Sunday, February 04, 2018

The Push For Pharmacists To Become Major Users Of The myHR. There Are Still Some Questions To Be Answered.

This release appeared a few days ago:

Consultation begins on My Health Record Guidelines

January 29, 2018
Consultation has started on the My Health Record Guidelines for Pharmacists developed by the peak national body for pharmacists, the Pharmaceutical Society of Australia (PSA).
The Guidelines provide guidance to pharmacists on meaningful clinical use of the My Health Record system.
By the end of 2018, all Australians will have a My Health Record unless they choose not to have one.
Pharmacists have a professional responsibility to review their practice and, where necessary, build on their digital health competency to ensure they are ready to integrate use of the My Health Record system into patient care.
During the public consultation, PSA welcomes comments from interested individuals and organisations including members of the pharmacy profession as well as consumers, other health professional groups and practitioners, educators, researchers and government bodies.
The consultation paper can be accessed at the PSA website. Please review the consultation paper first then provide feedback through the consultation survey.
Consultation will be open until Tuesday 20 February 2018.
Any queries regarding this consultation can be emailed to digitalhealth@psa.org.au
Here is the link:
While not totally easy to find there is  50 page consultation document found at this link:
This document has been created with funds from and assistance from the ADHA.
What I found most interesting is that there is no real discussion of the workload using the myHR will impose on pharmacists. It seems to me even if only 10% of patient records are reviewed there will be a lot of time consumed given the granular nature of myHR records (you have to access them serially etc.) No mention of how this will be paid for that I noticed. In places like Chemist’s Warehouse this time loss may really matter.
There is discussion of security and privacy but who at an outlet will have access to the myHR and what they need to do in the case of sensitive information is not clear. More work on looking at real pharmacist workflows and how it actually will fit is needed I suspect.
Here is the executive summary:

Executive summary

The My Health Record has been designed to allow the secure sharing of patient health information via an electronic platform. [1]
From the pharmacist’s perspective, this greater access to patient health information may:
·         enable more efficient and effective medication reconciliation
·         enhance their contribution to the quality use of medicines
·         improve continuity of patient care.
The ability for pharmacists to contribute patient health information to the My Health Record (i.e. dispensing records) may also enhance communication with other healthcare providers caring for their patients, and improve health outcomes.
These Guidelines do not replace the need for pharmacists to exercise professional discretion and judgement when using the My Health Record. These Guidelines do not include clinical information or detailed legislative requirements. At all times, pharmacists delivering these programs must comply with all relevant Commonwealth, State and Territory legislation, as well as program-specific standards, codes, and rules.
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This does not add much rather is notable for the uncertainty in the benefits flowing from use of the myHR.
The expectation of changes of practice in the absence of some decent trials using the working system to see what it adds would have to be worthwhile – but don’t seem to be contemplated. I wonder why?
The PSA’s National President is a very strong advocate for the my HR and that may be related:
See here for his views:
More haste, less speed and a bit more evidence might be a good idea in my view. The Guidelines still need some work and to address some of the more difficult issues head on.
Patients should also be rather wary of random pharmacists in the big chains just opening their myHR’s willy-nilly. I reckon and to me this is another reason to consider opting out.
David.

16 comments:

Anonymous said...

As a patient I am getting somewhat confused. Is my GP not trusted to look after my needs? Dispensing is already recorded. Why now do I have to have all sundry looking at my record?
I am happy for the pharmacist to walk me through the proper use and potential side effects of medicine. I am not sure I need this added stress. Or am I missing something?

Anonymous said...

Some people go to one GP and one pharmacy. Some go to many - this will help fill existing knowledge gaps for these patients.

Don't stress, you can control who sees your record.

Anonymous said...

As a patient you are a pawn in a large game where the health sector is also being played and divided. They can’t get GPS to adopt so they will bribe anyone to use it so it seems useful through transactions

Anonymous said...

"Don't stress, you can control who sees your record." Only if you don't have one.

Anonymous said...

Pharmacists or at least those who own pharmacies will require 'a small fee' to compensate for the additional time. The My Health Record claims relatively modest cash able benefits. Does anyone know how much is being eroded from the financial benefits through these incentives?
I have no issue with Pharmacy participation, but this is going to simply fuel the never ending feud between various political lobby groups at great cost to the taxpayer.

Anonymous said...

8:01 AM. I am not aware of any reports that indicate the erosion of claimed financial benefits. I would be surprised if Pharmacies are remunerated as this would open the floodgates for everyone from GPS to hospitals and probably even physio and eventually faith healers.
I would also question the need to provide remuneration. The system is founded on efficiency and better health outcomes. That also me should save everyone a lot of time and money.

Anonymous said...

The odds of the Pharmacy Guild accepting any MyEHR interaction without compensation are extremely low!

Grahame Grieve said...

"The system is founded on efficiency and better health outcomes. That also me should save everyone a lot of time and money" - it's possible that a system might save 'everyone' a lot of time and money, but do so by moving costs to a particular kind of stake holder, so this particular stake holder must be rewarded by receiving a portion of the improved efficiency. There is, in fact, many systems just like this; it's known as economics. Note that classical economics also describes a number of situations where market failure necessitates regulatory manipulation. Many of these market failure situations exist in this space - but just because something is being done it doesn't follow that it is the right thing to do...

Bernard Robertson-Dunn said...

Saving money? Please explain?

Read this:

"It Ain’t Necessarily So: The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs"
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.25.4.1079

Then tell me how making health professionals use two health record systems (MyHR is not designed or intended to replace clinical systems, the government says so) and adding to a pharmacist's workload by opening, reading and discussing with the patient their health record can possibly save money?

Just asking.

Anonymous said...

The government estimates anticipate that the My Health Record will generate savings of around $123 million by 2020-21. I have no idea how this figure was reached or what the savings are against, I presume against either the DoH budget or national expenditures on healthcare record keeping. What is clearly not stated is this will be reached through cost shifting.

Are the current planned incentives for various stakeholder groups factored in? Or is this a clear intention that any incentives will cease in 2020-21?

Anonymous said...

If pharmacies can take the spotlight off GP’s and let them get on caring for people using their own clinical systems then that is a good thing and all power to them.

The MyHR is just old technology and an old concept, it has no home in our modern and fluid world. You can’t put a bumper on a donkey and fool people into thinking it’s a SUV.

Bernard Robertson-Dunn said...

And if anyone is contemplating using the "better health outcomes will save money" argument, read this:

Preventive Care Saves Money? Sorry, It’s Too Good to Be True
https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html

"Wellness programs, based on the idea that we can save money on health care by giving people incentives to be healthy, don’t actually work this way. As my colleague Austin Frakt and I have found from reviewing the research in detail, these programs don’t decrease costs — at least not without being discriminatory.

Accountable care organizations rely on the premise that improving outpatient and preventive care, perhaps with improved management and coordination of services for those with chronic conditions, will save money. But a recent study in Health Affairs showed that care coordination and management initiatives in the outpatient setting haven’t been drivers of savings in the Medicare Shared Savings Program."

and:

"But all of these analyses looked within the health care system only. If we really want to know whether prevention saves money, maybe we should take a wider perspective. Does spending on prevention save the country money over all?

A recent report from the Congressional Budget Office in the New England Journal of Medicine suggests the answer is no. The budget office modeled how a policy to reduce smoking through higher cigarette taxes might affect federal spending. It found that such a tax would cause many people to quit smoking — the desired result. In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked.

In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes."

There is a well known saying circulating on the Internet:

"If you aren't paying for a product, you are the product"

How much does it costs a consumer to get a myhr?

It's the only rationale for the government to be spending $1.7billion on this data gathering tool. It wants your data.

Fortunately, just registering all the Australians it can, won't give it a lot more data than it already gets. If your GP wants to give the government more of your data, ask them why?

Anonymous said...

http://dilbert.com/strip/2018-02-05

Bernard Robertson-Dunn said...

Apple’s Health Records App: A Ripple or a Roar?

https://chealthblog.connectedhealth.org/2018/01/29/apples-health-records-app-a-ripple-or-a-roar/

"First, access to medical records is just not that compelling for the average consumer. Think about it. How many times do you wake up in the morning and feel the urge to check your medical records? Don’t get me wrong. It should be an imperative to have easy access to important personal health data, that you can simply and securely share with your healthcare providers, or access in an emergency. I have long been a vocal proponent to giving individuals access to their personal health data.

But that leads me to my second point. Access to personal health records will not magically improve clinical outcomes, or even motivate individuals to better manage their health and wellness. As we now know from our work at Partners Connected Health, it takes a sustained, highly personalized experience, seamlessly imbedded into our daily lives, in order to change behavior that can lead to better outcomes. Knowing my blood pressure results from my last doctor’s appointment six months ago will not motivate me to take a walk after dinner. We must not think that access to health records will automatically lead to improved health outcomes."

Anonymous said...

Does Dilbert work for the ADHA? I am beginning to think so
Lets rename the PCEHR to MyEHR

Anonymous said...

Its starting to look that way:
http://dilbert.com/strip/2018-02-06