Tuesday, June 20, 2017

Do You Think The AMA Is Convinced Regarding The myHR Or Is Just Waiting For It To Fail?

This appeared last week:

My Health Record – Lessons From The Opt-Out Trial

14 Jun 2017


By Dr Richard Kidd, Chair, AMA Council of General Practice
The recent Federal Budget confirmed that the My Health Record will move to an opt-out model.
While the AMA has drawn attention to the shortcomings of the My Health Record over the past five years, we have always acknowledged the potential for a well-designed and constructed electronic health record to improve patient care.
The AMA originally proposed an opt out model and the Evaluation of the Participation Trials for the My Health Record has demonstrated this is the right approach, with the evaluation report saying opt-out is the only sustainable way forward. Ensuring universal coverage with cross-sector clinical input over time will enhance the value of the My Health Record for patients, their doctors and a patient’s other healthcare providers.  
One of the clear outcomes from the trial was that once patients understood the benefits of having a shared electronic health record and the measures in place to protect their information and its use, any concerns they had about privacy and the security of their information were allayed. In fact, the trial highlighted that patients already fully expected their doctors to be sharing their health information with one another.
This is a strong signal to the profession that, whatever reservations we have about the MyHealth record, our patients want us to use it.
Not surprisingly, the trial highlighted a number of critical improvements to the MyHealth record that are needed. These go to the heart of its ease of use, utility and accessibility.
Several of the Evaluation recommendations targeted these areas and reflect much of what the AMA has been saying for some time.
Certainly, more work needs to be done to convince GPs of the merits of the My Health Record and to address its shortcomings. One of the interesting findings in the evaluation was that while most health care providers made it clear that the MyHealth record required additional time with patients, practice managers and practice nurses reported that it made the practice more efficient with less need to chase information from patients and other health care providers. This represents an interesting tension, given that GPs are not funded for this effort. My view, along with the AMA, is GPs need to be properly funded for this work.
The evaluation report contains a number of recommendations on ‘strategy’ to increase uptake and use of the My Health Record. These particular recommendations, which touch on funding mechanisms, are vague and unclear but seem to suggest making use of the My Health Record a requirement for funding. This approach has delivered very mixed results in relation to the PIP e-health incentive and there is no way the AMA would support any change that linked the use of the MyHealth record to patient rebates.
I was pleased instead to see Health Minister Greg Hunt, at the AMA National Conference, say he intends to explore “real incentives to assist the medical workforce in their work”. The profession is looking for support, not punitive approaches that can impact on doctors and their patients.
Over time, we can expect that utilisation of the My Health Record will be woven into standards for practice and accreditation across healthcare, from general practices to hospitals (public and private), to pharmacies and other allied health service providers, and to aged care facilities. Obviously, the AMA’s role is to ensure that this does not happen until we have a clinically useful system.
Digital health will become a key part of future undergraduate and postgraduate training programs, meaning supervisors like me will need to ensure that we too are up to speed.
With more useful content being added to the record such as patient medications, pathology and diagnostic imaging reports, and discharge summaries, the more valuable the record will be for doctors and the patient’s care. In my view, the value of the MyHR could be further enhanced by enabling the uploading of other documents where useful such as Care Plans, including Advance Care Plans and Advance Care Directives. This would help ensure the manner of a patient’s care, particularly if away from home, aligns with their agreed goals and stated preferences.
Changes such as these, along with the reality that the vast majority of Australians will have a record created, should remove some barriers for engagement and facilitate greater interaction.
The AMA will continue working to ensure the My Health Record fulfils the promise that an effective shared health record can deliver.


Published: 14 Jun 2017
Here is the link:
Read closely and I think they are saying they need serious payments to use the system and that they are still to be convinced that the system is clinically useful.
They are also, sotto voce, concerned that there may be pressure to use a system for the sake of using a system and unrelated to clinical benefit, and that this is not in their interest.
My take is that they are sitting on the fence at best – what do you think?
David.

4 comments:

Bernard Robertson-Dunn said...

re "One of the clear outcomes from the trial was that once patients understood the benefits of having a shared electronic health record and the measures in place to protect their information and its use, any concerns they had about privacy and the security of their information were allayed."

"...the benefits of having a shared electronic health record..."

Unfortunately, MyHR isn't a real shared electronic health record therefore the benefits claimed are spurious.

It seems to me that the AMA does not understand this any more than does ADHA.

IMHO, the real proof will be the number of GPs/specialists who actually use it (and gain value, not just mechanically upload stuff to get ePIP money) as well as their normal point of care health record systems.

Anonymous said...

The AMA is in a sweet spot, if they say nothing and it succeeds all good they can claim they supported, when it starts to crumble they can say they are sticking up for their members. This is a simplistic example and AMA is a political machine that should treated with the greatest respect and handled with extreme care. I am sure they will nudge out a couple of high profile members to claim this or that is great just to keep the pot boiling.

Anonymous said...

My biggest concern is the leadership of the ADHA, all very nice people but it does not sit well with me as a consumer the track record of those running the MYHR. From what I read from the UK there is a lot to be concerned about and I do not sense there is any notion what was done was woeful and deceitful, not a lot to form basic trust.

Trevor3130 said...

Yesterday I helped someone fill out the on-line preadmission guff for an elective booked at Epworth Eastern. It was 5 pages of every last little detail including some matters we'd never considered. Fluffing back and forth to look up various items it took 40 min instead of the advertised 20. And we are not total novices, either. I suspect all that data would be required again, for any procedure booked in the future under the same or another surgeon. It may have been easier to print the forms, check the boxes and send by post. At least, that's the option. If we did it the analog way I can't imagine Epworth would be paying a data entry clerk to pump our data into their digital system. That's where health records is now, and that's where it will stay, unless there's a mighty push from [somewhere].

Anyway, today I responded to an article at The Conversation on obesity and sugar tax. I wanted to know if the writer was able to access (any) actual records that would show obesity contributes to the outlays required for knee replacements. From the response, it seems not.

That pre-admission form (above) asked for measurements of height and weight. I guess we'll find out if Epworth admissions do their own scaling, since accurate weight is important for anaesthesia. We do not expect to be challenged to send our data on to MyHR.

One may think that accurate body weights are an important part of the equation for doling out public health money that's intended to reduce the unwanted outcomes of obesity, like clapped-out knees. Maybe I'm dreaming, but that can't stop me thinking of a range of perverse incentives lined up against preventative health, and any kind of useful national health data summary for citizens.