This appeared in the Daily Telegraph a day or so ago.
Taxpayers spent $1.7 billion on a health record doctors don’t use
Sue Dunlevy, National Health Reporter, News Corp Australia Network
January 18, 2018 10:44pm
Taxpayers have spent nearly $1.7 billion on an internet based My Health Record that doctors are refusing to use and which can’t be emailed or shared with digital health apps.
Every Australian will get a My Health Record in 2018 unless they opt out of the system but doctors are warning of major issues with its ease of use and fear patients don’t understand the privacy implications.
Five years after it was launched five million Australians have opted to set up a My Health Record.
However, fewer than one in twelve of Australia’s 31,000 medical specialists are registered to use the My Health Record and they still rely on GPs faxing them referral letters and patient information.
For the records to be useful, GPs have to upload a summary of a patient’s health condition, but this has happened in fewer than one in four cases.
The government has offered incentive payments to upload these summaries, but 1,440 GP practices had to repay this cash because they failed to meet the criteria.
Dr Rob Hosking the deputy chair of the Royal Australian College of General Practitioners e-health committee supports the concept of a digital record but he questions who uses it.
“None of the hospitals my patients attend have access to the My Health Record,” he says.
None of the specialists he sends his patients to use the record either and he has to use a separate private secure messaging service to communicate with specialists because he can’t do it through the My Health Record, he says.
“It’s quicker to pick up the phone and call the pharmacists to find out what medicines the patient is on because the (My Health Record) user interface is difficult to use,” he said.
If doctors do put a shared health summary on a patient’s record there is no incentive or even reminder to update it if a new medicine is prescribed or if the patient develops a new health condition which means it could be out of date, Dr Hosking says.
The Australian Medical Association has also warned in its budget submission the record is plagued with problems.
“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,” the submission says.
The problems with the record will reach a critical mass this year as the government switches from an opt in system and sets up a digital My Health Record for every Australian unless they opt out.
The Australian Digital Health Agency says there will be no television, radio or print advertising campaign to make Australians aware of the fact they are getting a digital health record or how they can opt out, instead patients will learn about it from social media and posters in doctor’s offices.
The AMA has told the government in its budget submission that doctors don’t have the time to educate the public about the new record.
“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 submission says.
“Some Australians will be surprised to learn that a My Health Record has been created for them without their explicit consent,” the AMA says.
More here:
I have seen e-mails from the ADHA claiming this reports are inaccurate but I can see nothing here that is in any way in error or unfair.
To me there seems to be some serious clinician dissatisfaction with the way the myHR is going and to them the apparent uselessness of the system contrasted with the rather large cost. This is despite the Memorandums these organisations have signed with the ADHA and Government on usage etc.
See here:
Lack of clinician conviction that the myHR is a useful and valuable initiative is a pretty certain indicator of where the myHR is ultimately headed.
We all know the most certain way to have a Digital Health initiative fail is to not have the clinicians locked in and committed from the start!
David.
Having asked my GP about this, she stated it was not in her list of priorities nor had she even heard of a Digital Health Agency. She had heard of the Goverments health record but said little else as she printed out a script, run up a referral and spoke to me about the new medication, what the referral was intended to investigate and to discuss next steps and generally put me at ease but skilfully remind me to look after my self. IT assisted, I got a text request confirming my appointment for the referral and booked a return visit to my GP using health engine. I am struggling why the MyHR? It seems my GP has it covered. I wonder if money would be better invested at a local and regional connectivity level rather than this centralised approach, just seems a lot of money for a few edge cases. It is almost as if the power and simplistically of modern communications is lost on ADHA.
ReplyDeleteThe AMA and RACGP have the Government is a nice position. Trying to force the system through mass subscription of citizens might be about to backfire. The ADHA is going to look nightly silly if everyone is signed up, few know they have been signed up and less than a majority of GP and specialists are using it. Wonder what they we demand from the government?
ReplyDeleteHaving asked my GP about this, she stated it was not in her list of priorities nor had she even heard of a Digital Health Agency. She had heard of the Goverments health record but said little else as she printed out a script, run up a referral and spoke to me about the new medication, what the referral was intended to investigate and to discuss next steps and generally put me at ease but skilfully remind me to look after my self. IT assisted, I got a text request confirming my appointment for the referral and booked a return visit to my GP using health engine. I am struggling why the MyHR? It seems my GP has it covered. I wonder if money would be better invested at a local and regional connectivity level rather than this centralised approach, just seems a lot of money for a few edge cases.
ReplyDeleteTell me if I've got this wrong.....
ReplyDeleteMyHR does not replace GPs' clinical systems, so GPs will have two systems into which they will need to put data and which they will need to consult.
When a GP uploads data into MyHR according to the myhealthrecord.gov.au:
"When creating the SHS, the nominated healthcare provider needs to ensure that all aspects of it have been completed and verify the accuracy of the information it contains. In assessing its content, the nominated healthcare provider should take into account other relevant information on the patient’s My Health Record."
This is not a simple matter of clicking a button and the data gets uploaded, it takes time and effort. What the risk and responsibilities are for the GP if they get it wrong is not known.
So, feeding data into the government owned and controlled MyHR system will increase GPs' workload and risks for little or no return - they already have most, if not all the patient's data in their system clinical system anyway.
As we have seen,
https://www.emrandehr.com/2018/01/16/ophthalmologists-worry-that-ehrs-decrease-productivity-boost-costs/
eHR systems can reduce productivity. Having two will just make it worse.
It's already cost at least $1.7b (and AFAIK that doesn't include the costs to hospitals and medical centres). Adding to GP's costs makes no sense whatsoever.
Why would GPs use this system?
Why would the RACGP and the AMA recommend GPs use it?
The RACGP and AMA would perform a great public service if they just instructed all their members to ignore the myhr and for them to advise patients to cancel their registration if they have one - for efficiency and safety reasons.
ReplyDeleteThe real tragedy is the MyHR does not even go ‘ping’
ReplyDeleteJesting aside, we have little interest in informing the public, there seems an open credit card for international travel. Has this international travel advance Australia voice in Standards development? Probably not. We seem keen to tell everyone else but those being forced into the system, and the last few years we have lost our way and emerging apps and standards seem to be getting adopted in a free for all zone.
They sinner the ADHA grows up or is replaced and managers damaging the brand through staff bullying the better. The AHHA blueprint at least gives hope
The AMA and the RACGP should never have put themselves and their Members in this position. It is not as though they hadn't been warned; repeatedly.
ReplyDeleteYet, through a shallow understanding of the problem to be solved and a misguided belief their peak body IT committees are well-equipped to set the agendas and steer the politics to deliver the outcomes that they and the government wants we have ended up with a $1.7 billion failed IT project.
The sooner the peak bodies, the ADHA and the Health Department get out of the way and allow free market forces to drive market development the better off will be every Australian and health service provider.
"Has this international travel advance Australia voice in Standards development?" - not that I am aware. There is some very useful work and skills in the agency but there is no observable strategic plan to engage with the standards community internationally, and the lack of travel is consistent with that.
ReplyDeleteNote, though, that figuring out a standards strategy is something that I did ask for comment on, for a consultation process in the first half of this year. So eventually we should hope for some improvement
Egos (6:27 PM) and hope (8.04 PM)have been two huge contributors to the failure we are now witnessing.
ReplyDeleteThat would be a good thing @8:04 PM. The right funding model and some good projects IHE would be well positioned to bring together a range of interoperability standards and initiatives and produce some useful outputs. IHE seems to be work well in Europe. Here it seems to be the only health focused SDO with any life and independence left in it.
ReplyDeleteThe funding of travel should not be restricted to ADHA. staff, some sort of model where anyone with merit and demonstrated value add participation in standards should be able to get subsidised travel. How that would work and be open and fair is worth perusing.
@ 6:27 PM. The RACGP, the AMA and the Department have much in common - inward looking, navel gazing, conflicted vested interests.
ReplyDeleteThe concept of IHE being the heart of some sort of National Standards collaboration is an interesting one and one worth exploring. Did you have any other thoughts how this might present itself @ Jan 22 7:44am
ReplyDeleteHas anyone done any work (or know of any work) comparing My Health Record with the requirements of the EU's General Data Protection Regulation?
ReplyDeletehttps://www.hldataprotection.com/2016/01/articles/health-privacy-hipaa/the-final-gdpr-text-and-what-it-will-mean-for-health-data/
Does this sound familiar? Bribing GPs doesn't seem to work, especially if they see no benefits.
ReplyDeleteAs background this describes two USA government incentives aimed at changing GPs behaviour - MACRA and MIPS
https://ehrintelligence.com/features/what-is-macra-and-what-it-means-to-providers-ehr-technology
This is an assessment of MACRA and MIPS.
https://www.emrandehr.com/2018/01/22/is-macra-ruining-healthcare/
The image is particularly interesting, especially if you replace MACRA with MyHR.
Some quotes:
"Why would a doctor find joy in recording data from a patient visit? That’s like asking a lawyer if they like writing really long legal briefs or contracts full of legalese. We’d all rather just do the fun parts of our job. In medicine that’s seeing the patient, treating the patient, etc."
"There’s no clear benefit to doctor for participating in MACRA and MIPS. At least with meaningful use there was a clear $44k payment that they’d receive. MIPS is much more nebulous and it’s revenue neutral so doctors really don’t know how much they’re going to be paid for participating."
"What about the clinical value associated with MACRA and MIPS? The studies haven’t really shown much clinical value. There’s a lot of hope around what could be done, but not any clear evidence of the benefits. Especially the benefits related to the specific MACRA requirements vs using an EHR generally."
"All of this leaves doctors I know upset with MACRA and MIPS. They wish it would go away and that the government would stop being so involved in their practice."
I would suggest the RACGP and AMA if they are serious, start working fast. The likelihood of an early election late 2018 early 2019 and the process diagram is this webpage - https://health.gov.au/internet/main/publishing.nsf/Content/my-health-record-national-opt-out
ReplyDeleteWould suggest to me we will see Optout commencing May 2018. If Mayday is irony at play is not for me to judge. I do believe DoH will not want elections to extend decision making out until 2020, nor will the Minister or Government want the risk of opt out impacting election campaigning, as there is a very real risk this may go horribly wrong as IT tends to do.
re "... as there is a very real risk this may go horribly wrong as IT tends to do."
ReplyDeleteLike this?
ACIC upgrade the latest tech wreck as biometric project delayed, over-budget
http://www.canberratimes.com.au/national/public-service/acic-upgrade-the-latest-tech-wreck-as-biometric-project-delayed-overbudget-20180122-h0m1ao.html
And that system only deals with fingerprints which are nowhere near as complex as health records.
And anyone heard any more about the National Cancer Screening Register initiative?
Australia: Stop blaming Centrelink debts on its IT systems.
ReplyDeleteExecutives and politicians, not developers, made the rules.
https://www.theregister.co.uk/2017/01/06/australia_stop_blaming_centrelink_debts_on_its_it_systems/
"It's no wonder the political dreams have borne so little fruit: they're borne of a simplistic view of the world. It's time the government listened to people with an understanding of operational detail, rather than visionaries"
Thee root cause of most IT failures isn't IT people, it's the misguided managers, executives and politicians, most of whom suffer from hubris - arrogance and ignorance.
myhr is no different.
Patients told NOT to go to A&E as 'major incident' hits NHS computer systems - leaving doctors unable to access records
ReplyDeletehttp://www.dailymail.co.uk/news/article-5308161/Patients-told-NOT-E-outage.html
And ADHA wants myhr to be come essential to healthcare in Australia? If they knew anything about building resilient highly available systems they would understand that the best approach is diversified, distributed systems that are capable of working independently and without the need for any central capability at all.
The exact opposite of the myhr architecture. Add this to the fact that local systems already exist, contain far more useful data than myhr ever will and achieving the objectives (minimal that they are) can be done at almost zero cost to the government and you wonder what is really going on in Health.
Is it just the sunk-cost effect? Or something more sinister? Conspiracy or incompetence? The Centrelink debacle and other projects would suggest incompetence. We can but wonder though.
Here is one to watch for a cost blowout in both implementation and operating costs. The Cloud pricing model is geared towards revenue generation. I do not see the Government being very agile
ReplyDeletehttp://www.zdnet.com/article/data3-gets-au600k-to-replace-govdex-file-sharing-service/
@ Bernard: "The root cause of most IT failures isn't IT people, it's the misguided managers, executives and politicians, most of whom suffer from hubris - arrogance and ignorance."
ReplyDeleteThe root cause is more like what lobbyists and business people can profit from more than anything else. And the 'managers, executives and politicians' will get their rewards too....
11:12 AM it's a little more convoluted. ... certainly incompetence and ignorance are a root cause but so too is the drive by lobbyists and business people seeking to profit from their endeavours.
ReplyDeleteOn the one hand a good sales person with aggressive performance goals will sell whatever they are given to sell. The bureaucrats, politicians and managers with a mix of ignorance, incompetence and naivety and the inflexibility of rigid public sector policies and procedures all combine to set complex projects like MyHR up to fail from the outset.
To my mind, based on first hand experience watching and being closely 'involved' with all these 'elements' at play over the last 4 decades, I have advocated a whole new way of thinking and a different approach to addressing the 'problems'.
Understandably and not surprisingly there is no interest in doing so as it is too challenging to preservation of the status quo.
@2:45 PM, Ian, what you say makes a lot of sense. I agree that the major challenge however is the overriding desire by the bureaucrats and politicians and also the consultants, lobbyists and business people to block change and preserve the status quo for as long as possible.
ReplyDeleteWhy do you think a new way of thinking and a different approach could counter those barriers?
@5:16PM. Why? Past experience. The strategies required come from left field and rarely publicised.
DeleteIf you think the ADHA is alone in taking on dissenters, have a look at this from 2009
ReplyDeleteAcademic claims NSW Health censorship
A professor at the University of Sydney who wrote a scathing essay about NSW Health's implementation of a Cerner system within emergency departments has accused the government of pressuring his institution to take the essay down, which it did, if only temporarily.
http://www.zdnet.com/article/academic-claims-nsw-health-censorship/
There's little evidence now of Jon Patrick's essay.
Health bureaucrats know they are in the right - just don't get in their way as they strive for nirvana.
Well, if he sends his article to the aushealthit blogspot it could be published and NSW Health couldn't force it to be taken down.
ReplyDelete