Quote Of The Year

Quotes Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, December 03, 2017

AusHealthIT Poll Number 399 – Results – 3rd December, 2017.

Here are the results of the poll.

Would It Be Preferable If Patients Accessed Their Electronic Health Records From A Portal Provided By Their GP Rather Than Via The myHR?

Yes 85% (104)

No 5% (6)

I Think Both Are Needed 2% (3)

I Think Neither Are Needed 5% (6)

I Have No Idea 2% (3)

Total votes: 122

Any insights welcome as a comment, as usual, especially regarding where it should go from here! It certainly seems there is definite belief that the myHR is not the way to go for patient health information access.

A really great turnout of votes!

Again we note three respondents who are clueless!

Again, many, many thanks to all those that voted!

David.

10 comments:

Anonymous said...

The design is just outdated, yes perhaps some want access to their information, many I am sure trust doctors, nurses, specialists etc to be able to interpret medical information, understand and action it appropriately. Is there a case for information technology as a supporting tool? Very much so but I struggle to find a reason. As a case in point I am sure you could find just as many ‘positives’ for a fax that saved someone, a paper script that was identified as being incorrect. These little ‘stories’ the ADHA push out are weak at best.

Anonymous said...

Correction - Very much so but I struggle to find a reason ‘for the Governments HR system’

Anonymous said...

MyEHR is like a giant virtual fax machine. You ask for a summary and it will fax you 500 pages of text so you can wade through all the drivel to find what you want. If you find it then you manually transcribe that information into your own system.

Wow, what a great design!

Anonymous said...

The humble fax, served us well. I wonder if the fax creeps into the ADHA narrative so repeatedly is because it is a technology they are familiar with, don’t they understand how it works, the statdrds it is based of or the many other standards/protocols that surround it, but it looks cute in their document and is safe for the CEO to brandish about as the ainto eHealth symbol. Sadly even. The bonfire of the faxes is not original and was picked up from a slide in the UK from many years ago.

Like the cancer registeries the optout will be many years from completion and when the rush the minister it will fail in some major way

Anonymous said...

@8:29 AM It is quite misleading to suggest "the design is just outdated". The design was never appropriate from the outset which has nothing to do with being outdated.

Bernard Robertson-Dunn said...

@9:21 AM " The design was never appropriate from the outset which has nothing to do with being outdated."

Agree.

If the future of healthcare is patient centric that means the health care system needs to be GP centric. Therefore the data needs to be with the GP, not the government.

And the government having the data will only distort the system, thus making it less viable as a source of medical data for health care professionals.

And the architecture of the system should start from the perspective of data and data flows, not functionality or "concept of operations", which is frequently used in by the military.

Anonymous said...

I guess that would depend on what the design was/is intended for. I can’t work that out anymore.

Bernard Robertson-Dunn said...

This is long winded response to the @ 2:42 PM commenter “I guess that would depend on what the design was/is intended for.”

In 2005, the RAND corporation published an article: “Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs”

This is the abstract “To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.”

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.24.5.1103

Unfortunately these technologists, management consultants, bureaucrats and governments did not understand that you cannot apply IT (actually, it’s not IT it’s automation, IT is only the mechanism) to health in the same way that it has been applied by the authors of the article. Health care is not high volume, highly repeatable industrial processes.

We’ve suffered from the consequences of the errors in this paper ever since.

If you look at the RAND report you can see two things:

The authors are management scientists, an economist, a policy researcher, a senior management systems analyst and senior consultants at RAND Health.

It was sponsored by Cerner, General Electric, Hewlett-Packard, Johnson and Johnson, and Xerox.

When I asked the RAND corporation if any further research had been conducted by them to identify why the predictions were so much in error, and suggested they might conduct one, this was the response

“Unfortunately, RAND has not conducted an evaluation like the one you proposed. We would be very interested in the answer to this question, but have not to date obtained research funding to study it. I am aware of many hypotheses as to why health IT implementation has not achieved the productivity gains hoped for, but not rigorous measurement of actual productivity changes or tests of the hypotheses.”

Of course no research has been done; nobody from the technology or health care vendor sector is interested in identifying reasons why applying IT to health care has failed. And bureaucrats and politicians are only interested in the sorts of certainties people selling solutions are too eager to peddle.

So, what was the design intended for?

The PCEHR was intended to be an IT solution to medical record automation. It was done without understanding the broader context of health care.

There are two problems with this intention.

1. Automating medical records does nothing to enhance health care. It's much more complex a problem.

2. It actually makes it worse if done badly, which is what PCEHR/MyHR does. The data is poorly managed, is incomplete, is fragmented, is owned by the government - not health care practitioners, is unreliable, is an invasion of privacy, and is a drain on those who are supposed to upload data, making sure the whole record is consistent (which is what GPs are supposed to do, according to myhealthrecord.gov.au)

If all this sounds somewhat negative, I’ll try and be a little more positive:

I am positive that what the government is currently doing is the wrong thing. The sooner it is persuaded of this, the better.

Anonymous said...

I came across whilst reading the Sunday Telegraph yesterday, a rebuff from the ADHA CEO on claims the MyHR was not at risk of placing medical records on the net. I do love they way he constantly dares hackers to have a go. The claims are fair on both sides but let’s face it nothing is totally secure if it is accessible

Bernard Robertson-Dunn said...

Talking about Tim's letter....

In his letter to the editor Tim says: "It is a criminal offence for anyone other than a registered clinical professional to access a patient’s My Health Record"

If we look at the government's website:

https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/healthcare-providers-faqs?OpenDocument&cat=Healthcare%20Providers

it says:

“I am a General Practitioner, can my staff access a patient’s My Health Record if I am at hospital and not at the clinic?

Yes. The staff at your Healthcare Provider Organisation can access My Health Records as long as they are authorised users, even if they do not have an Healthcare Provider Identifier-Individual (HPI-I) identifying them as a healthcare provider. The My Health Record system entrusts a participating organisation to grant access to ‘authorised users.’ An authorised user must be an employee who has a legitimate need to access the My Health Record system as part of their role in healthcare delivery.

When authorised users without a HPI-I access the My Health Record system, they are only permitted to access the records of patients with whom they are involved in delivering healthcare services. All access to the My Health Record system is with the patient’s initial consent and is audited. Authorised users without an HPI-I cannot be listed as the author of a clinical document submitted to the My Health Record system.”

So it would seem that a medical receptionist, who is not a registered clinical professional, could be an authorised user, playing a role in healthcare delivery and therefore entitled to access a patient's My Health Record on behalf of a GP.

Question: Is Tim's statement correct?