This abstract appeared a week or so ago.
Utilisation of the Australian government initiative MyHealth Record to support the clinical approach to factitious disorder
David R. Alchin Kristen Overton Duncan George Michael Murphy Anne P. F. Wand
First published: 06 August 2020
https://doi.org/10.1111/imj.14945
Abstract
Recently, the Australian Digital Health Agency launched MyHealth Record to the public. As of July 2019, 90.1% of Australians hold records with this service, allowing 16 400 health organisations access to >28 million clinical documents. The streamlining of patient data was intended to facilitate sharing of information and improve communication between medical providers, while promoting efficiency in clinical practice. We have identified a hitherto unrecognised application of this infrastructure in the identification and management of factitious disorder, a rare yet highly diagnostically challenging condition involving intentional feigning of illness, which presents a significant resource burden to the Australian health system.
The Australian government's roll‐out of the national electronic medical records database, MyHealth Record (MHR), was recently completed. The Australian Digital Health Agency (ADHA) reports 90.1% of Australians are active with this service, and as of July 2019, 16 400 health organisations have linked into MHR, enabling access to >28 000 000 clinical documents.1
The aim of MHR is to streamline the collection, storage and sharing of patient information, in order to avoid problems that occur when there is a breakdown in clinical communication.2
Adoption of this database may facilitate an individual clinician's understanding of the role and opinions of other providers who have been involved in a patient's care, while not replacing clinical handover where possible.3 Continuity of care is emphasised: ultimately the imperative is to improve overall clinical standards within Australian healthcare. However, given the infancy of this new health infrastructure the full benefits are likely yet to be realised. In this paper, the potential utility of MHR to improve the management of factitious disorder (FD) is discussed, an important function not previously specified by the ADHA nor reported in prior literature.
Here is the link:
https://onlinelibrary.wiley.com/doi/10.1111/imj.14945
What this paper seems to be suggesting it that the #myHR it will be possible to detect people who are deliberately faking illness and so prevent excessive usage of clinical and resources. Not surprisingly they suggest that no one has thought of this use for the #myHR – even at the ADHA.
Noting that the authors of the paper are psychiatric clinicians pre-dominantly so I assume the way they are using the #myHR is to have a clinical suspicion of the diagnosis and to then use the record to see what and how many Medicare consultations have occurred and to note just how many practitioners had been involved in the patient’s care.
I can’t imagine that the #myHR is being used proactively to
screen for too many different practitioners etc. to try and make the diagnosis! That would be quite a job I suspect.
Given this ‘disease’ is so rare and this application for a $2Billion + database so ‘out there’ I am rather surprised this paper was accepted, especially as the utility may be reduced by the patient simply deleting entries! It is also interesting that the paper did not contain a case description where the #myHR has been useful.
All in all a really odd one that is definitely not a mainstream use for the #myHR!
What do you think?
David.
1 comment:
The paper says:
"Through MHR we found a recent case to have consulted 47 specialists in 2019 alone."
I wonder how they did that? At least one of the authors must have been treating the patient and noticed the number of consultations from PBS data.
In other words, the useful data did not come from myhr it came from government data.
The paper says
"The current iteration gives patients capability to edit aspects of their record. For example, patients may alter their allergy alert history without oversight, potentially limiting access to lifesaving medications because of spurious reporting. This poses risks in the setting of FD – patients may validly access their records but alter or remove information discrediting feigned illness(es), further confounding clinicians.
If the editing capabilities allowed for allergy alerts extended to the wider medical record it could potentially nullify any benefit of MHR in detecting FD, if not the system as a whole."
The authors do not seem to realise that the editing capabilities referred to in the last sentence currently exist as well as the ability of the patent to delete the whole record.
As it says on the box, it's the patient's record; the patient decides what goes it it and who sees it. It's one of the government's selling points. From most clinician's perspectives its the worst feature of the system.
Cunning patients will soon learn that myhr is not their friend and delete the thing.
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