This release appeared last week:
Agency invests in local industry to design software for specialists
4 July, 2019 - 9:00
The Australian Digital Health Agency is partnering with Australian software organisations to design world leading software for specialists.
The Agency has provided nine specialist software vendors with $40,000 to complete designs that seamlessly and securely integrate the My Health Record into their current systems to bring benefits to specialists, such as cardiologists or anaesthetists. In addition to funding, the Agency will provide design expertise to work with each vendor’s design teams to co-produce improvements in design with their users.
Following an open approach to market, the Agency is partnering with:
- Best Practice Software
- Clinic to Cloud
- Clinical Computers
- Genie Solutions
- Intrahealth
- Medical-Objects
- Medical Wizard
- Software for Specialists
- Zedmed.
The software organisations will work with the Agency and specialists to develop these designs over the coming months.
Some parts of the health sector have enthusiastically embraced the My Health Record – such as community pharmacy which has increased registrations from 20% in June 2018 to 86% in June 2019. The Agency is now turning its focus to increasing use by specialists over the next 12 months.
Many specialists already use My Health Record through software systems they use in public and private hospitals. Having easy access to the My Health Record system in their private clinics as well will ensure a more complete picture of a patient is available during specialist consultations and improve continuity across care settings.
Associate Professor Mark Lane, President of the Royal Australasian College of Physicians says having real-time access will enable specialists to make more informed decisions about patient care and ultimately improve patient outcomes.
“Specialists play a key role in diagnosing and managing complex health conditions, increasingly as part of a care team.”
“Having seamless and secure access to My Health Record at the time of a consultation will help ensure specialists are equipped with as much information about a patient as possible when making a challenging clinical decision, such as recommending a course of treatment.”
James Scollay, CEO of Genie Solutions, a software provider for medical specialists in Australia, says the collaborative design initiatives will be welcome news for specialists.
“We know that well thought through, integrated workflows will help specialists and their patients get the best value from My Health Record,” he said.
“Having over 20 years’ experience in the industry, we have a deep understanding of their needs and what they require to run their practices efficiently. That’s why we’re working closely with the Agency – advocating on behalf of our customers and ensuring their needs are being met.
“This initiative is a positive step forward in this process. Not only will it improve the patient experience, but it will help bridge the gap between medical specialists and other healthcare professionals in the end-to-end management of patient information – ultimately improving health outcomes for patients.”
Agency Chief Operating Officer, Bettina McMahon says part of the challenge is designing solutions that meet the needs of specialists, which comprise a hugely diverse group of clinicians.
“Australian specialists are world leaders in innovation – whether in clinical techniques, robotics, or medical engineering. We want to support our local clinical information system vendors to integrate the My Health Record into their software in a way that encourages specialists to embrace these systems in the same way they’ve embraced other technology.
We won’t be specifying what changes should be made to systems. Instead, we will work vendors and their customers – the specialists themselves – to come up with designs that specialists and their practice staff will love to use, and which will benefit from the rich data provided by the My Health Record,” said Ms McMahon.
Medical Software Industry Association President Robert Best says medical software is vital to the management of patient care in Australia.
“We support a wide-ranging number of healthcare providers to capture consumers’ health information in order to augment clinical decision making,” he said.
“The integration of our members’ specialist software products with My Health Record may help both clinicians and consumers. This is no small undertaking, but we are pleased the Agency is working collaboratively with Industry to co-develop designs that are fit-for-purpose and draw on the software providers’ own knowledge of the sector. The importance of this co-design is to balance the firehose of data for specialists, while ensuring important and meaningful data is presented and delivered in ways that benefit patient outcomes from more informed data-led decisions at the point of consultation.”
The Agency ran an expression of interest process in May 2019, where software developers with a clinical information system being used in at least 10 private specialist practices in Australia at 1 May 2019 were invited to apply.
ENDS
Here is the link:
Before getting into the meat of my comments I am minded to channel Paul Keating who one wisely observed that you should never stand between a State Treasurer and a bucket of money! In this case we have the medical software industry doing what they can to drag in some extra funds – and good on them I say.
However how far do you think you can get for $40,000 as a one-off grant. That – with on costs and overheads etc. – might just pay for one competent developer for three months. Hardly enough time to make any real progress – especially if a new hire who has to come to properly understand the rest of the app before starting work so as to avoid breaking any of the older parts of the system.
If the grant was say $250,000 on might think the ADHA was serious, but $40,000 not as such.
The second point is that specialists are by their nature clinicians who start from scratch and anew with patients trying to work with the new patient in a un-distorted and un-opinionated way to gather solid, timely and complete information regarding the patient from the patient and their GP.
The myHealthRecord is hardly that compared with the doctor’s assessment, the current test results and the referral note – Hint: more effort on secure messaging may make more difference.
A third point is that for many procedural specialists the EHR is largely irrelevant – think Orthopedics, Neuro and Cardiac Surgery – bigger things at the top of mind for most of the time I would suggest.
Fourthly for specialists like me (Anaesthesia and Intensive Care) generalist systems are hardly relevant and what is need are really specialist and dedicated systems of very considerable complexity and communication capability (not on the list above).
Sure there may be some for whom all this may be useful (office based practices like dermatology etc.) but they also will be relying on their own skills etc and not the content of a – probably empty – myHealthRecord. In parallel with this is the fact that many specialists are highly mobile (ward round, clinics etc.) and don't have a base for much of their working day. The myHealthRecord is hardly suited for this workflow.
More pushing on a string by the ADHA in my view.
What do readers think?
David.
20 comments:
The folks at ADHA have no idea how the medical system works. Their childish attempts to bring simplistic solutions to a highly complex industry are laughable.
$40K will buy them a placebo which is all ADHA is after. You will get an API ( FHIR because you have to) you will get a button “view MHR’, Download PDF”, and “post to MHR”
Hardly earth shattering stuff.
"world leading software"
A neat bit of re-framing. Nobody else in the world sees any benefit in a system that needs patients to put data into, that patients can restrict access to, that only contains summary data with some test results, no history earlier than it started to collect data and which requires extra effort from practitioners.
We are the only country in the world spending so much for so little in return. We even have to create and pay for our own global institute that people can use as an excuse for international travel.
The only thing it's good at is being an embarrassment.
July 07, 2019 5:11 PM. Quite agree, it is a bit of a over-reach, na blatant lie for the ADHA to claim is is co-designing world leading software. All it is doing is finding a simple applet, and one that has no value outside the Australian market.
When Associate Professor Mark Lane, President of the Royal Australasian College of Physicians says having real-time access will enable specialists to make more informed decisions about patient care and ultimately improve patient outcomes.
and
Having seamless and secure access to My Health Record at the time of a consultation will help ensure specialists are equipped with as much information about a patient as possible when making a challenging clinical decision, such as recommending a course of treatment.
he demonstrates that he's drunk the ADHA KoolAid. He hasn't the foggiest idea of the realities of My Health Record. "as much information about a patient as possible" is ignorance of the highest order.
As David points out specialists are a different breed from GPs: many specialists are highly mobile (ward round, clinics etc.) and don't have a base for much of their working day. The myHealthRecord is hardly suited for this workflow.
ADHA is trying to solve a technical integration problem but will probably cause more problems than it thinks it can solve.
The more scope creep ADHA does, the more useless My Health Record becomes.
I agree that the more scope creep ADHA does, the less useful the MyHealth Record becomes. The original scope specified only summary information - like discharge summaries, GP summaries, immunisation status.
But various reincarnations have added anything and everything in desperation, so now we have a smattering of pathology results, diagnostic imaging results and a range of medicines-related information. But it's a smattering, incomplete, not current.
So rather than solving the silo problem, it adds yet another silo.
Then to complicate matters, we have each state/territory building its own state-wide electronic health record, with some, like ACT calling it a 'Digital Health Record', and having to explain the difference between the state digital health record and the national digital health record.
NZ seems to have the right idea, and won't be building competing silos. Perhaps Australia can outsource to NZ.
Does everyone registered under opt-out have an IHI?
When the GP sends a request to radiology or pathology is the IHI shown on the request form?
If not, how does the imaging report find its way into the correct patient's MHR?
An observation. The original scope had "conformant repositories" containing existing, historical patient health data, from which the pcehr was supposed to create a virtual record, the summaries were additional documents held in its own conformant repository.
Because NEHTA could not get the original NASH to work and could not solve the interoperability problem, they changed the scope to a central database that only acquired data after registration - so no historical data.
What has been delivered is nothing like the original proposal which was approved by Cabinet and as described in the Concept of Operations. Which probably explains why the ConOp is not available from www.digitalhealth.gov.au - too embarrassing.
It's not so much scope creep as scope change - in search of value and benefits.
Does everyone registered under opt-out have an IHI?
Yes everyone has an IHI. The HI service is independent of the GovHR system. HI was a key enabler for an open interoperable system. The PCEHR/MHR suffocated the clinical communication story
@12:46 PM Thanks - everyone has a HI. Is the HI entered on all radiology and pathology request forms? If not, how does the report get into the MHR?
I have a pathology request form in front of me and it does not have my IHI on it, but it does have my Medicare number.
AFAIK, there is a Medicare # -> IHI look-up system run by DHS. If the lab already has my IHI, they may not need to look it up again.
@1.30PM Thanks interesting. So I assume that because I have not opted out I have an IHI allocated as part of my MHR. Consequently it is reasonable to assume that my GP has my IHI recorded in my medical record on the medical practice system.
If the foregoing assumptions are correct why is it that the pathology request form, which I presume is filled in (populated) by my doctor's practice system, does not include my IHI on the request form?
Everyone has an IHI, whether you opt out or not of a MyHealthRecord.
A clinical information systems like one run by a radiology service or a pathology service is able to obtain your IHI from the HI Service run by Commonwealth Dept of Human Services (DHS) which is completed separate from the Ausatralian Digital Health Agency’s MyHealth Record system. A system can send an electronic message up to the HI Service, containing your name, DOB, gender and your Medicare Card number, and the HI Service sends back the IHI. The local path/rad system can then store that IHI against their local patient record – or go get it each time it needs it. When the Rad/Path system is ready to send a result up to the MyHealthRecordsystem (which is operated by the Australian Digital Health Agency), it includes the IHI in the message, and the My Health Record system uses the IHI to post the result into the correct record. The IHI can also be used to send messages from one healthcare provider to another.
Why is it not on the pathology request form? Good question, and I am guessing it is not essential for the form, because if they have your other details - your name, gender, Medicare card number and DOB, then they can always get your IHI from the HI Service or from where they have stored it in their local system. Too many different numbers on a paper form can be confusing? Another factor might be that the status of an IHI can change over time – e.g. if it is inactive for some reason (or a temporary IHI has now been merged with another), so for some scenarios, it is best to verify the IHI each time it is used.
If you go to
https://www.digitalhealth.gov.au/using-the-my-health-record-system/digital-health-training-resources/on-demand
you can access simulated clinical systems - assuming you can follow the convoluted instructions.
I've just checked the Medical Director version and the patient details screen shows the patient's IHI
I can't get most of the function re My Health Record to work properly
The others I've tried I can't get to work at all.
Funding was cut, team disbanded. The last of the Test and Training Environment is all you see whither on the dying vine Bernard.
@4.17 or 4.41 PM Can another alternate Health Record System (HRS) access patients' IHIs so that medical practices, pathology and radiology service providers can send their reports to a more relevant and more appropriately architected HRS which has the required functionality to fully meet the highly complex needs of patients and doctors?
In theory you should be able to. We did pay for a set of national infrastructures to deliver an innovation platform.
Doesn't it depend on whether the government might try to block such an initiative if it sees it as a threat? On the other hand it might be seen as a welcome initiative providing government with a convenient way out of a highly embarrassing political situation.
Anon 7:46
I haven't delved into legal restrictions re the use of the IHI so use this with care.
This is what the government (DHS) says about the IHI.
https://www.humanservices.gov.au/individuals/services/medicare/healthcare-identifiers
It would seem that anyone who provides health services is permitted to know and use your IHI. It is not restricted to My Health Record. It can be used by health service providers among themselves. (Which may or may not apply in the case of an alternate HRS)
However, this section from the above link may be relevant:
Releasing information
We can share your IHI:
with healthcare providers
with providers who manage health information
on your My Health Record
with anyone you’ve given permission to have your information
In other words, there is no restriction on you choosing to share your IHI with anyone.
FYI, if you have a My Health Record, it tells you what your IHI is. You can also ask a health service provider (GP etc) who is permitted to tell you what it is.
David's title for this blog post is "The ADHA Is Dreaming If They Think Specialists Will Flock To And Use The #myHealthRecord."
The ADHA's claim that giving patients access to their health records will allow them to "take control" of their health, is yet another dream.
The Discouraging Way Doctors Are Just Like Their Patients
https://www.theatlantic.com/health/archive/2019/07/what-doctors-are-like-patients/593482/
"A new working paper challenges the notion that better-informed patients make better decisions. It found that an especially well-informed group of patients — physicians — don’t always make the best choices when they are patients, either."
We know the ADHA and the government just love evidence based decision making. They can add this evidence to all the other evidence that shows that patient health records (as opposed to clinical and medical records) are worse than useless.
IMHO, if the government is really interested in improving the health of the Australian population they should concentrate on population level initiatives, not personal interventions.
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