NACCHO Aboriginal Health and #MyHealthRecords : Australia’s peak GP, pharmacy, and healthcare bodies support My Health Record and the Government’s decision to move the system to an opt out model

“The My Health Record will allow a range of benefits – from a full medication summary, to a record of diagnostic reports, through to the ability for patients to enter their own notes.

Ultimately it’s a tool that will help patients better track their own health and medical history,” 

Australian Medical Association (AMA) President, Dr Tony Bartone believes the opt out model is the fastest and most effective way to realise the benefits of My Health Record. See sector support Part 2

VIEW Rob and Sandra’s My Health Record Story VIDEO HERE 

 “At Galambila we aim to provide a culturally appropriate service to our local Aboriginal community. We have a range of clinics and services aiming to close the gap and keep our community healthy and living longer.

Galambila has six GPs and allied health services such as podiatry and been active in setting up My Health Records for patients and in uploading patient summaries.” 

My role is to provide linkages with community pharmacy, as well as actively enhancing our quality use of medication at a clinic level. I play an important role in the care of our clients as they transition through care settings by ensuring correct and appropriate medication usage.

It is an innovative role that adds value to the primary health care outcomes of our clients.”

Pharmacist, Chris Braithwaite Galambila ACCHO Coffs Harbour

See full ACCHO story Part 4 below

NACCHO Aboriginal Health and #MyHealthRecord : Puntukurnu Aboriginal Medical Service (PAMS) remote clinics to access My Health Record

Part 1 :From Monday 16 July all Australians will be able to decide if they want a My Health Record – an online summary of their key health information where they can safely store, access and share their important health information.

More than 5.9 million Australians already have a My Health Record and 12,860 healthcare professional organisations are connected, including general practices, hospitals, pharmacies, diagnostic imaging and pathology practices. The My Health Record is already making healthcare management for individuals and healthcare providers easier and safer, and could save lives in an emergency situation.

Australians can manage privacy and control access to their My Health Record including what information gets uploaded and who has access such as family members, carers and healthcare providers. This empowers them to share and control their health information with doctors, hospitals and other healthcare providers from anywhere, at any time.

By the end of 2018, a My Health Record will be created for every Australian, unless they choose not to have one. If people choose not to have a My Health Record, they will be able to opt out of having one created for them during a three-month period, starting on Monday 16 July and ending on October 15 2018.

Professor Meredith Makeham, family General Practitioner and Chief Medical Adviser to the Australian Digital Health Agency said, “My Health Record empowers Australians by giving them secure access to their own healthcare information and supports them in managing their health conditions.”

“People can choose which healthcare information they’d like to store in their My Health Record and who they’d like to share it with.”

“My Health Record aims to deliver better healthcare outcomes and safer care for people. It will reduce harm caused by medication errors because people and their healthcare providers will have access to important information about medicines and allergies. This could save your life in an emergency.”

“My Health Record will help people with chronic and complex health conditions have better coordinated care. It will enable all of their clinicians to see the same healthcare information. This should also reduce avoidable hospital admissions and the unnecessary duplication of pathology and imaging investigations.”

“My Health Record has the potential to have a significant and long-lasting positive impact on healthcare services for every Australian, and we encourage all Australians to find out about the benefits of the My Health Record,” said Mr Tim Kelsey, Chief Executive of the Australian Digital Health Agency.

“My Health Record is a key priority in the Government’s National Digital Health Strategy, and a great example of the collaboration underway as government, healthcare providers, industry bodies, and Australians all work together to deliver it.”

 

Part 2: Australia’s peak GP, pharmacy, and healthcare bodies support My Health Record and the Government’s decision to move the system to an opt out model

Consumers Health Forum (CHF) CEO, Ms Leanne Wells said the opt out period is an important time for Australians to learn more about My Health Record. “My Health Record gives Australians the opportunity to be active partners in their own care, with many potential benefits for those that decide to have one. The opt out period is a great opportunity for individuals to learn more about My Health Record so they can understand the impact it could have on their treatments. We are looking forward to seeing more records be created by the end of the year, so more Australians have access to the benefits the platform enables,” said Ms Wells.

Download full press release

My Health Record CHF opens new era

Royal Australian College of General Practitioners (RACGP) Chair of the RACGP Expert Committee – eHealth and Practice Services Dr Nathan Pinskier said My Health Record is one of the best examples of how technology can make a positive difference to society.

“Many Australians are already making use of digital services across a range of industries. My Health Record provides the opportunity for Australians to access their health information in a secure environment. The RACGP are working with GPs to obtain awareness on how to best use My Health Record to provide patients timely access to additional information and support better health outcomes,” said Dr Pinskier.

Pharmaceutical Society of Australia National President, Dr Shane Jackson is also looking forward to seeing more Australians take ownership of their healthcare. “In collaboration with the Agency we are helping our 30,000 pharmacists guide patients through this important healthcare decision. The information in the My Health Record System will allow pharmacists to deliver more effective and efficient care, and it is great that all Australians will have the option to benefit from this,” said Dr Jackson.

Pharmacy Guild of Australia National President, Mr George Tambassis said increased use of the system will result in sustainable healthcare delivery. “The Guild is committed to ensuring all pharmacy dispensing and medicine related services are fully integrated into My Health Record. By doing so we will help advance the efficiency, quality, and delivery of healthcare,” said Mr Tambassis.

Australian Healthcare and Hospital Association (AHHA) CEO, Ms Alison Verhoeven applauded the Agency’s decision to expand the My Health Record platform while respecting a patient’s right to privacy. “Health care is a sensitive topic, and so it is only right Australians are given the right to decide how it is disclosed and who to. Patients are at the centre of My Health Record – realising the health benefits it enables and controlling those who have access to it. It’s a critical and exciting development in the progression of healthcare services in Australia,” said Ms Verhoeven.

Part 3

More information on My Health Record can be found at

www.myhealthrecord.gov.au.

People who do not want a My Health Record can opt out by visiting the My Health Record website or by calling 1800 723 471 for phone-based assistance.

Additional support is available to Aboriginal and Torres Strait Islanders, people from non-English speaking backgrounds, people with limited digital literacy, and those living in rural and remote regions.

Part 4

Pharmacist, Chris Braithwaite has worked in a variety of Aboriginal and Torres Strait Islander health locations since graduating in 2012, including at Katherine in the Northern Territory, Mount Isa and Cape York in Queensland. He has been working at Galambila Aboriginal Health Service at Coffs Harbour in northern NSW – in Gumbaynggirr country – since October 2016 .

I was attracted by the opportunity take on the emerging role as a practice pharmacist working closely with GPs, Aboriginal Health Workers, nurses and other allied health professionals. Working with Aboriginal people is a unique and rewarding use of my skills.

My Health Record is particularly exciting for pharmacists as we have, for too long operated in an information poor silo and this will be a step in the right direction to close the loop and increase our capacity to deliver targeted care.

For patients, it will provide a platform for empowerment regarding their health and an accessible record for those Australian’s who find health literacy a challenge. This is really a priceless advance for the health system.

I have always been attracted by the concept behind My Health Record, but what’s really convincing are the case studies and examples I have heard where pharmacists and other health professionals have delivered more effective and efficient care. When these stories come to light, you can always recall a situation where having access to My Health Record would have made an enormous impact on the way you delivered care.

To me, this was especially relevant in Cape York, where the Aboriginal and Torres Strait Islander community is particularly transient. My Health Record will be invaluable in these situations.

Galambila

At Galambila we aim to provide a culturally appropriate service to our local Aboriginal community. We have a range of clinics and services aiming to close the gap and keep our community healthy and living longer.

Galambila has six GPs and allied health services such as podiatry and been active in setting up My Health Records for patients and in uploading patient summaries.

My role is to provide linkages with community pharmacy, as well as actively enhancing our quality use of medication at a clinic level. I play an important role in the care of our clients as they transition through care settings by ensuring correct and appropriate medication usage.

It is an innovative role that adds value to the primary health care outcomes of our clients.

In my work at Galambila I find the dispensing record and medicines view particularly useful. When performing a Home Medicines Review (HMR), this helps me assess dispensing intervals and gives an indication of medication adherence.

A phone call to the community pharmacist is still useful and important for their insights given the regularity of contact with patients. However this saves a major aspect of the conversation as well as unnecessary paperwork.

I also find discharge summaries particularly useful in ensuring the patient’s transition back into community is smooth. This is especially pertinent when they are discharged from a non local hospital and it isn’t sent directly to us.

A simple, but powerful example was when an unknown patient presented to see the GP. The patient did not have strong recollection about their previous treatment. They were asking for prescriptions but couldn’t remember what it was they took, nor could they name a recent community pharmacy (only the town). We were unable to get in contact with their previous GP.

In the past, it would have taken me 30 minutes to obtain the information I need. However, they had an active My Health Record and I was able to quickly access this with the GP and we were able to provide the care the patient needed immediately.

I believe the potential for My Health Record is incredible, especially for patient safety in terms of medication management. As time goes on and the conformity with clinical software increases, having someone’s renal function at your fingertips when dispensing medicines such as rivaroxaban, for example will revolutionise the dispensing process in the community.

In the future I imagine it will be part of my daily practice and widely accepted by the public and health professionals as an incredibly useful tool for more effective and efficient care.

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 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.