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, March 25, 2018

AusHealthIT Poll Number 415 – Results – 25th March, 2018.

Here are the results of the poll.

Will Blockchain Technology Become Very Important In Health Information Management In The Next Five To Ten Years?

Yes 17% (24)

No 61% (87)

I Have No Idea 22% (31)

Total votes: 142

Looks like most are pretty skeptical of the Blockchain’s potential in Health. Time will tell I guess.

Any insights welcome as a comment, as usual.

A really, really great turnout of votes!

It must have been a really hard question as 31 people were not sure what the correct answer was.

Again, many, many thanks to all those that voted!

David.

12 comments:

Anonymous said...

I wonder if it is to complicated in regards to policy and legislative needs for blockchain to flourish in time before its replacement emerges. The whole blockchain model seems out of place with Government philosophy around the MyHR. It would certainly take interoperability discussions beyond the technology layer. Not something the ADHA is equiped to facilitate at this stage.

Andrew McIntyre said...

I don't think we need new "better" technology what we need is reliable implementation of the technology we have. The original Health Connect PKI was fine for privacy, security and authentication and even a reliable PIT implementation would allow much of the functionality people want and is in some ways better than the pdf documents in MyEHR and it would be storage efficient, bandwidth friendly and searchable!

HL7V2 is better and provides atomic data and is widely implemented, but poor implementations and standards compliance slows it down. I am sure some parts of FHIR will be better and some worse and its certainly more complex. Throw in CDA, which is virtually all level 1 with minimal atomic data and you have vendors spread thinly across the technologies without solid implementation of any of them. The lack of governance over that last 15 years has been the major factor in preventing progress, not a lack of technology and the need for a new one. That illustrates that lack of common sense in the national "authorities" of which there have been many, all of which have failed or are failing. Generic management will not solve the problem!

Peter said...

By design, data placed in a blockchain is visible to everyone in the world and can never be removed. This does not sound like the sort of thing you would want to use for medical data.
Every transaction in a blockchain is added as a new, unalterable, record by every server which subscribes to the service. It is fully auditable so the final status can be checked by anyone involved. It is possible to make sure that only authorised machines can take part in the network - and therefore "visible to everyone in the world" is an exaggeration. But, since they are naturally peer-peer networks, there can be no restriction for anyone who is part of the group. There is no-one formally in control, which is the whole point.

Anonymous said...

David, this week's Poll 416 is double-barrelled making it impossible to answer in that for me the first part of the question is NO and the second part is YES. How should I answer?

Dr David G More MB PhD said...

Sorry, we know the data is valuable. Answer the question as to whether you want commercial use or not.

David.

Anonymous said...

I think is valuable as "big data" but not that valuable for treating patients as its often inaccurate and cannot be trusted to make a decision on an individual. Its the same story for MyEHR, which is a bit of a problem...

Anonymous said...

With 5.5 million subscribers surely there must be enough data to demonstrate the power of the GovHR as a consumer centred healthcare budget busting tool.

If the data is truely the consumers and it has value, is it not only fair we should be paid to have it used?

Anonymous said...

7:50am I would concur, there is a reasonable level of data to be able to start demonstrating if the MyHR can deliver on its promises. However, there is little chance that will happen.

Bernard Robertson-Dunn said...

Taking about demonstrating usefulness ... has anybody seen any outcomes from this study done at the end of 2016?

"My Health Record. Clinical Research Study Overview"

http://www.wapha.org.au/wp-content/uploads/2016/10/My-Health-Record-Research-Medicines-Integration.pdf

"The Australian Digital Health Agency wants to improve access to medicines, allergies and adverse reactions information in the My Health Record system, to better support medicines reconciliation processes and reduce adverse events."

A study like that could be very useful if it demonstrated lots of potential benefits if myhr were improved. Mind you it only looks at a very small component of someone's health so its benefits would be severely limited.

The outcomes of the study are not mentioned in the National Digital Health Strategy, neither is it mentioned in the References section. We know that the study was completed, this is what the study team says, although they too seem to have drunk the Kool Aid (...is becoming a critical part of how health works in the country):

"My Health Record is Australia’s e-health record system. Having launched several years ago, My Health Record now has well over a million records and is becoming a critical part of how health works in the country.

The Australian Digital Health Agency wanted to make sure My Health Record keeps delivering its benefits, making the Australian health system better. It asked ThinkPlace to help.

We worked with the Agency to build insight about the future design of the Government's national e-health record system, and to prototype the next version of e-health for the Australian community.

We began by creating a rich picture of the experience Australians have with their My Health Record. We visited well and ill people in their homes and engaged them in workshops.

After speaking to over two hundred people, from a wide range of backgrounds, we created a deep understanding of where e-health needs to go in the future. We developed a set of priorities for the community and insights into the challenges associated with the system.

We also engaged with a range of clinical professionals - from doctors to pharmacists - to understand what they need from e-health and how to make the system useful, efficient and safe.

Based on our research, we created the My Health Record Experience Blueprint. The blueprint reminds designers who the users are, their goals, needs and preferences, and the things that will hinder or help them use their health record to achieve a better outcome for themselves and their dependants.

A design thinking approach has provided the Government an evidence base for decisions about how consumers and providers can best be supported by future changes to the system. There changes are now being implemented, making the system more accessible and ensuring it supports safe and efficient health care."

https://www.thinkplace.com.au/work/listening-patients-improves-national-e-health-record

Evidence? That would be nice.

Bernard Robertson-Dunn said...

If you are not yet convinced of the total uselessness of the myhr (it isn't even a health record it's a pathetic shadow of a medical record containing only summary data and a whole load of disorganised test data, it most certainly isn't a Comprehensive Health Record) have a read of this:

Comprehensive Health Record Vs Connected Health Record

https://www.emrandehr.com/2018/03/26/comprehensive-health-record-vs-connected-health-record/

"The authors see today’s EHR as an “electronic file cabinet” which is poorly equipped to handle health activities and use cases such as shared care planning, genomics and personalized medicine, population health and public health, remote monitoring and sensors.

They contend that to create an interoperable healthcare ecosystem, we will need to move far beyond point-to-point, EHR-to-EHR connections. Instead, they suggest adding connections with patients and family caregivers, non-clinical providers such as school clinics for youth and community health centers. (They do agree with Faulkner that incorporating data on social determinants of health is important.)

Their connected health record ties more professionals together and adapts to new models of care. It would foster connections between primary care physicians, multiple specialists, hospitals, clinics, pharmacies, laboratories, public health registries and new models of care such as ACOs. It would be adaptive rather than reactive.

For example, if the patient at home with cancer gets a fever, her temperature data would be transmitted to her primary care physician, her oncologist, her home care nurse and family caregiver. The care plan would evolve based on the recommendations of team members, and the revised vision would be accessible automatically to the entire care team. “A static, allegedly comprehensive health record misses the dynamics of an interactive, learning health system,” the authors say.

All that being said, this model still appears to be at the vision stage. Perhaps given its backing, the comprehensive health record seems to be getting far more attention. And arguably, attempting to integrate a good deal more data on patients into an EHR could be beneficial.

However, both models are largely untested, and both beg the question of whether building more content on an EHR skeleton can lead to transformation. On the other hand, while the concept of a connected health record is attractive, my sense is that the components needed to this happen have not matured yet.

Ultimately, it will be clinicians who decide which model actually works for them, not vendors or abstract thinkers. Let’s see which model makes the most sense to them"

Anonymous said...

Sadly the only evidence is that the MyHR will proceed with no regard for the consequences, of which little thought has gone into considering. The Government will end up with a privacy and security nightmare that it will neither know what to do with or how to turn off.

At least the Minister will be remembered well beyond his term in government.

Anonymous said...

"Sadly the only evidence is that the MyHR will proceed with no regard for the consequences, of which little thought has gone into considering."

Little? Surely you jest sir. No, would be a more appropriate word.