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, December 17, 2017

The AMA Offers Some Input On The Possible Future Of The myHR. They Are Not Yet Convinced By Any Means I Would Say!

It is the season for Pre-Budget Submission for the 2018/19 financial year. Here it the link to that provided by the AMA.
There was relevant comment provided here:

AMA calls for improvements to My Health Record for it to reach potential

Lynne Minion | 15 Dec 2017
My Health Record has the potential to save lives and deliver economic benefits but the system needs improvements and doctors don’t have time to talk patients through the opt-out process, according to the Australian Medical Association.
In its Pre-Budget Submission 2018-19, the doctors’ advocacy group this week claimed the federal government needs to invest in improving the national repository of Australians’ healthcare information for it to reach its potential.
“The AMA believes a fully functioning and widely used My Health Record will not only save money but save lives. Ongoing improvements will help ensure its success,” the submission says.
“Electronic medical records promise much,” the AMA says, with early wins predicted to be reduced adverse drug events and duplication of diagnostic tests. Developing the platform’s functions could lead to additional gains.
“We note government estimates anticipate that the My Health Record will generate savings of around $123 million by 2020-21. Further iterations of the My Health Record could become even more useful to clinicians and patients alike via features such as recording specific prosthesis details, enabling targeted notification of drug recalls, and providing the opportunity for understanding of aged care directives and patient wishes.”
But the submission claims “more work is required” to minimise the burden on doctors and ensure interoperability with healthcare provider software.
Lots more here:
Here is what the AMA had to say on the myHR (Page 23 on)

10. My Health Record.

The My Health Record will offer digital access to a core summary of important patient clinical data when it matters most– at the time of treatment – irrespective of the clinician’s specialty or physical location in Australia.
Electronic medical records promise much. Early wins are expected in reduced duplication of diagnostic tests and reduced adverse drug events. A recent study estimated that admissions  due to adverse drug events could be as high as 230,000 per year, and cost $1.2 billion per year.  It has the potential to improve the information flow between hospital doctors and general practitioners when patients present to hospital and are discharged.
We note Government estimates anticipate that the My Health Record will generate savings of around $123 million by 2020-21. Further iterations of the My Health Record could become even more useful to clinicians and patients alike via features such as recording specific prosthesis details, enabling targeted notification of drug recalls, and providing the opportunity for understanding of aged care directives and patient wishes.
But more work is required. The return on investment will hinge in the short term on ease of use for medical practitioners who upload the clinical data. Interoperability with the multiple software packages used across the medical profession and broader health sector must be seamless.
Problems uploading specialists’ letters, poor search functionality, time-consuming adaptations   to existing medical practitioner work practices, or inappropriate workarounds will erode clinical utility and deter doctor use – and, more importantly, take time away from focusing on the patient.
Doctors do not have time to talk their patients through the My Health Record arrangements for opt-out, privacy, setting access controls in standing consent for health providers to upload health information. This is the work of the Government. Doctors must be allowed to focus on what they do best caring for patients. The lack of reliable broadband is also a barrier that will need to be addressed if nationwide, digitised health care is to be achieved.
The shift to opt-out arrangements in mid to late 2018 is also a critical success factor. Some Australians will be surprised to learn that a My Health Record has been created for them without their explicit consent. The communication campaign must reach as many Australians as possible, and promote a positive attitude towards the My Health Record created for them.
Privacy, health data security, and health data disclosure are also hot button issues – for doctors and patients. These will need to be carefully managed to maintain a high level of participation post opt-out.
The AMA believes a fully functioning and widely used My Health Record will not only save money but save lives. Ongoing improvements will help ensure its success.
This forms up to an AMA Position shown on the next page:

AMA POSITION

The AMA calls on the Government to:
           guarantee that doctors will not bear unnecessary costs for guiding patients through the intricacies of the My Health Record system for arrangements for opt-out, privacy, setting access controls in standing consent for health providers to upload health information;
           fully fund an opt-out communication campaign to avoid widespread fear-driven decisions to opt out;
           appreciate the high level of community concern about the My Health Record’s impact on patient privacy and health data security;
           invest in the ongoing improvement of the clinical utility of the My Health Record so it becomes a value add tool for clinicians in their day to day delivery of quality patient care;
           provide specific support for specialists to adopt the My Health Record;
           fund work to achieve a seamless interface between the My Health Record and My Aged Care; and
           excellerate the establishment of health data standards needed to make interoperability a short-term reality.
When you read what the AMA actually says – typo and all – it seems pretty clear that the AMA thinks:
1. The myHR is by no means fully evolved as far as being useful and user friendly.
2. The Government needs to spend a good deal more to get there.
3. Electronic records hold great promise – i.e. after 5 years we are yet to see realisation of that promise.
4. We are concerned that there may be additional costs that we might see doctors saddled with. For us it all has to be overall cost neutral or better.
5. Much of the populace are concerned about security and privacy and may be somewhat startled by the introduction of opt-out if the communication and explanation is not very well conducted.
6. Given time is money there is concern a lot may be wasted on poor systems and explaining opt-out.
7. Health Information Standards need a lot of work.
I would say their position is as negative as it could be given they have signed a Memorandum of Understanding on all things myHR, among others, with the Government. Here is the link about that:
https://www.australiandoctor.com.au/news/racgp-ama-formed-pre-budget-pacts-govt
and also here:
http://www.health.gov.au/internet/main/publishing.nsf/Content/0FFB2BE666C5627ECA25811B002759EB/$File/Shared%20vision%20AMA.pdf
They clearly see there is a long and expensive way to go with success by no means guaranteed. They also see the move to opt-out as a big risk – as so many of us do!
David.

38 comments:

Anonymous said...

The art of interoperability begins again, coaxing all those various human and computing systems into working together.

Correct me if I am wrong but is there not a significant difference between a health record and a medical record? I am not clear which one the AMA champions

Dr Ian Colclough said...

The AMA is its own worst enemy and the doctors too. It continues promoting the benefits and various features of the My Health Record yet, when one scrutinises its writings it becomes clear that the AMA has no understanding of the systems processes, architecture, system design and deployment issues involved in this vast domain of hugely complex and wicked problems. Further it is evident the AMA is proposing its perspective of a solution to a problem which it clearly does not understand. Like the ADHA, and NEHTA before it, the AMA needs to go back to the drawing board and start again using a different approach, a new way of thinking and some very different minds and skills from those involved in previous attempts.

Anonymous said...

Perhaps the intent of the MOU is to jointly convince the department to continue to invest in the MyHR regardless.

Ian my only comment is that perhaps the problem is we have got rid of a massive collection of experience in and exposure to these complex challenges. There remains scatterings in ADHA and others but not quite a powerhouse of intellect and capability. There will be again no doubt, in years to come as there is pool of talent. Just very little capability to transfer those learnings of the past decade.

Dr Ian Colclough said...

Yes, that's one of many problems. But the biggest problem is a failure to understand why the project has a failed.

Anonymous said...

12:47 PM I absolutely agree with Ian. I would also add than an even bigger problem, first and foremost, is being prepared to acknowledge AND accept that the project has failed. The psychology behind avoiding accepting failure is very complex, it goes against all the hubris, hard work and over-zealous optimism that has led to the failed state of the project so obvious today.

Anonymous said...

The ADHA Board can hide behind its various committees' advice and recommendations. The Health Department can hide behind the ADHA Board. The Ministers can hide behind their Departmental advisors and consultants. And the ADHA executive can keep doing what the ADHA Board and Department stakeholders keep telling them today because peak bodies keep and other government funded organizations saying that's (whatever that is) what everyone (whoever everyone is) wants. It's a bit like perpetual motion .... never ending, just keeps rolling along.

Bernard Robertson-Dunn said...

myhr is a partial copy of medical data held in other, clinically useful, systems. myhr is owned and can be used by the Federal government.

Clinically, it is not to be relied on; once the data is in myhr it is never removed, only hidden from normal users, but not the government; patients don't own most of the data, the author of the data does. All this is from www.myhealthrecord.gov.au

The government (ABS and PM&C are obvious examples - see their websites) has stated several times that it is very keen to link health and other data to extract as much economic benefit as possible.

IMHO, myhr is indistinguishable from a surveillance system using data fed into it by health care professionals and government funding mechanisms (MBS/PBS). The identifying information available in myhr (and the opt-out databases), along with meta data held by telecommunications companies gives a comprehensive real-time picture of most Australians.

If most doctors and Australians are fully informed of these facts, which are available on the government's own websites, and are happy with this system, then, Australia being a democracy, this is OK.

Not making every attempt to inform Australians and doctors about this is deception and fraud characteristic of a dictatorship.

Anonymous said...

So Bernard are we to assume that organisations like the AMA and RACGP are strongly supportive of that? Or do they and their advisors not really understand, or as one commentator said "naive".

Bernard Robertson-Dunn said...

Based on their utterances, my guess is a combination of naive and conflict of interest.

Anonymous said...

A banking crowd of mine pointed me to this during a discussion at yesterday’s Sunday brunch - https://www.google.com.au/amp/s/www.forbes.com/sites/forbestechcouncil/2017/12/15/the-real-threat-of-identity-theft-is-in-your-medical-records-not-credit-cards/amp/

She also made light of the ADHA seemingly public taunting of the online hacking community with their (ADHA) claims the MyHR is immune to unauthorised access.

Anonymous said...

My doctor uses my Medicare number for my health ID and to access my records on his system. Do I have to have an IHI if I have a My Health Record and if I do - why?

Bernard Robertson-Dunn said...

Having recently moved, I went to see a new GP today. I went armed with a download of my medical data from my old GP and a hard copy of some of the tests and reports I thought were relevant to my current situation.

Did the GP or receptionist ask if I had a myhr? - No.

Was the GP interested in the medical data from my old GP? No.

Was the GP interested in any of my test results? Yes, but only the most recent.

What did my GP recommend? Some more tests to see if the medication I had been put on recently was making any difference.

Some other tests in a year's time to see if the medication I was prescribed a year ago was having an effect on my bone density.

Could any of these tests have been avoided? - No. My GP was looking for changes and so needed updated tests as well as access to old tests. And before anyone says - well that's what myhr is for, the pathology lab keeps a record of my old tests and includes them with the latest set.

In other words, my new GP wasn't interested very much in my medical history, but was interested in my (relatively) current status. I didn't have to remember much about my current meds, I just took the packets along.

Tell me again what medical problem myhr is supposed to be solving. It certainly hasn't solved any of mine.

Dr Ian Colclough said...

A little bit of history from 2007.

NHS starts uploading clinical data to central computer, April 2007BMJ (online) 334(7594):604 DOI10.1136/bmj.39160.586829.BD, SourcePubMed Michael Cross
Not on ResearchGate

Abstract
The long delayed uploading of clinical information on to a central computer system for the NHS in England began this week. Extracts from the records of 14 500 patients from two GP practices in Bolton, Lancashire, will be made available to other local health services in the national care records system unless patients exercise one of two levels of opt-out, the NHS agency Connecting for Health has announced. Officials said the upload, originally due to start in 2004, would proceed cautiously and be subject to independent evaluation. “We are not pushing the pace. No one is going to get brownie points for running fast,” said Mike Pringle, clinical lead at Connecting for Health. The policy received a cautious welcome from the BMA, which had previously insisted that patients must opt in to shared electronic records. The care records spine is at the centre of the £12.4bn (€18.1bn; $24.1bn) centrally funded programme to computerise the NHS in England. It is intended to make key information about any patient available in any NHS setting. Although patients' demographic details have been on the spine for more than a year, the uploading of clinical information has been stalled by controversy over confidentiality and consent. In December last year, a report from a ministerial task force, on which clinical bodies were represented, created a consensus for going ahead, subject to safeguards. Professor Pringle said that the first uploads, from the two practices in Bolton Primary Care Trust, would follow the task force's recommendations. Each patient will receive a letter advising them that data covering major diagnoses, allergies, blood group, and current prescriptions will be uploaded to the care records service unless they opt out within eight weeks. No records will be available on the spine until after that period. Patients will have four options, Professor Pringle said. Firstly, to do nothing; secondly, to view their summary record and request changes; thirdly, to agree to a summary being created but not shared; and, finally, to opt out of the summary record entirely. He would not be drawn on what proportion of patients he expects to exercise each option. Two national newspapers, the Daily Mail and the Guardian, are publicising a grassroots campaign called The Big Opt Out, which urges patients to tell their GP not to load details on to the spine. If all goes well, another five GP practices are due to upload clinical data by the end of the year. Connecting for Health said the early adopters' experience would be independently evaluated during the roll-out and lessons learnt. Representatives of the BMA called for a pause for consideration, however: “The lessons from this independent evaluation must be learnt before a more widespread roll-out,” said Richard Vautrey, deputy chairman of the BMA's information technology committee.

Anonymous said...

Ian, don't leave us in suspense, how did the project go? Was it a success, did the little people like it, and did the dear leader go on to bigger and better things? Do tell.

tygrus said...

1) Can the MyHR be used to populate another EHR? No

2) Can the MyHR answer the admission questionnaire of the hospitals? No

3) Can the MyHR answer the "New patient questionnaires" used by specialists? No

4) Can I print a report or save the MyHR to a local computer to keep more than the most recent data? No easy way ie. requires lots of clicks or lots of copy&pastes.

5) Does it have an accurate history of immunisation? Not for me.

6) Does it have full details of my pathology, imaging and other tests? Not at the moment and in the future, is really only for the most recent.

7) Does it have a health summary uploaded to my OptOut created record after 5 visits to my GP in last 12months? Not for me.

8) Does the electronic hospital discharge include any information not included on the paper copy? No. Created by nurse and any GP questions require a call to the doctor responsible.

9) Has it saved anyone any time or avoided any actions regarding my care? Not for me.

10) Does it avoid first time allergy/drug reactions? Nope.

11) Does it avoid the majority of all adverse events which are from the often-long-list of known side-effects? Nope.

12) Does it provide secure communication of actions and events shared between clinicians for coordinated care? Not yet.

I score the usefulness as 0.5/10.

Is there any published research showing real costs & benefits of the current My Health Record system using actual numbers and rates ? No, I haven't seen any.

Verified cost/benefits analysis = Greater than $1.7B cost for no verified benefit.

So how on earth do the advocates think this is worth the cost? $M's paid to 'independent' analysts to make it look good.

Anonymous said...

Sir, sir, sir, I know, I know. Timmie went to Australia and a lovely big job with lots of travel to promote the My Elf Record.

Bernard Robertson-Dunn said...

In case anyone is interested, ADHA has deleted its My Elf Record tweet. Fortunately, someone saved it and has re-tweeted it.

https://twitter.com/Health_Privacy/status/942991740406939649

Bernard Robertson-Dunn said...

Tygrus, you are looking in the wrong direction. The benefit is to the government who gets to see and keep for all time all that lovely personal, medical and contact data, most of which is frequently verified and up-dated.

As has been reported recently, all you need is some known medical data and you can identify almost everyone in a large data set.

What does the gov't know about its citizens? Everyone has been given an IHI. Most are linked to existing medicare numbers, mobile numbers, addresses (physical and email).

The My Elf Record is the most complete of all government owned, citizen oriented data databases. Not everyone pays tax or earns money, or claims welfare or is unemployed, or has a driver's licence. Not everyone has a mobile phone or email address. Most people use the health care system.

The My Elf Record is the real or potential hub of a citizen identity/surveillance system. OK, the gov't won't admit to this, but the capability is there and it will be too big a temptation for it to keep its hands off.

Anonymous said...

As has been reported recently, all you need is some known medical data and you can identify almost everyone in a large data set.

With machine learning I doubt you even need that much Bernard. Make me wonder if all that is being sort is justification of what is probably happen now.

Anonymous said...

The project was terminated. The little people were not appropriately informed about the project. The dear leader resigned unexpectedly and popped up in Telstra Health for a few months then as CEO of ADHA for a repeat performance if history's is any guide.

Anonymous said...

Is the dear leader the chief elf?

Anonymous said...

Wonder why they took the tweet down? Can’t see any harm in it and was inline with Santa Cluas theme.

Anonymous said...

I am suspecting it being taken down is just another symptom of the growing concerns about aspects of ADHA not being ready to tackle the opt out. There is an email doing the rounds that indicates a very grave situation internally at the ADHA.

Anonymous said...

That tweets graphic was the sole output of the ADHA this year and it was tweeted without a press release or ministerial statement so it has been removed!

Anonymous said...

I think the my elf record tweet was cute, but perhaps they thought it could be ork-ward?

Anonymous said...

Some of the little people are hyper-sensitive, something to do with their small minds and big celery's.

Bernard Robertson-Dunn said...

The tweet graphic was accompanied by "Give yourself the gift of a myhr" to which I retweeted:

"Is that the best you can do?

The only gift is giving your medical data to the government"

Must have hit a nerve.

Anonymous said...

Maybe it was to close to a MYER stores advert

Anonymous said...

Grave! sounds rather funereal. emails have a habit of escaping, I'll keep an eagle eye open for it.

Anonymous said...

2:32 PM, hopefully the email stays buried out of respect. It is not pleasant reading. If half of it is true then the ADHA is a disgrace and is far removed from any of those values it publishes in its corporate plan. It has certainly put a large dent in my respect and trust of the ADHA.

Anonymous said...

Having been shown the email in question the executive team have some serious questions to answer. If that is reflective of their values and actions then we as a nation are not in good hands and I fear the day a minor hiccup happens leading up to opt out

I am a great supporter of ADHA this email is not what I have come to expect and respect of the ADHA.

Anonymous said...

I can tell you that they won’t answer anything of the sort. They are to detracted from the reality of the day to day activities, dishonesty, mismanagement and general nastiness. Easier to dismiss a few workers than address the underlying problem.

Anonymous said...

That does not sound good. It is the basis for some desperate decision making in an appeal to look in control, I am sure you can expect some mammoth stuff up to appear in the not to distant future.

Anonymous said...

@4:40 PM What do you mean "... mammoth stuff up to appear in the not to distant future?" We already have a mammoth stuff-up. $2 Billion worth of stuff-up. We are now recommending to our patient's that if they already have a My Health Record they should consider opting-out now. If they ask for help to do so we give them a some printed instructions to take away which they can follow to cancel their registration. Although it costs us in ePIP's it's well worth it for the time and inconvenience saved.

Anonymous said...

It is the reality many live through on daily basis. As always a few ruin the good work of the many and there are some great General Managers who support our efforts and the organisation as a whole. Sadly a few are fish out of water and just mean spiteful people that are not authentic.

Anonymous said...

6:18PM, please, you make it sound like anyone takes any notice of these select few. They are only engaged because they have to be. Any respect was lost a few weeks ago. The Agency is fine and we will deliver on our commitments, these people are not involved and have no impact.

Anonymous said...

December 22, 2027 5:42 PM, I read somewhere this morning that money was being taken back from PIP payments. I guess your story explains some of it. Some seemed a bit harder on the governments side though. I am sure it will not be long before patients will not be able to claim Medicare without a MyHR.

Anonymous said...

7:47 PM yesterday that was in the Medical Observer General Practice section

In total general practice has forfeited $11million in e-PIP incentives for failing upload My Health Record shared health summaries.

The above is only a summary, for context you need to read the article. Be quick I am sure someone somewhere will be sending a stern letter to have it removed.