Tuesday, February 23, 2016

Here Is A Larger Pile Of Spin Than I Have Seen For A Good While! Pretty Sad.

This appeared last week to let know Healthcare providers in the opt-out trial zones just where the mHR was up to.

My Health Record News - a digital bulletin for providers

Issue 1 - February 2016

Welcome

Welcome to the first digital bulletin for My Health Record, bringing you the latest news on the relaunch of My Health Record (originally called the Personally Controlled Electronic Health Record).

What is My Health Record?

My Health Record commenced on 1 July 2012. Like many similar initiatives around the world, it is a secure, online summary of an individual’s health information. It can be viewed by treating healthcare providers, including doctors, nurses and pharmacists across Australia.

My Health Record gives you access to information about a patient’s health which you may not otherwise have been able to see. To access this information you don’t need to copy it into your system or do any extra work. The information you can access through My Health Record is outlined below:
  • Shared Health Summary - A summary, authored by the treating doctor, of an individual’s health status including adverse reactions, medicines, medical history and immunisations
  • Hospital Discharge Summaries - A record of an individual’s hospital stay and any follow up treatment required
  • Diagnostic imaging reports - Such as ultrasounds or x-ray results (Currently Diagnostic Imaging reports are being updated by Northern Territory)
  • Prescriptions and dispense information - Such as dosages and frequency
  • Event Summaries - Clinical summaries of health events entered by the healthcare provider who was involved in the patient’s care to inform other treating healthcare providers
  • Specialist letters - Referral letters and reports from one treating healthcare provider to another

Through their clinical information systems, GPs can:

  • View hospital discharge summaries
  • View specialist letters
  • View and add medications
  • View an Event Summary contributed by another GP
  • Add a Shared Health Summary
  • Add an Event Summary

My Health Record:

  • The new name of the national digital health record system

Through their patient administration systems, hospitals can:

  • View medications
  • View Shared Health Summaries
  • View and create specialist letters
  • View Event Summaries
  • Add hospital discharge summaries

Individuals can:

  • View their Shared Health Summary and other health documents in their record
  • View Medicare or PBS claims
  • Add important information on allergies
  • Add emergency contact details
  • Add other medication they are taking
  • Add an Advance Care plan
  • Set access controls

My Health Record is growing!

  • Over 2.5 Million people have a record
  • 1 New record created every minute (on average 2015)
  • An extra 1 Million to get a My Health Record during participation trials
  • Over 2.9 Million Prescription and Dispense records
  • 8,010 Healthcare providers registered to use the system
  • Over 337,000 Clinical Document Uploads
  • Including 260,000 hospital discharge summaries

Why My Health Record is important.

Patient care

  • My Health Record facilitates the sharing of clinical and treatment information between healthcare providers as well as with individuals
  • It is ethical practice to ensure that the information you create about your patients is available and accessible by other healthcare providers involved in their care
  • As more information is contributed by different healthcare providers and as more patients sign up for a My Health Record, we will reach a tipping point where Australia’s health system becomes better connected
  • My Health Record helps deliver healthcare more efficiently and effectively by minimising unnecessary repeat tests, managing medication better and improving ontinuity of care

Access

  • My Health Record allows healthcare providers to access patient information quickly and easily
  • In a medical emergency, hospitals can get access to a patient’s record to provide the best possible care quickly, including information they may not have otherwise had access to

Security

  • The My Health Record system is a secure source of key clinical information

What’s new!

Overview: Improvements based on the review

In December 2013 an independent review of the system, titled ‘Review of the Personally Controlled Electronic Health Record’, was finalised. It found overwhelming support for a national digital health record system and made a number of recommendations to improve uptake and use. The 2015–16 Budget announcement is the Government’s response to the review. It includes:
  • Changing the name from PCEHR to My Health Record
  • Improving the usability of the system and increasing the clinical content in the records
  • Reviewing existing incentives to encourage use of the system by general practitioners
  • Refreshing training materials and training delivery for healthcare providers on how to use the system
  • Trialling new participation arrangements for individuals, including an opt-out system to inform future strategies for bringing forward the benefits of My Health Record nationally (see ‘Another million Australians to have a record!’ to the right)
  • Establishing a new agency (The Australian Digital Health Agency) as the single accountable organisation for digital health in Australia. This Agency is planned to be operational from 1 July 2016. Governance arrangements will reflect the key stakeholders and beneficiaries of the system

System: Making My Health Record easier to use

The My Health Record system is continuously improving to include more information and become easier to use.

Today’s My Health Record system includes:
  • Prescription and dispense documents
  • Consumer and Provider portal and system improvements
  • Specialist letters
  • Inclusion of Medicare data (MBS, PBS, RPBS, AODR)
  • Hospital Discharge Summary capability
  • Assisted registration for individuals
  • Healthcare provider access in an emergency situation
  • Pathology report capability
  • Diagnostic Imaging report capability
  • Security Improvements

The General Practice contribution

More patients will be able to share their health information through the My Health Record system in coming months, as general practices prepare to meet new ePIP eligibility requirements.

From May this year general practices will need to contribute about five Shared Health Summaries per GP per quarter, to maintain eligibility for the incentive payment.

The key contribution required from general practices is the shared health summary information for their patients. This will provide valuable clinical information for individuals and other healthcare providers involved in treating them.

New online and face-to-face training will help general practices and GPs become familiar with and confident to use today’s My Health Record system.

Formal, written notification to general practices of the new requirements will occur in March.

Trials: Another million Australians to have a record!

In mid 2016, around one million people living in North Queensland and the Nepean Blue Mountains of New South Wales region will have a My Health Record created (unless they choose not to).

Residents of these locations will be informed by letter that a My Health Record will be created for them, and that they have to notify the System Operator by 27th May 2016 if they don’t want one.

By creating digital health records for an entire geographical area, the trials will be an opportunity to understand the benefits and key considerations associated with a system of connected healthcare.

Training: How do I learn more?

New training will be available on the website from February 2016 for clinical and nonclinical staff including general practices, community pharmacies, residential aged care facilities, medical specialists, allied health, and hospitals.

Face-to-face training will be available in trial areas for General Practice, Pharmacies and Hospitals. It will also be available on demand for general practices outside trial areas.

Legislative changes: What they mean for you

Changes to the My Health Record legislative framework were made in November 2015 through the Health Legislation Amendment (eHealth) Act 2015.

These changes are designed to make it easier for you to connect to and use the system.
They are also there to protect individuals against misuse of their information.
What you need to know:
  1. Participation agreements for My Health Record will be abolished – these are the contracts you enter into with the System Operator when you register to use the system. From 1 March 2016 you will no longer need to complete these because they will be included in the My Health Record legislation. This will make the connection process quicker and easier.
  2. Penalties are changing – to protect the interests of individuals, there will be stronger sanctions against misuse of the system. These penalties won’t apply to you if you accidentally or inadvertently access an individual’s My Health Record. These won’t affect you if you are practicing in good faith.
  3. You won’t be required to store assisted registration application forms from early 2016 – you no longer need to store signed application forms or submit them to the System Operator. It is up to you to decide how to capture consent going forward.
We are currently creating materials that explain these changes in more detail and provide guidance on what they mean for the way you use the My Health Record system.

Suggestions please!

We want to know what you’d like to hear about in future editions of this digital bulletin.

To provide suggestions for topics or feedback, email the MyHealthRecord inbox.

For more information and assistance on My Health Record

Healthcare providers
Call 1800 723 471 (select option 2)

Individuals (healthcare recipients)
Call 1800 723 471 (select option 1)
Here is the link:
This is the contents of the brochure designed to encourage providers to adopt the mHR and what a joy it is.
We are told that the mHR has been improved to make it better and easier to use. That must still be in the works as when I logged in today it was just as empty and user-hostile as usual with no results and prescription information.
Really it still remains just a collection of departmental documents all piled up with no obvious searching or document selection capability other that just slug on through opening each tab to see what is hidden under it!
What a joke - I hope those lucky people who are being signed up - many I am sure will not be aware it has happened - find some more value that I can.
The money still seems to be being wasted with all this as far as I can tell!
David.

14 comments:

Anonymous said...

'Sad' is the right word. Sad to see people desperate enough for money in declining economy to work on this failed system. What an embarrassment it must be to put this on one's resume!

Anonymous said...

Sociopaths don't get embarrassed. They have no sense of right and wrong, their emotional IQ is almost non existent, they can distinguish between a lie and the truth. So they will be proud of their resume's whatever they claim.

Anonymous said...

correction ...... they cannot distinguish between a lie and the truth

Anonymous said...

I see no evidence that any statement in that text is untrue, I do though agree they have dance around the issues with the build of the system. Is the system is such a state because the developers did not implement the specifications from NEHTA correctly? Did the developers simply ignore the designs and specifications? Or can a system be developed based on NEHTA's specifications as found in the 'for implementers' section of their website?

I doubt the system could be redesigned using the current state, I would guess there is that many hacks in there undoing anything would be catastrophic. Something needs to change and 2-3 years is not long in reality so start planning and designing, not slapping lipstick on top of lipstick.

Anonymous said...

"I see no evidence that any statement in that text is untrue," .... yes, that would seem to be the case it is an exercise in using a lot of words in an attempt to reinforce the misguided perception that something important is happening.

The 6 bullet points listed in - Overview: Improvements based on the review – are pure fairy floss.

NONE of these are FUNCTIONAL SYSTEM IMPROVEMENTS – name change, incentives review, training materials, participating arrangement, a new Agency, The clowns at Luna Park can do better than that. Why am I paying taxes?

Eric Browne said...

"I see no evidence that any statement in that text is untrue,” Well I disagree! The opening sentences are particularly misleading:

"Like many similar initiatives around the world, it is a secure, online summary of an individual’s health information. It can be viewed by treating healthcare providers, including doctors, nurses and pharmacists across Australia.”

The PCEHR is most definitely not an online summary of an individual’s health information. It is an ad hoc collection of summaries, MBS reimbursements, etc. of varying and unknown completeness, quality and usefulness.
Nor would it be regarded as secure by the majority of patients if they knew who potentially could access their record. The default access controls allow almost any healthcare provider (doctor, nurse, pharmacist, allied practioner) to view the patient record of anyone, anywhere, anytime, irrespective of any treating relationship with the patient, unless the patient has taken steps to change the default access. The default access controls are even more open than most public hospital systems. Witness the alleged inappropriate access to one mental health patient in South Australia [http://www.abc.net.au/news/2016-02-23/health-workers-snooping-into-files-of-accused-crows-coach-killer/7194008]. An audit reportedly uncovered 13 hospital staff caught accessing the person’s medical record without due cause.
Unlike the publicised SA hospitals case, unauthorised access to PCEHR patient records by public hospital staff is far less likely to be discovered via an access audit of the PCEHR. My understanding is that the PCEHR logs only the Healthcare Provider Organisation accessing the record. In some states that may well be the entire public health system treated as a single entity. E.g in South Australia an access to my My Health Record from a nurse or doctor in any public hospital would be recorded simply as an access by SA Health(?). In NSW, Healthcare Provider Organisations are based on Local Health Districts. In other states, who knows?
So although most patients' My Health Records can be viewed by "treating healthcare providers across Australia", most can be viewed by any and all healthcare providers, for whatever reason. And in many cases, unwarranted access would go undetected.

Anonymous said...

"The PCEHR is most definitely not an online summary of an individual’s health information. It is an ad hoc collection of summaries, MBS reimbursements, etc. of varying and unknown completeness, quality and usefulness"

Perhaps you should start with your definition of "summary" since that would meet most people's definition of 'summary'.

As for your comments on security - yes, the PCEHR logs the organization accessing the information. After that, it is presumed to be copied onto the local system, and managed by that - as it should be - so it's to there that any requests for access information should go. Which returns you to those same institutions after all. Sounds like the lowest common denominator.

Dr David More MB PhD FACHI said...

"As for your comments on security - yes, the PCEHR logs the organization accessing the information. After that, it is presumed to be copied onto the local system, and managed by that - as it should be - so it's to there that any requests for access information should go. Which returns you to those same institutions after all. Sounds like the lowest common denominator. "

This clearly the response of a well paid Health Department bureaucrat - and is rubbish as most of the access systems lack decent audit trails - think the average GP practice!

The security design is badly flawed!

David.

Anonymous said...

Pity those 500,000 people in the NQPHN and NBMPHN who have been compulsorily opted-in are blissfully unaware of this else they would opt-out in droves. If they did would the government get the message? I doubt it. Unless a really good journalist covers the story they will remain blissfully unaware.

Bernard Robertson-Dunn said...

The government never lets on about what the legislation lets them do, and all they have to do is keep a note of it. They don't have to ask permission or tell anyone.

70 Disclosure for law enforcement purposes, etc.

(1)The System Operator is authorised to use or disclose health information included in a consumer’s PCEHR if the System Operator reasonably believes that the use or disclosure is reasonably necessary for one or more of the following things done by, or on behalf of, an enforcement body:

(a)the prevention, detection, investigation, prosecution or punishment of criminal offences, breaches of a law imposing a penalty or sanction or breaches of a prescribed law;

(b) the enforcement of laws relating to the confiscation of the proceeds of crime;

(c) the protection of the public revenue;

(d) the prevention, detection, investigation or remedying of seriously improper conduct or prescribed conduct;

(e) the preparation for, or conduct of, proceedings before any court or tribunal, or implementation of the orders of a court or tribunal.

(2) So far as subsection (1) relates to paragraph (1)(e), it is subject to section 69.

(3) The System Operator is authorised to use or disclose health information included in a consumer’s PCEHR if the System Operator:

(a) has reason to suspect that unlawful activity that relates to the System Operator’s functions has been, is being or may be engaged in; and

(b) reasonably believes that use or disclosure of the information is necessary for the purposes of an investigation of the matter or in reporting concerns to relevant persons or authorities.

(4) If the System Operator uses or discloses personal information under this section, it must make a written note of the use or disclosure.

(5) This section does not authorise the System Operator to use or disclose consumer only notes.

Anonymous said...

Your current poll question: Do Politicians And Bureaucracies Understand Just How Hard And Complex Successful Delivery Of E-Health Is? -- with 96% responding NO confirms how right the above respondents are.

Anonymous said...

The overwhelming response to your current poll question is compelling. The corollary is - Why is eHealth in such a mess?

Whilst complex the core of the answer is very simple.

Because the politicians have such a limited understanding they turn to their bureaucrats and ask: What should we do? Based on the bureaucrats’ advice the politicians set policy and strategy and ‘some form’ of illconceived eHealth project then takes on a life of its own.

Because the bureaucrats have such a limited understanding they turn to committees made up of senior execs from peak bodies and agencies who themselves have limited experience and understanding (but huge egos) and together, based on the vested interests they represent and infallible hubris they submit recommendations to the bureaucracy and their politician masters and these illconceived eHealth projects, of enormous significance to the nation, are driven by a false sense of urgency to deliver results without delay; at which time excessive funding is allocated to secure resources to build the project so that it can proceed at full speed over the cliff.

Knowledgeable, highly skilled industry experts are left out of the equation lest they get in the way of progress. Fundamental engineering principles behind the design of complex systems for complex markets get left out of the equation too, lest the engineering types with their precise enquiring minds ask too many difficult questions. Questions which need to be answered but are not answered because the process of doing so sloooowwwsss down the project. So the questions are avoided, the engineering types are pushed to one side, the experts’ advice is rejected and the bureaucrats and politicians rush full speed ahead.

Anonymous said...

huge egos….I always wondered what the 'e' meant in eHealth.

Anonymous said...

To all these very sharp observations I would add:

1/ Bureaucrats typically have the mistaken view that they 'control' the health system, and that the levers they have to hand actually do something useful. They can't see all the care that is delivered every day unchanged by whatever policy setting they put in place. They note with annoyance when everyone just settles back having discovered the latest workaround to whatever edict they last came up with. It is the same in the jurisdictions, where hospital workers just keep on doing whatever it is they need do to deliver real care to patients, unphased by the hundreds of policy documents they have never read.

2/ Consultation does not mean a share in the shaping of policy, only a process that must be tolerated so that a box can be ticked, and the original policy remains essentially unchanged, except for tweaks to working, or the odd easily qualified subclause.

Is it any surprise the PCEHR/myHealthrecord is ignored? We are simply working around the latest policy nonsense from government, and getting on with the real job at hand. We will do the minimum necessary to comply with whatever we must do to get our PIP payment, but don't imagine it is done in good faith, or will in any way alter our complete disregard for this giant policy bubble. We will (and do) buy and use effective IT to deliver real care, and we use it every moment of every day. In stark contrast to the loveless, ignored, barren wasteland that is the PCEHR.

Oh I forgot and

3/ It has always been thus and always be, with the kind of governance we have. Don't be fooled by the occasional random success when they do the right thing despite themselves.

Bleak? Probably. But please do line up to give me lots of examples where the reverse holds, because I'd be delighted to be prone wrong.