Wednesday, March 23, 2016

The AMA Has Yet Again Come Out To Say It Is Very Unhappy With The mHR. It Seems The DoH is in Denial Of The Scale Of the Issues.

This appeared a few days ago.

Government Ignores Flaws In E-Health Push.

15 Mar 2016


The Federal Government is pushing ahead with mass trials of its My Health Record e-health system despite concerns that fundamental shortcomings are yet to be addressed.
Health Minister Sussan Ley has announced that the personal health information of more than one million people will be automatically uploaded to the internet from July as part of a large-scale test of My Health Record prior to a nationwide roll-out of the scheme.
Under the plan, 700,000 people living in North Queensland Primary Health Network (PHN) and 360,000 covered by the Nepean Blue Mountains PHN in western Sydney, will have until the end of June to opt-out or have a digital health record containing details of their health status, medicines and allergies automatically created and uploaded to the system.
The trial is the latest development in the Government’s overhaul of Labor’s failed Personally Controlled Electronic Health Record (PCEHR) system, which failed to attract much support from health practitioners or patients despite the expenditure of more than $1 billion.
Ms Ley said it was important that patients be able to safely and securely share their medical records with health workers no matter where they were in the country.
“I consider this a landmark turning point in improving our health system and bringing it into the 21st century,” the Health Minister said. “Our new My Health Record means people will not have to remember the names of the medications prescribed, details of diagnosis and treatments, allergies, medical procedures and there will be no need to repeat the same information when they see another doctor or go to hospital.”
The move follows a heavy-handed attempt by the Health Department to boost the adoption of My Health Record by threatening to withdraw incentive payments from practices that fail to upload shared health summaries to the system in May – action condemned by the AMA as grossly premature, particularly given the trial did not start until July.
The AMA warned that the design of the My Health Record system meant it was unlikely to realise the Minister’s vision.
The clinical usefulness of the PCEHR was fatally compromised by the ability of patients to withhold or hide information, and the peak medical body said My Health Record was similarly flawed.
Patients can set controls on who has access to information in their My Health Record, and the AMA said that, whether or not such controls were used, doctors and other health providers had to be mindful of the possibility that the information that could view was incomplete.
“Unfortunately, My Health Record cannot be relied on as a trusted source of comprehensive information,” the AMA said. “This means that My Health Record can be a potentially useful additional source of clinical information, but it is not a replacement for existing clinical records maintained by doctors.”
The system incorporates a “break-glass option” to allow access to vital information in case of a medical emergency, but the AMA said there were many situations short of such a crisis where access to core clinical information would be valuable.
Other aspects of the system highlighted by the Minister are also likely to discourage the use of My Health Records by doctors.
Ms Ley emphasised that in designing the system the Government had paid particular attention to protecting sensitive medical information, and deliberate breaches of privacy could incur fines of up to $500,000 or even jail terms.
But the AMA said such heavy penalties were unjustified and were likely to prove counter-productive.
It said medical practitioners and practice staff already dealt with confidential information on a daily basis, and there was “nothing inherently different or unique” about the data contained in My Health Records.
Instead, it warned the complexity of the compliance rules for using My Health Records and the scale of the penalties for breaches would likely deter many practitioners from adopting them.
“While extreme penalties may appeal to those with very strong sensitivities and concerns on information access, they are counterproductive for encouraging participation by health care providers,” the AMA said. “They will be a very strong deterrent to participating in the My Health Record.”
The adoption of My Health Records is also being hampered by a failure to engage with specialists.
The AMA said medical specialists were a key group for creating and using information in electronic health records, but the Government was yet to consult with them.
AMA President Professor Brian Owler said this neglect was compounded by the fact most medical practice software was designed for GPs, not specialists.
“Until we engage with people as to how it might work, and the software vendors are on board, it’s never going to work,” Professor Owler told The Australian Financial Review.
Currently, around 2.6 million people have a digital health record, and about 8000 health providers are registered to use the system.
Adrian Rollins
Here is the link:
It really is hard to know just why the DoH is not working closely with the AMA and the College to come up with an agreed national approach to all this.
One can only hope the planned new Digital Health Agency will do what DoH has not done and found a way to proceed with e-Health that can gain public and clinical support.
Over to you guys and gals!
David.

15 comments:

Anonymous said...

Over to you guys and gals! has a cowboy flavour to it. Mmmmmm.

Anonymous said...

The AMA said medical specialists were a key group for creating and using information in electronic health records, but the Government was yet to consult with them.

Be that as it may ... there is not much point in consulting with specialists until the Government can at the very least get is act together on the most basic of levels with GP's and that is a very long way off the way they are approaching the entire project.

At the Department level nothing will change because they have repeatedly demonstrated they do not know how to change - in their words "we have always done it that way" ... and they always will. They don't know how to analyze the problem because they can't see the problem.

Bernard Robertson-Dunn said...

re: "The AMA said medical specialists were a key group for creating and using information in electronic health records, ..."

That seems a reasonable claim, in that medical specialists are the ones who need health data the most.

The government could start off (a bit late, I know) by talking to at least some of those medical specialists about the health record systems they already use.

The government might then learn what works best, including that a useless national dump of un-managed data that was a risk to privacy was a waste of time.

Anonymous said...

My Health Record system says - NO INFORMATION AVAILABLE - when I look at Prescription and Dispense Records.

Why is this so?

Anonymous said...

David,
You are absolutely right, unless government rolls its sleeves up and collaborates with the people that need to make it work, this will continue to be a waste of money and to suck all of the oxygen out of the eHealth environment, preventing real innovation and real value being created.

The thing is too big, poorly thought through and everyone is sick to death of it.

I would have thought that the current fiscal pressures might have helped the local luminaries to think more clearly. I think we could take note of Kiwi inventor Ernest Rutherford (splitter of the atom) who once said "We didn't have the money so we had to think"

The Aussie version however seems to be "The Taxpayer will pick up the tab, lets have another big lunch"

It just goes on and on.

Voldemort

Anonymous said...

“My Health Record system says - NO INFORMATION AVAILABLE - when I look at Prescription and Dispense Records.

Why is this so?”

This could be so because:
• your doctor’s prescribing system isn’t connected to the electronic prescriptions and dispense system (which in turn feeds your My Health Record), AND/OR
• your dispensing pharmacy’s system is not connected to the electronic prescriptions and dispense system, AND/OR
• you have decided to remove/hide this information in your record (did you forget you did this?) AND/OR
• you have not been prescribed any medicines, AND/OR
• You have recently created your record, and your retrospective information will not be loaded into your record – i.e. it will only be from this point onwards. Check your record again after you have your next prescription to be dispensed.

Suggestion: For my elderly mum, I use my phone to photograph her scripts and/or the labels on her medications. Very useful and accessible, and easy to share with other family members if needed.

Anonymous said...

“My Health Record system says - NO INFORMATION AVAILABLE - when I look at Prescription and Dispense Records.

Why is this so?”

If you look under Medicare Records (instead of Medicine Records) and then Medicare Overview you will find a list of all your Prescription Information which also tells you on what date they were prescribed and what date they were dispensed.

I have no idea why it is shown here instead of under Medicines Record section.

This makes me wonder why do we have the eRx and MediSecure Exchanges?
What purpose do they have?
Surely My Health Record has now made them superfluous to requirements?
Is the government playing catch up?
Has it taken over the medicines record space?
Has it undermined, even destroyed, eRx and MediSecure's business models?

Anonymous said...

Re 4:03 PM "Has it taken over the medicines record space?"

It certainly looks that way. If the National Prescriptions Dispense Repository provides a list of all medicines prescribed and dispensed and is updated by the medical and pharmacy software systems it makes one ask what contribution do eRx and MediSecure make in the overall scheme of things?

Bernard Robertson-Dunn said...

"...you will find a list of all your Prescription Information which also tells you on what date they were prescribed and what date they were dispensed."

Does it tell you what you took, how much you took and when?

Does it also tell you what other medication you have taken as well? Vitamins, NSAIDs, over the counter pain killers, St John's Wort (which can change the uptake of other drugs), etc?

You and health care professionals can't rely on what's in the My Health Record. At least, that's what the government says if you read their website:

"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.”

https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/healthcare-providers-faqs#ia9

So, health carers will have to:
a) validate what's in the My Health Record
b) ask what's not in the My Health Record
c) correlate what's in the rest of the My Health Record to find out why the patient is taking whatever it is they are taking.

I'm not a health carer, but I wonder if all this helps to make health care more effective and more efficient.

Anonymous said...

10:42 PM asked - Does it tell you what you took, how much you took and when?

1. Are there any systems which tell you what you took and when?

2. Are there any systems which tell you what other medication you have taken as well? Vitamins, NSAIDs, over the counter pain killers, St John's Wort?

3. One has to start somewhere and the Gov't has started with PBS medicines. I don't know whether Private scripts are included. Perhaps you are wanting to see a perfect all encompassing system at the outset. Surely you're dreaming!

4. If the gov't says "You and health care professionals can't rely on what's in the My Health Record.". Then it follows quite logically that neither can anyone else rely on what's in it - therefore it's useless. So why is the gov't persisting with it?

Anonymous said...

“This means that My Health Record can be a potentially useful additional source of
clinical information, but it is not a replacement for existing clinical records maintained by doctors.”

Is this not the mission of the My Health Record, to be a supplementary source of key information when it would otherwise be unavailable?

On the point of patients ability to hide information, how is that not the case now? I can walk into a GP's office and simply not mention any medications, diagnoses, procedures or immunisations from my past history. If that GP is my regular GP the information would exist in their EMR (As it does now irrespective of my MHR). The control mechanisms have been put in place to maintain the status quo for patients, not to take control away from clinicians.

Bernard Robertson-Dunn said...

Re: "Is this not the mission of the My Health Record, to be a supplementary source of key information when it would otherwise be unavailable?"

Yes. But does the (IMHO, minimal) benefit justify the risk to privacy and security?

IMHO, the only sort of national system that makes any sense is one that stores

1) a health summary document created and managed by a health professional (GP), if they think it is necessary and if it could be useful.

2) an end of life document - such as Coordinate My Care

and is not accessible from the internet and is optional.

Re: "On the point of patients ability to hide information, how is that not the case now?"

It is the case now, but does My Health Record help to address this issue?
A lot of money spent on not solving a well known problem.

Bernard Robertson-Dunn said...

As it happens, here's a report in today's FierceHealthIT email round-up

EHR 'gaps' hinder patient medication adherence
Thursday, March 24, 2016
Marla Durben Hirsch

Electronic health records and health IT are falling short when it comes to improving patient medication adherence, according to a new paper in JMIR Medical Informatics.

The paper is available here:
http://medinform.jmir.org/2016/1/e9/

Quote:
Results: The four persistent HIT barriers to medication adherence include

(1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care;

(2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research;

(3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and

(4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed.

Conclusion: To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

Dr Ian Colclough said...

As Bernard says “IMHO, the only sort of national system that makes any sense is one that stores a health summary document created and managed by a health professional (GP), if they think it is necessary and if it could be useful.”

Here his key words are: managed by a health professional.

The Gov’t however is trying to be all encompassing, all things to all people. It wants the Health Record to be ubiquitous and capable of receiving information from many sources and many providers. One day, sometime in the future, that may be possible.

For that to happen the first thing that needs to be accomplished is to deploy, test and prove the core functionality by focussing on one application function which is relevant, manageable and useful to all authorised users who need to have access; including the patient.

The bureaucrats have made the problem far more complex than it ever need be. The Department has not asked the hard questions, probably because they don’t know what questions to ask. In the process they continue to lose their way.

It shouldn’t be that hard. But until the Department is prepared to consider and comprehend alternative approaches it will so remain.

Bernard Robertson-Dunn said...

Ian said:

"(the gov't) wants the Health Record to be ubiquitous and capable of receiving information from many sources and many providers"

That will be its death - information overload coupled with poor data quality.