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

Sunday, December 10, 2017

I Am Getting The Feeling Things Are Not Going Well With The Roll-Out Of The myHR and The ADHA.

Why do I think this?

First the poll published earlier today makes it pretty clear that the confidence of the savvy audience in this blog that the myHR will be a success has pretty much evaporated.
See here:
Second we are seeing furious defensive reactions of the ADHA CEO to critical articles in the popular press, which are based on interviews with AHDA staff, being published. I am told this correspondence is being circulated to virtually every editor in the country while some odd claims are being made.
See here:
The letter does not seem to me to be 100% accurate.

As an example of probable error, from the letter:
“My Health Record requires each clinical professional to have unique identity credentials as well as conformant clinical software to open a My Health Record. This is not available to any medical receptionist. “
Last time I looked many practices used practice wide certificates that allow virtually all practice staff access to the myHR and that the Department has no real way of knowing who in a particular practice is accessing the myHR via that credential.
This is confirmed here:
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.”
Here is the link:
So anyone a practice authorises can access relevant records.
Also note that the myHR is internet connected (be it open or closed – whatever that means) and is so subject to breach – security experts say when not if. I tend to agree with the experts.
As for this:
“My Health Record places Australians in control of their healthcare and gives authorised healthcare providers secure digital access to key health information at the point of care, wherever that may be. Benefits include reduced hospital admissions, reduced duplication of tests, better coordinated care, and better informed treatment decisions.”
We have been waiting for evidence that this is true for 5 years and just saying it does not make it so!
Third was are seeing all sorts of non-technical people lined up to assist with getting more users.

Consumers’ voice drives digital health

7 December 2017Media release
Health consumers are central to the design and delivery of a digital transformed health sector and the ongoing development of My Health Record, a digital system that enables improved safety and quality of patient care.
A Memorandum of Understanding signed between the Australian Digital Health Agency and the Consumers Health Forum of Australia (CHF) will ensure that digital health solutions are consumercentred and advance the efficiency, quality, and delivery of healthcare in Australia.
“Our unique partnership with the Australian Digital Health Agency will ensure health consumers have a real voice in developing Australia’s digital health capability. “Importantly, the MoU supports the national effort to promote increased use of the My Health Record system by consumers and carers,” CHF CEO Leanne Wells said.
More here:
Note the sentence I have bolded.
Fourth there is increasing recognition that the current myHR is close to being past its use by date in its present form and will either need to be expensively re-developed / replaced or abandoned.
Last it is becoming clear that the roll-out of opt-out is only likely to be completed around the same time as there are cheaper and better ways to provide patient access to their data in the next 2-3 years rendering the entire effort redundant. (Think maybe the NBN and 5G). Also think the movement of GP Systems to the cloud.
To me the myHR is an idea (now 7 years old) whose time has passed.
What do you think?
David.

33 comments:

Bernard Robertson-Dunn said...

David,
I agree with all you've said.

I'd add that the idea that the government can attempt to grab Australian's health data that could be used for their own internal use was never a good one, even as opt-in. Making it opt-out is quite likely to result in disquiet among the population.

No amount of privacy legislation, secondary use frameworks etc etc will stop agencies with the power to access almost any data they wish to do so. The only defence is to not let them have it in the first place. If there are valid and over-riding reasons why they need access to such data, they can go through the courts on a case-by-case basis and justify it. Access should be difficult.

The government has been very open about making health data easier to access; where they haven't been totally honest is that they they are the ones who would gain most, and for no good clinical healthcare reasons.

Any solution that keeps the personal health data out of the hands of faceless bureaucrats is more likely to succeed.

Anonymous said...

The ADHA is on the verge of imploding David, some areas already have. There are value posters and culture initiatives that smack of hypocrisy. Openness and transparency are lifted about but the truth is you say nothing for fear of being put on certain people’s “list”.

It is a shame a few poison the well, and recruit “friends” from backgrounds with no experience in Health, Health IT or Government. Fortunately I am not under their direct reporting lines but do feel for those who are.

Anonymous said...

Never been to clear what the CHF is or what makes it think it is the voice of the consumer, are the public the consumers? Or healthcare workers?

Anonymous said...

Hi David, could you or any of the readers provide a link to the telegraph article? I do a search and it does not seem to be avalaible anymore.

Thank you

R. Abbotts.

Anonymous said...

7:31 AM Dear Tim must have scared the Sunday Telegraph's lawyers. "Provide us with the evidence to substantiate the unfounded claims in your article or we will sue you".

Anonymous said...

Syndicated copy here of Dunlevy article.

http://www.weeklytimesnow.com.au/news/national/privacy-groups-outraged-over-failure-to-inform-aussies-about-a-new-government-health-record/news-story/5d1c7f980de28966d3ede764ae875cb6

Anonymous said...

I cannot find the article either, seems an odd thing to have removed from history. Not exactly a good look for the Agency or Government. If their are alternative views should we not embrace these and work through them openly? Rather than through lawyers? What really is going on?

Anonymous said...

10:21 AM. Yes it does create an atmosphere of suspicion and mistrust. But it is a pattern, take this blog, the number of readers and poll numbers is significant. As a case in point, the ADHA or others fill a room with a hundred or so people, they base future direction on the “yes tally-ho” contingent, there is clear evidence that there are significant numbers of the community saying, “holdup, let’s have a good think about this, we maybe heading in the wrong direction” but that is slammed as naysayers and completely ignored, why is that?

Anonymous said...

"Consumers support the concept of an opt-out model for the My Health Record system,” Minister Greg Hunt’s explanatory statement to the My Health Records (National Application) Rules 2017 says.

And which consumers would they be then? No-one I've ever spoken to even knows it exists, let alone that they can opt-out!!

Anonymous said...

It's called confirmation bias - cherry picking the evidence.

Anonymous said...

The more money the 9 jurisdictions give the ADHA to spend the more problems they can deliver.

Anonymous said...

"The more money the 9 jurisdictions give the ADHA to spend the more problems they can deliver."

This nails it I think. All along the government has made pots of gold available and attracted the professional money miners who know how to charge a lot and deliver nothing. The sooner the money supply is cut off the sooner real eHealth can start to use existing solutions to incrementally evolve the environment.

Anonymous said...

8:27. I hear what you are saying but I do believe the ADHA makes significant contributions. It has its own internal issues and as many know transferring from commercial invironments that are not related to health or government can be a struggle. This is very evident at the moment and those feeling the strain are taking it out of staff. I guess this is no different to other organisations and nothing will be done, it is just sad to see happening.

Bernard Robertson-Dunn said...

"The more money the 9 jurisdictions give the ADHA to spend the more problems they can deliver."

Wouldn't it be better if they tried to understand the problems and delivered workable, effective solutions?

All they are doing is creating more problems.

Anonymous said...

9:09 AM Problems, what problems. The latest goodnewsletter #Share is a ripper.

Welcome to the second edition of #Share

Digital health will be further transformed next year with the implementation of the Framework for Action which delivers the priorities in Australia’s National Digital Health Strategy – Safe, Seamless and Secure. Providers, consumer and industry leaders, researchers and the governments of Australia are currently being consulted on the Framework for Action.

Don’t miss out enroll today. Enjoy all the benefits available to you and your family with Australia's My Health Record - leading the global revolution in Digital Health - putting health information at each patient's fingertips - showing the world how.

http://news.digitalhealth.gov.au/m/1/37777925/02-b17347-cb5db813be1a42f1a097daecd5de5ccf/1/548/3ca2d77b-1ded-4785-9fa4-45fcd5a65a63

Anonymous said...

It's like watching children at play.
ADHA still hasn't explained why every Australian needs a my health record as well as their GP's medical record. Some may get some benefit (which could be got from accessing their GP record directly) most won't get anything out of it.
The proof of a pudding is in the eating. So far nobody's eating.

Anonymous said...

@2:%$ PM .. Why? So they can see all their health information in one place. Why? So their doctor can look at it? Why? Because the hospitals are going to stop sending discharge summaries to the patient's doctor so that the doctor will have to use the MyHR to access the only available copy of the hospital discharge summary? Why? Because the hospital won't have to keep track of all those bothersome GPs who keep asking for a discharge summary - go to the patient's MYHR doctor and look for yourself.

Anonymous said...

And if the GP looks and finds no discharge summary and incorrectly diagnoses or treats a patient which results in harm to the patient, where does the medico legal responsibility? Is the national operator accountable?

Anonymous said...

8:46 you paint a bleak future. One where healthcare professionals are simple data entry clerks, the health system becomes a cold place much like a meat factory.

Anonymous said...

Rather than describe it as 'bleak' I would call it a disruptive transformative picture for which AMA and RACGP have consistently shown their support in submissions to the ADHA.

Bernard Robertson-Dunn said...

It might end up being bleak for ADHA and the government. Health professionals will minimise the amount of time they spend feeding the government's appetite for health data via the myhr, take the money and generally ignore it. They will concentrate on real medical record systems, ones that deliver benefits.

Anonymous said...

disruptive transformative? So what you are saying is for sometime now the Government has positioned itself to eliminate all completion and become the dominate health IT provider for eHR?

That will go down well, as will private sector jobs

Anonymous said...

@4:43 PM Exactly. We are witnessing the end stage result of a decade of naivety and stupidity by the doctors' peak bodies unable to comprehend how the politburo is applying its powerful grip over people through the ubiquitous deployment of digital health under the seductive guise of 'patient care'.

Anonymous said...

You should also include .... and the incomprehensible stupidity of their members who have allowed this to happen.

Anonymous said...

There is still time, there was a time when clinical advisors publically walked away from this mess. Some stayed and some convinced they should come back, I believe secure messaging is a con job that will lead nowhere but that is only my opinion.

Anonymous said...

@10:34 that too is naive. Some of the clinical advisors who walked away did so out of frustration because they weren't being listened to. However, there are a lot more advisors of one ilk or another who are content to hang around, keep their heads low and take the money. Often these people don't know what they don't know and are too self-centered and arrogant to ask the questions which exposes their deficient knowledge. The whole process is corrupted by an excess amount of money, complete lack of any competent informed leadership at the executive and Board level of the ADHA, the Health Department and the politicians in the 9 jurisdictions.

Anonymous said...

@11:21 AM you are correct except for one point. A few politicians and some senior bureaucrats know the project has been corrupted but they don't know what to do about it.

Anonymous said...

It will be interesting to see if Tim Kelsey can hold the ADHA together as they attempt opt out. The resilience of an organisation is easily measured when things inevitably go wrong. I am not convinced the ADHA is prepared to meet this pending challenge. As someone who Contracts to the ADHA, there appears to be signs that at the slightest hiccup witch hunts are the main strategy led by protectionism supported by a little circle of cult followers. Rather than let their staff excel and grow they overload them, then reward them by bringing is consultants over the top of them to manage them, rather than giving them the space to lead.

It has been a useful insight into an aspect of the Health IT world but I will move once my tenure is up.

I also agree with the views people make on this blog about the MyHR being an out dated system and founded on very old technology thinking. The most concerning aspect is that I am yet to find two people at ADHA that can explain the system in the same way

Anonymous said...

disruptive transformative, cast against what is terms the internet of healthcare things, sorry but the MyHR construct does not even come close to disruptive transformative. What does concern me most is that the MyHR is distracting policy and standards from laying the foundations for disruptive transformative technologies in healthcare. I wholeheartedly agree with some of the goals in the digital health strategy but the MyHR will hamper advancements not create opportunities.

Anonymous said...

1:40 PM I would suggest those politicians and senior bureaucrats DO KNOW what to do about it. They know the project should be scrapped just as a similar project of many billions of pounds sterling was scrapped in the UK a few years ago. THE PROBLEM is they don't have the courage. It's far easier to put their heads in the sand.

Anonymous said...

Will there be any money left over to buy a few more fax machines?

Anonymous said...

http://www.nationalhealthexecutive.com/Health-Care-News/digital-doldrums-nhs-remains-worlds-largest-purchaser-of-fax-machines

There is always monet for fax machines. I guess one should be careful who one attempts to burn at the stake or place on a bonfire.

Bernard Robertson-Dunn said...

Can anyone tell me if NEHTA or ADHA has ever seriously looked at this solution? It would seem that it has distinct possibilities, is a proven solution to the health information interoperability problem and has been in production since 2001.

However, there isn't a central, government owned, data base which may have ruled it out for Australia.

Anyone have any insights?

https://cyber.ee/en/e-government/x-road/
https://cyber.ee/en/e-government/uxp/

The X-Road interoperability platform is comprised of the core technology (Unified eXchange Platform), integration interfaces (portals, adapters etc), trust services, and the surrounding regulatory framework.

The X-Road framework is one of the drivers that has catapulted Estonia to top of various e-government rankings. X-Road is a solid backbone that has enabled creation of various innovative e-solutions.

Citizen portal acts as a one-stop shop to government e-services starting from various information queries and ending at submitting applications (such as applying for child benefits and municipal day care) and exchanging documents with government agencies.

Estonian e-health system connects hospitals, clinics and other organizations to implement unified Electronic Health Record that supports health care by supplying medical practitioners with detailed information about patient’s health all the while protecting their privacy.

The e-prescription system allows doctors to create prescriptions and make them immediately available to pharmacies. The patient can call the doctor and receive the medicine directly from pharmacy without having to visit the doctor for paper-based prescription.

X-Road is secure, reliable and simple

The X-Road system uses the Unified eXchange Platform technology and contains its own Public Key Infrastructure (PKI) that guarantees confidentiality, integrity and traceability of the exchanged data.

X-Road is designed to satisfy the security requirements of the inter-organizational communication by ensuring the authenticity, integrity and non-repudiation of exchanged data, high availability of services, confidentiality of exchanged data.

Implementation of X-Road is extremely straightforward from organisation information system side. All you need is support for web-services – in fact X-Road is just transparent and secure layer connecting different services in different systems.

There is no central gateway or hub in X-Road. All connected organisations could communicate directly. This kind of architecture makes system more secure and reliable – no single points of failure or attack exist.