Friday, August 26, 2016

It Looks Like Labor and The News Limited Papers Have Noticed The ADHA. They Are Not Convinced Yet!

This article appeared on Sunday.

A New Debate Debacle

Samantha Maiden
National Political Editor
Sunday August 21, 2016
A controversial former Journalist who created an “error strewn” database of British patients’ personal medical information has now been put in charge of Australia’s health records.
Labor has warned the appointment of Tim Kelsey as the new CEO of Australia’s Digital Health Agency has raised the spectre of another census night style debacle.
Mr Kelsey had a trailblazing career in the UK as the first national director of Patients and Information for the National Health Service and chair of the National Information Board.
But he also sparked controversy for his public remarks about privacy and his involvement in a project for health records that was later described by Cambridge University researchers as plagued with “mismanagement and miscommunications, inadequate protections for patient anonymity and conflicts with doctors. After it was reviewed in 2015 he left the UK before emigrating to Australia.
----- End Extract.
After the review the project was largely cancelled.
I guess we can all just sit back and wait to see what happens. The outcome of the secondary use of myHR data enquiry will provide some useful information I suspect.
David.

Thursday, August 25, 2016

The Macro View – Health And Political News Relevant To E-Health And Health In General.

August 25  Edition.
The big issue for this week will be just how the politics will play out and what impact it will have as Parliament comes back with the new government in the next week (Starts Monday 29 August, 2016).
Otherwise we have the Northern Hemisphere on Summer holidays – leading to very stable markets mostly.
In Australia we have the ongoing nonsense and political contention that is blocking progress.
There three paragraphs from the outgoing Reserve Bank Governor says it all!
“He observed that "when specific ideas are proposed that will actually make a difference [to the budget deficit] the conversation quickly shifts to rather narrow notions of "fairness", people look to their own positions, the interest groups all come out and the specific proposals often run into the sand.
"If we think this rather other-worldly discussion will not have to give way to a more hard-nosed conversation, we are kidding ourselves.
"That will occur should there be a moment of crisis, but it would be better if it occurred before then," he said.”
With the Health Minister at RIO we have policy quietness in the Health Sector for the moment.
-----
Here are a few other things I have noticed.

General Budget Issues.

  • August 15 2016 - 5:47AM

Why Treasury is wrong on deficits and debt

Ross Gittins
The last speech of the retiring Reserve Bank governor, Glenn the Baptist, was a touch biblical. Whatever your point of view, you could find a verse here or there that seemed to back you up.
If, for instance, you accept the conventional view that the budget deficit is way too high, that the government should be more daring in seeking to cut the deficit, and its opponents should be less opportunist and more responsible in agreeing to spending cuts, Glenn Stevens offered a verse for you to quote.
He observed that "when specific ideas are proposed that will actually make a difference [to the budget deficit] the conversation quickly shifts to rather narrow notions of "fairness", people look to their own positions, the interest groups all come out and the specific proposals often run into the sand.
"If we think this rather other-worldly discussion will not have to give way to a more hard-nosed conversation, we are kidding ourselves.
"That will occur should there be a moment of crisis, but it would be better if it occurred before then," he said.
-----

Treasurer Scott Morrison takes on childcare sector for unfair practices

index&t_product=CourierMail&td_device=desktopRENEE VIELLARIS, The Courier-Mail
August 15, 2016 12:00am
THE childcare sector has been criticised by Treasurer Scott Morrison for being inflexible and charging fees even when kids are absent.
Mr Morrison yesterday said he was “passionate’’ about helping to make child care more affordable, saying it was unfair to make families pay for a full day of care if only a few hours were required.
He said his aim was to bring the Federal Government’s childcare reforms forward, but he needed the support of Labor, which is refusing to back the policy.
Blaming an obstructionist Senate, the Federal Government announced in the Budget it had delayed $3.2 billion in reforms aimed at making child care more affordable.
-----

States rebel against PM's WA GST plan

Updated: 4:49 pm, Monday, 15 August 2016
A change to the way the GST is distributed among the states won't be made anytime soon, Treasurer Scott Morrison says.
Mr Morrison was defending what Prime Minister Malcolm Turnbull told the WA Liberal Party state conference about his plan to put a floor under the revenue carve-up - a move that would benefit the West.
'No one envisaged that the current way things are done would lead to a situation where Western Australia would just get 30 per cent of the GST that their people paid,' he told Macquarie radio on Monday.
'The system's got to be fair to everyone.'
-----
COMMENT
  • August 17 2016 - 12:05AM

Big business has had it tough for too long. Just ask them

Ross Gittins
I have disturbing news. The big business people of Australia are feeling quite upset about the recent federal election, or so I am informed by The Australian Financial Review.
Quite frankly – and this is a shocking thing to say – the mood of the campaign was "anti-business". As young people say, big business was disrespected. 
Those rotters in the Labor Party were shameless in their behaviour, seeking to win votes by portraying their Liberal opponents as apologists for big business.
Why did the Libs have cutting the rate of company tax as pretty much the only item in their plan for Jobs and Growth? Purely, so the voters were asked to believe, to please the Libs' cronies at "the big end of town".
-----
COMMENT
  • August 17 2016 - 12:05AM

Big business has had it tough for too long. Just ask them

Ross Gittins
I have disturbing news. The big business people of Australia are feeling quite upset about the recent federal election, or so I am informed by The Australian Financial Review.
Quite frankly – and this is a shocking thing to say – the mood of the campaign was "anti-business". As young people say, big business was disrespected. 
Those rotters in the Labor Party were shameless in their behaviour, seeking to win votes by portraying their Liberal opponents as apologists for big business.
Why did the Libs have cutting the rate of company tax as pretty much the only item in their plan for Jobs and Growth? Purely, so the voters were asked to believe, to please the Libs' cronies at "the big end of town".
-----
  • August 17 2016 - 11:45PM

Let's say no to Western Australia, the prodigal state

Peter Martin
prod·i·gal (prŏd′ĭ-gəl)
adj. Rashly or wastefully extravagant: a prodigal nephew who squandered his inheritance.
Western Australia wants the rest of us to bail it out.
Without warning, the GST lifeline it needs to fund its operations has collapsed, or so it says.
Our Treasurer, Scott Morrison, seems to believe it. Here is he on Monday telling radio host Ray Hadley no one saw it coming: "The simple point that the Prime Minister is making is this, no one envisaged that the current way things are done would lead to a situation where Western Australia would just get 30 per cent of the GST that their people paid."
-----

Bill Shorten kills hope of deal on $6bn budget savings

  • The Australian
  • 12:00AM August 18, 2016

David Crowe

Bill Shorten is holding out against $6 billion in budget cuts he “banked” in Labor’s election platform only weeks ago, shattering talk of a consensus on fiscal repair as he blasts Malcolm Turnbull for trying to legislate the savings.
Labor prepared the ground to reject or amend the most controversial measures, including cuts to renewable energy funding and welfare programs, despite renewe­d calls for both major ­parties to find common ground to fix the nation’s $37bn deficit.
Scott Morrison accused the Opposition Leader of “budget sabotage” by questioning the plan for an omnibus bill to legislate government savings that were made clear during the election campaign and adopted in Labor’s alternative budget.
-----

Morrison says AAA rating needs budget cuts

August 17, 201610:47am
Australian Associated Press
The federal government has used the decision of a second ratings agency to confirm Australia's triple-A ratings to increase pressure on Labor to pass its budget savings.
Treasurer Scott Morrison noted the Moody's decision on Wednesday cited risks to its fiscal consolidation plans, which are aimed at saving $6.5 billion.
"Support in the parliament to implement the Turnbull government's economic plan for jobs and growth, to avoid higher debt and reduce the deficit is necessary to support maintaining our triple-A rating," he said.
-----

Leadership or crisis the only answers to public sector jobs surge

  • The Australian
  • 12:00AM August 20, 2016

Judith Sloan

Once upon a time, retail was the biggest employment sector in Australia. For some time, health and social assistance have provided the most number of jobs and have experienced extremely rapid growth for more than a decade.
While not all jobs in health and social assistance are in the public sector, many private sector jobs in those sectors are also dependent on taxpayer funding — think Medicare and the National Disability Insurance Scheme.
We also know that federal government spending has gone from 23.1 per cent of GDP in 2007-08 to an estimated 25.8 per cent in 2016-17. Annual federal spending is fast approaching half a trillion dollars.
-----

Health Budget Issues.

  • August 17 2016 - 3:08PM

Stop 'fiddling around' with Medicare: AMA president Michael Gannon

The new head of the Australian Medical Association has warned conservative politicians that altering Medicare will come at a political cost.
Stephanie Peatling
The new head of the Australian Medical Association has warned conservative politicians to stop "fiddling around" with Medicare, saying it is a "totem" for voters who do not want it changed.
Dr Michael Gannon told the National Press Club in Canberra that Labor's so-called Mediscare campaign in the federal election campaign was successful because there was a "very strong undercurrent of fear and uncertainty" among voters as a result of the Coalition's 2014 budget.
"The Coalition government went to the election oblivious to, or unprepared for, the community's concerns about health services," Dr Gannon said on Wednesday.
"Right or wrong, co-payments became code for attacks on poor and disadvantaged people in the community. They were seen as attacks on sick people. They were seen as attacks on working families with young kids. In short, the co-payment strategy was a political disaster."
-----
  • August 18 2016 - 12:00AM

Delivering better health is about more than healthcare

·         Lesley Russell
Last month it was announced that the 2016 Boyer lecture series would be delivered by Sir Michael Marmot, a leading researcher on health inequality. He will explore how health is not simply a matter of genetics and access to healthcare but is intrinsically linked to economic and social factors. This lecture series comes at a time of growing recognition of the increasing inequalities in income and wealth and the subsequent impacts on health.
The social determinants of health include the obvious physical things such as clean water and air, healthy workplaces, adequate housing, transportation services and safe communities. Education and employment provide income and make housing, food and healthcare affordable. Equally important are less tangible factors such as social support networks, culture and beliefs, stress and exposure to violence, discrimination and racism.
The strong associations between these factors and health outcomes mean that providing for the health and wellbeing of the population requires more than hospitals, doctors and prescription pads and tackling the wicked issues such as obesity, ageing, mental health reforms and Closing the Gap on Indigenous disadvantage requires government involvement beyond the Department of Health. There can be no question that government involvement is essential for two reasons: many of the determining factors for health lie beyond the ability of individuals and communities to influence and population health contributes to national productivity and prosperity.
-----

AMA’s Gannon urges Turnbull to lift Medicare rebate freeze

  • The Australian
  • 12:00AM August 18, 2016

Sean Parnell

Australian Medical Association president Michael Gannon has called on Malcolm Turnbull and Health Minister Sussan Ley to “stare down” their cabinet colleagues and restore funding to the sector.
While acknowledging the underlying budgetary pressures, Dr Gannon yesterday said there was no health spending crisis and the recent federal election demonstrated that consumers valued any investment in public healthcare.
“In close consultation with the medical profession, the government can make wise and sustainable investments in health,” Dr Gannon told the National Press Club in Canberra.
“This will create tension within the government. But the Prime Minister and the Health Minister must stare down Treasury and Fin­ance to maintain health as a priority issue — and a political survival issue — for the Coalition.”
-----

MBS review 'will hit independent GPs hardest'

18 August 2016
SMALL medical centres and independent GPs are at greatest risk from the federal government's MBS review, Primary Health Care chief Peter Gregg says.
He says said the ongoing review, which kicked off last year, is hurting practitioners and that proposed changes will hit independent GPs the hardest.
"If the MBS review continues that is squeezing healthcare practitioners ... it's squeezing us. Now, we have the added advantage of scale and efficiency which helps us absorb some of that - smaller practices do not," Mr Gregg said on Wednesday as his business posted a 41.3% drop in full-year profit to $74.9 million.
-----

Health Insurance Issues.

Health fund profits up while their members lose out – time for change

Health fund members are paying ever higher premiums but getting back less in benefits while fund profits have ballooned, according to the latest official figures.
Health fund profits have jumped by a lucrative 8.9 per cent yet the latest statistics show that members are on average getting less back from each dollar in premiums they pay.
While premium revenues rose by 6.4 per cent in the year to June, the payouts members got back in benefits rose by just 5.3 per cent, according to figures released by the Australian Prudential Regulation Authority.
“These results underline the need for a searching review of the state of health insurance,” the CEO of the Consumers Health Forum, Leanne Wells said. 
-----
  • August 18 2016 - 5:46PM

Private health funds enjoy big profits but give less to members, APRA data shows

Esther Han
Private health fund members paid a record $22 billion in premiums in the past financial year, but received less back on each dollar, latest industry figures show.
New data released by the Australian Prudential Regulation Authority shows private health funds managed to boost premium revenues by 6.4 per cent and profit before tax by 8.9 per cent in the year to June.
But payouts to their members rose by just 5.3 per cent.
The industry says returning a profit – or a surplus in the case of not-for-profits – is a positive sign that the business is being "run responsibly and not bad for consumers".
-----

Exposing private hospitals’ surgery cost gap

  • The Australian
  • 2:28PM August 18, 2016

Sarah-Jane Tasker

The difference in the cost of a hip replacement between private hospitals can be as high as $43,000, a new report reveals.
Meanwhile a knee replacement can cost over $16,000 more at one private hospital than at another.
The stark difference in costs is revealed in a surgical variance report on orthopedic producers, released by Medibank and the Royal Australasian College of Surgeons.
It says that from a sample of 299 surgeons who performed at least five hip replacements, the average cost ranged between $18,309 and $61,699, with a median of $26,661.
-----

Doctors’ financial interests under scrutiny

  • The Australian
  • 12:00AM August 19, 2016

Sean Parnell

Australia’s second-largest health insurer has questioned whether doctors with financial interests in technology and facilities have a conflict of interest they should be forced to declare to their patients.
In a submission to the Prod­uctivity Commission, Bupa has repeated its previous call for ­reforms to the prostheses list, ­expected to be taken up by the Turnbull government.
But Bupa has also asked the commission to review commercial arrangements in private health and whether doctors should be required to provide ­patients with details of any financial interests they hold in medical facilities or equipment.
Bupa health insurance managing director Dwayne Crombie has previously questioned the use of robotic equipment for prostate cancer surgery, with data showing more than a quarter of the ­operations funded by Bupa left patients with out-of-pocket costs of between $5001 and $10,000.
-----

Medibank annual net profit surges 46pc

  • The Australian
  • 8:29AM August 19, 2016

Elizabeth Redman

Private health insurer Medibank has reported a jump in profit after increasing its premiums and reducing cover, following a controversial set of negotiations with hospitals as it transitions to life as a public company.
Net profit attributable to shareholders surged 46.4 per cent to $417.6 million in the year to June 30, compared to $285.3m in the prior year.
The insurer (MPL) said premium revenue lifted 4 per cent in the year, after the federal government approved average premium rate rises of 6.59 per cent from April 2015 and 5.64 per cent from April 2016.
-----
  • Updated Aug 17 2016 at 7:40 PM

Health funds put profits before patients: AMA's Gannon

Australian Medical Association president Michael Gannon wants the federal government and regulators to check private health insurers' increasingly aggressive behaviour that he says puts profits above patients.
With Medibank Private releasing its annual results on Friday and Sonic Healthcare and Primary Health Care reporting yearly profits on Wednesday, political attention is turning to whether taxpayers are getting value-for-money from the government incentives paid to the private health industry.
Mr Gannon said although Australia's health funding was in need of genuine reform, taxpayer incentives to private pathology providers still delivered "bang for your buck".
-----  

Pharmacy Issues.

  • August 19 2016

HIV prevention drug Truvada won't be subsidised in Australia

Rania Spooner
An expensive breakthrough drug that prevents people from getting HIV won't be funded by taxpayers in Australia this year, the nation's drug funding panel has ruled.
Truvada, a once-daily pill shown to be highly effective at preventing HIV in people at risk of getting the virus, costs about $1200 a month to buy in Australia. It can also be bought on the internet and imported into Australia for less than $100.
HIV advocates and groups say the drug is so popular among men having sex with men that it has the potential to halve the number of HIV transmissions in Australia within a year if it was made more affordable.
The antiretroviral drug, which is being used as a strategy known as "pre-exposure prophylaxis (PrEP)", was approved for use in Australia in May.
-----

Superannuation Issues.

Libs press Morrison to double super contributions cap to $1m

  • The Australian
  • 12:00AM August 20, 2016

David Crowe

Glenda Korporaal

Scott Morrison has hit another barrier in his bid to legislate a $6 billion tax hike on superannuation, as Liberal MPs insist on bigger changes to the divisive budget measure before they sign off on the plan when parliament ­resumes within weeks.
Liberals MPs told The Weekend Australian their constituents wanted greater concessions than the Treasurer’s mooted proposal to lift the $500,000 lifetime cap on post-tax super contributions to $750,000 in order to soften the impact on workers and retirees.
With more talks scheduled for the week ahead, Mr Morrison is being asked to lift the cap to $1 million in the hope of ending the ­dissent over the policy, so it can be fast-tracked through the Coalition partyroom and put into force.
-----
I look forward to comments on all this!
-----
David.

So Much For Trust In Shared Health Information Systems To Deliver Benefits And To Be Error Free For The Patient Or Carer!

This amazing yarn appeared a little while ago.

Computer system glitch puts thousands of NT patients at risk

  • The Australian

Amos Aikman

Thousands of Northern Territory patients have been put at risk by a major failure of a crucial computer system that transmits information between hospitals and remote clinics.
The NT Department of Health has established a crisis management team to urgently investigate the glitch, believed to have prevented as many as 5400 referrals and other pieces of information concerning about 2400 patients from reaching their intended destinations.
The problem was discovered by accident last Friday, but may have gone unnoticed for as long as 18 months from 2014 till May this year, when sources said it had been fixed “by accident”.
The failure to transmit patient information only came to light when a clinician rang up to see why his patient’s records had not gone through. The problem is understood to have affected clinics Territory wide, including prisons and some alcohol rehabilitation centres.
The Australian has been told most of the 2400 patients affected are unlikely to have suffered serious health consequences because their ailments were minor or their information was transmitted separately via other means.
However, when reached by phone in Melbourne this morning, Department of Health CEO Len Notaras was not able to rule out that patients had been harmed.
…..
Sources said the department had uncovered at least two cases in which cancer patients may have suffered serious consequences from having their treatment delayed, but that has not been confirmed.
The Australian understands one patient is being contacted after it emerged he had left hospital with a broken jaw before the results of his X-rays had been properly considered.
Part of the fix is understood to involve re-entering the missing records from oldest to most recent.
Once that has been done, remote clinic staff will be asked to sit down with patients 2400 individually and explain the situation and ensure their records do not contain errors.

More here:
I love the planned solution – but I am not sure the order of remediation is the right one!


This is really an interesting story and shows the risks of not having a specific provider recording information for a patient and then the same provider using that information - rather than pretending  information sourced from unknown others can be trusted to be true - or even to be there!

The healthcare provider has a strong interest in the accuracy and completeness of their records for their patients. The further you move from that situation the higher the potential risk of inaccuracy and incompleteness.
David.

We Need To Retain Some Healthy Scepticism As More Clinical Apps Come To A Phone Near You!

This appeared last week.
  • August 19 2016 - 1:08PM

Doctors warn over diagnosis apps amid Ada launch

Julia Medew

It is marketed as being "smarter than human doctors" and the "world's most accurate health diagnosis service".
It is a medical app on your smartphone that invites you to put in a list of symptoms to find the most likely explanation. According to the company that created Ada, the app includes 10,000 symptoms and diseases and was developed by 100 doctors, making it more knowledgeable than any human brain.  
But for all its promises, leading Australian GPs are urging consumers to be wary of it and other apps that make similar claims. Both the Australian Medical Association and Royal Australian College of GPs said they were concerned about the accuracy of the Ada system, and its potential to either falsely reassure people about their health or alarm them unnecessarily.
Despite a booming market for health apps, including ones that aim to diagnose, research suggests they may not be as reliable as they appear.  
Nathan Pinskier, chairman of the College of GPs' e-health and technology committee, said while many doctors were starting to use apps to support their clinical decision making and were directing patients towards some for their own health needs, research on such apps showed they were not always accurate and could be dangerous.
"There's still a lot of work to be done in this space," the GP said. "It's fair to say that clinicians can't remember everything and you do need access to support tools. The question is, how standardised are those support tools and if you enter the same information into different products will you end up with similar outcomes and guidance? The evidence says no at the moment."
Last year, three studies published in BMC Medicine found that health apps designed to help people calculate insulin dosages, educate them about asthma and perform other important functions were methodologically weak. The researchers also found that many apps lacked reliable privacy and security settings, with one sharing personally identifying data about users that should have been kept anonymous.
President of the College of GPs Frank Jones said that while he did not mind people Googling their symptoms before seeing a GP, he was concerned about the accuracy of an app that suggested it could diagnose people. He said users risked misinterpreting their symptoms without a physical examination while using the app. 
More here:
 I have nothing to add other than to point out that the routine criteria that are used to assess value and effectiveness need to be applied to these various app innovations. Only if we do that will we be clear as to what works and what does not!
David.

Wednesday, August 24, 2016

The Government Clearly Wants To Use Your Health Data For Things They Have Not Told You About. Who Benefits?

Spotted this the other day showing the sort of events now being run around the country:

My Health Record Secondary Use - Workshop 10 - Perth WA

Event Details

In June 2016 HealthConsult was engaged to assist the Australian Government in developing a framework for the secondary use of data in the My Health Record system for research, policy, system use, quality improvement, and evaluation activities.
Under the My Health Records Act 2012, health information in My Health Record may be collected, used and disclosed “for any purpose” with the consent of the healthcare recipient.  In addition, one of the functions of the System Operator (the Australian Digital Health Agency) is “to prepare and provide de-identified data for research and public health purposes.”  Before these provisions of the Act will be implemented, a framework for secondary use of My Health Record system data must be established.  
HealthConsult’s role is to develop a draft Framework and associated draft Implementation Plan that will facilitate the secondary uses of My Health Record system data.  HealthConsult is committed to working with stakeholders including the broader community to shape the development of the Framework.
There are 14 workshops scheduled across the country, of which this is one.  At each workshop, there will be a short presentation of the Public Consultation Paper, followed by a question and answer session, through which stakeholders can provide input. 
Here is the link:
There are a range of issues I see that need to be resolved here:
First, given the myHR is presently a large pile of documents (many .pdfs) just how is the data to be extracted and made useable? (an example I know of is that many of the PBS records use trade names rather than standardised names for comparability)
Second how certain can we be the records will be properly anonymised and not be re-linkable?
Third what will be the involvement of properly constituted ethics committees and data anonymization experts in allowing this data access?
Fourth will citizens be told if their data is being utilised and have the right to see the data before it is used so they can deny access if they are concerned.
Fifth, given NEHTA’s and DoH’s track record of ‘pseudo consultation’ where pretty much all input is just ignored what confidence can we all have what is done will be in accord with sensible requests.
To me the threshold question will be ‘Just who does this access and research ultimately benefit?’ If the answer is the patients or citizens there may be a case for this – otherwise I, for one, will be pretty sceptical!
David.

Tuesday, August 23, 2016

The Press Seems To Be Taking A Rather Negative Tone On The MyHR At Present.

These two quite long articles appeared this week.
First we had:

My Health Record: Medics speak up

By Marie Sansom on August 15, 2016
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.
Lots more here:
Second we had this rather strongly put article:

My Health Record 'dumb and useless': Australian Privacy Foundation

Forget last week's Census debacle. Far more has been spent on an e-health system with little clinical value and fewer than 17 percent of Australians on board.
By Stilgherrian for The Full Tilt | August 19, 2016 -- 04:59 GMT (14:59 AEST) |
"My Health Record (MHR) is not yet a f*** up because hardly anybody's using it, [but] it's a f*** up in terms of how much money the government has spent, and how little they've got for that expenditure," Dr Bernard Robertson-Dunn, who chairs the health committee of the Australian Privacy Foundation (APF), said.
"It's cost AU$2 billion so far, it's costing over AU$400 million every year, but the government has never told us how it has improved health care or reduced health costs. All it is doing is putting patient data at risk."
With the Census, the Australian Bureau of Statistics (ABS) was trying to do the right thing, but got it "somewhat wrong", Robertson-Dunn told ZDNet earlier this week. However, the Australian Digital Health Agency (ADHA) is trying to make access to MHR easier, the data is far more intrusive, and it's continually collecting data, as opposed to the Census' five-year cycle.
Established in 2012 as the "personally controlled e-health record system" (PCEHR), MHR is billed as a "secure online summary of your health information". Its 2015-16 Budget allocation alone was AU$485 million.
But as of August 7, 2016, only 4,029,386 individuals have accounts. That is to say, fewer than 17 percent of Australians have registered.
Apart from 332 million Medicare documents and 4.5 million pharmaceuticals documents, which would have been created automatically, the system contains fewer than 1 million clinical or user-generated documents.
That's a mere 0.25 documents per registered user.
After four years of operation, the vast majority of Australians haven't registered for My Health Record, and the vast majority of registered users aren't using it.
And as Robertson-Dunn said, MHR isn't useful anyway.
"They've built a glorified document management system. It's not really a health records system ... The data is contained mostly in PDFs, which are documents. It's difficult to search them."
If a health record system is to be useful in clinical care, it needs to be complete. That means the notes and data from every visit to a doctor, the results of every diagnostic test, and much more. Outdated information needs to be deleted, and medical data can go stale within hours.
MHR has none of these features. Indeed, MHR's own website warns medical practitioners that they can't rely on its data.
"Clinical information you find within your patient's My Health Record should be interpreted in much the same way as other sources of health information. It is safest to assume the information in a patient's My Health Record is not a complete record of a patient's clinical history, so information should be verified from other sources and ideally, with the patient," says the site's FAQ.
As the APF background paper put it, "[My Health Record] is a dumb and useless repository of badly managed documents with no clinical value."
Useless now, MHR is unlikely to get better.
"The sort of stuff that does go into health records, I believe, is going to change in the future, and that pure document management systems like [MHR] is just totally useless, from any perspective," Robertson-Dunn said.
"You could accuse this government of building this system because they want to literally gather data on people to monitor them."
Lots more here:
There is really little to add to all this – other than to point out that there does seem to be a concern from a number of quarters that the myHR might not be the most useful and worthwhile system ever conceived.
One tiny hope is that once they have settled in, and have got their executive organised, that the ADHA might conduct a strategic review of the system to form a view as to the probability of the myHR ever delivering on expectations and whether there may be alternative approaches that might actually contribute more to the quality and safely of care!
There would be a national sigh of relief if this was done properly and the e-Health ducks in Australia could be better aligned with need and potential benefit.
David.