Tuesday, May 09, 2017

This Was The Really Big News Of Last Week In Digital Health. What An Unexpected Outcome - NOT!

This appeared late last week.

Evaluation of the My Health Record Participation Trials

Page last updated: 04 May 2017
In July 2012, My Health Record (then called Personally Controlled Electronic Health Record) was launched. This is a secure online summary of a person’s medications, diagnosed illnesses, treatments, allergies and tests. Each person can control what goes onto their My Health Record, and who is allowed to see it. For healthcare providers, knowing more about a patient’s medical history can lead to a better understanding of what is happening, and result in better treatment decisions.

In most parts of Australia individuals need to actively register for a My Health Record. From March to October 2016, trials of different participation arrangements were run. The trials were of opt out arrangements in Northern Queensland and the Nepean Blue Mountains of New South Wales area, and innovative approaches to opt in in Western Australia and Ballarat. The aim of the trials was to understand consumer reaction to different participation arrangements, as well as healthcare provider usage and upload of clinical information to the patients’ records, when most of their patients have a My Health Record.

These trials were conducted as a collaboration between the Department of Health (the Department), Primary Health Networks, the state health departments and relevant hospital and health services. An independent evaluation of the trials commissioned by the Department of Health was conducted by Siggins Miller Consultants to look at the outcomes from these trials. The Evaluation of the Participation Trials for the My Health Record is available below. It will be used to inform future recommendations to the Government about the participation arrangements to best bring forward the benefits of the system to healthcare in Australia.

PDF version: Evaluation of the My Health Record Participation Trials - PDF 4397 KB
Word version: Evaluation of the My Health Record Participation Trials - Word 2614 KB
Here is the link:
There was a lot of coverage in the press. This was typical.

Health record ‘opt out’ trial a success

My Health Record should be opt out, says the Guild

The Pharmacy Guild of Australia has welcomed the success of the My Health Record trials which it says have confirmed the overwhelming benefits of the ‘opt out’ model involving automatic creation of patient records.
The formal evaluation of the trials, published today, has recommended that the Federal Government proceed to a national opt-out approach – a recommendation which the Guild says it fully supports.
The evaluation report says in part: “Taking all the data into consideration we can see no reason not to proceed with an opt-out approach in one national step rather than any progressive staged approach.”
The opt-out trials were conducted in the Northern Queensland PHN, and in the Nepean Blue Mountains PHN, with the final report on the trials completed in November last year. The opt-out trials included community pharmacists among the healthcare providers who took part.
When compared with two opt-in trials conducted in Ballarat and Perth, the opt-out trials achieved better outcomes in terms of participation, understanding and some aspects of use of the My Health Record system.
“The Guild has long supported an opt-out model for My Health Record as the clearest path to meaningful use of a national digital health record system,” said National President of the Pharmacy Guild, George Tambassis.
More here:
Siggins Miller have basically shown, with a few bells and whistles, that if you force a e-Health record on to people most people will be OK with that, but that there seems to be no demonstrable clinical benefits as they really were not looked for or measured as far as I can see.
Shared Health Summary uploads were closely related to the ePIP payment deadlines.
Essentially the Government got the report they wanted showing that if you create a record few will knock it back – and that most did not care one or another.
What a surprise!
David.

6 comments:

Anonymous said...

Not really a surprise at all. Just finished reading the link posted in you previous blog, recommend reading it.

This extracts seems timely:

Over the last several years, governments, insurance companies, health plans, and patient groups have begun to push for greater transparency and accountability in healthcare. They see EMRs as the best way to track a doctor's decision-making and control for quality. But the EMR and the physician are so at odds that rather than increase efficiency—typically the appeal of digital tools—the EMR often decreases it, introducing reams of new administrative tasks and crowding out care. Many EMRs are designed to facilitate the job of billing before aiding in clinical decision-making. The result is a bureaucracy that puts controlling costs above quality and undervalues the clinical intuition around which medicine's professional identity has been constructed.

tygrus said...

I'm a bit confused about the benefits and how the statistics are represented.

Table 19. "Impact of My Health Records on respondents’ clinical practice and decision making" (pg 174).

Table 23 (pg 74. Not the Table 23 on 178 or 294 just to confuse everyone).

Concern for My Health Record being useful or effective 144(39% of further comments).
Table 36 (pg 190) but I have no isea how many healthcare providers had the oppotunity to answer this question (372 gave some answer to this Q, but how many surveys ~600?, !1000?, !2000?). There are other indicators of negative views which haven't improved during the opt-out trial period.

The before and after survey indicated 64% of respondents agreed with "There was no benefit from having a My Health Record", see Table 63 (pg 147)

"There was no benefit from having a My Health Record" increeased from 10% to 15% of respondents, see Table 68 (pg 153). I haven't reviewed all the numbers but 218 (Table 69) doesn't equal 217 (12+48+84+73=217 in Table 69)

(PS: Please remove/ignore my comments from the Budget thread).

Anonymous said...

MyHR lives in a parallel universe along with Schrodinger's cat, where nothing is real and evidence doesn't count.

Bernard Robertson-Dunn said...

A little snippet from the Table 19 in the trial assessment:

My Health Record has provided confidence in clinical decision;

Before Opt-out Trials Yes 10.0%, No 90.0%

After Opt-out Trials Yes 3.5%, No 96.5%

My Health Record has led to a change in clinical treatment;

Before Opt-out Trials Yes 3.3%, No 96.7%

After Opt-out Trials Yes 1.8%, No 98.2%

Anonymous said...

These are interesting snippets, I must have missed those, where between the words recommend and proceed are these?

The right honerable minister of laziness and gullibility.

Anonymous said...

This is an overwhelming disgorging of more than 350 pages, with most of the findings providing scant support for the "highly recommended" switch to opt-out.

There's a very long list of things that need to be fixed before this approach is undertaken, but very few ideas as to how they can be achieved.

Also there's great deal of frustration and indeed disquiet with the need to use myGov as an entry portal expressed within the report's many pages. The Auditor-General has been engaged in an analysis of myGov for many months now, and if I remember correctly it was initially due to report in February.

But it's reporting timeline has been pushed out a couple of times, including most recently to June - beyond the budget, effectively.

One can only assume the auditor is having difficulty with the scale of the failures and problems to be remediated... and that's before the Govt forces the entire population onto a MyHR that can only be accessed by citizens through myGov.