Quote Of The Year

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

Wednesday, January 10, 2018

It Seems Portals Allowing Access to Health Information Do Not Make Much Of A Clinical Difference.

This appeared last week:

Study shows patient portals have no impact on hospital readmissions or mortality

Jan 3, 2018 10:33am
Previous research has have tackled patient portal usability and satisfaction among users, but few studies have looked at the impact of portals on hospital outcomes.
A new study out of the Mayo Clinic Hospital in Jacksonville, Florida, does just that with relatively uninspiring results.
Researchers found that 30-day readmissions, inpatient mortality and 30-day mortality were virtually the same when comparing hospitalized patients that used portals versus those that did not, leading them to conclude that patient portals may not ultimately improve hospital outcomes. The results were published last week the Journal of the American Medical Informatics Association.
But that doesn’t mean patient portals are entirely worthless. The researchers noted that of the 44% of patients that registered for a portal account, just 20.8% accessed it while they were hospitalized. Therefore, higher adoption rates could have a bigger impact on outcomes. 
Portal usage may also be more impactful for patients managing chronic diseases rather than an acute illness. Several other factors including mobile device availability, education and real-time access to physician notes could also have a positive influence on engagement and perhaps tip the scales when it comes to outcomes.
More here:
Yet another reason to be a little skeptical of the various claims of benefit that are made for the myHR portal.
It would be really good to see some real evidence of significant benefit flowing from the myHR. Thus far there has been little credible evidence of benefit I have seen.
David.

16 comments:

Bruce Farnell said...

This is precisely the type of analysis and assessment needed in relation to the myHR.

However, we won't get this. Instead, it will be more of the same spin and style over substance. Alternative views will be discouraged or ignored. Is it just me or does this sound like 'business as usual'?

It seems to me that a core principle behind the myHR train wreck is:

"A little bit of technology is good. Hence, more technology must be better."

Don't get me wrong. New technologies are great. However, any technology applied to solving the wrong problem cannot succeed.

Anonymous said...

I was thinking last night about the medico Legal implication of MyHR or alternatives. This pressing subject seems to have been quietly pushed of the agenda. Anyway I went looking via dr Google and cake across this interesting blog - https://tvren.wordpress.com/tag/myhr/

The questions are very valid as is the guidance provided. The readers might also be interested in the email at the end from the ADHA. My intention is not to highlight any party but simply gather insights from others around the Medico Legal issues. Unresolved in presents problems for both practitioners and patients.

Anonymous said...

@7:50am Bit of a legal mess isn't it? It's also a clinical mess and will become a political mess at opt-out time.

Anonymous said...

@7:50, thanks for sharing they are very valid points. Are there easy answers? I don’t think so at this stage and each one would need to be run against a number of scenarios IMHO. This is however a worthy candidate for public consultation as it effects all participants in a patients journey.

Anonymous said...

Opt-out will get deferred until much later in the year because some Health Ministers have been taking a long hard look at the MyHR and the ADHA and asking each other why nothing much has been delivered, why the goal posts keep getting moved, why timelines keep getting extended, why there are so many apparently sensible comments / criticisms consistently being made in the media, on this blog and elsewhere.

The suggestion is that the Australian National Audit Office should be asked to audit the entire project. This will result in another 6 - 12 months delay and enable ADHA's senior managers to plan their lucrative exits from the project.

Anonymous said...

I agree this needs to be played out over a wide range of scenarios using multiple actors in different context. As an example what if patient A is being transferred from aged care into mental health??, how does this work now everyone is being registered? Am I unknowingly now giving consent to have a my family GP accountable for things unknown?

Bernard Robertson-Dunn said...

I've made comments many times about the uselessness of MyHR and problems with simplistic health record systems that are little more than dumb document management systems.

I've also been critical of the naive and simplistic strategy for "Digital Health" developed by the Department of Health and ADHA. A strategy that says little more that "more data is good" without giving any justification for its usefulness.

Rather than just be negative, I thought I'd share a document from the American Heart Association, that I believes sheds some light on the health care systems of the future. It's not a full picture as it doesn't get into the mechanics of how this approach can or should be implemented. It also focuses primarily on the heart although lessons can be extended to other aspects of medicine.

The Learning Healthcare System and Cardiovascular Care
A Scientific Statement From the American Heart Association

http://circ.ahajournals.org/content/circulationaha/early/2017/03/02/CIR.0000000000000480.full.pdf

It is a useful document in that it shows the enormous chasm between MyHR - little more than a government owned copy of patient medical data that has virtually no clinical value whatsoever and what is being proposed by the medical profession in other parts of the world.

I suggest people read this document and compare it with ADHA's strategy documents.

As an Australian I am embarrassed by ADHA's pathetic attempts at leveraging Information System technology to improve health care, especially when they make claims to be world leaders in Digital Health.

These paragraph alone highlights the differences between the professional and informed approach of medical practitioners and ADHA's IT driven, ill advised MyHR initiative.

"The need for the LHS (Learning Health System) definition was motivated by the recognition that two imperatives, informational and value, mandate improving healthcare delivery in the United States.

The first imperative, informational, arises from the massive amount of clinical information healthcare providers need to manage and the increasing complexity of the current healthcare system and the patients it serves. As a result, these characteristics prevent the effective absorption and application of the right information to the right patient at the right time.

The second imperative, value, arises from the recognition that healthcare value, defined as health outcomes achieved per dollar spent, is suboptimal in the current healthcare delivery system. Optimal health outcomes require high-quality care, which is often impeded by incomplete information on both the best evidence and its optimal application to individual patients.

Similarly, optimal healthcare costs require efficient healthcare delivery, which is often impeded by duplication of efforts, misaligned incentives, and lack of cost transparency."

and

"Supplemental Data Sources

Although EHR, registry, and claims data are all essential sources of care delivery information, they alone cannot provide a comprehensive view of the various contributors to a patient’s cardiac health, particularly those influences that occur outside the setting of the healthcare delivery system. Accordingly, the LHS will need to develop, integrate, and ultimately act on supplemental sources of data that can provide important insights into untapped aspects of patient health."

And remember, this document is from the American Heart Association. The full range of medicine and health care activities is far more complex than just this view.

Read and weep.

Anonymous said...

AnonymousJanuary 12, 2018 9:24 AM - You jest surely?

Anonymous said...

@ 5:27 PM it's a politically pragmatic risk averse way forward providing the health ministers with a neat exit strategy.

Anonymous said...

Poetic in its simplistity. Hopefully the ADHA is as strategic and bold in emptying itself of the less than capable bullying element it seems to have accumulated and we can all move forward in a safe collaborative and innovative relationship.

Anonymous said...

If that is the strategy of the Jurisdictions then it is not a bad one. The states and territories have progressed well in being able to share information within their respective influences, albeit some better than others but all heading that way. For cross border exchange each can negotiate and agree their respective agreements and understand those divergences. It seems far easier than having a third party (feds) broker exchange using fragmented, static and out of date information. If patients have access to their local care providers then when out of state they can easily access that information. If they do chose they can easily set it up so in an emergency healthcare workers could access it via some simple authentication and access means. Could be a good use of FHIR and other more modern standards

Anonymous said...

7:45 AM. Let us examine this bullying. The ADHA states their cultural goals/principles are:

Working together;
• Respect and trust;
• Transparency;
• Leading through learning; and
• Customer focus.

What we learned is they are (or at least some wielding power) demonstrate:
- Berating people;
- Stealing credit;
- Excluding others;
- Making snide remarks;
- Threatening others; and
- Unfair criticism

Sounds like The CEO has a problem to me, hopefully he can fix it before he does experience a mass exit

Anonymous said...

A dysfunctional agency, led by an incompetent CEO, trying to deliver a crock of a system to achieve an unachievable goal. What could possible go wrong?

Anonymous said...

There will be no mass exit while the money keeps flowing.

In an unhealthy environment such as you describe it has been my experience that those who are bullied and understand what is happening simply take the line of least resistance. They keep their heads down and remain out of the firing line; in effect they take a holiday whilst remaining at work, and say "yes sir", "no sir", "whatever sir", "as you please sir".

We saw the same thing happening at NEHTA under it's two CEOs, it all stems from the way the Departmental bureaucrats and their culture has seeped deeply into the organisation.

The only appropriate solution as observed earlier "@ 5:27 PM it's a politically pragmatic risk averse way forward providing the health ministers with a neat exit strategy." The longer they prevaricate the bigger the scandal when its finally exposed.

Anonymous said...

Someone who worked there recently I can inform you the money does not flow to the masses, nor is the root problem the CEO or his executive team, they are all very nice and supportive in their own ways are fair but hard task masters as you would expect. The people this theme relates to are the next two levels. I know exactly who the original email refers to. The sooner they get an opportunity to implement operational and cultural change elsewhere the better the ADHA will be. The ultimate change needed would have nothing but positive impact, sometimes all that is needed is a change

Bernard Robertson-Dunn said...

Further to my rant of January 12, 2018 9:41 AM

Read this: Why is health care so damn expensive?
https://techcrunch.com/2018/01/13/why-is-health-care-so-damn-expensive/

"Call me cynical, but having talked with dozens of digital health startups over the past few years, this basic fact [i.e. the overall cost of health care is 17.5% of GDP] so rarely seems to register with founders.

Entrepreneurs are trying to digitalize medical records, or improve operating room efficiency through better analytics, or create a new (and expensive!) robotic medical device.

These innovations are important, but they are a bit like rearranging the deck chairs on the Titanic to try to right-size the ship: actions far too small to make a difference."

Even when it comes to cost reduction DOH/ADHA have no realisation that what they are doing is useless.

And if you haven't read the Scientific Statement From the American Heart Association

http://circ.ahajournals.org/content/circulationaha/early/2017/03/02/CIR.0000000000000480.full.pdf

it's worth looking at for at least one reason relevant to ADHA. The number of times the term "Digital Health" is used is exactly zero.

The rest of the world is coming to the conclusion that "Digital Health", as currently proposed and understood, is not the way of the future. For Health/ADHA to continue to throw money at it is unsustainable. IMHO.