This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Quote Of The Year
Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"
Sunday, October 29, 2017
Somehow Even The August Productivity Commission Has Been Drinking The Kool-Aide!
Early last week – before the High Court upended things a bit – we had a new major report released by the Productivity Commission.
Shifting the Dial: 5 year productivity review
This report was sent to Government on 3 August 2017, then tabled in Parliament and publicly released on 24 October 2017.
This is the first document of its kind for the Productivity Commission — a look out across the landscape of factors and influences that may affect Australia's economic performance over the medium term, in order to offer advice on where our priorities should lie if we are to enhance national welfare.
Australian doctors may be less inclined than their overseas counterparts to put patients at the centre of decision-making, and the primary care, public and private hospital sectors do not collaborate enough to improve healthcare, a review has found.
In an inaugural review to be repeated five-yearly, the Productivity Commission has questioned the lack of integration and informed decision-making in health. Not only do these “fault lines” lead to substandard care and inequality, they waste hundreds of millions of dollars each year.
The findings yesterday prompted Treasurer Scott Morrison, who commissioned the review, to link the economic benefits of future health reform to better outcomes for patients.
“The pathway of patient care in Australia is all too often fragmented and plagued by poor or non-existent communication between different parts of the health system,” he said. “This veil of ignorance, where a doctor may not even be aware of significant health issues affecting their patient, can slow down the process of care, put the patient at risk, and lead to unnecessary procedures.”
The commission recommended funds be diverted to funding pools for primary health networks and local hospital networks to target problems at a local level. It also wants the Australian Commission on Safety and Quality in Health Care to drive better performance monitoring, data collection and reporting to aid transparency.
While Mr Morrison has talked up the Coalition’s healthcare homes trial and a move to electronic health records, the commission had reservations. It suggested the homes trial was underfunded and should be better connected to local hospital networks to support people with chronic illness.
It said low public awareness of My Health Records pointed to a deeper problem: “Quite apart from the structural and attitudinal changes needed to the health system ... there is a glaring gap in peoples’ capabilities for exercising more control — a lack of health literacy. The majority of Australians have inadequate health literacy, and the share is greatest for those with chronic conditions. Even 40 per cent of people with a qualification related to health have inadequate health literacy.”
I thought it was important to see what the PC actually said about the myHR.
Here it a summary… (Page 68 of the main report)
The role of My Health Record
An effective My Health Record is an important foundation for an integrated health system. The introduction of an opt-out system (compared with the initial opt-in approach) will lead to nearly universal coverage of Australians, as very few people in the trial opt-out sites chose to opt out. Given high take-up by providers, there is some promise that My Health Record can provide a central, lifelong depository for each patient’s medical records, regardless of provider, in an electronic format accessible by providers and patients.
There are compelling grounds to use My Health Record as a platform for providing clinically-proven advice to patients, rather than just as a method for collecting data for clinicians. For example, a person might be reminded of the potential need to have a vaccination or a screening test, such as a check for osteoporosis for post-menopausal women. The Australian College of Nursing supported a role of My Health Record as a source of information for self-care. The form of the advice that has the highest degree of compliance could readily be tested — the right words and the right technology (smart phone app, SMS, email, letter) — geared to the traits of the person. The clinician would ultimately be the decision maker (and their decision could be undertaken remotely in many cases). General practice could also receive online reminders. Currently, 56 per cent of Australian GPs say they routinely receive computerised reminders for guideline-based intervention or screening tests — though how often they act on these is not known.
There is some evidence of a lack of awareness by people of the potential uses of the Record. For example, only 971 people (0.002 per cent of registered users) had used My Health Record to lodge an Advance Care Planning Document, despite the relevance of such a document to all Australians. Clearly, communication of opportunity in data systems for patients is currently failing. This and other barriers will need to be overcome (section 3.2 of SP 5).
----- End Extract.
So they are pretty keen – especially for patient use of the record – which we all know has been pretty abysmal to date.
But then you find this under the heading (Page 109 of Section 5) “Things that Work”.
Integrated ICT: shared electronic health record, linked clinical and financial measures
“What it means for Australia”.
1. Invest in information technology and software for information flows throughout the system (Great idea)
2. Use My Health Record as the key patient record (WTF!)
That is all you need to read – use of the myHR as the key patient record is just rubbish. It is not and was never intended to be the ‘key patient record’. Sorry guys back to the drawing board – the Kool-Aide has got you!
Again we see bureaucratic lust for data and control overwhelm common sense. Pity about that because there is a lot in the rest of the report on pharmacy, integrated care and the like that is pretty good.
Again so called experts have gone ‘off the reservation’ on expectations for Digital Health!