Labor supports the development of a national rural health strategy and associated implementation plan, as part of ensuring there is clear and targeted action towards closing the gap in health outcomes between Australians living in rural areas and their metropolitan peers. 

Shadow Minister for Health Catherine King announced Labor’s support for a strategy at the National Rural Health Conference in Cairns, calling on the Government to join in bipartisan support.

“The impact of inequity on health and recognising the challenges that some groups face which require more targeted support – including rural and remote Australians – was a clear theme to emerge from Labor’s National Health Summit in March,” Ms King said

“We think that a national rural health strategy is an important step to ensuring we have a defined roadmap to improving health outcomes for Australians living outside our big cities and I hope the Government follows our lead.”

Shadow Assistant Minister for Medicare, Tony Zappia, said while Labor welcomes the implementation of the National Rural Health Commissioner, this single role will not be a cure-all.

“The National Rural Health Commissioner would aid in the implementation of a national rural health strategy, but we still need to have an understanding of where we are going, and what we are trying to achieve in rural heath,” Mr Zappia said.

“A national rural health strategy would help achieve this goal of all levels of Government working more closely together, to reduce fragmentation and duplication.”

NACCHO Aboriginal Health News Alert : #MyHealthRecord slammed in privacy uproar

 ” THE private health records of Australians can be accessed by more than half a million people under the latest bungle with the $2.2 billion electronic My Health Record.

News Corp Australia has learned that the privacy settings on the government’s computerised My Health Record, which lists every medicine a patient takes and records every medical visit and procedure, are automatically set on “universal access”.

From the Daily Telegraph 11 April (see Article 1 Below )

For an extensive NACCHO background brief on Mr Health Records

NACCHO Aboriginal Health ” Opt out ” My Health Records News : Why aren’t more people using the My Health Record

 ” The Australian government has found itself embroiled in a privacy furore, this time for the privacy settings on its MyHealthRecord e-health system.

At issue is the system’s default privacy setting, which is that any health professional treating an individual can access their whole health history.”

MyHealthRecord slammed in privacy uproar : National Media Coverage 11 April

It was ‘absolutely essential to the success of the My Health Record that patients had confidence in the privacy of their information.

It needs to be there for their treating doctor not for everyone else to view,

It should be treated the same as a patient’s paper health record, no one shows that record to their physiotherapist or a mum at work who happens to be a nurse “

Australian Medical Association president Dr Michael Gannon

“Most people are comfortable with the level of access health professionals have to their information.

Broad access to information is part of the design of MyHealthRecord: “it helps overcome the fragmentation of health information … to reduce adverse events and duplicate treatments. This is of particular importance to people who have complex or chronic conditions,

Registered users can’t trawl health data at random: A healthcare provider can’t just provide a name: they need a health identifier number for that person, together with other personal information, to get their records.

He also noted the criminal sanctions that apply to misuse of MyHealthRecord data.”

Speaking to ABC Radio Sydney this morning, Department of Health Secretary Paul Madden said only a tiny number of people have added any access controls to their documents.

 ” The revelation that hundreds of thousands of health practitioners will be given open access to sensitive health data is extremely concerning.

Reports today say that electronic health records will be automatically set to “universal access” under the Turnbull Government’s opt-out scheme, meaning health practitioners will automatically have access to an individual’s full medical history – whether it is relevant to the treatment they are administering or not.”

This means that a dentist or optometrist could know if someone has had an abortion, or their history of mental illness, even if a person has not disclosed it to them.

Shadow Minister for Health, Catherine King, said that this was a concerning development and the Government needed to explain how they would address this.(see full press release below Article 2)

We certainly are encouraging that people look carefully at that because, in a matter of weeks, everyone will have an electronic health record, and any amount of information could be being placed there unaware. And so it’s about ensuring that you know that it exists, you know how to activate your privacy settings, and the access that you desire or wish to be sure of.

But it’s also about getting out that message that there’s still a lot of work to be done, and there’s a lot of curating of the medical information as an important concept between patient and doctor, and there’s got to be someone at the end of the day who is taking clinical charge of the curation of that information

Transcript: AMA Vice President Dr Tony Bartone, Mornings with Ali Clarke, ABC Radio Adelaide, Tuesday 11 April 2017 (article 3 below )

Article 1 : Optometrists and dentists will know if you’ve had an abortion or mental illness in health record bungle

THE private health records of Australians can be accessed by more than half a million people under the latest bungle with the $2.2 billion electronic My Health Record.

News Corp Australia has learned that the privacy settings on the government’s computerised My Health Record, which lists every medicine a patient takes and records every medical visit and procedure, are automatically set on “universal access”.

This means every registered health practitioner in the nation — 650,000 people — can view them, not just the family GP, unless the patient specifically requested to opt out.

Occupational therapists working for an employer, doctors working for insurance companies, a dietitian, an optometrist or a dentist or their staff can view the record and see if individuals have a sexually transmitted disease, a mental illness, have had an abortion or is using Viagra.

“Potentially your employer’s occupational therapist can look at your record and get information they really shouldn’t be getting access to, its confidential data,” says former AMA president Dr Mukesh Haikerwal who was a government consultant on the My Health Record.

The bungle came about because the record was originally set up as an opt in system and when people set up their record they were given the option to set a PIN number to protect the information and determine who got to see it.

Nearly four million people set up a My Health Record under the opt in system but doctors weren’t using it because four years after it was established 83 per cent of Australians still did not have one.

Last year the Turnbull Government trialled turning the failed record into an opt out system.

One million people in the Nepean Blue Mountains area of NSW and Northern Queensland were given a record unless they opted out.

News Corp has now learned only 147 of these one million Australians automatically given a record under the trial set up a PIN number to protect their health information.

“147 My Health Records created in the trials have access controls set to restrict which healthcare providers can see the record, or have controls restricting access to certain documents in the record,” the Department said.

“This equates to 0.0151 per cent of My Health Records automatically created in the trials. This is consistent with the rates of access controls set by those who have opted to register for a My Health Record,” a spokeswoman for the department said.

The My Health Record lists a person’s medications and allergies, doctors can upload a health summary about the person’s health problems, eventually the system will include X-ray results, pathology results, hospital discharge summaries and other data that for the first time can be shared between medical practitioners.

The privacy problem is about to affect everyone because two weeks ago state and federal health ministers agreed to give every Australian a My Health Record unless they opt out.

This decision was made even though the results of the original opt out trial have never been made public.

And it means the health records of every Australian will soon be on open access.

“With only 147 people out of a million setting up privacy settings, you’ve got to ask is that an informed choice to do that?” says Consumers Health Forum Chief Leanne Wells.

“It’s insufficient to write people a letter and give them a pamphlet.”

The Department of Health says “intensive communication activity” was undertaken to educate trial participants, including letters, GP information, local advertising and town hall sessions.

“People have full control over what information is on their record and who can access it,” a spokeswoman for the Department of Health said.

“This includes pin code access to all or certain healthcare providers, removing or limiting access to certain documents and asking providers not to upload information and SMS notifications of who has accessed your record, all of which must be adhered to under the My Health Records Act 2012,” she said.

The My Health record has cost taxpayers $2.2 billion but five years after it was set up doctors and hospital aren’t using it, its way behind schedule.

X-ray, pathology and other test results are not yet available on the record as promised.

$1 BILLION E-HEALTH RECORD NO DOCTORS USE

The e-health record has been plagued by a litany of troubles since its inception.

* When it was launched in July 2012 it was an empty vessel. No doctor or hospital was able to use it and no X-rays or pathology results could be attached to it.

*In 2016 the government sent letters to dead people telling them they were going to set up a My Health Record for them.

* In 2013 technology journalist Kate McDonald discovered that two prescriptions had been added to her e-health record “for drugs that had never been prescribed for me, and were for medical conditions I do not have”.

* A year after it was launched the government was rocked by the resignation in frustration of the two doctors advising it on the record because it was barely functioning.

* Former AMA president Dr Haikerwal revealed the computer system of his multi-doctor practice crashed when he tried to upload patient records on to the e-health record.

And even then he reported that “no one can read it”. Patients who want a hospital or specialist to see their e-health record have to take their own iPad to the consultation because hospitals and specialists don’t have the software to read it.

* When the Office of the Australian Information Commissioner assessed privacy risks to patient information held by seven GP practices in Victoria and NSW it found the clinics were at medium to high risk of breaching privacy laws when using the MyHeath Record.

Passwords were too weak or not changed often enough and, in some cases, a record of the master copy was kept at the clinic, Computers did not have self-locking screen savers turned on.

* The National E- Health Transition Authority (NEHTA) in charge of the record revealed in 2012 it had spent over $5 million on travel and entertaining stakeholders in five star hotels.

This included one event at Sydney’s Intercontinental Hotel where guests were offered steak and seafood and crème brulee. A former policeman was the motivational speaker at the dinner and entertained guests with grisly details about murders while they were eating dessert.

* NEHTA had to cancel a planned roadshow to Malaysia to promote the e-health system at a surgeons’ conference because of the “tight fiscal environment’’.

Article 2 Catherine King Press Release continued

“Given the Turnbull Government’s appalling IT record, Australians have every right to be worried about their rollout of this project,” Ms King said.

“Last year, one billion lines of Medicare data with private claims information were freely available for download in a massive data breach on the Government’s watch.

“They need to tell Australians what is happening, or they risk people losing confidence in the system before it even gets off the ground.”

When Labor originally set up the Personally Controlled Electronic Health Record it was an opt-in system, with users setting up access preferences and controls. Now that the system has moved to opt-out, it seems that the Turnbull Government has not set up the same automatic safeguards.

“The information in these records is too important to be another addition to the Government’s list of health bungles. Australians deserve to know how their information will be protected.”

Article 3 Full Transcript: AMA Vice President Dr Tony Bartone, Mornings with Ali Clarke, ABC Radio Adelaide, Tuesday 11 April 2017

Subjects: My Health Record


ALI CLARKE:  I’d love to know your experiences of it, because it seems that reports today suggest that your private health records now may be accessed by over half a million people. To find out what has happened, I’d like to say good morning to Tony Bartone, the Vice President of the Australian Medical Association. Good morning, Tony.

TONY BARTONE: Good morning.

ALI CLARKE: Why was My Health set up in the first place?

TONY BARTONE: My Health, the My Health Record, was set up and has been part of an ongoing process for almost the best part of a decade now, to get a robust, functioning, electronic medical health record into the public space to assist clinicians in terms of managing all the information and all the data that is available about patients from very many sources in the health system at a central repository, and to assist in the timely and efficient management of the patient’s condition.

ALI CLARKE: So that sounds like a great idea, but there’s been a lot of trouble trying to get an uptake of this.

TONY BARTONE: Essentially that’s correct. What’s happened is that during the process, perhaps ambition, perhaps goodwill or good intent, has led to many different iterations and different avenues being explored, and features. And clearly, still in 2017, we’ve had a number of stumbles along the way.

But we are getting so much closer to what is essentially going to be a revolutionary change in the way doctors can access information and clinical data, and share that clinical data with other people who are managing that patient.

ALI CLARKE: Well, you’re saying we’re getting so much closer. How many people would be on My Health Record now, do you know?

TONY BARTONE: I can’t exactly confirm, but I know the number of people who have got a record is certainly into the many millions now, and that’s been a process that’s been supported virtually over the last 12 months in particular. We’ve had these two trial sites that are referenced in the article where, in those sites, in those regions they are – all the people, roughly about a million people there have been given a record, so essentially, they’ve had to opt out …

ALI CLARKE: [Interrupts] Out of it.

TONY BARTONE: They’ve all been given a record. But around the country, other people can have the opportunity to voluntarily enrol and become part of that. There’ve been incentives to doctors to try and involve patients, but it’s really, at the moment, it’s the lack of robust data and the ability to share that data in a timely manner that is really the difficulty.

For example, many hospital networks around the country still can’t access or share that information into the Health Record because of their own issues with electronic software and hardware in their own facilities. So it really is still looking at only part of the information. It’s almost having one hand tied behind your back, you might say.

And until we’ve got all medical providers and establishments on the same ability to communicate with the same system, we’re still going to be not in a perfect world, and that’s where a lot of the issues remain.

It’s about giving everybody the ability to interact with the system. It’s getting everybody trained and understanding what’s required, and it’s getting also the sharing of information on protocols that are interchangeable and exchangeable between the various providers, and that’s where we’re probably still got a bit of work to do.

It means time, it means more resources. But essentially, it’s positive steps, but it’s still a lot more to do.

ALI CLARKE: So we say more resources. This is a $2.2 billion electronic record. If you have just tuned in to ABC Radio Adelaide, we’re talking about the electronic My Health Record. Tony Bartone is the Vice President of the Australian Medical Association, and he’s with us at the moment.

Now Tony, with regards to that information sharing that you just touched on, that seems to be the main issue of contention at the moment, because reports are around that because of the change of the way that people started this service – originally, you had to opt out, but now they’re setting up in a couple of trial sites, one in the Nepean/Blue Mountains in New South Wales, and the other in Northern Queensland, you could actually – you had to get out of it.

So you chose originally if you wanted to opt in, but now they’re going ‘well, not enough people are on to this record, so we’re going to put you on automatically unless you opt out’. But this has meant, it seems, that private health records now may be accessed by over half a million people. Can you please explain who those people are?

TONY BARTONE: These half a million people, 600-odd thousand, are essentially all health professionals, registered health professionals in the country, and essentially the system’s been set at a universal access setting level, because that was the default position beforehand.

Now clearly the people, once they’re notified that they have a record, they have been given some communication and some brochures to inform them that they can vary that privacy level. But with only 147 or so people having activated that, it means either the message is not getting through or people aren’t aware of the sensitivity and the actual availability of their records.

It’s an opportune time to reflect on the messaging so far, and to reflect upon the time and the information and the education from a patient’s point of view, from a consumer’s point of view, in terms of being aware of what’s out there and what can be on there and who can access it.

ALI CLARKE: So from my understanding, it means that doctors working for insurance companies, or dentists, or optometrists, can access this information.

TONY BARTONE: Essentially, any registered health professional can.

[Talkback callers ring in]

ALI CLARKE: Tony Bartone, I’ll go back to you on that, then. Are you still encouraging people, in your role as Vice President of the Australian Medical Association, to be a part of this?

TONY BARTONE: We certainly are encouraging that people look carefully at that because, in a matter of weeks, everyone will have an electronic health record, and any amount of information could be being placed there unaware. And so it’s about ensuring that you know that it exists, you know how to activate your privacy settings, and the access that you desire or wish to be sure of.

But it’s also about getting out that message that there’s still a lot of work to be done, and there’s a lot of curating of the medical information as an important concept between patient and doctor, and there’s got to be someone at the end of the day who is taking clinical charge of the curation of that information. And that’s a time-critical and also laborious process.

As [talkback caller] Dr Danny was saying, it depends on the amount of information, the quality of the medical information, but also – if you can imagine multiple different sources placing information into your electronic health record from different sites – that the timeliness and the synchronicity needs to be looked at. And as I say, the curation of that file is critical, and that’s what we’re talking about. More resources, both in terms of patient and consumer information and education.

But also in terms of time to spend with your nominated curator, medical curator – most often your GP, who’s obviously got the best concept of longitudinal care and idea of your past medical records – to take the time to curate that file into a really robust, valuable document to allow the portability that Dr Danny was talking about, to allow the break glass safety features that Dr Danny was talking about, that would be in terms of an emergency department miles away when you’re on holiday. It’s about the access to the appropriate information at the appropriate time to ensure the best outcomes for our patients.

ALI CLARKE: Well, thank you very much. Dr Tony Bartone, Vice President of the Australian Medical Association.


NACCHO Aboriginal Health ” Opt out ” My Health Records News : Why aren’t more people using the My Health Record?

 

 ” With a My Health Record, both a patient and their healthcare professional can gain immediate access to important health information on-line.

This can improve co-ordinated care outcomes, reduce duplication and provide vital information in emergency situations.

“It also enables us, as a consumer, to become more active in managing your health and provide links between the multiple services many of us may need through our lives.”

                          MY HEALTH RECORD WEBSITE

 HISTORY OF E-Health/My Health Record from NACCHO

” COAG Health ministers decided on Friday 24 March that the My Health Rec­ord system would be opt-out, making electronic medical records compulsory for all Australians unless they said otherwise, despite trials of that model having yet to report.

Those trials concluded this year, with only 1.9 per cent of individuals deciding to opt-out — so proving the success of this approach “

Update March 24 2017

 ” The opt-out approach, which was first proposed in a 2013 Department of Health review, has been trialled in both the Nepean Blue Mountains and Northern Queensland since June last year.

Around 1 million new My Health Records were automatically created for all people living in the areas, unless they responded in the negative.

Nationally the number of people signed up to My Health Record is 4.6m, according to figures shared today by the Australian Digital Health Agency (ADHA).”

 ” The Australian Medical Association has called on the government to tackle barriers to the use of ehealth and telemedicine in rural and regional Australia.

In a position paper released earlier this year the AMA argued that “the utilisation of telehealth and telemedicine in rural and remote Australia remains patchy and is not used to full potential, because of no, or inadequate internet access”.

Internet connections in rural areas are often expensive, slow and have relatively small download allowances.”

Download the AMA Position paper

Better access to high speed broadband PS_Final_0

Read moreEhealth: AMA call for bush broadband boost

The AMA Position Statement on Shared Electronic Medical Records 2016 can be found here

Why aren’t more people using the My Health Record?

Published in The Conversation 24 March

 

The My Health Record is an online summary of personal health information that patients can share with health providers. As many as one in five Australians have a My Health Record.

But recent statistics show the My Health Record is only being used by a small percentage of consumers, and even then not to its fullest uses. So how can we get a greater return on the estimated A$1.2 billion taxpayer dollars invested in the system?

1. More health professionals need to add information

To date, approved health-care providers in the system have uploaded only about 1.7 million clinical documents, for the 4.6 million Australians who have a My Health Record. Just over one third of these clinical documents are Shared Health Summaries – listing health conditions, allergies, medications, and immunisations.

Information about health-care recipients is also added to the My Health Record from other sources – including Medicare and the Pharmaceutical Benefits Scheme, along with pharmacy medications information and hospital discharge summaries. Some health-care providers might be willing to share clinical documents, but hold concerns about privacy and may be unsure how sharing the information will improve patient care.

The shared health information in the My Health Record could help many patients recall vital health information. It could be particularly useful for those who struggle with medication management, have multiple health conditions, enter hospital frequently, or have multiple health providers.

The main purpose of the My Health Record is to improve the quality, safety and efficiency of patient care. Reducing medical errors related to the poor exchange of health information between patients and their health providers, or across multiple health providers, is a high priority.

We need more health information added into the system before it’s going to be useful for more people in supporting their health-care decisions. Patients prompting their GP or practice nurse to upload a Shared Health Summary at each visit could increase use of the system, which is designed to improve patient control over their health information.

2. We need to add more information ourselves

Many consumers with a My Health Record have only had one since June 2016 through a trial of “opt-out” sites. Lacking experience or guidance in using the My Health Record, they will not know what they can upload or why, or how to use the technology.

Currently, there are only about 80,000 “Consumer Entered Health Summaries” in the My Health Record. These summaries contain emergency contact details and very brief information on allergies and medications. There are also about 35,000 “Consumer Entered Health Notes” – similar to a health journal or diary.

Fewer than 900 people have uploaded a copy of their Advance Care Directive – a critically important document outlining a person’s wishes for future medical treatment – into the My Health Record. As it is the only national online repository for Advance Care Directives that can be accessed anywhere, more legal information websites need to prompt people to store their Advance Care Directive in the My Health Record.

Not knowing how to use computers, navigate the My Health Record, or save and upload documents will prevent many people from taking advantage of the system.

3. More people need to know how to use it

Currently, the My Health Record places high demands on reading and e-health literacy, making it difficult for many people to use. This could be a barrier for a large number of people.

People with low health literacy, people who lack engagement with digital health, people who lack access to a computer and the internet, and people with limited English literacy could struggle with these online records.

Information about the My Health Record needs to be inclusive, easier to read, and translated into many languages – and use pictures and videos – to enable everyone to use the system.

4. The people who need it most need support to use it

As many as one in five Australians have a disability. Anyone with a condition that affects their ability to explain their health history to others might need help to use the My Health Record. This includes people with dementia, stroke, traumatic brain injury, intellectual or developmental disability, autism spectrum disorder, motor neurone disease, Parkinson’s disease, and people with a wide range of social, physical, cognitive, or sensory impairments affecting communication.

People with communication difficulties have three times the risk of preventable harmful adverse events in hospital, relating to their problems communicating their needs to health providers. The My Health Record might be particularly helpful for this group, who are at risk of exclusion because of their communication impairments and low levels of digital inclusion.

While the My Health Record is set up for use by all Australians, people with communication difficulties and their families may need additional information, funding, and other supports to enable their participation. They might also need help to identify who would be their Nominated or Authorised Representative in the system.

Future enhancements of the My Health Record need to take into account the views and experiences of people with multiple health conditions who are engaging with the My Health Record. Gathering their stories of experience could lead to a greater understanding of the types of support needed for more people to use and benefit from this important e-health initiative.

NACCHO Health News : Doctor’s peak bodies speak up about problems with My Health Records

AMA Ley PM

” The Federal Government will drive better patient outcomes for Australians living complex chronic illness as part of its Healthier Medicare reform package, by improving digital heath records and data around health outcomes that will make it easier to co-ordinate their care and measure their progress. “

The Hon. Sussan Ley Minister for Health Press release

Doctors and other health workers need to have access to core clinical information in electronic medical records if the Federal Government’s My Health Record system is to deliver an improvement in patient care

Doctors treating a patient need to be confident that they have access to all relevant information, Shared electronic medical records have the potential to deliver huge benefits by giving health workers ready access to critical patient information when it is needed, reducing the chances of adverse or unwarranted treatments and improving the coordination of care.

AMA President Dr Michael Gannon

Pictured above meeting with the Health Minister and Prime Minister in Perth last week

“There is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.

He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.

“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”

Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems. See full interview below

The AMA Position Statement on Shared Electronic Medical Records 2016 can be found here

Releasing the AMA’s updated Position Statement, Shared Electronic Medical Records 2016, AMA President Dr Michael Gannon said that giving patients the ability to block or modify access to critical information such as medications, allergies, discharge summaries, diagnostic test results, blood pressure and advance care plans compromised the clinical usefulness of shared electronic medical records loaded on the My Health Record system.

“But, if patients are able to control access to core clinical information in their electronic medical record, doctors cannot rely on it.

“Giving patients such control, as the My Health Record system does, is a big handicap to the clinical usefulness of shared electronic medical records.”

The Federal Government launched My Health Record earlier this year to replace Labor’s troubled Personally Controlled Electronic Health Record (PCEHR) system, and trials of its opt-out arrangements are due to commence in mid-July.

But the system, like the PCEHR, gives patients the power to control what goes on the health record, and who can view it.

The AMA said giving patients such control meant the My Health Record would never realise the full benefits of a national electronic health record system.

“All shared electronic health records must include core clinical information that is not subject to patient controls,” the AMA Position Statement said. “Certainty that shared electronic health records contain predictable core clinical information which is not affected, conditioned or qualified by the application of access controls, is critical to the achievement of the legislated objectives of the My Health Record.”

Like its predecessor, the My Health Record system has generated little interest among patients or doctors – in April just 798 health providers had uploaded a shared health summary to the system.

An AMA survey of 658 medical practices, undertaken last month, found GPs were reluctant to take part because of lack of confidence in the reliability of information it contained, combined with little patient demand and an absence of support for practices undertaking the task of creating shared health summaries.

Dr Gannon said the AMA encouraged individuals to take responsibility for their health and strongly supported the idea of a national shared health summary system, but it had to be the right one – one that supports clinical care.

“All health care workers involved in providing clinical care to a patient should have access to core clinical information,” he said. “Where specific information, other than core clinical information, is not made generally available, this should be made clear to treating doctors with a flag on the medical record.”

The AMA added that in ‘break glass’ emergency situations, implied consent must sometimes be assumed to allow access to the full medical record.

The Association said the system should also provide protections for doctors who acted in good faith but missed or were unable to locate critical data “because it is buried in a sea of electronic documents”.

Dr Gannon said shared electronic medical records should not be treated as a replacement for a patient’s medical record, and should not be treated as the single and definitive source of ‘truth’ regarding clinical information about a patient.

But he said it was an extra source of information, accessible at the point of care, that may otherwise have not been available.

My Health Record: Medics speak up

As the new trials of the My Health Record roll out in Queensland, NSW, WA and Victoria, Government News asks clinicians what might help – or hinder – the progress of the revamped national individual electronic health record.

A bit of history

The idea of a national individual electronic health record has been around for decades, routinely popping up in report recommendations from government health agencies.

It was an idea former Prime Minister John Howard helped spread and one the National Electronic Health Transition Authority (NEHTA) was set up to drive in 2005.

Labour introduced the Personally Controlled Electronic Health Record (PCEHR) in 2012 after two years of GP trials.

But from its inception, the electronic health record has been dogged with problems and fraught with complexities and it still has not had the uptake needed to fulfil the vision of a concise patient record available in an emergency.

Academic Dr Helen Cripps compared the Australian e-health experience to that of Slovenia in her 2011 research paper The Implementation of electronic health records: a two country comparison, and found Australia was making much slower progress.

In it, she lists a whole host of reasons for Australia’s sluggish progress in e-health: the country’s complex health care system, with state and federal involvement and a large private health sector; uneven adoption by clinicians;  problems securely sharing data electronically between GPs and other clinicians; the proliferation of different electronic health record formats and systems; fears about data protection and patient privacy; a lack of national direction; the cost of infrastructure, maintenance and training and a disconnect between government-led implementation and software vendors.

The new Australian Digital Health Agency opened its doors on July 1, and appointed ts first CEO UK digital whizz Tim Kelsey. It is a clear sign that e-health is seriously back on the government’s agenda but what about the clinicians the government is relying on to make the record valuable?

Both Dr Nathan Pinskier, Chair of the Royal Australian College of General Practitioners (RACGP) and Dr Tony Bartone, Vice President of the Australian Medical Association (AMA), have weathered the vicissitudes of the electronic health record over the years.

They spoke to Government News about what pitfalls should be avoided this time around and where the road to success lies.

Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems, says there is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.

At the moment, when doctors want to refer patients, for example to specialists, physios and hospitals, they must wrestle with a number of different electronic systems (including Argus, HealthLink and MEDrefer), as well as using fax machines, scanners, emails and letters.

He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.

“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”

Prescription for change  

Data quality

Both clinicians say that the value of My Health Record will not be fully realised until there is decent data quality and coverage so that health providers can feel confident using the information.

Dr Pinskier says there are currently eight sources of data within the My Health Record and patients can also add their own data. Instead, he suggests homing in on the most vital pieces of information: bad reactions to medicines, current medications and allergies.

He recalls a hospital doctor searching through a jumble of sometimes conflicting records to find out what medication an out-of-town patient was on. The doctor eventually gave up and phoned the patient’s pharmacist.

“What’s the value if you have all these lists for providers to spend hours trawling through the records?” he asks.

Dr Pinskier says it is worth looking at alternatives, citing international examples such as Boston Open Notes, where local records of healthcare providers are made available to consumers. The patient sees exactly what the healthcare provider sees, which can also help reinforce medical advice, for example about how to take medication.

He says Scotland’s Emergency Care Summary is a good example of how local records work, calling it “simple, effective and functional.” The summary lists essential details such as a person’s name, age and GP and their medications, allergies and bad reactions to medicines, extracting the information from GP records.

“There is one source of truth, which is highly accurate and repeatedly uploaded to a national system. That is certainly regarded as a preferred model,” Dr Pinskier says.

Dr Bartone, Vice President of the nation’s peak body for GPs, agrees that the success of the individual electronic health record relies on good data and not just from GPs, who he says have always been “ahead of the curve” and early adopters of e-health.

The record also relies on getting good information from allied health providers, pharmacies and hospitals, amongst others, in order to get a useful medical summary. This could include pathology results, diagnostic imaging, immunisation, Medicare and Pharmaceutical benefit claims, organ donation, medication and advanced care directives.

He says records are not expected to be as detailed as those held by GPs, but a reliable, secure and useful summary.

“All of these things go into making up the record but at the moment we have got a situation where some hospitals’ IT platforms won’t allow them to upload information. For example, in Victoria whereas some hospitals were able to upload data right now,” Dr Bartone says.

“It’s about an emergency situation where the patient is unknown to the doctor who needs to get some information on them in a hurry. It’s never going to replace the GPs file … it’s not designed to be that.

“You don’t need all these details. Other providers need a snapshot of medications, tests and conditions; then they will move on.”

A Department of Health spokesperson said that the quality of information uploaded to the My Health Record system reflected the quality of the records kept in local clinical information systems.

“It is the responsibility of healthcare providers and is part of their professional standards that they keep accurate and up-to-date records about their patients,” said the spokesperson. “It is anticipated that records which are accessible by both patients and other healthcare providers treating that patient will see an improved quality over time.”

Getting clinicians on board

Dr Bartone believes the work needs to be clinically-led and the scheme’s practical implications for clinicians, such as cost and increased workload, properly thought through and addressed.

He says there has been a lack of engagement with clinicians, caused by “too many people with various agendas pushing different methodologies and ideas” holding the process back so that it failed to deliver enough value to consumers.

Although medics were consulted initially under the PCEHR, Dr Bartone believes this fell by the wayside when the project was delivered, with little thought to how it would actually work on the ground.

“They expected patients to be registered by doctors in their waiting rooms. That’s a cumbersome and difficult process and these are busy places,” he says.

“There was no awareness that this would impose a workload, red tape and duplication. There was lots of money but it wasn’t going to the right people.”

The results so far have been questionable in terms of outcomes and performance.

“The need to have a robust and reliable individual electronic health record is without question,” Dr Bartone says. “The issues thus far have been in terms of scope and implementation: how and who is controlling it and how it would be rolled out.”

But he says offering GPs payments to register a certain number of patients (which has been announced as policy) and making the scheme opt-out for patients, rather than opt-in (which has not, as yet), were both be good ideas.

The My Health Record trials have been a mixture of opt-in and opt-out, to test the public’s response. While the Nepean and Queensland trials were opt-out, two earlier trials in Western Australia and Ballarat, Victoria were opt-in.

Dr Bartone says it is imperative that the back-end of the system is easy for doctors to navigate and does not involve duplication of effort – which he says had only recent been possible through new software – so it does not impose an additional burden on doctors.

“There’s been lots of good will invested over the last four or five years. That will run thin if there are any further problems,” he says.

Another discouragement for doctors to use My Health Record has been anxiety that they may be prosecuted under privacy legislation for accessing or sharing information, a fear which Dr Bartone says resulted in disillusionment, even for rusted-on fans of electronic health records.

Government News put these concerns to the federal Department of Health.

A departmental spokesperson said the My Health Records Act 2012 specifically authorised the collection, use and disclosure of health information in the My Health Record so that there would be no breach of the Privacy Act 1988.

“This means that treating healthcare providers can access and use an individual’s My Health Record for healthcare purposes,” the spokesperson said.

The spokesperson said the penalties for unauthorised collection, use or disclosure of data – which can be up to $540,000 or two years’ imprisonment – did not apply to accidental misuse. Patients are also able to restrict or remove documents in their My Health Record.

“For example, if a healthcare provider inadvertently or accidentally accesses an individual’s My Health Record – they are not liable for a civil or criminal penalty,” said the spokesperson.

Healthcare providers can use their judgement about what they upload onto an individual’s My Health Record.  There is nothing in the My Health Records Act 2012 that requires them to upload if they choose not to.

Dr Pinskier says that some of the difficulty getting a national e-health record off the ground stems from earlier efforts to appease everybody, patients and multiple healthcare providers, ending in an extremely complex system.

The national individual electronic health record became a hybrid of a clinical and consumer record, without quite meeting the requirements of either, he says.

“I think we need to go back to basics and ask what we want to achieve – what’s its core purpose?

“We are not addressing the questions of utility and functionality. There is still a really good opportunity to see what is it we’re trying to achieve, how best to achieve it and the steps needed to do it.”

He is emphatic about how this should be done.

“This is not a technological questions, it needs to be clinically led,” Dr Pinskier says. “We need to start again but we need the key clinical stakeholders involved and the clinical community needs to be listened to.”

My Health Record trials

Opt-in trials began in July in Ballarat, Vic and Western Australia. The Ballarat Health Service help patients register when they are admitted to hospital and their discharge summaries are uploaded to My Health Record.

In Western Australia, the trial involves helping chronically-ill patients register at selected practices and modifying chronic disease management software. This will give treating healthcare providers, including specialists and allied health professionals, access to patients’ My Health Records using connected software.

Opt-out trials are underway in the Nepean Blue Mountains area and Northern Queensland.

The Department of Health says the trials are being conducted to gauge consumer reaction to an opt-out system of participation, as well as looking at healthcare provider use and how much clinical information is uploaded to the My Health Record when most patients have a My Health Record.

Federal Health Minister Sussan Ley announced last month that the number of My Health Records in Australia had surpassed four million, with an average of 2,200 new registrations every day in the preceding four weeks.

“With changes to the General Practice Incentive, healthcare providers are increasingly contributing and viewing on-line health information about their patients,” Ley said. “We are now seeing one upload of clinical health information from a healthcare provider every 21 seconds.”

Ley says that every day, one in five GPs saw a patient for whom they have little or no information but My Health Record would change that.

“This may be a Medicare claim or pharmacy prescription, or clinical information uploaded by other healthcare providers such as a specialist, hospital and pharmacy,” Ms Ley says.

“With a My Health Record, both a patient and their healthcare professional can gain immediate access to important health information on-line.

“This can improve co-ordinated care outcomes, reduce duplication and provide vital information in emergency situations.

Ley says My Health Record puts the power in the hands of health consumers to decide who they shared their health information with.

Patients can register through MyGov for a My Health Record online and then link the two.

NACCHO Aboriginal Health : Growing at one every 38 seconds the My Health Record hits 4 million!

MHR

With a My Health Record, both a patient and their healthcare professional can gain immediate access to important health information on-line.

This can improve co-ordinated care outcomes, reduce duplication and provide vital information in emergency situations.

“It also enables us, as a consumer, to become more active in managing your health and provide links between the multiple services many of us may need through our lives.”

Minister for Health Sussan Ley today announced the number of people with a My Health Record has surpassed 4 million, or around 17 per cent of all Australians.

                          MY HEALTH RECORD WEBSITE

“With a My Health Record, both a patient and their healthcare professional can gain immediate access to important health information on-line,” Ms Ley said.

   HISTORY OF E-Health/My Health Record from NACCHO

Ms Ley said that following the recent re-launch of the My Health Record there has been a steady increase in registrations.

“In the past four weeks alone, there has been an average of 2,200 new registrations every day, or one new My Health Record created every 38 seconds,” she said.

“With changes to the General Practice incentive, healthcare providers are increasingly contributing and viewing on-line health information about their patients. We are now seeing one upload of clinical health information from a healthcare provider every 21 seconds.”

Ms Ley said every day one in five GPs will see a patient for whom they have little or no information at all. With the My Health Record, they will increasingly have access to at least some information about a patient.

My Health Record

 

“This may be a Medicare claim or pharmacy prescription, or clinical information uploaded by other healthcare providers such as a specialist, hospital and pharmacy.

A My Health Record puts the power in the hands of health consumers to decide with whom they share their health information,” Ms Ley said.

 

 

NACCHO #HealthElection16 : AMA calls to suspend e-health changes until system fixed

Health

The AMA is calling for a moratorium on changes that will penalise general practices thousands of dollars if they do not upload patient health summaries to the My Health Record system, with less than a quarter of practices indicating they will be able to comply with new rules introduced earlier this year to the Practice Incentives Program (PIP).

Read 22 NACCHO Articles about E-Health

The AMA has written to Health Minister Sussan Ley and Shadow Health Minister Catherine King urging them to commit to a suspension of rules that came into effect last month, under which practices that fail to upload shared health summaries for at least 0.5 per cent of their standardised whole patient equivalent each quarter are not eligible for payment under the newly-branded PIP Digital Health Incentive.

An AMA survey of medical practices found that just 24 per cent considered themselves able to comply with the requirement, while 39.5 per cent said they were unable to, and 36 per cent were unsure. Those that could not comply estimated it would cost them, on average, $23,400 a year in lost PIP incentive payments.

AMA President, Dr Michael Gannon, said the rule was grossly unfair and premature because the My Health Record system was still a work in progress and had substantial flaws that compromised its clinical usefulness.

“The AMA has strongly backed the introduction of a national e-health record because of the real benefits it could provide for patient care,” Dr Gannon said.

“But the My Health Record system is plagued with shortcomings that need to be fixed before the Government tries to foist it on patients and practices.”

Of those practices unable to meet the new eligibility requirement, around a third estimated it would cost them up to $15,000 a year in lost incentives, 29 per cent reported it would cost them up to $30,000 a year, almost 20 per cent forecast an annual loss of up to $45,000 and 12 per cent put the annual cost at up to $60,000.

Dr Gannon said this amounted to a significant financial blow to practices already struggling under the burden of the Medicare rebate freeze.

“The extension of the rebate freeze has already pushed many practices to the financial brink, and the last thing they need is to have thousands more ripped away from them because of a flawed process to introduce a national e-health record system,” he said. “The Health Department should call a halt to the process until its gets the My Health Record system sorted out.”

The Health Department has pushed ahead with the new eligibility requirements even though trials of My Health Record’s opt-out arrangements are not due to commence until mid-July, and numerous issues affecting the extent to which doctors can rely on the record are yet to be resolved.

“The Government and Opposition should commit to holding off until the trials have been run and the system’s flaws have been addressed,” Dr Gannon said.

The AMA told the Department last year that fundamental issues with the design of the My Health Record system, including incomplete and hidden information and a lack of take-up among consumers, had to be fully resolved before any moves were made to link its use to PIP payments.

The reluctance of patients and the medical profession to use the system has been underlined by official figures showing by April just 798 health providers had uploaded a shared health summary.

The AMA survey, which was conducted last month and involved 658 practices across the country, reinforces the consistent advice that the AMA has provided to the Department and the Government.

Those practices that said that they would not be able to comply with the new rules had multiple concerns about the technology, including:

  • that My Health Record was not a reliable source of clinical information for GPs (65.1 per cent);
  • there was no demand from patients (66.7 per cent);
  • there was no financial support for the extra work involved in preparing and uploading shared health summaries (67.5 per cent);
  • there were unresolved issues regarding the security of the My Health Record system (61.5 per cent); and
  • other health providers are not using the My Health Record and GPs see little value in using it (61.3 per cent).

Dr Gannon said the proposed moratorium should, at the very least, extend to include the conclusion of the opt-out trials, so that the lessons learned during that process could be applied.

He warned that rushing ahead with the My Health Record and linking it to PIP incentives risked undermining the support of the medical profession.

“Adopting the proposed moratorium is essential,” Dr Gannon said. “Otherwise, the Department may undermine support for My Health Record within general practice and do long-term damage to the goodwill of GPs, which is essential if a national e-health system is to be successfully rolled out.”

NACCHO Health News Alert : Improving privacy in Australia’s general practices a joint effort

images

“Privacy is fundamental to the trusted relationship between a doctor and a patient and practices go to great lengths to protect this. The assessment report shows that some may need more guidance on how to develop transparent and robust privacy policies. The AMA is actively helping them with this.”

Chair of the AMA Council of General Practice, Dr Brian Morton

Acting Australian Information Commissioner, Timothy Pilgrim, has today welcomed a series of actions by Australia’s peak medical groups to improve privacy practices at Australia’s GP clinics.

“A recent assessment of GP practices by the Office of the Australian Information Commissioner (OAIC) suggests that many practices could use more practical support to improve or establish privacy policies,” said the Commissioner.

“The OAIC appreciates that many GP practices are small to medium sized businesses and so practical, industry-relevant support is an effective way to improve privacy outcomes for practices and patients.”

“So I welcome the fact that the Australian Medical Association (AMA), the Royal Australian College of General Practitioners (RACGP), the Australian College of Rural and Remote Medicine (ACRRM) and the Australian Association of Practice Management (AAPM) have come together with the OAIC to provide practical support to their members to deliver open and transparent privacy policies within their practices.”

The OAIC regulates Australia’s Privacy Act1988 and last year conducted an assessment of the privacy policies of 40 GP practices from across Australia. When the assessments revealed room for improvement, medical peak bodies were approached to help deliver training and practical solutions to assist GP practices.

Chair of the AMA Council of General Practice, Dr Brian Morton, said that “privacy is fundamental to the trusted relationship between a doctor and a patient and practices go to great lengths to protect this. The assessment report shows that some may need more guidance on how to develop transparent and robust privacy policies. The AMA is actively helping them with this.”

The Royal Australian College of General Practitioners President, Dr Frank R Jones, said the report was a timely reminder for general practices to review their privacy policies. “The RACGP provides useful resources to general practices to make adherence to the rules straightforward and our goal is to improve the practical help and support we already provide.”

Danny Haydon, President of AAPM, confirmed that Practice Managers have a key role in ensuring their practice has an easily accessible privacy policy in place and that AAPM assists practice managers to implement this through a range of resources.

ACRRM President Professor Lucie Walters said, “rural and remote doctors are keenly aware of the importance of privacy issues, especially given the circumstances of rural medical practice. ACRRM will be doing as much as possible to support its members to ensure that both the documentation and implementation of practice privacy policies are consistent with the requirements of the Privacy Act”.

Commissioner Pilgrim emphasised that a collaborative approach to create strong privacy governance in Australian businesses was always the OAIC’s preferred approach.

“The OAIC works constructively with businesses and the wider community to build an integrated approach to privacy compliance,” said the Commissioner.

“Thanks to the efforts of these peak bodies and the OAIC’s team, that preferred approach will lead to improved privacy management for Australian GPs and their patients.”

About the report

The report focused on assessing the privacy policies of 40 General Practice Clinics against Australian Privacy Principle (APP) 1 under the Privacy Act 1988. APP1 has a focus on open and transparent management of personal information.

The purpose of the assessment was to assist GP clinics to improve or enhance their existing privacy policy, taking into account the requirements under the Privacy Act 1988 (Privacy Act).The assessment aimed to enhance the GP clinics’ understanding of privacy and their obligations under the Privacy Act.

It examined the content, layout and availability of the privacy policy but did not consider how the information handling procedures set out in the privacy policy were implemented in practice. This report does not make conclusions about broader privacy practices of GP clinics beyond the scope described above.

The General Practice Clinics APP 1 Privacy Policy assessment report was conducted under Section 33C of the Privacy Act 1988.

To access the report, please visit https://www.oaic.gov.au/privacy-law/assessments/general-practice-clinics-app-1-privacy-policy-assessment.

About the OAIC

The Office of the Australian Information Commissioner (OAIC) has a range of regulatory responsibilities and powers under the Privacy Act 1988 and other legislation including the Freedom of Information Act 1982.

The OAIC is headed by the Acting Australian Information Commissioner. The Information Commissioner is supported by the Assistant Commissioner, Regulation & Strategy and the Assistant Commissioner, Dispute Resolution, and OAIC staff.

For further information about the OAIC, please visit www.oaic.gov.au or follow @OAICgov.

AMA WORKING WITH GENERAL PRACTICE TO ENSURE PATIENT PRIVACY

The AMA acknowledges the release of the privacy assessment report undertaken by the Office of the Australian Information Commissioner (OAIC), which examined the privacy policies of 40 general practices across Australia.

Chair of the AMA Council of General Practice (AMACGP), Dr Brian Morton, who runs a busy suburban general practice in Sydney, said today that patient privacy is a priority for every GP and every general practice.

Dr Morton said that the OAIC report showed that some general practices needed to do more to ensure that they had a privacy policy that was fully compliant with the Australian Privacy Principles (APP). The report does not suggest that patient privacy had been in any way compromised by any of the practices.

“Privacy law is a very complex area and this report, which looked at a small sample of practices, is an important reminder that general practices should review and update their privacy policies on a regular basis,” Dr Morton said.

The OAIC report provides some useful guidance for GPs, highlighting how practices could improve their privacy policies, including:

  •  how easily policies could be read and comprehended;
  •  the provision of appropriate contact information, and provisions in the event an individual wanted to access or correct information held about them, or make a complaint;
  •  identifying the kinds of personal information collected and held, as well as why and how it is collected and held;
  •  describing the reasonable steps the practice took to protect patient information, and how a privacy complaint is dealt with; and
  •  how health information (including Individual Health Identifiers and prescribed medicines) is collected, used, or disclosed through the MyHealth Record system and the Electronic Transfer of Prescriptions (eTP) service.

Dr Morton said that patient privacy is fundamental to the trust relationship between doctors and patients, and practices go to great lengths to ensure the privacy of their patients’ records.

“General practices are serious about protecting patient privacy, but the report sends a clear signal that we can do better, including with getting all the paperwork right,” Dr Morton said.

“The AMA has already acted upon the concerns of the OAIC, updating our own Privacy and Health Record Resource Handbook to include an updated privacy policy template to guide practices when writing or updating their privacy policy.

“This resource is available on the AMA website at https://ama.com.au/article/privacy-and-health-record-resource-handbook-medical-practitioners-private-sector

“The AMA will continue to work with practices to help them to navigate privacy laws, and have in place the right policies and processes to satisfy their legal and ethical obligations,” Dr Morton said.

 

NACCHO #Aboriginal Health Special Feature : 20 Indigenous health research papers

150525youngboy(withtext)850x240

” This study aimed to examine the accuracy of patient self-reported screening status for diabetes, high cholesterol and cervical cancer among Aboriginal and Torres Strait Islander patients when compared with pathology records.

The study was undertaken in an Aboriginal Community Controlled Health Service (ACCHS). ACCHSs are culturally competent primary health care services and represent self-determination in the provision of health care. They are ideal settings for delivering prevention activities to Aboriginal and Torres Strait Islander people.”

From Insights into nutritionists’ practices and experiences in remote Australian Aboriginal communities

The Australian and New Zealand Journal of Public Health is the Journal of the Public Health Association of Australia and is published six times a year, in February, April, June, August, October and December

The current issue features Indigenous health 20 research papers

1.Aboriginal and Torres Strait Islander health: accuracy of patient self-report of screening for diabetes, high cholesterol and cervical cancer

Chronic diseases including diabetes, cardiovascular disease and cancer account for the majority of excess deaths and diseases among Aboriginal and Torres Strait Islander people, despite being largely preventable.1 Prevention activities such as regular screening are likely to produce significant health gains.2 To achieve these gains clinicians need appropriate, valid and reliable measures of a patient’s screening history.

Patient self-report is often used by clinicians as a quick and inexpensive way to obtain information about a patient’s screening status. Self-report is also used to determine the effectiveness of interventions intended to increase screening rates. The accuracy of self-report is therefore critical. Research studies in non-Indigenous primary care settings,3–11 including Australia,12–15 have shown that relying on self-report can result in significant under-estimation of the proportion of people who require screening. Under-estimating the time period since a patient’s last screening has been reported, especially among minority populations16,17 including indigenous native American women.18 Studies have also found that self-reported population survey data often under-estimates the prevalence of screening, particularly among marginalised population groups.9,10,19,20

Few published studies have investigated the validity of self-reported health issues among Aboriginal and Torres Strait Islander people in Australia. One study found self-reported information under-estimated the smoking status of pregnant Indigenous women,21 and another found a modest correlation between self-report and measured physical activity among Aboriginal children.22

This study aimed to examine the accuracy of patient self-reported screening status for diabetes, high cholesterol and cervical cancer among Aboriginal and Torres Strait Islander patients when compared with pathology records. The study was undertaken in an Aboriginal Community Controlled Health Service (ACCHS). ACCHSs are culturally competent primary health care services and represent self-determination in the provision of health care. They are ideal settings for delivering prevention activities to Aboriginal and Torres Strait Islander people.

2.Insights into nutritionists’ practices and experiences in remote Australian Aboriginal communities

Access to and adequate intake of a range of foods to meet the body’s energy and nutrient requirements is a universal cornerstone of good health and wellbeing. Among Aboriginal Australians, nutrition plays a significant direct and indirect role in suboptimal growth and development in children and the excessive burden of preventable chronic disease in adults.1,2 Public health nutrition is an integral part of population health that seeks to promote optimal nutrition status and good health, and prevent illness and associated economic and social costs of disease.3–5

For more than 20 years, public health and community nutritionists have worked in the Northern Territory (NT) within remote Aboriginal communities, both within the government public health sector and non-government organisations, such as Aboriginal Community Controlled Health Organisations. The term ‘public health nutritionist’ refers to practitioners working in population approaches to public health nutrition.

In the remote Aboriginal context, stakeholders within the food landscape can include remote community stores/shops, schools, childcare, aged-care facilities and health centres, community groups, Aboriginal health workers (AHWs) and families and individuals.6 Within these settings, nutritionists ideally work with and through local community members, including AHWs, to jointly address expressed food and nutrition-related priorities. For these reasons, the terms ‘community nutritionist’ and ‘public health nutritionist’ have been used interchangeably. The term ‘dietitian’ tends to refer to practitioners focusing on clinical and individual aspects of nutritional health. Increasingly, dietetic qualifications are mandatory for nutritionists working with remote Aboriginal communities, as many practitioners also provide a clinical service.

In remote Aboriginal communities, nutritionists perform numerous functions calling for a wide range of competencies that require social, communication and relationship building skills3 and cultural adeptness, including a culturally competent7 and culturally safe approach.8 The call for nutrition practitioners, and their training and employment structures, to move towards broader sociological9 and critical10 approaches appears especially relevant in a cross-cultural world where food permeates many aspects of life. This also supports the internationally agreed notion of ‘health’ that recognises the existence of various cultural and world views, and the imperative of supporting the layers of social and ecological factors that underpin one’s state of health by addressing healthcare at multiple levels.11 Across all these skills and levels, one universal and fundamental element is communication. All health workers in cross-cultural settings must communicate across social and cultural world views. Clear health communication is vital to assist with understanding and to empower individuals and groups to make informed decisions.12,13 Community empowerment is one key element of successful community nutrition interventions.14 Nutritionists working in remote Aboriginal communities ideally engage with a range of community stakeholders, including Aboriginal health and local community workers.

Remote health staff and health services speak of numerous challenges in providing remote health services and the complexities of delivering primary and health promotion services.15–19 While high staff turnover is a considerable issue,17 little is understood of the challenges facing nutrition practitioners especially in this cross-cultural context.20,21 We used a qualitative methodology to explore communication methods, education practices and approaches, perceived challenges and the potential role of nutritionists. The study aimed to support nutritionists working in remote Aboriginal communities and inform ongoing efforts to create supportive environments that promote nutritional health and effective communication and facilitate behaviour change.

3.Legally invisible: stewardship for Aboriginal and Torres Strait Islander health

4. The comparative cost of food and beverages at remote Indigenous communities, Northern Territory, Australia (pages S21–S26)

5. Use of electronic visual recording to aid assessment of dietary intake of Australian Aboriginal children living in remote communities

6. Bundap Marram Durn Durn: Engagement with Aboriginal women experiencing comorbid chronic physical and mental health conditions

7.The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities

8. Trachoma in remote Indigenous Australia: a review and public health perspective

9. The value of partnerships: lessons from a multi-site evaluation of a national social and emotional wellbeing program for Indigenous youth

10.Hypertension: high prevalence and a positive association with obesity among Aboriginal and Torres Strait Islander youth in far north Queensland

SEE ALL ARTICLES HERE

Download the NACCHO Newspaper April edition here

KME623p037-naccho-V2-247x350

150525youngboy(withtext)850x240

Watch NACCHO TV HERE

NACCHO’s new Baseline Profiles to demonstrate extent, experience and value of the ACCHO Sector to policy makers

NACCHO-Member-Services-2015-11-1024x939

“NACCHO will use the Baseline Profile to demonstrate the extent, experience and value of the ACCHO Sector to policy makers in government and those developing new programmes and budgets.

NACCHO is developing Baseline Profiles for its Member Services in 300 locations coordinated by 140 NACCHO Member Services as a first step in getting health and related data back in the hands of the Member Service ACCHOs and their communities.”

ACCHOs are a critical component of Australia’s primary health care system; the Baseline Profiles and Member Service’s localised profiles will re-enforce this fact “

Matthew Cooke Chair NACCHO

NACCHO delivers Map-Based Decision Support Services – Our Data in Our Hands for more info

NACCHO Baseline Profiles – putting data to work is from NACCHO Aboriginal Health Newspaper Page 10 April edition : Download 24 pages here

In these times of changing Federal policies, cut backs in areas of funding and overall fiscal constraints, ACCHOs are faced with providing broad ranging evidence of their performance to justify existing budgets and staffing levels, as well as justifying applications for new funding for the expansion of services into identified areas of need.

Challenges are also arising as an increasing number of programmes are being funnelled through the newly formed Primary Health Networks.

A new approach for determining funding allocations being used by the government and PHNs is referred to as “market testing”. This approach will potentially require ACCHOs to compete with state and territory health departments, other NGOs and for-profit practices and corporations for the provision of basic services and for the delivery of new programmes.

Mapping the service delivery footprint of ACCHOs service areas is important to demonstrate their role and significance as unique providers of comprehensive primary health care in over 300 locations coordinated by 140 NACCHO Member Services. ACCHOs are working with many of the new PHNs to build an understanding of the actual range of services provided to the population in their communities and the geographic extent of their service delivery. PHNs are required by the Department of Health to develop Health Needs Assessments and associated planning.

The ACCHO Sector has over 320,000 clients with over 3.7million client contacts delivered in 2013-2014. In comparison, the number of Emergency Department presentations in public hospital emergency departments in all states and territories was 7,195,903 (2013-2014) and RFDS undertook 292,523 client (patient) contacts in the same period.

NACCHOs Baseline Profiles, based on publicly available data, are being created for each Member Service. The profiles form a template to enable Member Services to add data from their own information systems. These localised templates will then be available for use in reports for Service planning and to provide evidence of performance, as well as for communications with community, funding bodies and policy makers.  A critical aspect of planning is “access to services”, for both existing services and for identifying areas where there is no access i.e. gaps.

The Baseline Profiles are using drive times (the time it takes to drive to an ACCHO) as a way of determining accessibility to health services, building on the work of the Australian Institute of Health and Welfare (AIHW) and the Queensland Aboriginal and Islander Health Council (QAIHC).

SEE Koori Mail for 2 and 3 below :The graphic shows example panels from the Baseline Profile for the Geraldton Regional Aboriginal Medical Service in the electorate of Durack and Country WA PHN.

Map 1

1.Maps showing the 60 minute drive time area from Geraldton, age-gender pyramid of the population and service delivery area for the Geraldton Regional Aboriginal Medical Service (GRAMS)
2.Heat map showing areas with a high density of Aboriginal people and the area included in a 60 minute drive time. Aboriginal population within the 60 minute drive-time of Geraldton is 3,382 with 4,727 in the larger service delivery area (ABS Census 2011) 3.Age-gender pyramid of the Aboriginal population in the 60minute drive time area.

Service delivery area with GRAMS fixed and mobile clinic serviced locations.