Wednesday, November 08, 2017

The Voice Of The ADHA CEO From India Reveals An Switch In Emphasis Or Does It?

This appeared last week.

Better use of technology should be the first priority for any healthcare service provider: Tim Kelsey

The cost on society of a paper based health service is enormous, the inefficiencies are tremendous, clinicians find their administrative burden takes them away from those crucial moments in which they can counsel their patients.
October 31, 2017, 08:13 IST
interview with ETHealthworld, Tim Kelsey, Chief Executive of the Australian Digital Health Agency, talks about the role of technology in expanding healthcare services. Edited excerpts:
About Australian Digital Health Agency
The Australian Digital Health Agency was setup in July last year and the intention by all the governments of Australia was to harness the power of modern information revolution to empower and enable clinicians to offer the industry, entrepreneurs and innovators a new platform for delivery of new services for patients and citizens and to provide citizens with new ways in which they can engage with the health and wellbeing. The agency has recently had the new national digital health strategy approved by the governments of Australia and that calls out seven key priorities for Australia.
Programme priorities
The first of these is a programme to give every Australian citizen a personal mobile health record which they can access through the mobile telephone. They can access online, which they can share with their clinicians if they choose to. The programme will have given all Australians access to by the end of 2018 unless they choose not to have one. So, that’s the priority and new strategy.
The second priority is around providing clinicians, doctors, nurses and allied health professionals with tools that enable them to communicate securely with each other without the fax machine, to avoid paper based healthcare. India & Australia have in common the challenge of ending the age of paper based healthcare and delivering digital services that’ll enable to secure real time communication between clinicians at the frontline of delivery.
‘My Health Record’ is a summary of a person’s health information; it includes the medication history, pathology reports, radiology reports and many other items of information. It’s not a comprehensive EMR type presentation of information instead it has the summary of a person’s health information accessible online through their mobile telephone, something that is shared with their clinicians. It’s quite different to the concept of an electronic medical record, say in a hospital or in general practice where you have fully comprehensive records of a person’s medical history. ‘My Health Record’ helps the clinician treat the patient to identify key history that’ll help them to prevent an error and improve the outcome for that patient.
Lots more here:
Assuming the reported heard Mr Kelsey correctly I find it interesting that a mobile personal health record is the ADHA’s highest priority.
One can only assume that what this is as an access mechanism to the myHR which will mean all the content, currency  and data integrity issues remain.
In the National Digital Health Strategy (as the first point) the following is found:
1. Health information that is available whenever and wherever it is needed.
By the end of 2018, every Australian will have a My Health Record, unless they choose not to. By 2022 all healthcare providers will be able to contribute to and use health information in My Health Record on behalf of their patients, providing potentially lifesaving access to reports of their medications, allergies, laboratory tests and chronic conditions, and supporting significant improvements in the safety, quality and efficiency of healthcare for the benefit of individuals, the healthcare system and the economy. Patients and consumers will be able to access their health information at any time online and through mobile apps.
----- End Extract
So it seems this is due for 2022 and is what is being discussed is in the last sentence. I rather think most GPs will be offering mobile direct access to their live credible EMR records long before this occurs.
I certainly know what I would prefer to access!


Anonymous said...

It maybe as simple as playing to the audience, India like many countries that have rapidally modernised are Majority users of mobile devices. I would support India is approaching Tim Kelsey to work directly for them, might be the best money of ours he has spent.

Anonymous said...

It maybe me, but the ADHA crew do seem to be acclimating a lot of international travel, wonder how much this all cost us tax payers and what trade it bring back and what commercial doors is it opening for Australian businesses

Anonymous said...

"Patients and consumers will be able to access their health information at any time online and through mobile apps."

He missed something out. What he should have said is:

"Patients, consumers and the government will be able to access their health information at any time online and through mobile apps."

Oliver Frank said...

It's good to see secure electronic messaging listed at least as the second of ADHA's priorities.

I hope that Shahid Akhter's report that Tim Kelsey said that: "‘My Health Record’ is a summary of a person’s health information" results from a misunderstanding of what Tim actually said.

A person's My Health Record is a collection of documents that *can* and *might* include a Shared Health Summary. Currently a small minority of people's My Health Records contain a Shared Health Summary, which means that most people's My Health Records contain no summary of any kind at all.

Peter said...

I am struggling to think of a scenario where a person might wish to access their health record through a mobile phone.
Apart from curiosity, what use is the MyHR summary to an individual outside a consultation. Are you going to be sharing it friends at a party? And mobile devices are usually for things that you might want to refer to either while away from other access channels, or quickly without prior notice. Neither of which is likely to be a prime use-case.

Anonymous said...

At least the ADHA has a few medical folk at hand if they get a splinter scratching the bottom of the barrel. We do seem to be running dry on plausible grounds to invest.

Anonymous said...

9:19 AM You should stop complaining while the MSIA supports the ADHA. What more do you want?

Anonymous said...

Oliver, as a remunerated ($25,000+) Member of the ADHA Clinical and Advisory Committee, what are you and your committee doing to make "A person's My Health Record' relevant.

As you say "most people's My Health Records contain no summary of any kind at all."

Oliver Frank said...

In reply to Anonymous November 09, 2017 9:35 AM:

Certainly advising the Agency about how My Health Record can be made most useful is within the scope of the charter of the Clinical and Technical Advisory Committee to the Board:

"The Clinical and Technical Advisory Committee will:

provide advice to the Board about the efficient and effective delivery of clinical care using digital health;

provide advice to the Board about the architectural integration of digital health systems;

make recommendations to the Board in relation to priorities of investment in, and development and implementation of, national digital health systems;

provide advice to the Board on changes to digital health system design to improve clinical useability and usefulness based on experience with the use of digital systems;

provide advice to the Board on proposed innovations and measures to improve the efficiency and effectiveness of digital health systems for clinicians and users of the system."

It is important to note that this committee is only advisory, and has no role or authority to make things happen. I have certainly had some things to say about My Health Record.

Since I was appointed to the Committee in February 2017, according to the information that I have just checked in my records, to date I have been paid $2,291 before tax for my work for the Committee. Where did you see that members of the Committee are being paid $25,000?

Anonymous said...

Where did you see that members of the Committee are being $25,000?

My apologies. I may be wrong. I have checked " Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016 Federal Register of Legislative Instruments F2016L00070 " and also checked Remuneration Tribunal "Remuneration and Allowances Determinations". Somewhere however I do recall receiving a document that indicated $25K but cannot locate it now. Again, my apologies, I may have been wrong but somewhere there is a document that clearly states how much Committee Members can expect to be paid.

Anonymous said...

@ 1:34 PM Yes - I think you have confused Board Members with Committee Members. Here are the rates for Board Members.

Rates are effective from 8 December 2016 unless otherwise specified:
Australian Digital Health Agency Board
Chair $112,290
Member $56,150
A Member of the Board who is appointed to Chair a Standing Advisory Committee is entitled to an additional fee of $10,000 per annum.

Anonymous said...

None of those remuneration figures seem unreasonable, in fact the advisory seems low, noting I am not aware of how much or how little commitment was provided to reach that figure. The cost/benefit would be in the usefulness of the advice and if sound advice is acted in. Either way it is a side issue and simply a distraction from the main debate, which I am finding very informative. What is missing is the system operators viewpoint.

Oliver Frank said...

Minor possible correction to my comment above about most people's My Health Records containing no summary of their health status:

The new Medicines View:

sounds like a a summary of sorts, just of the patient's medicines. As I understand it, having not yet seen one, it is an attempt to bring on to one screen all of the patient's medicines listed in up to eight (according to the info on the Web page above) different types of documents.

Others might and probably do know more than I about this.

Bernard Robertson-Dunn said...

This is what it says in the Medicines Preview

"To assist you to find medicines related information in this My Health Record, previews are provided of medicines related information in documents (where available) with links to the source documents where more detailed information can be obtained.

Important: Some documents do not allow for a preview of medicines or allergies and adverse reactions information and should be opened by the links provided. This view should not be wholly relied upon as a complete record of medicines or allergies and adverse reactions information.

Note: To print all the information in this view please select 'Show All' first and then the 'Print' button."

My comments:

"more detailed information" is misleading (at least in my case) as all it does is repeat the same (very limited and non-clinically useful) information as in the preview. What it doesn't give is the reason for the medication or any instructions (i.e. if and when I'm supposed to take it).

One of the documents it found is a discharge summary (I had some tests in a hospital) but there is no medicine information in the discharge summary.

In fact all the discharge summary says is "See attached Discharge Summary document" but there is nothing attached, neither can I find it anywhere in my MyHR. Considering the discharge summary is the only document in MyHR it's fairly obvious that the real discharge summary hasn't been uploaded.

So the only information in MyHR is some data regarding various visits to health care professionals (but no information about why, or how different visits might relate to one another) and some prescriptions (but no information about why I have been prescribed these medicines) and that I have been discharged from a hospital (but there is no indication of why I went to hospital or how it might relate to anything else in my MyHR.)

Compared to the data in my GP's system (which I have a copy of) MyHR is both trivial and misleading. And my GP's system contains only a proportion of my recent medical data.

Not only that, but the medicare/PBS data is missing a swag of data because I had a major operation a couple of years ago that was paid for under a medical liability scheme.

If I want MyHR to contain a true summary of my medical data, I would have to work quite hard to set it up. Even then there is no place for my health data.

Whatever the government claims, MyHR is not a summary of my health information and it serves no useful purpose.

IMHO, most people won't understand all this, but what they will understand is that the Federal Government will be gathering and storing their health data and will keep it forever, to do with as they see fit.

And as anyone who knows anything about big data - he who gathers the data, owns the data. Todd Sampson made just that observation in Gruen this week when talking about Amazon.