This appeared last week:
The 2.9 million reasons why My Health Record is still wasting GP time
With doctors still deeply skeptical about its clinical value, the spin needs to end
12th February 2020
By Paul Smith
There are still serious issues over the My Health Record and whether the billion-dollar system has a future.
Australian Doctor editor Paul Smith warns nothing is being done to address the crisis of faith among the medical profession.
The number is basic, but it helps tell an unwanted story. In December last year, GPs collectively uploaded 2,996,570 documents to the My Health Record.
Over the same period, the number of documents uploaded by GPs that were actually read by another health organisation was just 16,944.
The statistical disparity is a measure of the shallow depths the system has reached in terms of its relevance to day-to-day clinical practice.
Last month, the CEO of the Australian Digital Health Agency, Tim Kelsey, left for a new job in the US. He had arrived three years earlier to much fanfare, a fat pay packet and a fancy office overlooking the Sydney Harbour Bridge.
His tenure was by no means a disaster in a job engineered to cripple reputations: he dealt with the transition to an opt-out system, and pathology and radiology results are now being uploaded en masse.
He also avoided the political fallout when Australians discovered that police and government agencies were free to access medical information held on the system without the knowledge of patients themselves or any scrutiny from the courts.
But to many doctors, the system remains a white elephant exploding in slow motion.
The digital health agency has spent much time and effort producing big statistics for public consumption — virtually all of them are bubbles, floating in the sky to look pretty.
Yes, 1.7 billion documents have been uploaded, including 1.5 billion 'Medicare documents'.
Who cares? The only real issue has ever been clinical engagement and its clinical value.
On this, there are fewer numbers. How many non-GP specialists are looking at shared health summaries, for instance? Who is uploading event summaries (sold as a way for after-hours doctors to keep daytime GPs in the loop)? How many hospital and non-GP specialists are resorting to the My Health Record to guide their own decision-making?
The digital health agency won’t say.
The big selling point for the system was that it would save lives in ED. On admission, a patient’s shared health summary would be checked for medication history, for potential allergies to ensure no misadventures.
Lots more here:
The first thing to be said is that, if this week’s poll is to be believed, a very significant majority of those who read here, really don’t see the #myHealthRecord lasting all that much longer and don’t see much ongoing funding.
See here if you missed it.
Secondly the author has noticed just how the ADHA is obfuscating and attempting to justify the system on the basis of totally meaningless statistics.
The secrecy surrounding the meaningful stats regarding the #myHealthRecord is frankly a national scandal!
I reckon we all need to write to our local MPs to tell them to stop wasting our money!
David.
44 comments:
".. write to our local MPs to tell them to stop wasting our money!" David, surely you don't think they will take any notice?
I mean really, if they can keep pretending there is nothing wrong, and if they can keep believing all the lies, spin and hype that they have been swallowing from NEHTA, and now the ADHA, for the last decade, how on earth can you in all good conscience suggest that asking or telling them to stop wasting millions more on this unmitigated mess will be given the slightest consideration by any politician?
For the $2 billion spent on the My Health Record the za Govern.ent could have constructed per 6,000 homes which would have housed well over 12,000 people. What expenditure would have given the best ROI?
Is the myHR a waste of money and resources? Absolutely. There may be some small benefit for some small cohort of the population but for the vast majority of the population, it is totally irrelevant and unsafe.
For my part I have well over 200 Shared Health Summaries to my name - all of them are clinically useless. In my day job, most of my clients are GPs and GP clinics and I consent to use myself as a test patient to ensure that their software works. I wonder if this was one of the Use Cases considered when justifying the myHR. I suspect not.
I wonder if doctors have noticed just how good "military grade security" really is?
U.S. agency that handles Trump's secure communication suffered data breach
https://uk.reuters.com/article/uk-usa-defense-breach/u-s-defence-agency-personal-data-may-have-been-compromised-letter-idUKKBN20E270
The DISA is probably one of the best in the world at secure communications, far better than a civilian IT contractor working for a policy agency.
The myhr contains very little data of clinical value but it could be useful for other purposes. It could leave the government open to blackmail if a bad actor were to break into the system and threaten to reveal the breach.
I pointed this out to various political advisors and the ANAO and, as usual, quick as a flash was ignored.
The irony is that most people probably think myhr is full of their medical data - but it isn't. They would probably get quite cross at the government for not properly protecting their data.
There is no evidence that myhr is delivering any significant value to physicians. What is certain is that the cost of the system is increasing and so is the risk of a data breach. Maybe one day the penny will drop.
Perhaps this is a good time to tell the politicians (one more time). Who should be told? The PM, Treasurer, Fiance Minister, Lead of the Opposition, Shadow Health, and the Health Minister.
@11:43AM Someone needs to send them Paul Smith's excellent Australian Doctor article - the case is clear - the project has failed, stop wasting taxpayers' money.
The Morrison government is well and truly on the back foot with this. Labor could do them a lot of damage if it raised this in Parliament.
One of the comments on that Australian Doctor article says:
"Just wanted to add regarding the Electronic health record that is called Digital Medical record or DMR in Tasmania. I have found the DMR really useful every time. Very user friendly and easy to navigate. It’s been there for many years and almost every patient has one - I have always felt that the DMR team did a great job in Tasmania and I think they should do it for us in the mainland!"
I did a bit of digging.
A search of the Tasmanian Government's website
https://www.dhhs.tas.gov.au
for Digital Medical Record (without quotes) brings up My Health Record as the first result.
With quotes, there are 24 hits none of which specifically mention the DMR (or myhr), except in some of the Annual Reports.
e.g. the Tasmanian Health Service Annual Report for 2015-16 has quite a bit about the system
https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0003/233328/THS_Annual_report_2015-16.pdf
Under the heading "On the 28th June 2016, the Digital Medical Record (DMR) was successfully launched at the Launceston General Hospital."
it says:
"This successful system deployment is the culmination of ten years’ work to provide a single instance medical record across all acute facilities across the state of Tasmania.
Tasmania is the only state to have a single medical record spanning all State hospitals and all staff of the DHHS and THS should be very proud of this significant achievement.
Having a single instance medical record across the acute sector ensures all clinicians have access to relevant patient information, regardless of their location; and by providing a central repository for clinical information, the DMR supports patient flow across the state.
Further to this, by providing a statewide platform for viewing the medical record, the DMR offers significant patient safety and quality aspects (such as a platform to view Patient Administration System based Clinical and Administrative Alerts).
There is still significant opportunity for further deployment of the DMR. Currently, work is occurring with many rural facilities and Mental Health to support their transition to and adoption of, the DMR.
Further work is occurring to ensure that information from other Clinical Information Systems (CIS) is received by the DMR, increasing its value to clinicians for accessing holistic clinical information.
Continuous system enhancements provide opportunity to ensure the system is able to fulfil the need of its intended function.
The DMR is a necessary step in the State’s journey towards a complete Electronic Health Record (EHR) with appreciation that scanning of paper will always be an important aspect of collecting health information. Currently 90,000 new pages are scanned into the system each week."
The Tasmanian Government's webpage on myhr is here:
https://www.dhhs.tas.gov.au/about_the_department/my_health_record
There is not a single mention of the DMR!
IMHO, there's far too much politics and not enough health care and government going on in Australia.
Looking at the wall of statistics dressed up as artwork I notice the number of conscription has fallen to some 600,000 above 10% so no longer do more than 90% have a record but it is now less than 90%. I am using 2019 population so as to avoid births etc....
For a system supposedly useful a lot of people go online to optout
My reading of the population of Australia, based upon data from http://www.population.net.au/
is that on 31 March 2019 the population was 25,415,000 with a growth rate of 1.62%
Projecting this number to the end of December 2019 gives 25,690,782
https://www.myhealthrecord.gov.au/statistics tells us that the number of myhr as at the end of December 2019 is 22,689,000 (which probably includes some people who have died or emigrated, but whose record is still live).
This gives the proportion of the Australian Population with a record as no more than 88.28%
Which means that in the first 10 months of the opt-out model, according to published government figures, the proportion has dropped from 90.1% to 88.28%
Maybe the ADHA could clarify the situation by publishing explicit numbers for each month, specifically the number of new registrations and the number of deletions.
I think a former General Manager of ADHA explains why ADHA and the MyHR ended up such a cluster F. Taken from Twitter:
Some really lovely use of strong #visualdesign and #infographics tied with clear communication and messaging to share latest statistics on usage of #myhealthrecord nice work Australian Digital Health Agency ! #Digitalhealth
I do agree it is clear (once the cartoon crap is removed) that either a steady and alarming number of people are continuing to opt-out or the ADHA has been misleading everyone on the true numbers
It's all content free spin.
The government wants a tick in the box that they are doing something - rather like climate change and aged care and mental health and helping the disabled. The problem the government has is that the something they are doing is pretty useless - but expensive.
Australia has the same problem as the USA and the UK - a useless opposition that can't get its act together.
Tim who??February 25, 2020 7:47 AM - that narrative is a bit creepy at best. I guess someone is fishing for consultancy gigs. On a more serious not those figures do raise a number of questions that you can guarantee will not be answered by ADHA
What's worse than no data? Bad data.
"More than one in 10 people in parts of Sydney say they have avoided or delayed filling a prescription because of cost"
https://www.smh.com.au/healthcare/one-in-10-people-not-filling-prescriptions-because-of-cost-20200225-p5445o.html
More ADHA stats
https://www.myhealthrecord.gov.au/statistics
My first analysis assumed the number of records was 22.68 Million. This is a rounded number.
A better estimate is that the number of records is between 22,684,999 and 22,675,001 giving a range of 88.18% to 88.14% of Australians registered for a myhr.
The statistics for up to the end of January report that 22.69 Million Australians are registered for a myhr. This gives the proportion between 88.10% and 88.06%
At the current rates of population and myhr growth, by the time of the second anniversary of opt-out, the proportion will be about 87.12%, a drop of 4%
@ 4:13 PM You seem intent on splitting hairs. Too much free time perhaps!
@4:28 PM could you elaborate a bit I am not sure I can thread together you “splitting hairs and too much time on your hands”
@6:39 PM 88.1% versus 87.1%. Really, who cares. How about focussing on the real issues like how to improve the health system instead of fretting over 1% change in the number of registered users of a useless, irrelevant IT system called the My Health Record.
8:14 PM The little matter of $2b and counting? Money which could have been better spent on improving the health system.
@10:38 PM, Yes, the money "could have been better spent". It wasn't, it was wasted.
My point was and remains, move on, stop giving oxygen to incompetent bureaucrats and ADHA psychophants. Move on. Focus on improving the health system instead of fretting over a titchy 1% decrease in ADHA registrations.
With respect, sadly the MyHR is a factor that needs dealing with. Some still believe it is an innovation platform sent by the gods. The highlighting of a downward trend in numbers does help. These maybe small but that actually demonstrates that a majority of actual market place consumers have ‘moved on’ and are looking for alternatives to ‘improve’ the status quo.
I agree with you underlying sentiments and focus should be on clinical communications and then allow virtual consumer records to overlay the clinical priority. It appears at present the Wheatley domain is dominated by the two extremes. Somewhere is the middle is the Goldilocks zone we need.
Which leads me to a question David regarding this weeks poll. We are seperate getting the poor performance of the Digital Health Agency from digital health efforts in general? It is a hard question to answer
@9:44 AM. With respect, "the Goldilocks zone" and "the gods" will continue in the thinking of those who lack the experience and ability to know what to do.
The pragmatic reality is that in the real world of business and commerce the project would be closed down. Indeed that would have happened a long time ago. It's that simple.
And just what is it that you propose, using this knowledge you hold of commence in the real world of business? And how do you propose the system is shut down and those who will claim usage are compensated?
@12:26 PM Good question. Caveat emptor is a Latin term that means "let the buyer beware." Similar to the phrase "sold as is," this term means that the buyer assumes the risk that a product may fail to meet expectations or have defects.
Those who claim usage will not be compensated. In this instance the government is not a bank and is not obligated to accept any legal liability to compensate users. Contracts with vendors can be cancelled and if those contracts contain compensation clauses for early termination they should either be paid, renegotiated or contested in the courts.
Closing down involves turning off the system albeit endeavoring to do so with minimal disruption to those who may be adversely impacted by the act of closing down. This may need to be phased in with a few months warning / advance notice. Cessation of funding helps focus the mind.
A commercially pragmatic approach.
MyHR is a political risk. If the government ‘fesses up that it is useless it runs the risk of voter backlash. It would rather brazen it out (like the sports rort) and spend taxpayer’s money pretending all is fine and dandy. A gradual decline in registration numbers would look bad, which is why the government has never published any proportion other than the one at 31 January 2019 (90.1%). The anonymous commenter who thinks we should move on may well have a vested interest that it is better for him/her if the spotlight is not focused on the apparent reduction in registrations. Faint hope. Not now it has started and been noticed. The ADHA has tried to hide the reality with its "range of statistics about how My Health Record is being used by healthcare provider organisations and patients". It has stopped sharing the truth about Shared Health Summaries, but it can't help itself when it comes to total registrations. I suggest Bernard keeps on digging into the numbers which will ratchet up the pressure, small though it may be now but it will grow.
@5:22 PM I have no vested interest but I do have extensive experience in both public and private sectors. Sure Bernard can keep on digging into the numbers but that will not effect any significant change.
The government should have no fear of voter backlash as it is well able to point out that the project was a Labor party initiative which the government inherited. So, we come full circle - withdraw funding, discontinue the project, move on, stop procrastinating and waving around the magic wand. Bite the bullet. Surely you are not scared of doing so, ahhhh, but if you are a public servant you probably wouldn't be able to make that decision.
6:37 PM. You are still avoiding putting forward an alternative or at least a concept of an alternative. Without that you do sound somewhat like a bedpan looking to be emptied.
@6:37 PM The alternative is to let the market decide. Market forces will allow the good, better, best, rise to the top and the less than good settle in your 'bedpan' until emptied.
@7:40 PM I agree wholeheartedly with with 8:49 PM. Free market forces will enable the good to collaborate and free government from the self-imposed responsibility of attempting to do what it is not equipped to do.
.... so government becomes the first occupant of 8:49 PM's bedpan waiting to be emptied.
The My Health Record is an example of market forces. I am sure Oracle and Accenture see it as commercially viable if not deliciously profitable while allowing newer iteration to be peddled to other procurers of large health information repositories.
Don't be so sure that market forces will improve matters. The healthcare industry is dominated by individuals, institutions and vendors all profiting from the built in inefficiencies of the current system. People have been calling this out for decades.
@5.22 may have no vested interest but others do.
@10:42 correct. Resistance to reform is a huge barrier which cannot be overcome by adopting traditional approaches built on the same old way of doing things. New ways, new thinking, outside the box and off-the-radar are the essential elements required to overcome the almost insurmountable barriers to reform and resistance to change.
@8:58 AM Your succinct approach explains why nothing much in the way of 'reform' has been achieved; even although "people have been calling this out for decades (10:42 PM)".
You nailed it. Most people don't get it. The few who do get blocked or shot down in flames except for those who cannot be seen!
You have still avoided providing an alternative. I see lots of rhetoric and self congratulating but no sense you have the faintest idea what he design and implementation of reform requires. I look forward to seeing your step by step outline
@12:45 PM "..... no sense you have the faintest idea what the design and implementation of reform requires ...... ". I see where you're coming from. Unfortunately your inability to comprehend is deeply embedded within you.
2:15 PM.
4:32 PM.
Disabled.
@10:15 AM said ".... The few who do (get it) get blocked or shot down in flames ... ).
Absolutely, which is the BIGGEST BARRIER to progress.
@10:10 AM That leads one to ask why do "the few who do (get it) get blocked"?
There are multiple reasons.
Some being, a failure by decision makers to understand what problem(s) they are attempting to solve, powerful vested interests including big consulting firms selling their solutions to solve the wrong problems, everything being so urgent that it must be done yesterday before the health system bankrupts to country, government bureaucrats intent on being at the heart of the 'control centre' to tell all participants what needs to be done, cross-jurisdictional issues, jealousies and resistance, etc.
@12:45 PM T-38. It seems to me that ".... the design and implementation of reform requires ... " addressing the issues raised @ 6:21 PM.
I agree with 6:21 PM - wicked problems are inordinately difficult to solved, vested interests need to be excluded from the think tank, disciplined planning and thinking needs to replace hype, government should be excluded from the 'project control centre'.
This month’s update of the mostly meaningless stats for myhr from ADHA are available.
https://www.myhealthrecord.gov.au/statistics
The statistics for up to the end of March report that 22.74 Million Australians are registered for a myhr, an increase since the end of February of 30,000, plus or minus 10,000. This gives an estimate for the proportion of Australians registered for a myhr as between 88.06% and 88.02%
This was the same range as last month.
The only conclusion we can safely reach is that the proportion of Australians registered for a myhr may have gone up or may have gone down.
The reliability of the estimates decreases over time as I am using a growth rate of the population that was reported by the ABS last July. A better estimate will be possible when the ABS releases its annual data in the middle of the year.
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