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.

How to upgrade an organisation’s tribal culture

Immature tribal cultures create silos and distrust, and sustain undesired behaviours. How can we change a dominant culture and become more effective?

My mother spent years of her childhood in Tjideng, a Japanese internment camp for women and children run by the cruel Captain Kenichi Sone.

She was born in the former Dutch East Indies, now Indonesia. The Dutch occupied and exploited the country for over four hundred years, but in 1942 things changed dramatically as a result of the Invasion by the Japanese imperial army.

The women in the Japanese internment camps are sometimes called the ‘forgotten women’ of the war in the East. These camps, as well as Dutch colonialism, are some of the worst examples of tribalism.

Tribalism comes of course in many shapes and forms including, as we all know, in the medical world.

Tribes & organisations

Most leaders know that tribal cultures are a key factor in the performance of organisations. Some leaders are experts at creating close-knit cultures, but only a few can change a culture that doesn’t perform optimally.

Tribalism is the natural way we organise ourselves into social groups. Our ‘tribes’ are part of who we are. They offer support, security and a sense of belonging an there’s nothing wrong with that.

However, tribalism can also refer to a false sense of superiority, sometimes leading to exclusion, bullying and discrimination.

We can change a dominant tribal culture and upgrade our organisations to more collaborative, healthy stages. History shows that goal-oriented groups and organisations that work well with others are more successful.

5 tribal cultures

In the book ‘Tribal leadership’, Professor David Logan et al describe five stages of tribal culture. As he points out, the medical profession is only half way, at stage three of five.

Five tribal cultures
The five tribal cultures. Source: Tribal leadership. David Logan, John King, Halee Fischer-Wright 2011

Logan’s tribal stage one is the mindset of gangs and war criminals – people who come to work with weapons. There is hostility and violence and no cohesion.

People working in a stage two culture may have coffee mugs with slogans like: “I hate work,” or “I wish it was Friday”.

There is often a high suspicion of management and authority in general, and team-building efforts are not effective in this culture.

Stage three is the dominant culture in almost half of all organisations, including many professional workplaces. Quite often doctors fall into this category. In stage three it is all about personal success and being the smartest. Stages four and five are the collaborative cultures.

Let’s have a closer look at the most common culture, stage three.

I’m great (and you’re not)

The mantra of stage three is ‘I’m great’, often followed by the unspoken words ‘and you’re not’. There’s a long history in medicine of stage three cultures with a strong focus on individual expertise and success.

Anatomy lesson
The Anatomy Lesson of Dr Nicolaes Tulp, by Rembrandt. Source: Rembrandt Huis.

One of the earliest examples I could find is this well known Rembrandt painting titled, ‘The anatomy lesson of Dr Nicolaes Tulp.’

Dr Tulp was a highly respected surgeon in Amsterdam in the seventeenth century; he is clearly the central figure in this painting. He’s the only one wearing a hat. Sadly but not surprisingly there are no women present.

You could argue that this scene demonstrates the dominant culture of the exclusive Amsterdam Guild of Surgeons. These days, almost four hundred years later, the dominant culture in medicine hasn’t changed all that much.

Professionals working in a stage three culture are often very good at what they do as individuals but what they don’t do is bringing people together.

They may think they are. Interestingly people in stage three often think that they are at one of the collaborative stages. They may talk about collaboration and teamwork – hallmarks of stage four and five – but their actions firmly put them in stage three.

The issue with a stage three culture is that it cannot be fixed – it can only be abandoned. The solution is to move your tribe to the next stage, stage four.

How to upgrade

People working in a stage four culture don’t talk about themselves. They first start listening. It’s no longer about being the smartest or about personal success.

There’s a move from ‘expert’ to ‘partner’. The language used is not “I’m great” but “We’re great”. There’s tribal pride.

Eventually, later in stage four, organisational boundaries become less important and cross-pollination between organisations may occur.

So how do we upgrade our culture from stage three to the more collaborative stage four? Logan describes several principles, including:

  • Focus your team on tribal success instead of personal success
  • Point out the superior results of stage four tribal cultures
  • Describe role models in the organisation that show stage four behaviour, for example people who are talking about ‘we’ instead of ‘me’
  • Encourage transparency and sharing of knowledge & information as much as possible.

There’s one main problem with stage four, reflected in the unspoken sentence that often follows “We’re great,” and that is: “… and you’re not,” referring to other groups or organisations. That’s where stage five comes in.

Stage five is the dominant culture in two percent of work places. In this stage there is no ‘they’.

‘Them & us’ thinking has gone out of the window and there is a focus on inspiring purposes. These are often universal values, taking away the need to compete.

People working in stage five cultures can work with any group that has a commitment to universal core values – even if these values are different from their own.

Effective followership

More collaboration in medicine has many benefits, including for direct patient care, mental health of doctors and healthcare reform.

We always talk about leadership but effective followership is just as important.

Effective followers don’t blame their leaders when things don’t go as planned; instead they offer support and gently, but persistently, steer their leaders in the right direction to help them achieve the organisational goals.

What the medical profession needs is people who build bridges.

I’d encourage you to review your own organisation(s) and look for opportunities to collaborate. Don’t accept non-collaborative cultures.

Find role models and like-minded people, people who talk about ‘we’ instead of ‘me’, and together take your dominant culture to the next level.

This is an adaptation of a presentation given at GPDU18.

The no. 1 blogging tip you should always keep in mind

The no. 1 blogging tip you should always keep in mind
Picture from my first travel blog in 2004: Dropped off at Lizard Island, North Queensland, with food, water, tent & map.

My first blog was a travel blog. Nancy and I were working and travelling around Australia  & New Zealand and, like so many others, we blogged about our down-under experience. The audience: Family and friends. Number of daily visitors: 3-5.

In 2004 there was no Twitter, and LinkedIn and Facebook were the new kids on the block. Still, it was good fun. We were passionate about our travel adventures and we enjoyed uploading the pictures we took with our 4 megapixel Sony Cybershot.

Professional blogging

Four years later we settled down in Western Australia and started a business. The Panaceum blog became part of the new practice website.

In the early days the blog attracted 20-30 visitors per day, but after a while the number grew to 40-60. Connecting the blog to the practice social media accounts made a big difference. I learned a lot about content – what works and what doesn’t.

In 2013 we decided to move back to Queensland and I left the practice. I began to focus more on my Doctor’s bag blog (it’s good to see the Panaceum blog is still very much alive).

Keeping a blog going is hard work. There is no ‘easy way’ to do it. The competition is fierce and as there are many great bloggers out there, it’s not that simple to get noticed.

I really enjoy blogging – which helps of course. I am fortunate to work in an industry that’s a constant source of inspiration.

Slowly the visitors number started to climb to 80-100 per day.

The struggle

But just as I thought my blog was taking off, writer’s block hit me hard. My creativity was gone. I didn’t blog for a while. The longer I didn’t post anything, the more attractive the thought of deleting my WordPress account.

English is not my first language and I often struggle to find the correct words. So, I argued, why not save myself the trouble and stop blogging altogether?

One evening I was reading an article about writer’s block. It was the break-through I needed. The author, Jeff Goins, simply said: “You overcome writer’s block by writing.” His message was short & sweet: It doesn’t matter what you write, as long as you get going.

That’s what I did and somehow it worked. Before I knew it, the inspiration was back and the blog ideas started flowing again.

The first time my daily visitors number reached 1K, I couldn’t believe it. I thought it was a one-off, just luck, but last month over 15,000 people visited Doctor’s bag.

Although I want people to read my posts, it has never been my goal to get more visitors – nor do I think the hit counter is a measure of success. I enjoy producing content that makes others think. If it leads to change – even in the smallest way – I’ve reached my goal.

There will always be people with more writing talent, better posts and more followers, so I try to keep Bill Gates’ words in mind:

“Don’t compare yourself with anyone in this world… if you do so, you are insulting yourself

But there is one thing that is more important than anything else…

The best tip

The one thing that determines success in blogging, and in many other ventures in life, is perseverance. It is important to follow your passion. But if you enjoy writing, the best tip I can give you is: Don’t give up.

Everybody has a story to tell, so keep writing. You will get better at it and people will find your blog.

Follow me on Twitter: @EdwinKruys.