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Friday, May 04, 2018

ADHA Can’t Even Say What They Mean As Far As myHR Availability Is Concerned?

This appeared last week:

My Health Record – the connection to accessible information at any time

Hospital pharmacist Leonie Abbott discusses the benefits of My Health Record.
This article originally appeared on Australian Association of Practice Management (AAPM).
By the end of this year, every Australian will have a My Health Record unless they decide they do not want one – and all healthcare providers need to be prepared, wherever they are.
Already 5.5 million Australians – more than 20% of the population – have a My Health Record.
Almost 1,000 public and private hospitals around Australia have connected to the My Health Record system via their electronic medical record systems. Across Australia, 72% of public hospitals are connected to My Health Record – covering approximately 81% of available beds nationally.
Hospital pharmacist Leonie Abbott from the University Hospital Geelong, at Barwon Health in Victoria, has been uploading records to, and using My Health Record, since 2013.
She said having My Health Record accessible ‘24/7’ is an extremely useful benefit of the system.
“Within a busy emergency department, being able to access information at any time is essential. Patients come in at any time of the day or night with emergencies, and often they have little healthcare information with them, including knowledge of their medicines.
“My Heath Record is a summary of multiple clinical information software all in one record. It gives some preliminary information that may allow you to identify which healthcare practitioner in the community to call. This avoids unnecessary phone calls, or faxes and time wasted,” Ms Abbott said.
Lots more here:
When you go to the new website what you find is this:

Service availability

There is currently no planned outage to the My Health Record system
So knowing how, in the past weekends have been favoured for downtime, and reading here that there can be planned, as well as obviously unplanned, outages the 24/7 has not in the past been true and won’t be in the future.
Here is a recent example:

My Health Record system Release 9.2

Created on Tuesday, 16 January 2018
Release 9.2 of the My Health Record system is a technology release which will improve some functionality for both individuals and healthcare providers. There will be minor visible changes to the user experience, mainly to improve access on mobile devices.
Release 9.2 is scheduled to go live on Monday 22nd January 2018.
There will be a planned outage from 8pm Friday 19th January to 6am Saturday 20th January.
Here is the link:
That is 14 hours off-line – not really 24/7 I would say – and not really fit for the purpose claimed – isn’t Friday night the busiest time in ED? Great for planed downtime!
More proof it is not a clinically focused clinical system but a useless data pile.
Might be good to get the story straight. Anytime is not all the time, but when it suits us and we have not had an unexpected outage!
David.

10 comments:

Anonymous said...

What a difference a day makes David - https://www.myhealthrecord.gov.au/service-availability

Wonder what has been discovered? Is this another sign that ADHA is lacking technical and quality assurance capabilities? That would not surprise me, I hear much of their internal IT issues are due to HR manager and some friend is running Corporate IT, good knows who is overseeing the MyHR.

Anonymous said...

David could you validate -

Service availability
There is currently no planned outage to the My Health Record system

Was this captured Friday the same day of your post?

Dr David G More MB PhD said...

Capture was last weekend when I wrote blog - thanks for the heads up!:

It now says:

Service availability


Due to system maintenance, some channels to access and view records in the My Health Record system may be interrupted between 12:00am and 11:59pm, Saturday 5 May 2018 (AEST).

During this period new registrations to the My Health Record may not be possible. Existing consumers may be able to access and view records online and via mobile apps (see available apps), however access to some documents may not be possible. Healthcare providers may be unable to add new reports, update or remove existing information from your record via their connected computer systems.

We apologise for any inconvenience.

If you need assistance, you can contact the Help line on 1800 723 471. The Help line is a free service and is available from Monday to Friday 8:30 AM to 5:00 PM (AEST). (Call charges apply to mobile phones.)

----

Making my point this is not a clinically relevant system but a data vacuum cleaner / collection mechanism for Govt.

David.

Anonymous said...

Thanks. It is still a bit concerning. A less than a weeks notice for what is presumed to be ‘scheduled maintenance’. As any replay forming (whatever that means) will take several years or more, perhaps the first step is to put it on a platform and make it a resilient platform.

Telling everyone we are ready to fly when all they have is some cardboard and an old bicycle is stretching things a bit

tygrus said...

This beta system with 90% uptime should be working when GP's are harder to contact ie. after hours and the weekend. It needs to be designed for 99.99% availability. The banks can do it, so why can't the myHR ?

The whole system should be multi-tier, use duplication and partitioning. System, database and software admins should be able to do more work independent of each other instead of all-or-nothing (adding a field, changing code, fixing hardware takes system offline).

To add tables and change design then you have to copies of the databases. You make a change to one while traffic is directed to the other and writes are buffered. Stage, test and verify changes; then process the buffered writes waiting to be committed and keep all copies synchronised; then switch the primary data source to be the updated source. You could also do this so that you had different racks storing different groups of patients and a fault only affects a smaller group of patients not the whole.

Now that you have the database supporting new data & functions you can switch the middle-tier software using the similar 3 instances for develop/test/production and quickly switch routing without the users noticing.

Now do the same for the web servers (front-end) where the next request picks up the latest version of files, or at worst, asks the user to login in again.

Load balancing and controlling the routing of requests down and up through the tiers become critical but overall flexibility and reliability are improved.

Anonymous said...

Tugriks. The ADHA can’t even do that with on-site servers and three building with there own server rooms. The common thread between MyHR and the ADHA Network is they are (mis) managed by arrogant souls with little or no depth and breath. Still shouting and bulking will get things through. Well until reality catches up.

Bernard Robertson-Dunn said...

For that sort of availability you need to make sure you don't have any single point of failure. Which means multiple comms, power and preferably locations. Banks and airlines often do it by having a distributed system over two data centres a significant distance apart. Plus a disaster recovery capability. DR isn't for availability it's for a disaster.

AFAIK, myhr is a single instance (i.e. no redundancy, although it's got multiple comms and back-up power) and a DR site. That's a guess based upon the original infrastructure RFT and a lack of expenditure that would have delivered additional capability.

The interesting question is capacity. To pre-register 20 odd million isn't the problem, that can be done quite slowly. If those 20million were to try and complete their registration and upload a SHS in the first month, I doubt the system could cope. But then they'd have to see their GP, make them their nominated provider, discuss the requirement for a SHS and agree the contents. Not everyone sees a regular GP once a year, a large proportion won't see any in a given year.

In reality, I doubt they'll get anywhere near 40% of the population with a first SHS after 5 years. They are currently running at the number of SHS = 29% of total registrations. This includes updates. So after 6 years of opt-in (i.e. the keen ones) and the opt-out trials, they haven't made 30%.

And many of those SHSs will be old, very old.

If you were to say that only those SHSs uploaded this year had any chance of being current, that's 6%.

Anonymous said...

Tygrus, Bernard and others, you might find this section of the 7th clinical safety report insightful. https://www.safetyandquality.gov.au/wp-content/uploads/2017/08/Seventh-7.3-Downtime-Clinical-Safety-Review-of-the-My-Health-Record-System.pdf

Looking at historical patterns and the last report being released in August 2017, one would expect the 8th to be close if not already underway.

Will privacy and clinical safety impact assessments be done prior to opt out? Will architecture, security, privacy and clinical assessments be undertaken across the changes to enable opt out?, what is the planned frequency during the first year and then what is the planned periods post year 1? Is there a tolerance threshold?

Bernard Robertson-Dunn said...

Anon @5:03, Thanks.

Other questions:

1. Does ADHA have plans to enhance and modify the system? If so, will they let people know the nature of those planned changes so that they can make an informed decision prior to the close of the opt-out period?

2. Does ADHA or the government plan to require, induce or compel GPs or other health professionals to input data to the system? If not, can they assure Australians that they never will?

tygrus said...

I was wrong about the 90% uptime. It would appear they are claiming 98.5% uptime (downtime 125hrs/12mths) of the 100% functionality or probably 99.29% uptime (downtime 62hrs/12mths) if you just ignore planned outages (read-only access still available). Unfortunately, the exact start & end dates were not specified, only that a 12 month period was used. The report was dated October 2016 but made public August 11, 2017.
Page 6 from the following report.
https://www.safetyandquality.gov.au/wp-content/uploads/2017/08/Seventh-7.3-Downtime-Clinical-Safety-Review-of-the-My-Health-Record-System.pdf
https://www.safetyandquality.gov.au/publications/seventh-7-3-downtime-clinical-safety-review-of-the-my-health-record-system/


Finding 3: My Health Record system downtimes were evenly split between planned and unplanned downtimes in the period examined. Risk rating: Minor Total downtime was evenly balanced between unplanned incidents (62 hours, 50 per cent) and planned events, which included release deployments (53 hours, 42 per cent) and emergency extensions (10 hours, 8 per cent) Recommendation 3: That the system moves to a fault- tolerant architecture so that software can be updated on a redundant system and moved to the live environment when the update is successful, with no downtime. [The recently implemented read- only environment upgrade strategy partially addresses this finding.] from page 6