This appeared last week:
Welcome to the second coming of My Health Record: the AusDoc interview
Why did anyone think 100 million PDFs would be a good idea?
13 June 2025
Doctors have long asked an existential question about My Health Record. Why does it exist? What is its clinical utility?
It has now amassed 1.7 billion documents — from medication lists to radiology results to health summaries.
And yet for many, the system that was intended to reduce patient harm by preventing medication misadventures, bungled diagnoses and unnecessary tests or interventions appears to have no role in the day-to-day workflow of doctors and the wider system.
Despite the recent wonders of digital technology, to its critics, after 15 years, My Heath Record is still a “shoebox of PDFs”.
This is an interview with Peter O’Halloran, chief digital officer with the Australian Digital Health Agency.
Appointed two years ago to make the $3 billion system clinically relevant, his main task is to “atomise” the clinical information in the system so, when medications and diagnoses change, hospital discharge occurs or the pathology results arrive, the details are updated within the doctor’s own software with no fuss or messing around.
Why has something so basic taken so long?
And are non-GP specialists using My Health Record? What would happen to healthcare if you just switched off the system and accepted it had been an expensive waste of time?
In a frank discussion, Mr O’Halloran explains why pulling the plug is not an option, that the system is fundamental to future healthcare.
AusDoc: First question, why, having spent billions of dollars on the system, were the data never atomised in the first place?
Why did anyone think several hundred million PDFs would be a good idea?
Peter O’Halloran: You have to go back to when My Health Record — the PCEHR as it was back [then] — was first created.
The standards 15 years ago were simply not at a level where data from across the country could be brought together at an atomic level. It was a step too far.
AusDoc: Because of the cost or because of the technology?
Mr O’Halloran: Well, mostly technology. When the PCEHR was designed, iPhones didn’t exist. In fact, a lot of the things we can do now using desktop computers didn’t exist then.
AusDoc: So back then it was assumed that a patient’s health summary — the diagnoses, the medications, the allergies — would be in a PDF even though it could not be updated in the way we can do now?
Mr O’Halloran: Absolutely. But it was always seen [as] the beginning.
It was going to be a kind of document, like a Word document or a PDF back then and the clinician in ED would look at it and the information would be accessed on that level.
That was the intention.
AusDoc: I remember Dr Mukesh Haikerwal, who ended up quitting as the National E-Health Transition Authority clinical lead, talking about the need for atomisation. That was years ago … and I’m sure he’s still talking about it now.
It seems very slow progress. How far has the agency got?
Mr O’Halloran: [We are close] to the next level where the individual data elements can be assembled in clinical software to produce a shared health summary more efficiently.
That means the ability to automatically pre-populate a summary or another document with clinical information on things like allergies and medication alerts and the like.
AusDoc: But in terms of a time frame — how long do you think before it becomes routine?
Mr O’Halloran: In less than two years we should be able to accept all the data at that atomic level. But it will mean software vendors need to modify and update their software.
Some of them are already starting to do that.
So, for early adopters, the changes will come within two years.
I expect [for] everyone in the system the changes will be in place within five years.
I’m impatient, so it feels like a long time to me, but we’re talking about changing the software used by every single clinician in Australia, and so that’s not a quick overnight fix.
However, the real endpoint for us is that we want to move away from My Health Record being seen as an afterthought in terms of how care is provided.
The doctors
may not know what is happening beneath the surface but the clinical information
they will be given about a patient will come from data from their existing
system as well as what’s being sourced from My Health Record.
This will mean, for example, that clinicians will see data sourced from
referrals, discharge summaries, shared health summaries and the like relating
to allergies, medications and treatments in context in the existing screens in
their clinical software without the need to go into separate sections or
systems.
The fundamental point is that when this is done it is all displayed seamlessly on one screen, not two different systems.
AusDoc: The software vendors often complain that they need more money and support to change their systems.
This is about them changing their own software to communicate in this new ecosystem, is that right?
Mr O’Halloran: Yes, you are right, but it depends on which software vendors we’re talking about.
The software vendors in the acute hospital sector are generally already using the same data standards that we’re moving to.
So for them, it’s a small amount of work rather than a large rewrite.
For some of the vendors for primary care, their software is often bespoke to Australia.
However, if you look across the sector, you will see Best Practice and Telstra Health have announced massive investments. They are making these modernisation journeys now.
They’re already seeing which way we’re going and they are heavily engaged in that work.
As an agency, one of the big things we’re pushing is the need to use global standards with minimal local customisation which makes it more efficient for them to adapt.
I understand, if you’re in primary care, you probably sit there and say ‘This My Health Record is a horrible, clunky system.’
But that does not recognise the fact that the Australian Digital Health Agency doesn’t provide any software for clinicians in primary care.
Every single element they’re seeing on the screen has been built by their software vendor.
They’re not actually in the My Health Record system but they’re seeing [it] as such.
That is why we’re working with those software vendors.
If the system becomes atomic, you don’t actually have to have a separate screen for My Health Record.
You can just display it in the usual settings that doctors are using.
AusDoc: I’m going to ask you the dumb question. With all the PDFs in the system, literally hundreds of millions of them, doesn’t AI technology have the capacity just to read those PDFs and atomise the information in the way that you’re suggesting?
Mr O’Halloran: There is technology that could do it tomorrow, and we are exploring how we could surface, at an atomic level, the data in the CDA [ER1] wrapper that exist in the background with the PDF.
The question, as always, is what is the clinical accuracy of it?
While it probably doesn’t matter if I use AI to pull some key insights from my thousands of domestic bills, it’s a very different story when we’re talking about clinical data that could be relied upon to make a treatment decision.
But to be clear, the benefit of atomisation is that it lets clinicians integrate data from My Health Record into their main clinical record.
So, when they’re writing a shared health summary or authoring a referral letter, their software could pull in a list of medications and allergies.
They don’t have to type that history themselves.
If these changes come together as they should, it should reduce the administrative burden.
If I look at what’s happening with ambient AI scribes and that type of technology, which is becoming increasingly routine, I think we’re on the cusp of seeing clinicians being [physically] freed from their computers during a consult and able to spend more quality time focused on the patient.
AusDoc: Speaking of AI scribes, their uptake by doctors has been rapid which is in stark relief to the embrace of My Health Record.
The embrace of AI scribes shows clinicians will rapidly adopt technology when you make it useful to them. My Health Record has been a failure up to now because it’s been irrelevant — nothing complex about the reasons.
Mr O’Halloran: When I look at my own My Health Record, five years ago I had almost nothing in it — and that’s despite asking people to share test results or GPs to write shared health summaries.
Two years ago, it had a bit of data in it.
Now every time I get some blood work done or I’ve got a prescription, the data is just routinely in there and this is before the legislative mandates for sharing come into force.
The feedback I’m getting is clinicians are starting to find it useful a lot more often. We are getting to a tipping point now.
We expect within two years that almost all pathology and diagnostic imaging testing for all consumers will just be routinely in the system [whenever someone looks].
And that’s where what we are doing will derive its value. A clinician will be able to see the results and the history in an atomised, easy-to-read format.
That is why it’s worthwhile.
AusDoc: On behalf of fellow technophobes, can I ask a question. When it comes to My Health Record I’ve got a vision that there’s a big warehouse full of computers in Canberra, storing all this information, all the pathology reports, the PDFs. This warehouse, if it exists, is the PDF shoebox people talk about.
What is the reality? Where is all this information? Isn’t it on the cloud?
Mr O’Halloran: All the data of My Health Record is hosted in Australia, in a secure cloud environment.
It’s spread around different geographic regions in different states.
But in essence, if you brought it all together and looked at it, it would simply be a row of computers.
And it would not involve a large amount of space physically. It’s probably smaller than the office I’m sitting in if you put them all in one place.
The data is simply there and available.
The benefit of the cloud is that it lets us get the additional cyber protections and the ability to scale up as more data is being shared with us.
AusDoc: Going back to clinical utility, the hospital discharge summaries for GPs are fundamental for communicating new treatments, new medications, new diagnosis.
But My Health Record is not among the communication mechanisms being used by hospitals to communicate with GPs.
Mr O’Halloran: The discharge summaries are supposed to be shared through My Health Record.
Of course, a lot of hospitals will send them directly to the GP either via secure messaging or occasionally email and really occasionally by hard copy mail.
AusDoc: But the aim is for My Health Record to be the communication channel for discharge summaries?
Mr O’Halloran: Absolutely. That’s the goal in all this.
We want the summaries routinely in My Health Record every time a patient goes to a hospital.
Once clinicians in primary care can expect that every time they go and check when the consumer comes back to them after being discharged, they’ve got access to their data through My Health Record, that really adds to the clinical usefulness of the system.
AusDoc: But again, this depends on the software vendors ensuring their systems are fully integrated?
Mr O’Halloran: It does. As I mentioned, the two biggest vendors of software systems in primary care are embracing the change.
And there are other smaller software vendors out there today who are already doing a lot of these things.
AusDoc: I know you can’t speak on their behalf, but why have the software vendors been so reluctant to embrace My Health Record? There is no incentive for them to make using the system via their software unnecessarily unpleasant for doctors.
Mr O’Halloran: I think it goes back to the history.
Once again, if you look at the PCEHR back in the day, the standards were very rudimentary, and our expectations of the software were much lower.
Also, the awareness of what the system could do and how useful it could be for consumers and clinicians was unknown.
A lot of work was put in in those early days to build the interfaces and to have those basic screens designed, but to be honest, there’s been very little maintenance of them by most of the major software vendors since those days.
AusDoc: GPs have embraced computers from the beginning — but the non-GP specialists, some haven’t even got a computer on their desk.
To what extent are they integrated into this future vision?
Mr O’Halloran: It depends on each specialty, but yes, as a rule, I agree specialists have a lot lower take-up of computers on desks than GPs.
But I would add that certain specialties and the technology they use make the rest of us look like Luddites.
The point is we’re seeing change. The paradigm is starting to change where there’s more and more software designed for specialists that meets their needs because their needs are often quite different, each specialty is often quite different.
When we have more data from the acute sector, more data from primary care — say the pathology and diagnostic imaging data — a lot of those specialists will see the value and embed it into their practice.
AusDoc: You mentioned that in the next two years we will see a big change in the clinical utility of the system.
Does anything worry you in terms of reaching that goal?
Mr O’Halloran: Look, I don’t think I’m worried about anything. I think it’s a lot of work but technically, it’s fairly easy.
It’s about procuring services, bolting it together, going through processes of clinical validation and checking that it works as it should.
The bit that interests me is how we work with the colleges, how we work with the professions to ensure what we’re building is fit for purpose and meets their clinical needs.
AusDoc: Can you give me a picture of what the Digital Health Agency consists of? Again, I’ve just got an idea of lots of people in a room, computer boffins with thick spectacles working on software code.
But it sounds that a lot of your job is about building relationships — with government, with software vendors, with the medical colleges.
You talk about the agency’s core work in creating standards. Forgive me, it sounds quite boring. It’s not Silicon Valley.
Mr O’Halloran: [Laughing] A lot of the kind of stuff we do to do our job is probably on its own quite boring.
What’s exciting is what it enables and how it comes together. I understand [that] may sound tragic, but the true value for me is when I see a clinician say, ‘Hang on, I used this information in my practice, I’ve got data giving me insights into a patient that I hadn’t seen previously.’
That’s where we get excited.
The role of the agency is not lots of computer boffins sitting in a room, and to be honest, we have a relatively small number of deeply technical people.
I would say I spent 80% of my time working with consumers and clinicians across the sector. I’m not sitting there, elbows deep in architectural drawings.
AusDoc: A few years ago, we ran a story which I don’t think won many friends in the PCEHR world, but it was about the clinical uptake of the system which was very low.
From that point onwards we were often wondering why every federal budget millions were still being poured into it.
In fact, there is still an enormous amount of money going into it.
But what do we really lose if you simply turned it off?
Mr O’Halloran: My Health Record is more than just the system.
The legislation underpinning it is actually one of the strongest parts. We now have some of the best legislation in the world in terms of information sharing.
We have unique individual identifiers for healthcare providers, for their organisations, and unique individual identifiers for consumers.
If I look at the US, some 20-30% of the [healthcare] data being exchanged is mismatched or duplicated.
Those are things that don’t really happen in Australia.
I haven’t heard anyone saying we should turn off. That is not part of [the] debate.
I’d refer people to the Senate review into the sharing by default legislation a few months ago.
The legislation was supported by all parties — we’re talking the Opposition, the Government.
The system wasn’t what we wanted it to be necessarily in the past.
But I’d simply say, as you watch My Health Record over the next 12 months, I think the questions will drop away because people will see the value that was originally envisaged 10-15 years ago.
It’s just taken longer to realise the vision than any of us would have expected or wanted.
This interview with Peter O’Halloran took place last month. Responses were edited for concision and clarity.
Here is the link
https://www.ausdoc.com.au/news/welcome-to-the-second-coming-of-my-health-record/
Poor Peter, he and his team still have not established a compelling case for any-one to use the myHR. All the data in it is already sent to GPs and specialists as a matter of routine and is in the system(s) they already use.
Pretty much no-one needs the myHR as far as I can tell and after the 10 or 15 years of being useless it is hard to actually see what has changed to make it now useful!
As always, I would really like to hear from people who are finding it useful and valuable. The total cost for this folly must be in the billions by now and they still have not established a compelling use case! How can all this be possibly justified?
Can’t we please stop this nonsense until we have a much better plan, demonstrated need, and proven useful technology to support it!!!
I wonder how many times I have said the same thing over the years? The one small step forward this time is that the ADHA have noticed how important discharge summaries are as a document of record......
David.
3 comments:
The iPhone 4 existed, even back then it was clear the mobile would become a key gateway access device. Also, there is some confusion and contradiction with Standards and Technology, the standards addressed the underlying data requirements, not just in V2 at the time but also as this chap admits to - in the CDA. The PCEHR was a useful policy tool that has had its day. AdoHA need to be disbanded, we don't need implementation people designing our way out of this.
In HL7V2 we have had atomic pathology data since the early 2000's and I was certainly one of the people chastising NEHTA for turning atomic data into pdfs. Virtually everything he says is a lie, which is pretty much the default when government speaks these days. It's very frustrating when so much taxpayers money has gone down the drain. The suggestion that hospitals are better than private practice is quite laughable as they are the worst culprits when it comes to quality data and standards. Queensland health are now sending out emails with a "clickable link" to supply documents. We have tried to train our staff not to click that sort of link and even inspecting the email headers made me unsure if it was safe or not as the origin was in Europe! Trying to find someone to say, "Please stop this nonsense" is also quite difficult.
Proper point to point secure, authenticated standards based message has been possible for decades but it seems Canberra is out of the loop and has a bottomless pit of borrowed money to blunder around armed with power point slides and and no insight as to how brain dead they actually are...
The original business case for the PCEHR was so that patients could take control of their health care. However the system was supposed to have access to data repositories (existing data sources) and a few additional documents (e.g Personal health summary, Discharge summary) which were curated data based upon medical (i.e. treatment) data.
What was built was and still is nothing like that, it's a health data exchange which adds very little value to the data that is in it.
The last time I looked at my record (yesterday) there is just a long list of pathology documents (multiple documents for each time I had a blood test) with no indication of what is in them, and details of visits to health providers, with no indication of what the visit was about.
IMHO, the biggest flaw in the system is that it collects medical/treatment data but the real value would be if it is curated and summarised, a nontrivial and expensive task and one that has problems staying current.
It has always been assumed that each patient's nominated health provider (expected to be their GP) would do that. The question is: who pays? GP's are already stretched caring for their patients, adding a substantial data administration role is naive.
There never was a business architecture that described how the system was supposed to fit into the business model of the various players in the healthcare environment.
All there was was a concept of operation which described how the system worked internally. In other words it was a technology system designed by technologists to solve a technology problem.
That interview shows that nothing has changed. It's the wrong solution to the wrong problem.
The best thing about the system is that it isn't dangerous, as long as a health professional doesn't believe that it is a complete, accurate and uptodate record. And I doubt that any of them are that silly.
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