This appeared last week:
Welcome to the second coming of My Health Record: the
AusDoc interview
Why did
anyone think 100 million PDFs would be a good idea?
Paul Smith
13 June 2025
Doctors
have long asked an existential question about My Health Record. Why does it
exist? What is its clinical utility?
It has now
amassed 1.7 billion documents — from medication lists to radiology results to
health summaries.
And yet
for many, the system that was intended to reduce patient harm by preventing
medication misadventures, bungled diagnoses and unnecessary tests or
interventions appears to have no role in the day-to-day workflow of doctors and
the wider system.
Despite
the recent wonders of digital technology, to its critics, after 15 years, My
Heath Record is still a “shoebox of PDFs”.
This is an
interview with Peter O’Halloran, chief digital officer with the Australian
Digital Health Agency.
Appointed
two years ago to make the $3 billion system clinically relevant, his main task
is to “atomise” the clinical information in the system so, when medications and
diagnoses change, hospital discharge occurs or the pathology results arrive,
the details are updated within the doctor’s own software with no fuss or
messing around.
Why has
something so basic taken so long?
And are
non-GP specialists using My Health Record? What would happen to healthcare if
you just switched off the system and accepted it had been an expensive waste of
time?
In a frank
discussion, Mr O’Halloran explains why pulling the plug is not an option, that
the system is fundamental to future healthcare.
AusDoc:
First question, why, having spent billions of dollars on the system, were
the data never atomised in the first place?
Why did
anyone think several hundred million PDFs would be a good idea?
Peter
O’Halloran: You have to go back to when My Health Record — the PCEHR
as it was back [then] — was first created.
The standards
15 years ago were simply not at a level where data from across the country
could be brought together at an atomic level. It was a step too far.
AusDoc:
Because of the cost or because of the technology?
Mr
O’Halloran: Well, mostly technology. When the PCEHR was designed, iPhones
didn’t exist. In fact, a lot of the things we can do now using desktop
computers didn’t exist then.
AusDoc:
So back then it was assumed that a patient’s health summary — the diagnoses,
the medications, the allergies — would be in a PDF even though it could not be
updated in the way we can do now?
Mr
O’Halloran: Absolutely. But it was always seen [as] the beginning.
It was going
to be a kind of document, like a Word document or a PDF back then and the
clinician in ED would look at it and the information would be accessed on that
level.
That was the
intention.
AusDoc:
I remember Dr Mukesh Haikerwal, who ended up quitting as the National E-Health Transition Authority
clinical lead, talking about the need for atomisation. That was years ago … and
I’m sure he’s still talking about it now.
It seems very
slow progress. How far has the agency got?
Mr
O’Halloran: [We are close] to the next level where the individual data
elements can be assembled in clinical software to produce a shared health
summary more efficiently.
That means
the ability to automatically pre-populate a summary or another document with
clinical information on things like allergies and medication alerts and the
like.
AusDoc:
But in terms of a time frame — how long do you think before it becomes routine?
Mr
O’Halloran: In less than two years we should be able to accept all the data
at that atomic level. But it will mean software vendors need to modify and
update their software.
Some of them
are already starting to do that.
So, for early
adopters, the changes will come within two years.
I expect
[for] everyone in the system the changes will be in place within five years.
I’m
impatient, so it feels like a long time to me, but we’re talking about changing
the software used by every single clinician in Australia, and so that’s not a
quick overnight fix.
However, the
real endpoint for us is that we want to move away from My Health Record being
seen as an afterthought in terms of how care is provided.
The doctors
may not know what is happening beneath the surface but the clinical information
they will be given about a patient will come from data from their existing
system as well as what’s being sourced from My Health Record.
This will mean, for example, that clinicians will see data sourced from
referrals, discharge summaries, shared health summaries and the like relating
to allergies, medications and treatments in context in the existing screens in
their clinical software without the need to go into separate sections or
systems.
The
fundamental point is that when this is done it is all displayed seamlessly on
one screen, not two different systems.
AusDoc:
The software vendors often complain that they need more money and support to
change their systems.
This is about
them changing their own software to communicate in this new ecosystem, is that
right?
Mr
O’Halloran: Yes, you are right, but it depends on which software vendors
we’re talking about.
The software
vendors in the acute hospital sector are generally already using the same data
standards that we’re moving to.
So for them,
it’s a small amount of work rather than a large rewrite.
For some of
the vendors for primary care, their software is often bespoke to Australia.
However, if
you look across the sector, you will see Best Practice and Telstra Health have announced massive investments. They are
making these modernisation journeys now.
They’re
already seeing which way we’re going and they are heavily engaged in that work.
As an agency,
one of the big things we’re pushing is the need to use global standards with
minimal local customisation which makes it more efficient for them to adapt.
I understand,
if you’re in primary care, you probably sit there and say ‘This My Health
Record is a horrible, clunky system.’
But that does
not recognise the fact that the Australian Digital Health Agency doesn’t
provide any software for clinicians in primary care.
Every single
element they’re seeing on the screen has been built by their software vendor.
They’re not
actually in the My Health Record system but they’re seeing [it] as such.
That is why
we’re working with those software vendors.
If the system
becomes atomic, you don’t actually have to have a separate screen for My Health
Record.
You can just
display it in the usual settings that doctors are using.
AusDoc:
I’m going to ask you the dumb question. With all the PDFs in the system,
literally hundreds of millions of them, doesn’t AI technology have the capacity
just to read those PDFs and atomise the information in the way that you’re
suggesting?
Mr
O’Halloran: There is technology that could do it tomorrow, and we are
exploring how we could surface, at an atomic level, the data in the CDA
[ER1] wrapper that exist in the background with the PDF.
The question,
as always, is what is the clinical accuracy of it?
While it
probably doesn’t matter if I use AI to pull some key insights from my thousands
of domestic bills, it’s a very different story when we’re talking about
clinical data that could be relied upon to make a treatment decision.
But to be
clear, the benefit of atomisation is that it lets clinicians integrate data
from My Health Record into their main clinical record.
So, when
they’re writing a shared health summary or authoring a referral letter, their
software could pull in a list of medications and allergies.
They don’t
have to type that history themselves.
If these
changes come together as they should, it should reduce the administrative
burden.
If I look at
what’s happening with ambient AI scribes and that type of technology, which is
becoming increasingly routine, I think we’re on the cusp of seeing clinicians
being [physically] freed from their computers during a consult and able to
spend more quality time focused on the patient.
AusDoc:
Speaking of AI scribes, their uptake by doctors has been rapid which is in
stark relief to the embrace of My Health Record.
The embrace
of AI scribes shows clinicians will rapidly adopt technology when you make it
useful to them. My Health Record has been a failure up to now because it’s been
irrelevant — nothing complex about the reasons.
Mr
O’Halloran: When I look at my own My Health Record, five years ago I had
almost nothing in it — and that’s despite asking people to share test results
or GPs to write shared health summaries.
Two years
ago, it had a bit of data in it.
Now every
time I get some blood work done or I’ve got a prescription, the data is just
routinely in there and this is before the legislative mandates for sharing come
into force.
The feedback
I’m getting is clinicians are starting to find it useful a lot more often. We
are getting to a tipping point now.
We expect
within two years that almost all pathology and diagnostic imaging testing for
all consumers will just be routinely in the system [whenever someone looks].
And that’s
where what we are doing will derive its value. A clinician will be able to see
the results and the history in an atomised, easy-to-read format.
That is why
it’s worthwhile.
AusDoc:
On behalf of fellow technophobes, can I ask a question. When it comes to My
Health Record I’ve got a vision that there’s a big warehouse full of computers
in Canberra, storing all this information, all the pathology reports, the PDFs.
This warehouse, if it exists, is the PDF shoebox people talk about.
What is the
reality? Where is all this information? Isn’t it on the cloud?
Mr
O’Halloran: All the data of My Health Record is hosted in Australia, in a
secure cloud environment.
It’s spread
around different geographic regions in different states.
But in
essence, if you brought it all together and looked at it, it would simply be a
row of computers.
And it would
not involve a large amount of space physically. It’s probably smaller than the
office I’m sitting in if you put them all in one place.
The data is
simply there and available.
The benefit
of the cloud is that it lets us get the additional cyber protections and the
ability to scale up as more data is being shared with us.
AusDoc:
Going back to clinical utility, the hospital discharge summaries for GPs are
fundamental for communicating new treatments, new medications, new diagnosis.
But My Health
Record is not among the communication mechanisms being used by hospitals to
communicate with GPs.
Mr
O’Halloran: The discharge summaries are supposed to be shared through My
Health Record.
Of course, a
lot of hospitals will send them directly to the GP either via secure messaging
or occasionally email and really occasionally by hard copy mail.
AusDoc:
But the aim is for My Health Record to be the communication channel for
discharge summaries?
Mr
O’Halloran: Absolutely. That’s the goal in all this.
We want the
summaries routinely in My Health Record every time a patient goes to a
hospital.
Once
clinicians in primary care can expect that every time they go and check when
the consumer comes back to them after being discharged, they’ve got access to
their data through My Health Record, that really adds to the clinical
usefulness of the system.
AusDoc:
But again, this depends on the software vendors ensuring their systems are
fully integrated?
Mr
O’Halloran: It does. As I mentioned, the two biggest vendors of software
systems in primary care are embracing the change.
And there are
other smaller software vendors out there today who are already doing a lot of
these things.
AusDoc:
I know you can’t speak on their behalf, but why have the software vendors been
so reluctant to embrace My Health Record? There is no incentive for them to
make using the system via their software unnecessarily unpleasant for doctors.
Mr
O’Halloran: I think it goes back to the history.
Once again,
if you look at the PCEHR back in the day, the standards were very rudimentary,
and our expectations of the software were much lower.
Also, the
awareness of what the system could do and how useful it could be for consumers
and clinicians was unknown.
A lot of work
was put in in those early days to build the interfaces and to have those basic
screens designed, but to be honest, there’s been very little maintenance of
them by most of the major software vendors since those days.
AusDoc:
GPs have embraced computers from the beginning — but the non-GP specialists,
some haven’t even got a computer on their desk.
To what
extent are they integrated into this future vision?
Mr
O’Halloran: It depends on each specialty, but yes, as a rule, I agree
specialists have a lot lower take-up of computers on desks than GPs.
But I would
add that certain specialties and the technology they use make the rest of us
look like Luddites.
The point is
we’re seeing change. The paradigm is starting to change where there’s more and
more software designed for specialists that meets their needs because their
needs are often quite different, each specialty is often quite different.
When we have
more data from the acute sector, more data from primary care — say the
pathology and diagnostic imaging data — a lot of those specialists will see the
value and embed it into their practice.
AusDoc:
You mentioned that in the next two years we will see a big change in the
clinical utility of the system.
Does anything
worry you in terms of reaching that goal?
Mr
O’Halloran: Look, I don’t think I’m worried about anything. I think it’s a
lot of work but technically, it’s fairly easy.
It’s about
procuring services, bolting it together, going through processes of clinical
validation and checking that it works as it should.
The bit that
interests me is how we work with the colleges, how we work with the professions
to ensure what we’re building is fit for purpose and meets their clinical
needs.
AusDoc:
Can you give me a picture of what the Digital Health Agency consists of? Again,
I’ve just got an idea of lots of people in a room, computer boffins with thick
spectacles working on software code.
But it sounds
that a lot of your job is about building relationships — with government, with
software vendors, with the medical colleges.
You talk
about the agency’s core work in creating standards. Forgive me, it sounds quite
boring. It’s not Silicon Valley.
Mr
O’Halloran: [Laughing] A lot of the kind of stuff we do to do our job is
probably on its own quite boring.
What’s
exciting is what it enables and how it comes together. I understand [that] may
sound tragic, but the true value for me is when I see a clinician say, ‘Hang
on, I used this information in my practice, I’ve got data giving me insights
into a patient that I hadn’t seen previously.’
That’s where
we get excited.
The role of
the agency is not lots of computer boffins sitting in a room, and to be honest,
we have a relatively small number of deeply technical people.
I would say I
spent 80% of my time working with consumers and clinicians across the sector.
I’m not sitting there, elbows deep in architectural drawings.
AusDoc:
A few years ago, we ran a story which I don’t think won many friends in the
PCEHR world, but it was about the clinical uptake of the system which was very
low.
From that
point onwards we were often wondering why every federal budget millions were
still being poured into it.
In fact,
there is still an enormous amount of money going into it.
But what do
we really lose if you simply turned it off?
Mr
O’Halloran: My Health Record is more than just the system.
The
legislation underpinning it is actually one of the strongest parts. We now have
some of the best legislation in the world in terms of information sharing.
We have
unique individual identifiers for healthcare providers, for their
organisations, and unique individual identifiers for consumers.
If I look at
the US, some 20-30% of the [healthcare] data being exchanged is mismatched or
duplicated.
Those are
things that don’t really happen in Australia.
I haven’t
heard anyone saying we should turn off. That is not part of [the] debate.
I’d refer
people to the Senate review into the sharing by default legislation a few
months ago.
The
legislation was supported by all parties — we’re talking the Opposition, the
Government.
The system
wasn’t what we wanted it to be necessarily in the past.
But I’d
simply say, as you watch My Health Record over the next 12 months, I think the
questions will drop away because people will see the value that was originally
envisaged 10-15 years ago.
It’s just
taken longer to realise the vision than any of us would have expected or
wanted.
This
interview with Peter O’Halloran took place last month. Responses were edited
for concision and clarity.
Here is the link
https://www.ausdoc.com.au/news/welcome-to-the-second-coming-of-my-health-record/
Poor Peter, he and his team still
have not established a compelling case for any-one to use the myHR. All the
data in it is already sent to GPs and specialists as a matter of routine and is
in the system(s) they already use.
Pretty much no-one needs the myHR as
far as I can tell and after the 10 or 15 years of being useless it is hard to
actually see what has changed to make it now useful!
As always, I would really like to
hear from people who are finding it useful and valuable. The total cost for this
folly must be in the billions by now and they still have not established a
compelling use case! How can all this be possibly justified?
Can’t we please stop this nonsense until
we have a much better plan, demonstrated need, and proven useful technology to
support it!!!
I wonder how many times I have said
the same thing over the years? The one small step forward this time is that the ADHA have noticed how important discharge summaries are as a document of record......
David.