Tuesday, December 13, 2016

Remind Me Please Of The Evidence That The myHR Is Fit For Purpose For Complex Patient Care Management.

Dr Edwin Kruys has kindly provided a table from the DoH covering the requirements for the Health Care Home Trials
Here is the link to his blog and some good commentary on the general care home issue:
In a nutshell these trials aim to test using a capitation payment approach where a GP or practice undertakes to provide holistic care to patients with chronic disease.
Here is the link to the Government release:
Practices have to apply to be part of the trials (applications now close Dec 22, 2016)  and as you read the requirements you will notice a considerable emphasis on the myHR.

Table: Health Care Home requirements

(Source: Department of Health)
A general practice or Aboriginal Community Controlled Health Service applying to be a Health Care Home must be within one of the ten selected PHN regions and needs to:
  • be accredited and maintain accreditation, or be registered for accreditation, against the RACGP Standards for general practices;
  • participate in, or be prepared to participate in, the Practice Incentives Program (PIP) eHealth Incentive;
  • register and connect to the My Health Record system and contribute to their enrolled patients’ My Health Records;
  • participate in the stage one HCH training program;
  • use the patient identification tool to identify the eligible patient cohort in their practice or service, assess individual patient eligibility and stratify their care needs to one of three complexity tiers according to their level of risk;
  • ensure that all enrolled patients have a My Health Record;
  • contribute up to date clinically relevant information to their patients’ My Health Records;
  • develop, implement and regularly review each enrolled patient’s shared care plan;
  • provide care coordination for enrolled patients;
  • provide care for enrolled patients using a team-based approach;
  • ensure that all team members have roles that utilise their qualifications and allow them to work to their scope of practice;
  • provide enhanced access for enrolled patients through in-hours telephone support, email or video-conferencing, as well as access to after-hours care where clinically appropriate;
  • ensure that all enrolled patients are aware of what to do if they require access to after-hours care;
  • collect data for the evaluation of stage one and for internal quality improvement processes.
-----  End Extract.
Now I have no problem with the idea of patients being supported by a nominated and responsible practice that they have found works for them and the Government using whatever reasonable payment approach for the care provided they choose but mandating the use of the myHR, really.
The myHR was never designed as a multidisciplinary care co-ordination system – is pathetically time consuming and clumsy in use (I went through the latest demos last week to check) – and worse there are much better products to address this task.
As just one example – endorsed by the RACGP for care-coordination etc.- we have cdmNET.
Here is the link to their home page:
The what does it do says it all:

What does cdmNet do?

cdmNet makes it easy to:
Communicate
Effortlessly communicate and collaborate with the care team
Plan
Create and share best-practice health assessments and care plans
Follow up
Ensure that every action, health assessment and care plan is followed up and reviewed
Manage
Track and monitor patient progress and actions across the whole care team
Support
Send reminders to patients to help them stay on track
Comply
Be guided through Medicare requirements and ensure safe Medicare audits
Document
Create, electronically sign, and distribute all documentation and referrals
I am sure there are others and additionally virtually all the mainstream practice management systems (BP, Medical Director etc. etc.) have significant complex care management and follow-up capabilities and functionality.
Demanding use of the myHR (and its huge pile of unsearchable .pdfs) is totally potty – to be polite!
This is yet another example of DoH snatching defeat from potential victory. I wonder when they might learn and face up to the fact the myHR is a useless lemon? Next year maybe.
David.

11 comments:

Bernard Robertson-Dunn said...

David.

My opinions:

MyHR is totally unsuitable as a critical, point of care health care service. Apart from the dubious nature of the data in it, it cannot be relied on to be available 24/7 or in the event of communications/power failures. (See my earlier comments).

The only sensible answer to the question "what is the value of MyHR and to whom?" is: the government, maybe researchers (depending on the quality of the data, which (see above) is dubious) and maybe to those few people who travel, but why they can't take responsibility for their own health and take some records/data provided by their GP I don't know. It would be safer, cheaper and probably more trustworthy.

Thank you for your blog, it gives some of us a place to rant and let off steam, knowing there are others with similar views.

A Merry Christmas and please keep the blog going next year, it's likely to be even more relevant and valuable when ADHA stops "consulting" and tries to deliver something of value.

john scott said...

David, Bernard, I absolutely agree. One can only imagine the damage done to a potentially useful initiative by burdening it with the dead hand of the MyHR.

Bernard Robertson-Dunn said...

Public servants sit idle as ATO's IT melts down
http://www.smh.com.au/national/public-service/thousands-of-public-servants-sit-idle-as-atos-it-melts-down-20161213-gt9xfd.html

A bad enough headline.
This would be even worse:
"Thousands suffer as Health's record system melts down"

Dr David More MB PhD FACHI said...

Bernard,

I doubt anyone would be seriously disadvantaged, or even notice, if the myHR was down for a week, a month or indeed even just turned off altogether.

David.

Bernard Robertson-Dunn said...

David,

I agree - as it is today, however if it is ADHA's intention to make it an essential part of health care service delivery, then that's another story altogether.

Anonymous said...

Maybe there are other questions for ADHA and the department to answer - https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2881787

Anonymous said...

Anon 5:34 thank you for posting that. I think there are some very serious question arising from that paper, love to hear from other readers more attune to such legal matters

Anonymous said...

But will it get the light of day? Doubtful it's to complicated. We are living in a expert freezone chasing little trinkets that are safe and simple. If know one is qualified or smart enough to understand a problem then it is clearly not a problem

Dr David More MB PhD FACHI said...

I don't think the Conclusion is too complicated!

CONCLUSION

The My Health Record system and the legislation that establishes and supports it have fundamentally changed understandings of the functions of clinical records. No longer created and used simply to provide health care to patients, health practitioners’ records of their treatment of patients have become property for use by government and commercial entities for a variety of purposes well beyond serving patients’ therapeutic needs. Patients’ lack of control over their electronic records and derivation of minimal, if any, benefit from the My Health Record system will ultimately engender distrust in the system. To have any hope of restoring the community’s faith in electronic health records, the Australian Government will need to ensure that the My Health Record system genuinely serves patients’ interests, be completely transparent about all of the objectives of the system, and obtain patients’ agreement to the collection, use and disclosure of their health information for purposes that may not benefit them personally. In other words, the government operating the My Health Record system needs to be mindful of Immanuel Kant’s second categorical imperative to “act in such a way that you treat humanity, whether in your own person or in the person of any other, never merely as a means to an end, but always at the same time as an end”.124

David.

Anonymous said...

You might not David and many others might not, but I am not sure many in ADHA or the broader department would.

Bernard Robertson-Dunn said...

Here's some evidence - from the Department of Health and their statistics page:

The daily rate of registrations has popped up a bit in the last week, new registrations ran at 2,506 per day.

However, the number of Shared Health Summaries uploaded was 1,658 per day. This number represents both new and modified SHSs.

The inescapable conclusion is that people may be registering for a health record but many (most?) are not uploading a SHS. At absolute maximum, only two thirds of new registrations are followed by an uploaded SHS, in which case nobody is updating their existing SHS.

The actual numbers are probably a mixture, some new SHS, some updated.

However, the fact is that the My Health Record system is filling up with largely empty records.

And we still don't know if anybody has used a MyHR as part of health care or how much money it has saved the Federal Government. Or how much good they could have done with the money being spent on it - things like dental care:

"Thousands to lose free dental care under cuts that will 'hurt the most vulnerable', experts say"
http://www.abc.net.au/news/2016-12-15/dental-cuts-will-'hurt-the-most-vulnerable',-experts-say/8124814

And I find this statement particularly galling "Ms Ley said the Government made changes to the existing Child Dental Benefits Schedule to keep it sustainable."

It will be interesting to see what the analysis of the opt-out trails says, although I suspect the only point of interest will be the opt-out rate.