My Health Record: what’s next?

My Health Record: What's next?

The end of the My Health Record opt-out period is in sight. Unless the government decides otherwise, next month the vast majority of Australians will have a digital national shared health record. What’s next?

A while ago I saw a patient who was passing through my town, on her way home from Cairns to Sydney. She had been seen at the emergency department in Cairns and was told to visit a GP for follow-up. She had no hospital letter or medical records but with a few clicks I was able to get access to the hospital discharge summary through the My Health Record, which included results of blood tests, ECG and chest x-ray, and I could see what medications were prescribed.

This is a rare example of the benefits of the MyHR; once the system will be used at a larger scale this could become an everyday reality.

The Australian Digital Health Agency (ADHA) says that about 1.14M Australians have opted out and apparently the opt-out rate is slowing down. At the same time others are signing up and there is an expectation, based on the opt-out trials, that many of those who opted out will eventually opt back in.

The Australian My Health Record is a compromise between a consumer record and a clinical record. This means that there will always be people in both camps who are not completely satisfied. Despite everything we’ve come a long way.

Work in progress

The My Health Record, currently in version 9.4.2, continues to evolve. Looking back over the years progress has been slow but significant.

For example, the software is far less clunky these days; accessing a record or preparing and uploading a shared health summary can now be done within seconds; we got rid of the dreadful participation contracts; there is a secondary use of data framework and users can choose to opt-out of secondary use of their data.

It is expected that more pathology and imaging providers will come on board next year and the legal framework will be further adjusted to improve privacy of Australians, including complete deletion of data if people decide they don’t want a record anymore.

Awareness?

According to ADHA over 87% of Australians know about the record and more than 85% of general practice is registered.

It is likely though that this awareness is rudimentary despite hundreds of engagement activities by the agency and Primary Health Networks (PHNs). Most Australians will not be aware that they have control over who-can-access-what in their records and how to change the privacy settings.

The RACGP has held many PHN-based peer-to-peer workshops across the country as well as webinars for general practitioners and staff, and around 2000 people attended – which is a lot but probably not enough. Most non-GP specialists are not yet on board.

Then there are still the concerns about for example privacy, workflow and accuracy, many of which are summarised in this year’s senate inquiry report. It appears there is still work to do.

The next stage

The agency has started preparing for the ‘post opt-out period’. As it stands around mid December empty shell records will be created, and activated once accessed by providers or consumers.

ADHA says the aims of the next stage of the consumer campaign will be maintaining awareness, taking control of the My Health Record and encouraging consumers to discuss the MyHR with providers.

The provider campaign will focus on the expected benefits including improved efficiency, such as less search-time, and better health outcomes – although skeptics will question the latter claim by the agency.

There will also be a focus on getting specialists on board, aged care access, improved family safety and child protection and education for vulnerable consumer groups.

International review

Meanwhile ADHA has released an international review of digital health record systems. The findings show that the Australian MyHR empowers consumers to access and personally control their information, including what’s in it and who can see it.

ADHA emphasised that, although many countries have laws that allow users to view their health information, only Australia and a limited number of other countries allow citizens to control who sees their information and request corrections to their own health data.

The MyHR PR machine is in full swing. It will be interesting to see what the response to the senate inquiry will be and what happens next year. I hope the momentum of recent times will continue.

What needs to change?

From a usability point of view the wow-factor is still missing and although that’s nothing new in healthcare, some work in this area would go down well.

For example, it would improve workflow and safety if doctors could download MyHR information not just as PDF but import new medications straight into a local medication list.

The secondary use of data framework is fairly broad, and could be tightened up a bit further. Many have commented that the messaging around the MyHR should be less promotional and more about benefits versus limitations – but I’m not holding my breath here.

What change do you want to see?

Details have been changed in the case above to ensure patient confidentiality.

8 thoughts on “My Health Record: what’s next?

  1. Privacy for under 18 year olds .
    I work in a youth sexual health clinic and fear that confidentiality for the under 18’s may be compromised. It is my understanding that unless we actively ask for information not to be uploaded ( ie scripts / pathology ) parents will be able to acess this information.

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  2. Surely a good first move would be to do what the Senate Inquiry Info The myHR recommended. We also need a major tech upgrade which no-one seems to want to pay for. Equally no one seems to want to pay GPs to properly curate and upload properly reviewed data. So if they won’t pay do they actually care?

    But, in reality the core problem is identified by Edwin:

    “The Australian My Health Record is a compromise between a consumer record and a clinical record. This means that there will always be people in both camps who are not completely satisfied.”

    Without a major re-design it is always going to be a very poor compromise which actually satisfies few IMVHO!

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  3. As a person with multiple health issues and a consumer advocate, I’ve been following the development of MHR with interest. Like you, I acknowledge that there is still work to be done but that it will make a huge difference for many people.

    Unfortunately, it looks like my GP doesn’t feel the same way. When I asked his clinic manager about MHR recently, she said that they are not connected to the system and that they think it is too time-consuming and risky to be worthwhile. I understand that practitioners need to use specific apps to access the system, so it may take a bit of work to get set up, but surely it is worth it?

    Is my GP obliged to upload my information if I ask them to? I know I could go to another GP, but given my complex health history, I would rather avoid this if I could.

    Are many other GPs still dragging their heels like this?

    Thanks,

    Rosemary

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    • Hi Rosemary, the history of the PCEHR/MyHR has put many GPs off and I guess it will take some convincing as well as further improvements.
      GPs are not obliged to upload or use the record.
      It’s important to know though that some data will be uploaded even if the prescribing/requesting doctor/practice does not participate.
      For example PBS/MBS data, pathology and imaging results will eventually go up (unless a consumer doesn’t want it to be uploaded).

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      • Thanks, Edwin,
        It’s good to know that some of my data will be there. I wonder if anyone else will feel strongly enough to consider changing GPs if they are in a situation like mine? It will be interesting to see.

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  4. Australia’s eHealth (MyHR) system is based on a centralised online accessible database open to hundreds of thousands of legitimate users.
    Preventing cyber attack through all these access points is impossible. Hacking any of these points exposes the entire database. It is indefensible.

    A national eHealth system need not be based on a centralised database. Germany, with a population of 80 million, have 70 million using eHealth Cards, which contain each citizen’s eHealth record.

    Australia’s system gives wide ranging powers of access and My Health Record data sharing to the “System Operator”. Originally the Secretary of the Department of Health, the System Operator powers have been delegated and can be delegated to any public servant in the Department and to anyone by the decision of the Minister.

    This means technically any government department may have access to everyone’s My Health Record.

    Currently only 8.7% of Australia’s population have a MyHR shared health summary and there is no reason to believe these are up-to-date. GPs are incentivised by Practice Incentive Payments up to $50,000 per practice per annum to upload a quota of SHSs, but are not paid to update them.

    Paul Power

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