The Quality Of Digital Health Advice Given To The Aged Care Royal Commission Regarding The #myHealthRecord Was Simplistic And Naïve I Believe.

If it wasn’t we would not have the evidence free outcome we see!

First what did the Commission recommend?

Here is the way it was put:

Recommendation 68: Universal adoption by the aged care sector of digital technology and My Health Record

The Australian Government should require that, by 1 July 2022:

•   every approved provider of aged care delivering personal care or clinical care: uses a digital care management system (including an electronic medication management system) meeting a standard set by the Australian Digital Health Agency and interoperable with My Health Record
•  invites each person receiving aged care from the provider to consent to their care records being made accessible on My Health Record
•   if the person consents, places that person’s care records (including, at a minimum, the categories of information required to be communicated upon a clinical handover) on My Health Record and keeps them up to date
•  the Australian Digital Health Agency immediately prioritises support for aged care providers to adopt My Health Record.

No pussy footing around here with the statement that “ The Australian Government should require that, by 1 July 2022”. Strong stuff!

Here is the link to the Commission Report page:

https://agedcare.royalcommission.gov.au/

Here are the other #myHR references in the Executive Summary (Vol 1).

P118

“Aged care providers should be using digital care management systems. Paper-based systems are outdated, inefficient, and can lead to errors during the transfer of residents between residential aged care and hospital settings. Transition to a digital care management system interoperable with My Health Record will result in a safer, more efficient and more comprehensive transfer of critical information relating to a person’s relevant care and medical history. In October 2019, only 247 out of a possible 1800 aged care residential and home care providers (14%) were registered for My Health Record. We recommend universal adoption by approved providers of My Health Record to ensure that multiple health care and aged care providers can access one central source of health information about people receiving aged care.”

P148

Architecture and investment in technology

Commissioner Briggs highlights major problems and limitations with the current technology infrastructure and architecture for aged care. These include the variable use of digital record keeping for clinical and administrative information management, including of My Health Record. This is inefficient and often means there is duplicative record keeping. Also, the current systems that are supposed to support the aged care sector are either designed to support specific administrative and financial reporting requirements or are program-centric. They are not focused on the person. Furthermore, information and communications systems across government, aged care services, hospitals and other health care providers are not interoperable. This is not only inefficient but increases the risk of errors.

Here is the detail from the Future State description in Volume 3.

P323

Here is the detailed text supporting the recommendation cited above:

Aged care providers should be using digital care management systems. Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, gave evidence that the aged care sector currently relies heavily on faxing, scanning, emailing and, in some instances, mailing information between external care providers and service providers. She said that this ‘increases the risk of error’ and ‘is resource intensive and inefficient’.198

Electronic medication management systems are particularly important in aged care given the high use of medicines by people receiving aged care. We are encouraged that the Australian Government is trialling an Electronic National Residential Medication Chart in a number of residential aged care facilities.199

My Health Record is an Australian Government online summary of a person’s key health information. It is progressively being adopted across the health care system. The Australian Digital Health Agency has stated, however, that ‘while a number of aged care clinical information systems are conformant and can connect to My Health Record, it is not extensively used across the aged care sector’.200 In October 2019, only 247 out of a possible 1800 aged care residential and home care providers (14%) were registered for My Health Record.201 The Australian Digital Health Agency stated that aged care is ‘a key priority area for future focus’.202

Universal adoption by approved providers of My Health Record should be an immediate focus. Given the high frailty and acuity of older people receiving aged care and their increased need for health care, it is appropriate to expect that all approved providers should be using My Health Record by no later than 1 July 2022. This will ensure that multiple health care and aged care providers can access one central source of health information about people receiving aged care. Any improved information sharing will depend on the person receiving aged care having a My Health Record and giving prior consent to their health records being accessed, used and shared in this way.

System interoperability will support communication and information sharing between the aged care sector and the health care sector.203 For instance, system interoperability between the clinical systems of general practice and approved providers would ‘improve communication and minimise any errors in treatment, particularly when a GP [general practitioner] is required to respond to a clinical situation’.204

Interoperability should be pursued in the short term through My Health Record. The adoption of My Health Record, and systems interoperable with it, will assist with information sharing between care providers and others and hence assist with improved and safe care. Data interoperability, whereby data is captured according to a common set of definitions, is also worthwhile pursuing.

The Australian Government has agreed that all residential aged care services should move to digital electronic care records.205 The Government has further supported the use of electronic discharge summaries through My Health Record.206 The Government also supports changes to encourage the use of My Health Record by aged care providers.207 The Government has, however, submitted that ‘My Health Record has been designed as a fundamentally voluntary system’ and that ‘the My Health Record system is voluntary for providers as well as health care recipients’.208 We accept that a person receiving health care is entitled not to participate in the My Health Record system, but observe that the Australian Digital Health Agency has said that over 90% of Australians have a record.209 We also do not consider that the participation of aged care providers should be voluntary.

Paper-based systems are outdated, inefficient, and can lead to errors during the transfer of residents between residential aged care and hospital settings. Transition to a digital care management system interoperable with My Health Record will result in a safer, more efficient and more comprehensive transfer of critical information relating to a person’s relevant care and medical history. Such a transition by approved providers should be supported by the Australian Digital Health Agency.”

Here are the references:

198 Transcript, Melbourne Hearing 3, James Vickers, 17 October 2019 at T6191.14–21; Transcript, Adelaide Workshop 2, Megan Corlis, 17 March 2020 at T8031.19–24; Exhibit 11-63, Melbourne Hearing 3, Statement of James Vickers, WIT.0462.0001.0001 at 0007 [36].

199 Transcript, Adelaide Workshop 2, James Vickers, 17 March 2020 at T8051.39–43.

200 Transcript, Adelaide Workshop 2, Andrew Robinson, 17 March 2020 at T8057.42–8058.4.

201 Exhibit 16-1, Adelaide Workshop 2, general tender bundle, tab 2, RCD.9999.0296.0001 at 0012 [1.1]; Transcript, Adelaide Workshop 2, Kate Barnett, 17 March 2020 at T8040.44–8041.5.

202 Exhibit 16-1, Adelaide Workshop 2, general tender bundle, tab 2, RCD.9999.0296.0001 at 0011; M Kirkevold, ‘Teaching nursing homes: the Norwegian experience 20 years on’, Journal of Research in Nursing, 2018, Vol 23, 2-3, p 256; Transcript, Adelaide Workshop 2, Kate Barnett, 17 March 2020 at T8040.11–17; T8040.24–26.

203 Transcript, Adelaide Workshop 2, Kate Barnett, 17 March 2020 at T8040.19–24.

204 Aged Care Workforce Strategy Taskforce, A Matter of Care Australia’s Aged Care Workforce Strategy, 2018, p 92 (Exhibit 11-1, Melbourne Hearing 3, general tender bundle, tab 205, ACW.9999.0001.0022); See Australian Nursing & Midwifery Federation, Nurses & Midwives’ Paycheck, 2020, Vol 19, 3.

205 Transcript, Melbourne Hearing 3, Paul Gilbert, 16 October 2019 at T5997.7–5998.8; Exhibit 11- 21, Melbourne Hearing 3, Statement of Paul Gilbert, WIT.0430.0001.0001 at 0007 [32].

206 Aged Care Workforce Strategy Taskforce, A Matter of Care Australia’s Aged Care Workforce Strategy, 2018, p 95 (Exhibit 11-1, Melbourne Hearing 3, general tender bundle, tab 205, ACW.9999.0001.0022).

207 Aged Care Workforce Strategy Taskforce, A Matter of Care Australia’s Aged Care Workforce Strategy  

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I can be brief here! What I was looking for was the evidence that a move to compulsory use of the #myHR would make a positive difference. Sadly, as with so many other reports and investigations there are warm feelings in “the water” that this would be a good idea but no citations I could see of research or publications that would justify the compulsion, work and expense all this might involve!

No doubt better electronic record keeping (clinical and admin.) within Aged Care facilities is an excellent idea, as it the adoption of the various assistive and supportive technologies that are under study and being implemented, but I see this #myHR recommendation as evidence-free over-reach!

What do you think?

David.