Sunday, July 31, 2016

The Health Minister Talks At HIC 2016 - What Did She Say And Did She Make Sense?

First here is the speech.



Health Informatics Society of Australia (HISA) MELBOURNE

Monday 25 JULY 2016 4.00 p.m.


Dr Pradeep Philip - Chair, HIC 2016 and CEO of LaunchVIC
Dr David Hansen – Chair of HISA and CEO, The Australian E-Health Research Centre Distinguished speakers and guests
I am very pleased to again attend this HISA (pronounced High-zar) conference.
This is a premium event for everyone in the rapidly expanding Australian health informatics and digital health community.
In the year since the last HIC conference, the Australian Government has achieved a lot in this space. I’m not just pleased I am excited by how much progress we have made.
I am privileged to be continuing as Health Minister in the government which is re-booting and revamping the digital health system to make it work for everyone.
I’m proud to be part of the Government’s push to move health, along with other parts of our economy, into the 21st century.
This is the age of information technology. It’s helping to make our lives better in so many areas – it’s beyond time for us to let digital technology help us to better health.
We are well on our way now… But we still have much to do in terms of gathering, analysing, sharing and acting on health information and data.
It will be a game changer. It will enable us as health consumers to become more active in managing our health, and will provide coherent links between the multiple services that so many of us now need.
And at the local, regional, national and global levels, will enable much improved monitoring and analysis of population health and trends.
HISA has long recognised this and promoted this message – you have led the way.
Like most of you, I am quite passionate about harnessing the potential of this technology to support and benefit the health of Australians.
The last time I was here I told you about some of the important work that the Government was planning in the My Health Record space.
We’ve done what we promised. Finally, we are on track to have a really functional, national system for consumers to electronically manage and share their health information with their healthcare providers.
Many of you provided input into the review into of the Personally Controlled Electronic Health Record system. And we listened.
We have supported all of the recommendations and have already adopted most of them to substantially improve the system.
We provided the funding for the changes and to continue to operate the system. We’ve changed the name.
The Personally Controlled Electronic Health Record, or the PCEHR which some of you pronounced as the “pecker”, is now simply My Health Record. It’s a lot easier to say, a lot more consumer friendly. It is what it says.
There have been many changes to the My Health Record system to improve the usability. The most recent work allows the system to work in a mobile friendly way, and it works with all smartphones and tablets.
Last year I announced that we would put the power in the hands of health consumers to decide who or what services they can share their My Health Record information with.
I’m pleased to now announce that in late June 2016, the My Health Record was established as a mobile accessible platform. This allows app developers to get on with the innovation to turn this data into useful advice and information for consumers and healthcare providers.
The APIs to support app developers connecting to the My Health Record to access and upload information is now available.
This is a great first step in the open innovation space that we need to do more of.
Consumers, Clinicians, Connectivity, Community – the theme for this conference – is a good summary of what My Health Record is all about.
In any one week, one in three Australian GPs will see a patient for whom they have little or no health information at all. More than one in five GPs faces this situation every day.
With My Health Record, any healthcare provider finding themselves in this situation will have access to at least some information about their patient.
This is the national system that we need, underpinned by strict privacy regulations and access controls in the hands of the consumer.
It will empower health consumers, inform clinicians and connect our often fragmented health system for patients. More Australians and more doctors are now using the system, and we still need more to reach a critical mass.

My Health Record Participation Trials

Four trials are currently underway in different parts of Australia on ways to increase consumer and provider participation, and the value of sharing health information.
The trials will run until the end of October 2016.  They will then be assessed by an independent evaluator. Obviously, I will be very interested in the results. The trials will provide the evidence base on which the Government can make the next big decisions on My Health Record.
I expect that to happen in the first half of next year (2017).
Two of the trials, one in Northern Queensland and the other in the Nepean Blue Mountains area of NSW, are trialling opt-out participation.
People living in these regions had a My Health Record automatically created for them, unless they told us they didn’t want one and opted out.
The results were very clear.
Just 1.9 per cent of eligible people across both regions – less than one in 50 – chose to opt out. That’s in line with international experience so it is not a surprise but still very valuable information.
It means that the two trials have resulted in more than 970,000 newly registered My Health Records.
All of the people who got My Health Records through the trials had the opportunity to access their record and add their personal information.
They also set access controls and could elect to receive SMS or email notifications when their My Health Record is accessed by a healthcare provider.
These new My Health Records have been available to their registered healthcare providers since mid July.
I look forward to the results of these trials which are expected to show how the providers engage with and use the My Health Record system.
Two other trials are using different approaches to encourage individuals and healthcare providers to use My Health Record under the current opt-in arrangements.
In Victoria, all patients admitted to Ballarat Hospital are offered assistance to register for a My Health Record. If they agree, their discharge summary is uploaded to their My Health Record when they leave hospital.
GPs and other healthcare providers around Ballarat have been contacted and made aware that the discharge summaries are available on their patients’ My Health Record.
The Western Australia trial is targeted to chronically ill patients and their healthcare providers.
General practices participating in the trial are prompted to register their chronically ill patients for a My Health Record when they establish or maintain care plans for them in chronic disease management software. The software is accessible to all providers involved in the co-ordinated care.
The trial also provides My Health Record functionality to healthcare professionals who would otherwise have been unable to access the system because they didn’t have the right software, or their practice was not registered with My Health Record.
Having doctors and other health professionals using and gaining value from the system is where the real benefits will be realised.
For this reason, earlier this year I made changes to the Practice Incentives Program eHealth Incentive - ePIP – which provides payments to general practices for continuing to adopt and use eHealth.
Since 2012 the ePIP Incentive has been given to GPs to become “My Health Record ready”. We need more than that from general practice now.
From May to July 2016 general practices will only receive the ePIP payment if they upload a certain number of Shared Health Summaries to their patients’ My Health Records.
It’s not a big ask – an average of about five Shared Health Summaries per full-time GP, per quarter.
The Government has also communicated directly to GPs about My Health Record; we have provided online self-paced training, and the 31 Primary Health Networks across Australia are providing training and support to GPs in how to use the system.
I’m very pleased to report that this combined approach is working.
In April this year, around 2,000 patient summaries were being uploaded by doctors each week. Now, in the week ending July 17, it was over 16,000 uploads.
That’s real progress.
We have also established the Australian Digital Health Agency, which began operations at the start of this month (1 July 2016). It’s chaired by Jim Birch AM – I understand he’ll be addressing you on Wednesday.
The Agency is governed by a Board with membership comprising a broad range of skills reflecting the health community.
It is a statutory authority, and is funded by and reports to state and territory Health Ministers through the COAG Health Council.
The Agency draws together activities and resources from NEHTA [National eHealth Transition Authority] and from within my department.
While the department remains responsible for national digital health policy the Agency provides a single, transparent and streamlined governance arrangement for national digital health strategy and operations.
It has a whole-of- system, integrated and strategic approach to digital health services, a focus on clinical quality and safety, and real engagement and collaboration with consumers, healthcare providers and industry.
The Agency will continue to develop the national technical and data standards, and set and promote clear principles for interoperability and open source development.
It’s leading the next stages of consultation to finalise the National Digital Health Strategy – setting out the shared vision for digital health innovation to drive better healthcare delivery and outcomes over the next three years.
In the short to medium term, priorities for the Agency include enabling secure point to point messaging between all healthcare providers, increasing use of My Health Record in public and private hospitals, and upload of pathology and diagnostic imaging reports for patients to their record.
The Agency will be establishing an open innovation capability which will level the playing field for technologists and innovators. This will build on the early work done to make the My Health Record accessible, and will draw on partnering arrangements with other open innovation platforms supported by the Government.
It will also be involved closely with the trial and implementation of Health Care Homes – a crucial element in the Government’s reforms to primary health care.

Primary health care reform

Health Care Homes will improve co-ordination, management and support for people with chronic conditions. The concept is not new – it’s known in the US as the Medical Home or Patient Centred Medical Home.
Health Care Homes will initially be trialled over two years in seven Primary Health Network regions across Australia, starting in July next year.
Up to 200 general practices and Aboriginal Medical Services and up to 65,000 patients will take part. Expressions of interest from practices in the trial regions will be taken later this year.
The trial will be limited to Medicare-eligible patients with two or more complex or chronic conditions. The GP practice they choose as their Health Care Home will tailor care packages for them and simplify the process of managing their varied health needs.
The aim is to provide better, coordinated patient management – to keep them healthy and out of hospital. My Health Record will be essential to the operation of Health Care Homes.
It will be a key connector – allowing the patient and all members of the patient’s health care team to work in constant consultation with each other and to easily share information on medications, treatments, allergies, care plans and so on.
Being able to see the clinical decisions of other healthcare providers will mean better diagnosis and treatment decisions, better care for patients, and will support patients to take greater control of their own health.
The use of My Health Record in the operation of Health Care Homes is a good example of the synergy between better use of digital technology and better health care.
It will reduce frustrating duplication of tests and treatments, make the whole system more efficient and help patients to learn more about their health.
With over 3.9 million Australians now having a My Health Record, we will also see these benefits increasingly through other digital innovations and services – such as remote health monitoring, telehealth, and medication management technologies.
Embracing digital technology and primary care reform will put Australia on the path to better health.
How we receive our health care and monitor its success will continue to evolve with new initiatives, technologies and digital services.
Innovation will continue at a fast pace.
The Australian Government is working to ensure that our health system becomes digitally enabled and connected, and can continue to keep up with technological advances.
The Australian Digital Health Agency will work with the public and private sectors to deliver new complementary products and services to leverage off the national digital health infrastructure.
Today we are embracing mobile technology, apps, and trackers.
Tomorrow it could be artificial intelligence, precision medicines, tailored and personalised technologies as well as implantables.
It’s all very exciting.
I look forward to engaging with you more and learning more about the news from HIC 2016 as it unfolds.
Here is the link:
Essentially what the Minister is saying is we have spent the $1B+ on this myHR and now we want it used, and so we are now going to trial the concept of the Patient Centered Medical Home (PCMH) – assuming that the myHR is suitable as the IT Infrastructure – along I presume with the GP Practice Systems.
A quick look at the US experience reveals – after more than five years of well-funded trials – reveals that the benefits case for implementation is still less than proven, but that in some circumstances the PCMH does offer some clinical and financial benefits but that the set up costs are pretty high.
As far as the IT that is needed here is a brief summary from experience.

Using Health IT to Support the Patient-Centered Medical Home

By Jennifer Bresnick on
The patient-centered medical home (PCMH) model is such a successful initiative because it puts the patient-provider relationship at the core of a data-driven, coordinated care continuum.  Providers interested in achieving PCMH recognition must rely on a multi-faceted health IT infrastructure complete with robust population health management capabilities, health information exchange, and open communication between patients and staff.
Assuming the healthcare organization has already taken the step of implementing basic EHR technology, the PCMH model requires providers to leverage health IT in several key areas that support patient-centric care.  A healthcare organization striving for the upper levels of PCMH recognition must be able to use patient registries, risk stratification tools, health information exchange, and clinical analytics to provide services, assess their progress, and continually improve care quality.
Lots more here
Unless I badly miss the mark we are a fairly long way from having this sort of infrastructure available and ready for use in trials.
Equally a system that is designed for patient control is hardly designed for ‘open communication’!
I have used to comment of having a hammer (the myHR) and seeing nails everywhere previously!
It is interesting that we are having two years of trials of the PCMH and then national implementation. There seems to be a culture in DoH of doing trials with known outcomes! See here:

Practices need $100k extra to make Health Care Homes work: RACGP

| 28 July, 2016 | 2 comments Read Later
The average practice needs an extra $100,000 a year in funding to implement the Health Care Homes model otherwise it will fail, the RACGP has warned.
This is the first time a practice-level figure has been placed on the cost of the scheme, which was announced by Health Minister Sussan Ley in March as one of the biggest reforms of Medicare in 30 years.
The college issued the figure in response to news that no new money would be made available by the government for the program, above the $21.3 million pledged to pay for IT, infrastructure and training.
Instead, the Department of Health will pay for care administered under the scheme by allocating $93 million over two years (2017/18 and 2018/19), generated by “targeting and alignment of existing healthcare resources”, such as chronic disease items.
The college says this is just a case "shifting [money] from one shrinking pot into another".
See here:
All in all I suspect Minister Ley is hoping that before the outcomes of all this are available she will have a new portfolio and someone else will have to pick up the mess. Ms Roxon and Ms Plibersek both avoided being blamed for the PCEHR! All this just looks like a Minister who is conducting trials with known outcomes while just ignoring other and possibly better alternatives
Read the speech closely and see just how realistic and practical you think Ms Ley’s comments are!


Bernard Robertson-Dunn said...

OMG. "In any one week, one in three Australian GPs will see a patient for whom they have little or no health information at all. More than one in five GPs faces this situation every day.

With My Health Record, any healthcare provider finding themselves in this situation will have access to at least some information about their patient."

And at best, not much information about a patient.

There's a good chance that in many cases it is because they have had no need to see a doctor for quite a while. So their MyHR would be empty or at best have old data in it which would need validating and adding to.

The UK approach - access to existing GP health record systems - would provide far more information, be far cheaper and have far fewer risks to privacy.

Oh, and she didn't say how many MyHRs have been downloaded and how much the system has saved the government.

We're still waiting on that useful bit of information.

Bernard Robertson-Dunn said...

And while I'm going on about the UK environment, it's wroth looking at the principles within which they are working. They're called The revised Caldicott principles, and I've taken the following from this document:

1. Justify the purpose

Every proposed use or transfer of personal confidential data within or from an organisation should be clearly defined, scrutinised and documented, with continuing uses regularly reviewed, by an appropriate guardian.

2. Don’t use personal confidential data unless it is absolutely necessary

Personal confidential data should not be included unless it is essential for the specified purpose(s) of that flow. The need for patients to be identified should be considered at each stage of satisfying the purpose(s).

3. Use the minimum necessary personal confidential data

Where use of personal confidential data is considered to be essential, the inclusion of each individual item of data should be considered and justified so that the minimum amount of personal confidential data transferred or accessible as is necessary for a given function to be carried out.

4. Access to personal confidential data should be on a strict need-to-know basis

Only those individuals who need access to personal confidential data should have access to it, and they should only have access to the data items that they need to see. This may mean introducing access controls or splitting data flows where one data flow is used for several purposes.

5. Everyone with access to personal confidential data should be aware of their responsibilities

Action should be taken to ensure that those handling personal confidential data – both clinical and non-clinical staff – are made fully aware of their responsibilities and obligations to respect patient confidentiality.

6. Comply with the law

Every use of personal confidential data must be lawful. Someone in each organisation handling personal confidential data should be responsible for ensuring that the organisation complies with legal requirements.

7. The duty to share information can be as important as the duty to protect patient confidentiality

Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles. They should be supported by the policies of their employers, regulators and professional bodies.

I'll leave it up to you to decide if the MyHR conforms with them.

Anonymous said...

"Oh, and she didn't say how many MyHRs have been downloaded and how much the system has saved the government"

Last week at HIC we were informed that the Myhealthrecord had 2500 document views the week before, for 4 million registered patients.

Anonymous said...

I have often wondered why the Minister never refers to My Health Record by the convenient acronym of as MyHR. I found the answer on IP Australia's database of trade marks. MyHR is owned by Hewitt Associates LLC, Illinois, so any reference to MyHR would be an infringement by the government of Hewitt's intellectual property rights which could attract substantial damages. Amazing they never checked this out before charging ahead without ensuring they had the name protected.

Bernard Robertson-Dunn said...

2,500 views per week from 4m registered patients converts to 3.25% over a year. A bit simplistic, but order of magnitude.

It's also quite close to the number of health summaries in the system (182,615 as of 17 July)

Do we know what a "document view" is? Is it the same as a download of data?

If a GP updates a MyHR does that count as at least one document view?

Would be nice for them to be a bit more transparent.

Anonymous said...

Those 4M registered patients should represent about 22M patient encounters per year based on the average of 5.5 visits per person per year. That's about 420,000 per week with 0.6% of that number possibly accessing the My Health Record (2500/wk). Even assuming they have an uploaded health summary it is only about 13% utilised per week (2500/(182615 * 5.5 /52)). It could take 8 trips to the GP before someone (including your GP) checks your My Health record. It seems it would take a lot longer before a GP uploads/updates a My Health record. The usage does not match the usage required to generate $M's of savings far less the promised saving of $B's. The real impacts and resulting savings of a fully used record remain untested.
~~~~ Tim

Bernard Robertson-Dunn said...

Well said, Tim.

One question to add:

Why would a GP you've already seen access your myHealthRecord? If (s)he is your nominated representative, all the data they need is in their (the GP's) record system.

There's a lot of Truthiness going on in the Department of Health and ADHA.

To save you looking it up:
"Truthiness is a quality characterizing a "truth" that a person making an argument or assertion claims to know intuitively "from the gut" or because it "feels right" without regard to evidence, logic, intellectual examination, or facts."

It was Word of the Year for 2005 by the American Dialect Society and for 2006 by Merriam-Webster.

Anonymous said...

August 01, 2016 12:03 PM It's not the first time the Department has failed to do due diligence and check whether the brand name is available for registration before prematurely starting to market it.

Bernard Robertson-Dunn said...

How to game the ePIP

$50k for 200 keystrokes per quarter on ePIP? Get typing!

Medical Director’s ePIP tool simplifies the new ePIP incentive so much you can earn about $42.50 for each tap of your keyboard


The issue now is, what actually is getting uploaded in a health summary? There are no quality protocols and standards protocols for a health summary upload. You just have to upload one.

The variability between practices is likely to be huge and as such it will potentially soon be another issue for the beleaguered MHR program. And even if doctors do upload well documented and reasonably standardised summaries, then the patient can alter it themselves if they don’t like what they see anyway.

The MHR has a long way to go, incentives or not.