This appeared last week:
My Health Record: 5 problems and 1 solution
In an ideal world, e-health records are a terrific idea - in real life, however, there are several medicolegal issues that are of concern
Dr Craig Lilienthal
28th February 2019
I have been trying to get my head around the medicolegal implications of My Health Record for some time now.
I have studied the legislation (which is confusing for a non-lawyer) and statements from the Minister for Health (which change every time pressure is applied by diverse, interested groups).
In an ideal world, e-health records would be terrific if they could be relied upon and privacy could be guaranteed. I doubt either of these objectives can be fully achieved.
Nevertheless, the following issues with My Health Record (MHR) strike me as areas of medicolegal concern:
1. Data input deficiencies
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2. Too many cooks
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3. Data retrieval
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4. Data updating
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5. Doctor–patient relationship
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So what can we do to protect ourselves?
I think the first thing to do is to not rely exclusively on our patients’ MHRs.
We must continue to evaluate our patients in the traditional, direct way — via a history, appropriate examination and therapeutic recommendations.
We must not be distracted by MHR data if it does not coincide with our classical patient evaluation. Remember the IT axiom: ‘GI = GO’ or ‘garbage in equals garbage out’.
MHR data needs to be evaluated and weighed up against the presenting situation, and we must assume it may be incomplete.
Our medicolegal obligations to our patients will not be altered — either enhanced or diminished — by MHRs.
These records may or may not make life easier for us, but they will not change our level of responsibility and liability.
No one — governments, patients or insurance companies — is going to indemnify us against claims and complaints brought by patients as the result of an inefficient or inaccurate e-health system.
The buck stops with us, as always. MHRs represent another source of patient information, which needs to be properly evaluated — just like any other patient history or medical report.
The full article is here:
The bottom line is that any clinician uses the myHR at their own risk and must ensure that an critical decision making is based on the soundest possible information that has been sourced in safe and reliable ways.
The ADHA and the Government do not indemnify you if you make a mistake or are misled by information in a myHR. You – the clinician – remain totally responsible.
The myHR is nothing but a pile of documents which may or may not be either relevant or useful. It is vital the benefit / risk equation is considered carefully all the time.
David.
20 comments:
This is a interesting situation but another example of a longstanding issue that the PCSHR/MYHR pusher have avoided and smothered at every opportunity. The ADHA can be sued. What concerns me about this situation is it is no a situation not of someone’s conscious decision. They are forced into a risk based scenario with some considerable consequences.
The Government has a real challenge here. Normally we could look to them to provide some form of independent leadership, draft and inaction some policy of legislation. As they in a sense are the core of the issue, are they not conflicted?
Government should be there to protect its citizens not put them in unreasonable harms way.
Just keep nudging forward, we can deal with catastrophic failures as they happen. Many have been opted in, no one can check-out
Thanks David this is not good from a risk/reward viewpoint. Again what problem is the Federal Health record system trying to solve? Is it a strength or a weakness in the current wheatgrass landscape?
I note that neither the RACGP or AMA have much to say (wonder why) with the latter now being sucked into a turf war with the pharmacy guild. That will be a tough outcome for AMA as the ADHA Department are indebted to the Guild over the MHR.
There is an asymmetry of cost/benefit/risk for a GP.
By definition, a GP already has all the data that they can put into a patient's SHS.
It costs them time, effort and a reduction in time to treat their patient. They run risks of security and privacy.
It also means (if you believe the government) that a patient will find it easier to go to other GPs.
The GP either loses their patient or has to read up on what the other GP has put in a replaced SHS or has to talk to the patient about what happened if they didn't.
And the benefit? None that I can see.
myhr make life harder for GPs so why would they use it?
" I think the first thing to do is to not rely exclusively on our patients’ MHRs.
We must continue to evaluate our patients in the traditional, direct way — via a history, appropriate examination and therapeutic recommendations.
We must not be distracted by MHR data if it does not coincide with our classical patient evaluation. Remember the IT axiom: ‘GI = GO’ or ‘garbage in equals garbage out’.
MHR data needs to be evaluated and weighed up against the presenting situation, and we must assume it may be incomplete."
How is this news, obviously that's how all data should be treated. Do doctors think computers are magic?
Do doctors think computers are magic?
No but Health/ADHA do
It might be case that some are unable to recognise or grasp genuine intelligence, frustrated and meddling they impose artificial intelligence, sadly they view the world through administrate lenses not clean clinical or patient lenses. The result is no one wins and I still have no right over my data.
https://www.abc.net.au/article/10887174 - There's no lung left': Man told he's going to die by doctor on robot video
When we are stripped and dehumanised, packaged and presented as a number in a balance sheet, it is not magic, although it does rhyme with magic.
The correct link is:
https://www.abc.net.au/news/2019-03-10/us-man-ernest-quintana-learns-he-is-dying-from-doctor-on-robot/10887174
David.
Can anyone tell me why, all of a sudden, patients want to control access to their health data?
In the past, people were quite happy for their various health providers to keep health records that assisted them (the providers) to do their job. The providers had a vested interest in keeping the data protected. They only collected the data they needed for the care they provided, not for the patient to look at and not for other providers to look at and consolidate.
This fixation on patient controlled access to (as opposed to patients having access to) their health data has only arisen since the concept of a complete record came about.
It could be argued that simple solutions to the problem of fragmented health data have created rather serious problems of their own.
Making it easier to access all a patient's health data is not the answer.
The real answer is to make it easier to access appropriate health data on a need-to-know basis and with appropriate consent. This is not easy and myhr comes nowhere near to delivering this answer.
In fact, because the original NASH was never implemented, and because explicit consent has now been removed, and because myhr is a government owned database and the government has no need to know your health data, myhr is a bit of a mess.
All it needs is another $2b and ten years in which to deliver a federated model with appropriate data management/curation, and need to know and consent capabilities (assuming such things are possible and/or feasible) and we might see some progress.
Or not.
The real world may well have moved on having recognised that the manual effort required of doctors to manage and input all this historical data is just not worth it.
Not for all patients, maybe not for any.
And a final thought. Healthcare must always be capable of operating in a context of zero usable historical data. True transformation of healthcare will only happen when this is the normal practice, in which case the need for (and overheads of) health records will be minimised.
BTW, hospitals are different because they have a need for continuous monitoring of current status and treatment. Their problems are different so are their solutions.
Bernard asked - "Can anyone tell me why, all of a sudden, patients want to control access to their health data?"
Technology enthusiasts and marketing misfits with a distorted view of health and medical practice have conjured up a perceived and somewhat artificial need for patients to control access to their health data. To support the argument they have undertaken market surveys designed to justify such claims and convince politicians and bureaucrats of the need to invest huge sums in developing solutions, like the My Health Record, in pursuit of this ill-conceived goal.
"This fixation on patient controlled access to (as opposed to patients having access to)" lies at the core of the problem with the My Health Record.
@10:42 AM .... and along the way they lost sight of the deep underlying reasons behind why we need to have a medical record. Instead, they set out with irrational haste to develop a solution to a series of wicked problems without understanding precisely their inter-dependencies that needed to be solved.
You should not overlook how consumers and every imaginable stakeholder (often with conflicting agendas and vested interests)were extensively consulted, so that the resulting mishmash of beliefs, wants, must-haves and nice-to-haves, were all added to mix to give 17 million Australians the My Health Record potpourri we have today.
"the problem of fragmented health data" remains unsolved and the My Health Record has failed to address the problem.
A distributed or federated business model such as the Australian healthcare landscape will never be solved by a centralised solution. Funding models alone constrain this possibility. Better to allow standards based solutions to address the messaging requirements and then have a consumer virtual record sit over the top. Oh wait that was the thinking before the PCEHR came along.
Agree, the My Health record has created yet another fragment.
Yes but it is about the fax remember. We must axe the fax.
@10.08AM "Healthcare must always be capable of operating in a context of zero usable historical data. True transformation of healthcare will only happen when this is the normal practice, in which case the need for (and overheads of) health records will be minimised."
Certain historical data is relevant and important in healthcare and always will be whilst plenty of other data is not relevant and more often than not just noise. Some data has high relevance from a medico-legal perspective. In certain circumstances some Past operations and illnesses are highly relevant to the clinician.
Ian,
I agree that's why I said minimised, not eliminated.
The push at the moment is to pump as much data as possible into health records without any regard for relevance or quality.
There's an interview on USA TV with Drs Dave Campbell and Eric Topol who knows a lot about what's wrong with healthcare, but unfortunately not as much about how to fix it. That’s not my opinion, see * below
http://www.msnbc.com/morning-joe/watch/health-officials-encourage-vaccination-amid-measles-outbreak-1455716419690
At 3:50 the interviewer raises the issue of doctors with their noses in the computers, bashing away at their keyboards. Dr Campbell identifies this as a major problem that needs to be solved. Dr Topol thinks that voice input and natural language processing will help. D'Oh.
All that will do is increase the amount of unprocessed data in health records.
The segment starts with the problem of people not getting their children vaccinated. You know, people taking control of their their (and their children's) health! What the government thinks will happen when all Australians have started to use their myhr.
a) it's unlikely to happen very often and b) there's a good chance people who do try and take control will stuff it up.
* Re Dr Topol
From this review of The Creative Destruction of Medicine:
https://www.newscientist.com/article/mg21328502-800-medicine-for-me-not-for-the-crowd/
"According to Topol, modern medicine's focus on the population rather than the individual may be damaging our health."
and
"Individualised medicine for the masses is still a long way off, and although Topol provides a seductive vision of the future, he is vague on just how we get there."
He’s currently promoting his new book on AI. He really needs to go back and read his own book. Artificial Intelligence and machine learning are both approaches based upon analysis and use of big data – i.e. population data.
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