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, June 16, 2019

Do You Remember When The ADHA Regulations Were Changed To Allow Shop Assistant Access To The #myHealthRecord?

I spotted this last week:

My Health Record: learning opportunity for PAs

Pharmacy assistants play an important role in helping customers obtain the medicines they need, and part of that process is using My Health Record in the supply of medicines and advice to customers.
Often pharmacy assistants have well established relationships with customers, based on familiarity, time and the previous high-quality service they have provided.
With the introduction of My Health Record, pharmacy assistants now have an opportunity to develop those relationships through helping pharmacists and customers get the greatest benefit from the system.
In recognising that the My Health Record system makes it easier and safer for pharmacists, doctors and other health professionals to provide care to customers, Guild Learning and Development has partnered with the Australian Digital Health Agency to develop an online module titled Introducing My Health Record.
This is the first of two modules to be launched on this topic, written especially for pharmacy assistants and dispensary assistants. The second module will be launched in July.
This first module examines how My Health Record works, and explores the information stored in the My Health Record system. On completing this module, pharmacy assistants and dispensary assistants will have learned how they can support their pharmacy to use My Health Record when supplying medicine and advising customers.
To enrol in this course, visit guilded.guild.org.au or contact Guild Learning and Development on 03 9810 9930 or email learninganddevelopment@guild.org.au for more information.
Here is the link:
Let us be quite clear here – these “pharmacy assistant” are not registered clinicians in any sense but my have received training from the Pharmacy Guild in store front operations and so on. Basically they are just shop assistants.
Here is the advertisement for a training session.

Enabling the Clinical Use of My Health Record in Pharmacy       

With 9 out 10 Australians now having a My Health Record (MHR), this important session for community pharmacies will provide an update on privacy and security obligations for pharmacy as well as introduce a new pharmacy clinical document for the MHR.
Open to all pharmacy staff, this workshop will expand upon participants' knowledge of MHR and will explore its features, functionalities, benefits and uses as they relate to pharmacy practice. Participants will be asked to participate in an extensive case study group discussion and will have the opportunity to discuss the MHR system.
Here is the link:
Note  the workshop is open to all staff:
“Who can attend: All pharmacy staff including proprietors, pharmacists and pharmacy assistants.”
So what training do these PAs have?

Pharmacy Assistant Training

Pharmacy Assistant Training is supported by Guild Learning and Development and delivered by your local Guild Training Team. The Pharmacy Guild has been delivering training to Pharmacy Assistants for over 15 years, longer than any other provider.

The Guild offers training in the following accredited qualifications for Pharmacy Assistants:

SIRCIND002 Support the supply of Pharmacy Medicines and Pharmacist Only Medicines (S2S3)

This unit will give your pharmacy assistants the knowledge and skills to support supplying S2 and S3 medicines to your customers. Accredited training can help you ensure your customers receive the best advice, care and health solutions.

SIR20116 Certificate II in Community Pharmacy*

The Certificate II in Community Pharmacy is your first step in a career in pharmacy. This qualification will provide you with basic pharmacy and retails skills. Expanding your skills provides career growth and opportunities, helping you to secure your future.

SIR30116 Certificate III in Community Pharmacy*

Comprehensive product knowledge and health information including cough and cold, analgesic and anti-inflammatory and allergies management. Grow and specialise your career with key pharmacy roles: health conditions, front of shop operations, merchandising and display, marketing, stock control, dispensary operations and key product and health categories.

SIR40116 Certificate IV in Community Pharmacy*

This qualification will benefit experienced pharmacy assistants who are looking to expand their skills to become a senior pharmacy assistant or front-of-shop manager. Senior pharmacy assistants are often responsible for the management of particular functions in the pharmacy, the management of a range of health categories or for the supervision of pharmacy staff.

SIR40216 Certificate IV in Community Pharmacy Dispensary

This qualification will benefit experienced pharmacy assistants who are looking to expand their skills in the area of dispensary. Dispensary assistants work with the pharmacist to provide prescription medicines to pharmacy customers. Under the supervision of the pharmacist, dispensary assistants maintain customer records, select and label medicines and process claims.
*Jobs and Skills WA funding may be available and is dependent on eligibility criteria.
** If enrolling person was not born in Australia
Here is the link:
Here is another useful link:
Does anyone think these unregistered staff should be anywhere near #myHR data.
AFAIAK it is not what the law says and these non-registered staff a committing a crime, in terms of the relevant act, accessing and using the #myHR. If indeed a pharmacist can authorise shop staff to access the #myHR then all the protections are a bigger farce than most of us thought.
What do you think?
David.

20 comments:

Anonymous said...

They will be launching MHR loyalty cards next. This is as you say David not lawful. Peter Dutton has enough to do surprising reporters and government whistleblowers without Timmy generating business for him.

As for the bit about relationship building, most pharmacies have become part of a larger corporate entity and required to deliver high run-over not to get intimate. These assistants are being used for some other purpose perhaps?is there funding for pharmacies to use MyHR? Or is this a nudge to normalise pharmacies leading to a normalisation of pharmaceutical and insurance companies obtaining access?

At least 1-10 have been fortunate enough to opt out.

Bernard Robertson-Dunn said...

David,

My reading of the legislation (IANAL) is that employees of a service provider have always been able to access PCEHR/myhr if authorised.

This part of the legislation originally (2012 version) said (an entity includes health care service providers)

"Division 3—Authorisations of entities also cover employees
99 Authorisations extend to employees

An authorisation under this Act to an entity (the first entity) is also an authorisation of:
(a) an individual:
(i) who is an employee of the first entity;"

It now says:
https://www.legislation.gov.au/Details/C2018C00509

Division 3—Authorisations of entities also cover employees

99 Authorisations extend to employees etc.

An authorisation under this Act to an entiy (the first entity) is also an authorisation of:

(a) an individual:

(i) who is an employee of the first entity; and

(ii) whose duties involve doing an act that is authorised in relation to the first entity;"

The only change has been to make it a condition that employees had a duty that involves doing an authorised act.

"doing an act" is not defined.

This hole has always been there.

At one time the myhr website made this explicit. Such advice has been removed.

BTW, it would appear that a contractor to an entity (such as an IT service person) can access myhr.

The hole is bigger than you or anyone else realises.

On top of all this is the fact that the protective legislation only applies to information that cannot be obtained elsewhere - which is most of the health data.

See section 71 of the above legislation.

Dr David G More MB PhD said...

So Bernard is your view that this free-for-all access is appropriate or not?

David.

Bernard Robertson-Dunn said...

David,

My view is that the government is giving the impression that access to a consumer's (i.e. not even a patient's) health record is limited to health professionals, is controlled and logged at the individual user level, and the data is protected by myhr legislation.

None of these is correct.

It would seem that the legislation permits a pharmacy (i.e. an entity in legal speak) to permit children to assist behind the counter after school hours or at week ends and these children, being employees, could be authorised to access myhr.

IMHO, a strong case could be made that this is a fraud, however the reality (not the claims) is enshrined in law. As we have seen with the claims made during the elections, political statements are not so much above the law but immune from the law.

To be explicit, this is a bad thing.

The bureaucrats in the government have been convinced that myhr is a good thing. That this is false is irrelevant. The strategy now is to do whatever it takes to get people to use the thing. The sunk cost fallacy.

IMHO, most people will ignore it (like they do with their health anyway). Most GPs will realise they get nothing out of it. The only reason they will upload data is to get paid for it.

Bernard Robertson-Dunn said...

A question:

Can existing pharmacy software download data from a patient's myhr?

Long Live T.38 said...

Not 100% sure across all.

https://www.myhealthrecord.gov.au/sites/default/files/hd173_pharmacyqa_v0.10_20190201_wr.pdf?v=1548994084

Q33. How can I access the My Health Record system at my pharmacy?
There are two ways to access the My Health Record system:
1. Conformant Software: Accessing the My Health Record system through conformant software enables healthcare providers to upload, view and download information from a patient’s My Health Record. Examples include Fred Dispense, Fred NXT, Aquarius, Minfos, MyScript, Corum, Dispense Works, LOTS and Z Dispense. A full list can be found at https://www.myhealthrecord.gov.au/for-healthcare-professionals/conformant-clinical-software-products
2. National Provider Portal: If a healthcare provider does not have access to conformant software, they can view a patient’s My Health Record through the National Provider Portal. The healthcare provider will be able to view and download information from the patient’s My Health Record, but will not be able to upload clinical information.

Bernard Robertson-Dunn said...

@11:00 AM

Thanks. That means any pharmacist who is filling a script for a patient can view and download patient information into their own system, upon which all myhr privacy protections are null and void and so is user logging.

It also means that it is unlikely that any information in myhr that is subsequently updated and or corrected will get to the pharmacist.

It would seem that the original goal of the PCEHR - to reduce the fragmentation of a patient's health data - has been subverted by the very solution that was supposed to achieve this goal.

That's what happens when you fixate on the supposed benefits and don't look at the system as a whole.

Nobody knew that health care could be so complicated
D.J. Trump

Long Live T.38 said...

1:13 PM based on your take on the legislation would I be right in assuming anyone working at a pharmacy could down load, and who knows if that can be straight to a USB stick or Facebook

Bernard Robertson-Dunn said...

@Long Live T.38

myhr data is only legally accessible to a health service provider who is delivering health care to the patient.

It is not clear to me that filling a script is really delivering health services. It may have been deemed so in which case it is legally OK.

Neither is it clear what the window for "delivering health services" is. If you get a script filled today, is the pharmacist permitted to review your myhr tomorrow? Next week? Next year? AFAIK, such a matter has never been tested in court - like so many other myhr legalities.

It may well be that the Pharmacy Guild should be careful what they wish for.

re personal data in a pharmacy system I would expect that to be covered by the default Privacy Act.

There is certainly no free for all re access to health data, but there are a number of legal grey areas.

As with all such legal matters, the system does not stop something bad happening it only punishes those who transgress and who get caught and who are prosecuted and who are convicted.

Long Live T.38 said...

My observations are that pharmacy systems run only basic (but fair) information security. Gaining access to these end points and using them to “teach” machine learning security applications normal patterns over time in order to then obtain access to swaths of citizens data for all sorts of profitable reasons might just pose a threat to our health system and our people. Anti-patterns are just patterns the machine has not learned, once a behaviour is normal then the algorithms will not question.

Anonymous said...

The only thing that has saved My Health Record so far is its uselessness - there's very little data on very few people so the risk is low.

The more ADHA tries to make it relevant the more likely it is that it will blow up in their faces.

Then we will see politicians and bureaucrats running for cover and rats deserting a sinking ship.

And there will be no shortage of people saying very loudly - We Told You So

Anonymous said...

Long Live T.38June 18, 2019 8:44 AM

That is a plausible undertaking, wonder how the ADHA is addressing that? What is normal activity, accessing 10000 records a day is only 10 records per end point. Easily fly under the radar and geographically an easy target to hit. Probably happening now.

Anonymous said...

The MyHR has been safely put in a box, if it explodes only the people and contents in the box will be damaged. Tim failed to elevate himself and now is branded a shoebox manager. The minister is off saving us from mental health which on the surface is heroic, ready an article in Croakey yesterday it faces similar policy, political and funding challenges as everywhere else. Highly recommend the article some great perspectives

Anonymous said...

@11:47 yes that is a great piece. https://croakey.org/the-personal-and-the-political/

Anonymous said...

Bernard Robertson-Dunn said...
@11:00 AM

Hi Bernard, many years ago, maybe 20 years, I attended a US data analytics conference held by one of the world's biggest business intelligence.

I was shocked that one of the key events was drug company use of doctor's prescribing and patient health data, with a view to compiling "tailored" and "targeted" information about individual medical providers.

This allowed their company sales reps to walk into a doctor's surgery for a "discussion" about their prescribing habits, and make "suggestions" about their own alternative products as well as "educating" doctors about new products...

No doubt drug company interests and data capabilities are now far more advanced... potentially even allowing them to target individual patients with "news" and ads suggesting they ask for a new or different medication.

One of the blessed things about the Oz health system is that the PBS has largely kept a rein on this type of behaviour, but for how long, I wonder?

Andrew McIntyre said...

They absolutely gather prescribing data on you in Australia. I have not seen a drug rep for 20 years, but have on occasions been advised that "you prescribe xxx, my sales figures are low in this area". Back they they used to go and talk to the local chemists. Would not be surprised if they get other prescribing data from them these days as they profile individual prescribers quite intensively. They would certainly pay for the data, not sure if its being sold, but would not be surprised.

Anonymous said...

The real owners of the national health strategy.
https://www.abc.net.au/news/2019-06-20/pharmacy-guild-lobby-wields-great-political-power/11217028?pfmredir=sm

Anonymous said...

What national health strategy? There isn't one, although ADHA pretends there is. All the states are doing their own thing.

My Health Record is supposed to be a summary system but ADHA is working hard to get as many test reports uploaded as it can. The latest are reports from breast and gynaecological ultrasound scans and mammograms.

It's running the risk of drowning in data and making itself totally unsuitable for patients and doesn't have everything/anything doctors need.

The "data is good, more data is better" is the wrong strategy for healthcare but not for pharmacists.

Anonymous said...

What could possibly go wrong with pharmacy assistant access to confidential health information like this?

Perth diagnostic imaging centre Women's & Breast Imaging has connected to the My Health Record and will begin uploading reports from breast and gynaecological ultrasound scans and mammograms directly to the system.

https://www.pulseitmagazine.com.au/australian-ehealth/4982-women-s-breast-imaging-connects-to-my-health-record

Anonymous said...

@June 20, 2019 9:14 AM

Oh, the Guild will really not be happy with that take-down! Put the ABC board chair on standby for return salvo...

Like the Guild has been doing this week with respected News health reporter Sue Dunlevy...

https://ajp.com.au/news/guild-hits-back-at-location-rules-beat-up/

and also

https://ajp.com.au/news/this-is-australia-not-russia-cwh/

Not sure if the Guild has ever really played nice... but this over-the-top reaction indicates they're feeling a teensy bit vulnerable.

CW's Mario Tascone is perfectly correct in his comments on the pharmacy situation in New Zealand