This appeared last week:
My Health Record struggles to be useful for patients
Tom Burton Government editor
Nov 30, 2022 – 4.28pm
Poor uploading of pathology and diagnostic imaging reports, lack of participation by specialists and clunky interoperability between clinical systems continue to hamper uptake of My Health Record, with only about a quarter of registered users participating in the e-health system.
My Health Record is only capturing a fraction of clinical information and despite efforts to lift participation, officials say progress has been slow.
Despite a boost from COVID-19 PCR testing, health officials estimate only around half of all pathology test results are being uploaded to patients’ My Health Record. In radiology, federal authorities estimate that only about 20 per cent of diagnostic reports generated annually in Australia are being uploaded to the system.
Statistics from the Australian Digital Health Agency show that only 12 per cent of all specialists are using the system. Key sectors such as first responders and ambulances have limited access patients records to inform their clinical response for emergencies. Aged care usage remains similarly limited.
In contrast, there is now almost 100 per cent coverage of pharmacies, general practices and public hospitals. This has resulted in viewing by public hospitals increasing by 160 per cent to 22.2 million views, from 8.6 million, for the year to June 2022.
But the poor meaningful patient use of the My Health Record and patchy clinical participation of the national health record has prompted the former dean of the Notre Dame medical school. emeritus professor Christine Bennett, to call for a review of the scheme.
“Around 90 per cent of the population have a record but I do think it needs a major review about where it is and where it’s going,” said Professor Bennett, who chairs the Digital Health Co-operative Research Centre and led the Rudd government’s 2009 health and hospitals review.
Professor Bennett said poor digital skills and clunky usability and interface design were impeding uptake of health workers and only about 5 per cent of system functionality was being used.
Make it easy for doctors
“The very first thing you have to do is to make it easy. You have to have it embedded in the workflow of a busy clinical setting, whether it’s a GP or specialist or hospital or aged care,” Professor Bennett said.
“The provider’s system has to literally be a click of about 10 to 15 seconds. But at the moment, there’s this laborious kind of drafting of summary statements.”
Professor Bennett said the data needed to be “atomised” (reduced to its most basic level) so the record can be clustered and analysed and presented to doctors and allied health workers in a meaningful way.
The call for a review comes as Health Minister Mark Butler told The Australian Financial Review the uptake of digital health by medical practitioners was a key focus for the Strengthening Medicare Taskforce, set up in July.
“Australians rightly expect that their digital health record to actually reflect their health record,” Mr Butler said.
“One of the constant areas of concern is the low rate of uploading of pathology results into My Health Record.
“So, when a patient goes to a doctor, there’s no guarantee that doctor can look up their pathology results.
“What ends up happening is unnecessary repeated tests and further bookings for patients.
“Our health resources are already stretched – not uploading the data is a waste of time and money for patients and practitioners.”
Mr Butler chairs the Medicare taskforce and regards digital health and virtual care as central to modernising primary care and lifting the focus on preventative medicine as part of a broader strategy to reduce pressure on acute care. The push towards personalised care assumes widespread availability of quality heath data to guide clinical responses.
COVID-19 accelerated the uptake of virtual care with the embrace of telehealth and the roll-out of major “hospital in the home” programs. Telehealth has grown from less than 1 per cent to more than 25 per cent of all Medicare consultations.
A new hospital every month
Deloitte modelling estimates the health workforce will need to be four times more productive by 2050 to meet forecast demand.
The modelling was done as a collaboration between Curtin University’s Digital Health Co-operative Research Centre and the Consumers Health Forum of Australia.
Deloitte said modelling of public and private hospital bed requirements from 2016 to 2036 showed that Australia would need to build a hospital with 375 acute-care beds every month for the next 15 years to keep pace with demand and replace ageing stock.
The Deloitte report said the Australia’s health system was heavily geared towards “an acute, reactive system of treating illness”.
An associated survey found around 70 per cent of Australians were willing and ready to use virtual care and 80 per cent were ready to share their health data in a digitally enabled health system.
Australian Digital Health Agency research has also found that Australians largely want to be involved in their healthcare. Four out of five consumers (81 per cent) surveyed already assume their healthcare providers are sharing or have access to their key health information.
“We are keen to work with government to support the Strengthening Medicare Taskforce by leveraging our relationships with jurisdictions, healthcare providers and the health technology sector to progress a range of innovative healthcare solutions,” said Amanda Cattermole, chief executive of the ADHA.
No compulsion to upload data
The ADHA administers My Health Record, which has around 23.4 million participants, after the previous government opted all Australian citizens into the scheme. Successive omicron waves have spiked usage of the scheme, with the latest data showing 6.3 million people had accessed their record in October.
The ADHA is targeting a 20 per cent increase in consumer use of My Health Record, a 15 per cent increase in clinical and provider use of MHR and a 20 per cent increase in electronic prescribing for 2022-23.
The ADHA is pushing for a major increase in aged care transfer summaries, the near-real-time sharing of primary care and acute care data, and a digital version of a child’s baby book.
The push to increase data sharing among clinicians comes as officials note several private pathology and diagnostic imaging providers are using My Health Record but are uploading only a small number of reports.
Once registered, these organisations may elect to upload content to My Health Record or not, as there is no regulatory lever compelling them to do so.
Officials have noted that too often healthcare providers put in place local policies, system rules and other constraints that restrict what they upload to My Health Record.
An example cited is where an imaging provider might only upload test results that have been requested electronically, rather than via a paper request. Pathology lab are also electing to upload results only for certain test types.
More here:
SBS was also raising issues:
After Optus and Medibank, could your My Health Record be hacked next?
Health service providers accounted for the highest number of data breaches - 20 per cent - reported in the last six months, according to the Office of the Australian Information Commissioner.
There are concerns health data held by government agencies could also be at risk, including the My Health Record profiles held by 23.4 million Australians.
Highlights
· Cybersecurity experts say Australians' health data remained a key target for hackers.
· Online health database My Health Record remains vulnerable, experts say.
· Australia should consider strengthening data protection for consumers, one expert said.
Cybersecurity and privacy experts are warning the health data of Australians remains a target of hackers, even more so after the hack of Medibank
The data breach of the country's biggest private health insurer exposed the health records of 9.7 million Australians - 40 per cent of the population.
And it's raised concerns about another cache of health data: My Health Record.
Are there concerns about a My Health Record hack?
David Vaile, chair of the Australian Privacy Foundation, said there was potential My Health Record could be subject to a "massive data breach".
"The security model for My Health Record is appalling. I've been monitoring it and trying to engage with this discussion, you know, wearing several hats over about 10 or 15 years.
"They ended up with something [a system] that gives default access to probably hundreds of thousands of people," he told SBS News.
The system was designed to ease access patient information among clinicians, but this is a weakness from a cybersecurity perspective.
"At one stage in the debate on the early iteration of the My Health Record, the estimates were in the range of 700,000 to 1.1 million Australians with potential access to the My Health Record."
Established in 2012 by the federal government, the database contains the profiles of more than 23.4 million Australians with information including specialist reports, test results, prescriptions, dental records, billing details, and notes on symptoms and diagnoses.
The Australian Digital Health Agency, which manages the platform, says 90 per cent of Australians have a My Health Record profile, with a large boost in numbers during the pandemic when people acquired the COVID-19 vaccination certificates.
The My Health Record system became entangled with issues on informed consent when it switched over to an opt-out system in 2019 with short notice.
Dr David Glance, director of the Centre for Software Practice at the University of Western Australia, said the security infrastructure for My Health Record is robust, but another factor to consider is how much information is contained in the profiles.
"My Health Record isn't exactly heavily used, despite all the attempts by the government to make it something useful. The amount of information in there is somewhat limited [for a number of individuals, including myself], and certainly would be less problematic than Medibank, for example, who have all the claims data and data about mental health and abortion procedures and other things."
Questions remain over how frequently the system is being used by Australians and clinicians.
A study in a Melbourne emergency department in April and August 2020 found that among 88 pharmacists and physicians, half had used My Health Record at least once, but barriers to its use remain, including an "outdated content, a lack of trust, a low perception of value, no patient record and multiple medical record systems".
What would happen in the event of a hack?
Cybersecurity experts say the extortion potential of the information is what hackers target to keep their criminal operation going - with the dark web and cryptocurrency fuelling the activity.
Dr Suelette Dreyfus, a digital security and privacy expert at the University of Melbourne, said there is no evidence to suggest a cyber attack on My Health Record is imminent, but that a proactive plan is necessary for all groups holding health data.
"The health area has to be much more serious about upping its cybersecurity game to protect health records."
She said the July 2018 attack on Singapore's largest healthcare group, SingHealth, demonstrates the end goal and tactics of hackers seeking sensitive health data.
The cyber attack exposed the data of 1.5 million patients, including Prime Minister Lee Hsien Loong.
"What was interesting about that hack is that the forensic teams found the hackers actually specifically targeted the records of powerful politicians and ministers," Dr Dreyfus said.
"Imagine if you knew (and it wasn't known to the public) that a prime minister had a terminal disease and wasn't going to probably live more than two or three years ... that would be incredibly valuable information to other nation states leaders, but also potentially to markets or companies that might be making decisions about investments."
Medibank's board grilled from shareholders at AGM
What is the government doing about it?
The federal government agency that manages My Health Record said a new review of the cybersecurity risks was conducted after the recent Medibank hack,
Optus breach in September and Medicare exposure in 2020.
"In light of these breaches, the agency reviewed relevant identification processes to continue to ensure that only authorised persons can access a My Health Record," the Australian Digital Health Agency said in a statement.
The agency said progress had been made to improve the cybersecurity vulnerabilities highlighted by the Australian National Audit Office (ANAO) in a 2019 report that found "management of shared cyber security risks was not appropriate and should be improved".
The OAIC has produced a factsheet with tips on protecting your My Health Record, which can be found here
Here is the link:
You can listen to a podcast of all this (and indeed more) here:
(This provides a very useful summary).
As all who read here the #myHR is not much used and is not delivering on its objectives while continuing to cost millions a year.
Disappointingly it seems that the new Federal Health minister has consumed the Kool-Aide and thinks that the key problem is that those ‘naughty’ doctors are not entering all the data they should be (for little, if any, value to them) and that all would be great if they did – as if they are not busy enough already!
AFAIK there are still not any decent studies showing real clinical value in use of the system – which is strange when it had been operational for a decade. (Links would be nice if you find a good study or two!)
(In passing I noticed the NSW Government now has a portal for looking up COVID and Flu results with pretty quick turnaround and no obvious link to the #myHR.)
I guess time will tell if the clumsy user-hostile monster is eventually abandoned, as it should be, and replaced with better designed and more user-friendly systems.
We can all come back nest Christmas to see what has changed!
David.
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