Tuesday, November 29, 2016

Do You Reckon This Success In New Zealand Might Just Help Reshape Our Digital Health Strategy? A Critical Post I Believe!


This appeared a few days ago:

Online health portals prove popular in New Zealand

November 21, 2016 2PM Shannon Williams
Nearly a quarter of a million New Zealanders are now using a patient portal to access their health information, the Government has revealed.
In 2015, a $3 million funding boost gave more New Zealanders access to patient portals, included $500,000 for an awareness campaign.
Health Minister Jonathan Coleman says it great to see a significant increase in portal users.
“Patient portals enable patients to manage aspects of their own healthcare such as booking appointments, requesting repeat prescriptions and messaging clinical staff directly,” says Coleman.
“It’s great to see the number of patient portal users significantly increase from around 175,000 in June 2016 to over 241,300 in September 2016 – a 38% increase in just over three months,” he says.
Coleman says the number of practices offering a portal service has also increased over this period, from 335 to 423 - a rise of 27%.
Compared with September 2015, the number of portal users increased by around 160%, and practices offering portals increased by 56%.
“Patients can now access their personal health information whenever they need it,” says Coleman.
More here:
Well what a surprise!
Provide patients will a portal that is useful to get repeats, make appointments, check results and communicate with clinicians and they use it. Who would have guessed. Provide a myHR with none of this after 5 years of development and it gets ignored – amazing….
Maybe the myHR system should be re-designed to deliver what patients want. Is this not what the consultation should be showing?
If these points are not addressed it will be clear to all we are having a Clayton’s consultation process!
David.

17 comments:

Bernard Robertson-Dunn said...

The My health Record doesn't match “Patient portals enable patients to manage aspects of their own healthcare such as booking appointments, requesting repeat prescriptions and messaging clinical staff directly” or “Patients can now access their personal health information whenever they need it” and I doubt that it could ever match direct access to GP/practice data. And I bet it didn't cost over $1billion

eHealth is more than just Health Records. ADHA would do well to look to the future, not try and resurrect a relic of the past.

Anonymous said...

If the focus is to be on patient portals it might be better if they thought about rebranding My Health Record to something a little more personal.

Particularly so if the patient can access a patient portal "to manage some aspects of their own healthcare" and download relevant information like appointments and repeat prescriptions and "access their personal health information whenever they need it"

Jeffrey said...

There are something that patient can do with MyHealthRecord such as record conditions or maybe even upload personal record. But, who will look at those documents at the moment? My GPs never upload or download anything from MyHealthRecord.

There are some fundamental things patient really want to do but cannot be included in MyHealthRecord such as appointment management and billing. Those are the functions need to be built into the practice/patient management software. Do we have those kind of PMS available? That's a question.

Anonymous said...

I was recently referred to an orthodontist and was asked to fill in an online medical history form prior to the first visit. http://www.anywheredolphin.com/ I presume this is a “patient portal”. I didn’t proceed as Dolphin Imaging and Management Solutions’s Privacy Policy said you consent to the transfer of information to the United States and that various uses of “anonymised” data would be made.

Is this not a concern? That Australian practices are using overseas systems for patient portals?

Terry Hannan said...

The NZs not only beat us at rugby they are well ahead in the eHealth game. I have seen some excellent projects in that country during my recent visits. They are very collaborative across the social sectors.

Tom Bowden said...


As a New Zealander and frequent visitor to Australia (currently writing this from Sydney) I have to say "Credit where Credit is due" - the All Black Coaches favourite saying.

Patient Portals are extremely useful - I use one from time to time to look at my own test results and other info. They are great for that purpose as well as planning appointments etc.

The hard work has been done by NZ EMR companies Medtech and MyPractice who have done an outstanding job of enhancing their core EMR products in this way.

In my view, having a portal is an excellent way of promoting record sharing and should be, for the majority of us who are fortunate enough to remain generally well, the primary means of sharing information with other providers as well as a tool we can use to manage our own healthcare (The MedTech product is even called 'Manage My Health'). People with significant health issues should probably be have their records managed in conjunction with more comprehensive/sophisticated systems eg My Health Record?.

I definitely would recommend development of Patient Portals - the evidence strongly supports it as a cost-effective strategy.

Dr David More MB PhD FACHI said...

"People with significant health issues should probably be have their records managed in conjunction with more comprehensive/sophisticated systems eg My Health Record?"

Tom, what on earth have you been smoking? The myHR is neither comprehensive or sophisticated. It is also clumsy, incomplete, insecure and unusable.

David.


Tom Bowden said...

OK, OK

I am an incurable optimist. But you are right, it is not fit for that purpose.

My intended point is/was that a good patient portal solves problems for those of us who are basically well and hoping to stay that way, but a more sophisticated record sharing solution may be needed to meet the needs of patients with more complex needs, multiple health problems etc.

I would hope that the huge investment in MHR is going to result in something that will be helpful in that regard.

If that doesn't work, perhaps we need a competitive market to meet the specific needs of patient groups.

TB

Anonymous said...

My Health Record suggests everything is there in one place and nothing could be further from the truth. Patients have health records all over the place - in their GP's practice, in their specialists' practices, in various hospitals which they have attended, and many other places. None of this is under the patient's control.

I would much prefer to see a Patient Portal which let's the patient pull down information into their file - My Personal Health Information.

Anonymous said...

My Health Record was supposed to address data fragmentation. As has been observed - it doesn't. It was supposed to be opt-in, but now isn't. It was supposed to be personally controlled - but isn't (as a start you can't hide your shared health summary). It's supposed to tell you who has seen your record, but doesn't. I'm amazed that anyone thinks it's a good idea.

Anonymous said...

I agree a lot of good things happen there but they are certainly NOT ahead in the eHealth game in the acute sector. There is no major hospital with a true EMR, whereas we have quite widespread deployment in both NSW and VIC, and QLD and SA are also moving ahead (although not without drama).

There is a lot of talk about EPIC and the Auckland DHBs but I will be surprised if that actually ever happens. In my experience they simply don't have the money for the big solutions - which is why they are so good at the smaller scale innovations.

Bernard Robertson-Dunn said...

This is an indication of how well My Health Record is doing in Australia.

https://www.privacy.org.au/Campaigns/MyHR/twtter_images/MyHR_Stats.jpg

The graph data is after the 1 Million odd registrations following the opt-out trials.

It shows the total number of registrations as reported by the Department of Health, the change compared to the previous report and the number of registrations per day during the reporting period. No allowance has been made for holidays.

It will be interesting to see the analysis and conclusions they come to in assessing the benefits of the opt-out trials.

Anonymous said...

What are you saying here Bernard? Are these 'registrations' voluntary opt-in by individuals OR are they co-opted registrations driven by the Department or by hospitals compulsorily registering patients when they attend for treatment.

Bernard Robertson-Dunn said...

The department publishes statistics on My Health Record here:
https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/news-002

They don't show historical data, only the current status. I keep old data and thought it worth showing historical data, something Health doesn't appear to be very keen on.

As an aside, they have changed the website in the past day or so to only say that "Over 4.3 million people have a My Health Record" earlier they had a more precise figure of 4,384,811. (This figure is still available in the dashboard pdf:
https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/137785A2DF7FF487CA257F8A0008E40D/$File/MyHealthRecordDashboard-27November2016.pdf)

They also add "with an average of 1 new record being created every 38 seconds."

In seven days there are 604,800 seconds which, by my calculation 604,800/2455 gives about one record every 246 seconds (i.e. 4 minutes). They are obviously using something closer to business hours but even then 5 days of 8 hour each only gives a new registration every minute.

My interpretation is that the total number of registrations is the total number of records from all sources, probably including those who have inactivated their record or who have died.

I get the impression that the reason for the last part is because they are trying to inflate the numbers as much as they can.

Foor example, if you look at the section "Healthcare provider registrations", the total of 9,504 Healthcare provider registrations includes "Organisations with a cancelled registration" - 187.

In addition, the section "My Health Record Usage" under
Clinical Document Uploads
Total number of clinical documents uploaded to the My Health Record system by healthcare providers

claims that the number of Shared health summary uploads is 440,360

At first glance this might seem to be the number of people with a Shared Health Summary but in fact, almost certainly, refers to the total number of SHSs that have been uploaded. Every time a GP modifies a SHS, a new one is uploaded, replacing the old one.

If you assume that, on average, in the time since the system went live, each SHS has been updated once, then a much closer estimate of current SHSs is about 220,180.

Relating that to the number of registrations means that about 5% have a SHS.
Relating it to the number of Australians suggests that fewer than 1% have a SMS.

Considering that a current and complete Shared Health Summary is the only document with any real value in the system, this is not a great return on $2billion (my estimate and which includes the cost of non MyHR direct costs - e.g. GP time, medical centre support staff, nurses, Informatics staff etc).

Bernard Robertson-Dunn said...

In New Zealander (at least some):
“Patients can now access their personal health information whenever they need it,”

In the UK they have:
"Patient Online is an NHS England programme designed to support GP practices to offer and promote online services to patients, including access to coded information in records, appointment booking and ordering of repeat prescriptions."

https://www.england.nhs.uk/ourwork/pe/patient-online/

Question. : Is none of this software or capability available in Australia? If not why not?

I would have thought it was a golden opportunity for software vendors to use practice software to take much of the burden off GPs when managing a patient's MyHR.

And I'm not just talking about regularly uploading Shared Health Summaries, they could build in functionality that removes and/or hides patient data if the patient so wants it; monitors MyHR activities on behalf of the patient.

If a patient has access to a medical practice portal they could manage (to some extent) their MyHR through that portal.

In addition, health data could be exchanged between service providers without going anywhere near the MyHR.

IMHO, with the exception of very few, patients are the last people who should or can manage their health data.

And also IMHO, patient centric should mean the capability for a patient to choose how they interact with the health care system, including having available a single point of contact with that health care system for everything, appointments and all. And that includes minimising the amount of health and personal data that the government is able to see. If the government wants the data they should specifically ask for it, explain why they want it, who will see it and what will happen to it.

I would think that very little of this needs the ADHA - or have I got it all totally wrong?

Anonymous said...

Bernard - you have it absolutely right but that is not what Mr Madden and the Government want to see which is why they intend to keep control of and dictate to the ADHA. They can do that simply because they hold the purse strings. This vested interest creates conflicts, corrupts the process of eHealth development and deployment and undermines private sector initiatives.

Bernard Robertson-Dunn said...

Do the medical profession and software vendors need the permission of ADHA/Govt to use the MyHR for their own and patient's benefit? Are GP's allowed to act as proxies for the patient? Especially to remove or forbid the uploading of data?

Can GPs be a patient's nominated representative - in which case, my understanding is that the GP can do anything a patient can do. It's up to medical practice software vendors to provide the appropriate functionality.

From a technical perspective the MyHR is neither necessary nor sufficient to provide patient centric health care services. It might add to the solution space via some functionality (e.g. patient identification, secure messaging) but in general it can be ignored.

At the extreme, GPs can use its functionality and undermine it for their own and the patient's benefit and protection.

Correct?