Thursday, April 20, 2017

I Wonder Why Discharge Summaries Are Not Discussed With The Patient Before Being Uploaded To The myHR.

This blog appeared last week:

My Health Record in General Practice

Monday, 10 April 2017
Dr Steve Hambleton, MBBS FAMA FRACGP (Hon) GAICD
Follow Dr Steve on Twitter @SteveJHambleton
Amongst my other roles, I've been a GP at the Kedron Park 7-Day Medical Centre in Brisbane for the past 29 years. Many of my patients have been in my care for a long time and I know them very well but I cannot be there for them every day. Like a lot of GPs who have been in the same practice for a long time, I mainly treat people with chronic and complex disease.
I believe one of the responsibilities of General Practitioners is to facilitate patients’ interactions with the health system as a whole, and it’s particularly important for those with chronic ailments. For this reason, I am an early adopter of My Health Record – the secure, online digital summary of a patient’s pertinent medical information, including diagnosis, outcomes, medications, reactions and allergies.
The benefits of the My Health Record cannot be understated. One of my patients with a list of chronic diseases – heart disease, Parkinson’s disease, peripheral vascular disease, kidney disease and chronic myeloid leukaemia – was recently taken to a Queensland public hospital with an acute deterioration in his heart condition. As a result of his various illnesses, the patient had several different specialist doctors attending him, and each of these doctors was able to consult his My Health Record for information on his latest treatments, medications and outcomes. These details informed their own treatment plans. Ultimately, everyone involved, and particularly the patient, benefited from having all of his crucial medical information stored in one accessible digital file avoiding duplicate testing and the inevitable phone calls needed to find bits of information from multiple sources.
Another example benefit of My Health Record adoption involves the automatic inclusion of a patient’s hospital discharge summary. I’ve had patients come to see me so soon after a stint in hospital that their discharge summary hasn’t had time to arrive. Although sketchy on the details, my patient recalled that there were changes in their medications which I should to be aware of. In the old days, I’d have had to chase up the discharge summary, or call the hospital pharmacy, wasting time and resources. Now I can simply check the patient’s My Health Record, which in Queensland public hospitals, now usually contains a recently added copy of the summary that includes all the relevant information – a streamlined system in which, once again, the patient wins.
More here:
Note the last paragraph mentioned: I was given a copy of the discharge summary from my last admission and at the time I said to the intern not to upload the Summary. She had not heard of the myHR etc. so was more than happy to comply.
A day ago I checked and somehow it had been uploaded as there as one detail I was not happy with.
Seems to fascists have taken really taken over.  Looks like automatic does really mean automatic despite consent being specifically being denied.
Might make a call or two and see what is going on.


Anonymous said...

A case of uploading photo to iCloud is not the same approach for eHealth. There is a technical void in ADHA David

Terry Hannan said...

In my situation I do not use the MyHR but all (or nearly all) are given a copy of their record with an explanatory note as to why I do this. The same copy is sent to the GP/Referrer and in my hospital is digitally scanned into the 51 million plus pages of scanned documents in the Digital health record.
The GP, patient or carer can choose to have the record (encouraged) by e-transmission with measures for confirmation of their receipt.
The patients are encouraged to take it with them everywhere and if possible store it on their e-devices.
The patient/carer of GP can add to the record and have direct communication with me via email or phone [Research by Sands shows the number of nuisance calls or communications with this model is leas than with the paper record].
ALL communications are added to and stored IN the record -eliminates ambiguity of communication.
So where should the record be stored and kept for access? With the creators-docs and patients/carers.

Anonymous said...

Will be inspiring to watch how the ADOHA ladies club makes a 'we are doomed without MyHR' from this

Anonymous said...

Does anyone else find it odd that all these blogs there is not one comment. Not exactly demonstrating an organisation focused on creating a community of inspired followers and partnerships

Anonymous said...

Interesting observation 9:37 PM. There are no comments on any ADHA blogs and I checked maybe 80%. Not exactly inspiring stuff. Would be a failure in any other organisation, however ADOHA (which seems a fitting acyrom posted by others), will turn this around as success as the quality leaves the reader fulfilled and speechless.

Personally the MyHR is the problem for these folks, that and some very poor employment choices.

Anonymous said...

For those still interested in the strategy I found this little hidden gem when looking at how engaging (and therefore valuable) the ADHA blogs have been.

Scroll down to a survey:

How could the use of digital services such as health apps best be managed?

Seems pretty clear apps need to be approved by clinicians, supported by evidence, and not but Government, the ADHA being government that counts them out. So much for Rachael De Sian and the Planet of the Apps. Unless of coarse these surveys and the results count for nothing.

Trevor3130 said...

I tried to append a comment to one of the ADHA blogs the other day. Went thru the registration process, responded to the email, etc. Got into the comment space, wrote it in, pressed 'Submit' ... several times without any noticeable effect. Gave up, won't go back.

Anonymous said...

Dear Doctors More, Frank, Hannan, Colclough, McIntyre and others including many other learned commentators to this widely read informative blog. Please take careful note of Dr Hambleton’s blog on the ADHA website “My Health Record in General Practice”.

Dr Hambleton describes in compelling detail how he has been using My Health Record to manage a patient with multiple chronic diseases, “heart disease, Parkinson’s Disease, peripheral vascular disease, kidney disease and chronic myeloid leukaemia”.

He tells how his patient was taken to a Queensland Public Hospital where several specialist doctors attended him and AND EACH of these doctors consulted the patient’s My Health Record for his “latest treatments, medications and outcomes” thus informing the specialist doctors own treatment plans. He also observed that everyone involved, particularly the patient, benefited from having all the patient’s crucial medical information stored in one easily accessible digital file. This avoided duplicate testing and multiple phone calls to find bits of information from multiple sources.

From this we can deduce that Dr Hambleton uses the My Health Record routinely when caring for those of his patients who are registered. He also points out that the colleagues in his practice can also see the new information (when needed) – whatever that might mean. One has to assume that the practice also has a shared health record on its computer system which his colleagues can also access when needed.

You should be asking that if Dr Hambleton can so readily do this today why then are all doctors not doing so?

Anonymous said...

April 24 12:02 PM. That is a valid point and Dr Hambleton does seem to demonstrate a use case, however does it justify a central document store? Or can the same effect be achieved using more modern methods. We also don't get a viewpoint from those specialists. However, always good to see examples where this works for clinicians, maybe we should refocus its use back to those I trust to understand health information and less on 'citizens'

Anonymous said...

Trevor, perhaps you need to fax it on a PDF?

I tried as well, a bit sloppy from Timmy the communication king, perhaps stick to limited text twitter.

Andrew McIntyre said...

Having accurate reliable information on a patient is essential. There are many ways to do this, but normally a patient has this information in a referral, which should be current. The centralized database does nothing to ensure currency and is a round about way of achieving the aim. Its not to say that it can't work but would not seem to be the optimal path. The optimal path is sharing information as appropriate, on demand in an atomic format, that is known to be current and only sharing with the appropriate clinicians.

john scott said...

Absolutely agree with Andrew.
We need a Communications paradigm not a Medical Records paradigm at the very heart of e-health thinking and acting.

Only in this context can we begin to work out appropriate and acceptable information flows; information flows that are the difference that makes a difference to care and uphold medicine's duty of care AND address the privacy as well as medico-legal issues associated with electronic data flowing within and across the various boundaries of health.