Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, June 21, 2017

Aged Care Seems To Be Starting To Move On The Technology Front. A Good Thing I Suspect

This press release appeared last week:
13 June 2017

Aged care Technology Roadmap to support consumer choice and control

The Technology Roadmap for Aged Care in Australia released today by the Aged Care Industry Technology Council (ACIITC) recognises the need for technology to underpin the delivery of aged care services and ensure independence, choice and control for consumers.
Prepared by the Flinders University Medical Device Research Institute on behalf of ACIITC, the report acknowledges three issues: population ageing that has never been experienced at the same level; the rapid development of new technologies; and, reform of the aged care sector that fundamentally changes the way in which older Australians will be supported.
The Technology Roadmap will ensure older people are able to remain independent for longer with choice and control over their support services. It highlights issues such as:
  • ¬ Further reform depending on consumers being able to use technology in order to maintain independent lives or access services.
  • ¬ Increasing consumer choice and control depending on engaging consumers in decision-making with aged care service providers.
  • ¬ Aged care organisations will need to uptake IT in the provision of care.
  • ¬ The aged care workforce will need to upskill its technology literacy.
“The aged care industry is in an era of unprecedented change. The convergence of current aged care reforms, business model transformation and technological disruption is reshaping multiple areas of the aged care industry. Consumers are at the centre of these changes and the Australian aged care industry is embracing this change,” ACIITC Chair Glenn Bunney said.
“Following the release of the Aged Care Sector Committee’s Aged Care Roadmap, ACIITC was interested in exploring the contribution technological interventions could make to realising the Aged Care Roadmap’s vision for a sustainable and robust aged care industry.
“It is hoped that the insights from this research will help policy makers evaluate the benefits of embracing technology as well as provide guidance and information for aged care providers seeking to embed appropriate technology in all aspects of their operations.
“The Aged Care Industry Information Technology Council trusts this work will assist in enhancing the positioning of the Australian aged care industry for a vibrant and sustainable future. Further it is hoped that this work will stimulate continued research, evidence gathering, and the deployment of practical demonstration projects designed to explore how greater innovation and technological uptake will help to improve the quality of the aged care industry in Australia.”
The Technology Roadmap for Aged Care in Australia is available at this link:  2017 ACIITC Roadmap
Here is the link to the release:
There is coverage of the Ministerial Announcement of this roadmap is found here:
The report and literature review(s) are well worth downloading.
My scan of the work has left me with a positive impression (claiming no real Aged Care expertise) - with the report delivering a really useful breadth and depth of the issues around all sorts of technology use in the Aged Care Sector.
Coverage areas include  - Robotics, General ITC ,  Sensor technology, Telemedicine, Medication dispensers and Video games and their relevance to Aged Care.
Enjoy reading a properly structured collection of evidence to support the plans. I hope we see a similar effort when the ADHA finally releases its strategy.
David.

Tuesday, June 20, 2017

Do You Think The AMA Is Convinced Regarding The myHR Or Is Just Waiting For It To Fail?

This appeared last week:

My Health Record – Lessons From The Opt-Out Trial

14 Jun 2017


By Dr Richard Kidd, Chair, AMA Council of General Practice
The recent Federal Budget confirmed that the My Health Record will move to an opt-out model.
While the AMA has drawn attention to the shortcomings of the My Health Record over the past five years, we have always acknowledged the potential for a well-designed and constructed electronic health record to improve patient care.
The AMA originally proposed an opt out model and the Evaluation of the Participation Trials for the My Health Record has demonstrated this is the right approach, with the evaluation report saying opt-out is the only sustainable way forward. Ensuring universal coverage with cross-sector clinical input over time will enhance the value of the My Health Record for patients, their doctors and a patient’s other healthcare providers.  
One of the clear outcomes from the trial was that once patients understood the benefits of having a shared electronic health record and the measures in place to protect their information and its use, any concerns they had about privacy and the security of their information were allayed. In fact, the trial highlighted that patients already fully expected their doctors to be sharing their health information with one another.
This is a strong signal to the profession that, whatever reservations we have about the MyHealth record, our patients want us to use it.
Not surprisingly, the trial highlighted a number of critical improvements to the MyHealth record that are needed. These go to the heart of its ease of use, utility and accessibility.
Several of the Evaluation recommendations targeted these areas and reflect much of what the AMA has been saying for some time.
Certainly, more work needs to be done to convince GPs of the merits of the My Health Record and to address its shortcomings. One of the interesting findings in the evaluation was that while most health care providers made it clear that the MyHealth record required additional time with patients, practice managers and practice nurses reported that it made the practice more efficient with less need to chase information from patients and other health care providers. This represents an interesting tension, given that GPs are not funded for this effort. My view, along with the AMA, is GPs need to be properly funded for this work.
The evaluation report contains a number of recommendations on ‘strategy’ to increase uptake and use of the My Health Record. These particular recommendations, which touch on funding mechanisms, are vague and unclear but seem to suggest making use of the My Health Record a requirement for funding. This approach has delivered very mixed results in relation to the PIP e-health incentive and there is no way the AMA would support any change that linked the use of the MyHealth record to patient rebates.
I was pleased instead to see Health Minister Greg Hunt, at the AMA National Conference, say he intends to explore “real incentives to assist the medical workforce in their work”. The profession is looking for support, not punitive approaches that can impact on doctors and their patients.
Over time, we can expect that utilisation of the My Health Record will be woven into standards for practice and accreditation across healthcare, from general practices to hospitals (public and private), to pharmacies and other allied health service providers, and to aged care facilities. Obviously, the AMA’s role is to ensure that this does not happen until we have a clinically useful system.
Digital health will become a key part of future undergraduate and postgraduate training programs, meaning supervisors like me will need to ensure that we too are up to speed.
With more useful content being added to the record such as patient medications, pathology and diagnostic imaging reports, and discharge summaries, the more valuable the record will be for doctors and the patient’s care. In my view, the value of the MyHR could be further enhanced by enabling the uploading of other documents where useful such as Care Plans, including Advance Care Plans and Advance Care Directives. This would help ensure the manner of a patient’s care, particularly if away from home, aligns with their agreed goals and stated preferences.
Changes such as these, along with the reality that the vast majority of Australians will have a record created, should remove some barriers for engagement and facilitate greater interaction.
The AMA will continue working to ensure the My Health Record fulfils the promise that an effective shared health record can deliver.


Published: 14 Jun 2017
Here is the link:
Read closely and I think they are saying they need serious payments to use the system and that they are still to be convinced that the system is clinically useful.
They are also, sotto voce, concerned that there may be pressure to use a system for the sake of using a system and unrelated to clinical benefit, and that this is not in their interest.
My take is that they are sitting on the fence at best – what do you think?
David.

Monday, June 19, 2017

Weekly Australian Health IT Links – 19th June, 2017.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

A really, really quiet week as we roll up to the 5th birthday of the myHR / PCEHR. As we all know it has saved many, many lives and is an example or a really great Health IT project brought to us by the combined genius of both the Liberal / National and Labor Governments.
There are also a few interesting stories to browse, especially the increasing unease regarding just how well the NBN will deliver  – Enjoy!
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First NSW ICUs get e-health records

By Justin Hendry on Jun 14, 2017 5:15PM

With a further six to come.

eHealth NSW’s electronic record for intensive care (eRIC) has gone live in three of the state’s hospitals, with a further six hospitals to introduce the system before the end of 2017.
The statewide electronic clinical information system has been designed to drive better patient decision-making and patient outcomes in all 43 hospital intensive care units (ICUs) across NSW.
The iMDSoft MetaVision-based platform will be one of the world’s largest health system-wide ICU clinical information systems when complete.
St George Hospital is the state’s first metropolitan hospital to introduce the platform, following the deployment of eRIC at Coffs Harbour Health Campus earlier this month, and a pilot at Port Macquarie Base Hospital in October 2016.
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My Health Record – Lessons From The Opt-Out Trial

14 Jun 2017
By Dr Richard Kidd, Chair, AMA Council of General Practice
The recent Federal Budget confirmed that the My Health Record will move to an opt-out model.
While the AMA has drawn attention to the shortcomings of the My Health Record over the past five years, we have always acknowledged the potential for a well-designed and constructed electronic health record to improve patient care.
The AMA originally proposed an opt out model and the Evaluation of the Participation Trials for the My Health Record has demonstrated this is the right approach, with the evaluation report saying opt-out is the only sustainable way forward. Ensuring universal coverage with cross-sector clinical input over time will enhance the value of the My Health Record for patients, their doctors and a patient’s other healthcare providers.  
One of the clear outcomes from the trial was that once patients understood the benefits of having a shared electronic health record and the measures in place to protect their information and its use, any concerns they had about privacy and the security of their information were allayed. In fact, the trial highlighted that patients already fully expected their doctors to be sharing their health information with one another.
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  • Updated Jun 16 2017 at 11:00 PM

Now it’s time to rate how your medical procedure went

Whitecoat, the controversial health insurer-backed website that has been labelled the "Trip Advisor" of the sector, will be expanded to include patient reviews about the success of procedures performed by doctors, surgeons and other health professionals.
The site, which was set up by the $2.3 billion listed insurer NIB in 2013 and now counts Bupa and HCF as partners, allows consumers to search and pay for health care treatment with their providers that include GPs, surgeons, dentists and optometrists. In April it was announced that former National Australia Bank chief Cameron Clyne would chair the site.
Like review sites in other sectors, Whitecoat gives consumers the ability to rate their experiences with a variety of medical practitioners, but currently this is limited to observations on a doctor's manner or listening skills.
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Holograms put to the test in virtual reality learning

  • The Australian
  • 12:00AM June 14, 2017

John Ross

The skull hovers motionless in space, sporting engorged blood vessels and surrounded by people in virtual-reality style headsets. A man in a jacket pokes his finger inside the disembodied cranium, pointing out the fatal aneurysm.
It’s not some television drama about hi-tech forensics. It’s an anatomy class at the University of Sydney, where holograms of body parts, organs and cells are part of the teaching experience.
“Virtual reality is an immersive experience, where you are removed from reality as it were,” says Jim Cook, who develops learning technologies for the university. “Augmented reality takes the existing space and moves something on top of it. Mixed reality has the capacity to do both.”
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Queensland government invests in health IT

Budget earmarks $135.4 million in 2016-17
Rohan Pearce (Computerworld) 13 June, 2017 16:49
The Queensland government has earmarked $135.4 million for upgrades and new IT systems for its health service in 2016-17.
The state’s budget, handed down today, allocates funds for investment in core Queensland Health infrastructure to support digital hospitals, as well as the replacement and enhancement of core clinical and business systems “to support frontline health service provision, corporate functions and decision making at the point of care”.
“The department takes a strategic view to ensure health infrastructure and healthcare technology and information communication technology strengthens our public health system to meet the growing demand for world class facilities and services,” budget documents state.
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Qld budget commits $135m to health IT upgrades

By Justin Hendry on Jun 13, 2017 5:37PM

But Health not the only winner.

The Queensland government has set aside $135.4 million in its 2017-18 budget to ramp up the state’s delivery of digital healthcare.
The initiative covers investment in Queensland Health’s core infrastructure in order to "support digital hospitals", budget papers state.
It will also allow for the replacement and enhancement of  “core clinical and business systems to support frontline health service provision, corporate functions and decision making at the point of care".
The state’s 2015 ehealth investment strategy had identified replacing ageing core systems as crucial for the delivery of future health services. It earmarked $1.2 billion for ICT infrastructure, clinical systems and business systems over five years.
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Aged care sector gets technology how-to guide

By Natasha Egan on June 13, 2017 in Government, Industry

A fund jointly resourced by government and aged care organisations to help providers develop and buy technology to integrate into care services is among initiatives proposed in a sector technology plan launched by Minister Ken Wyatt today.
The Technology Roadmap for Aged Care is an initiative of the Aged Care Industry IT Company developed in conjunction with a team from the Medical Device Research Institute at Flinders University, which was appointed in November to undertake a literature review and scoping study.
The roadmap tells the sector how to make technology a core part of aged operations and service delivery and the action needed in the short, medium and long term to address ICT-related shortcomings across key areas including operations, care, information and workforce.
Proposed action includes collaboration with government departments to embed technology capability as a requirement of aged care service delivery and work to facilitate connections across aged care systems.
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Technology ‘will be critical’ to aged care: Wyatt

By Natasha Egan on June 14, 2017 in Government, Industry
Minister Ken Wyatt launches the report yesterday alongside its authors and sector stakeholders
The aged care technology roadmap launched yesterday has been welcomed by government and the opposition for its potential to integrate into the ongoing reform process.
While the sector waits to see whether that leads to financial support, the provider peaks Leading Age Services Australia and Aged and Community Services Australia have identified how government could assist aged care services to realise the report’s goals.
As Australian Ageing Agenda reported yesterday, the Technology Roadmap for Aged Care is an initiative of the Aged Care Industry IT Company that tells the sector how to make technology a core part of operations and service delivery (read that story here).
It aligns with the Aged Care Roadmap developed by the Aged Care Sector Committee.
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My Health Record in Pharmacy – Tweed Heads

July 18 @ 6:00 pm - 8:30 pm

Digital Health in primary health care is rapidly evolving.
Our guest speakers Dr Shane Jackson (Australian Digital Health Agency) and Mr Tony Browne (North Coast Primary Health Network) will demonstrate the benefits and features of the My Health Record and how this relates to patients, providers and pharmacists.
These workshops are FREE. Attendees can participate in one of the four workshops on offer.
Each workshop commences at 6pm (registrations and dinner) and closes at 8:30pm.
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LiveHire signs up with Australia’s largest public health service provider

14:00 16 Jun 2017
The company’s LiveHire platform is a cloud-based recruitment platform.
Signing with Queensland Health is a significant milestone
LiveHire (ASX:LVH) has launched a “Live Talent Community” for Queensland Health, Australia’s largest public health service provider.
LiveHire’s Talent Community platform provides a cloud-based hiring ecosystem where potential candidates connect with companies by becoming part of a virtual talent community.
Queensland Health has now launched a Live Talent Community for its Rural Nursing & Midwifery workforce.
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Paediatric protocol reduces missed sepsis diagnoses

By Australian Hospital + Healthcare Bulletin Staff
Wednesday, 14 June, 2017
US researchers have developed an electronic sepsis alert, using a combination of vital signs, risk factors and physician judgement, to identify children in a paediatric emergency department with severe sepsis. Their study and an accompanying editorial, published in the Annals of Emergency Medicine, claim to have reduced missed sepsis diagnoses by a whopping 76%.
Researchers built a two-stage electronic sepsis alert (ESA) and implemented it into the hospital’s electronic health record (EHR). The first-stage alert is triggered when an age-based elevated heart rate or hypotensive blood pressure is documented in the EHR at any time during the emergency visit. If the patient also has a fever or risk of infection, the alert triggers a series of questions about underlying high-risk conditions, perfusion and mental status. The second-stage alert triggers if there is an affirmative answer to any of these questions. When patients have positive first- and second-stage alerts, a ‘sepsis huddle’ is triggered, which is a brief, focused patient evaluation and discussion with the treatment team, including the emergency physician.
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Report from joint #openEHR / #FHIR meeting

Posted on by Grahame Grieve
Last month, the openEHR and FHIR communities met for a day in Norway. From the openEHR community, Ian McNicoll and Silje Ljosland Bakke were present, and from the FHIR community, Ewout Kramer and myself were present, along with a group of Norwegians who are involved in FHIR and/or openEHR. My thanks to HL7 Norway, DIPS (en) and the Direktoratet for e-helse for collaborating to bring the meeting together.
The overall agenda for the day:
  • Welcome, introductions / complaints about the weather (de rigueur, but Norway was lovely, there was even some sun one day)
  • Opening presentations from Ian and myself
  • Discussion on specific model mapping HL7 FHIR – openEHR
  • Discussion on a general form solutions
  • Some general questions on HL7 FHIR – openEHR: Mapping, query, Workflow, Pub/Sub, Terminologies, Modeling
And then drinks afterwards, where we solved all the worlds problems (except for a few big ones).
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Health care robotics: the elephant in the room

Authored by Balaji Bikshandi
“You can resist an invading army; you cannot resist an idea whose time has come.” Victor Hugo
TODAY I am going to talk about two animals. One of them was thought to exist only in dreams. The other is consciously ignored as non-existent.
The first one is called the “Black Swan”. A radical thinker and popular writer, Nassim Nicholas Taleb, coined this phrase to denote things that we can never predict when they will emerge, but will have a massive impact on the way we live – take for example, the computed tomography scanner, the smartphone or the mobile speed camera.
The term was based on the discovery of black swans, which were previously considered to be non-existent until Australia was discovered. But, we live in the land of black swans. We have embraced the unpredictable – geological separation, evolution in isolation, technological changes and disruptive inventions, such as Wi-Fi, as examples. We invent ways around them.
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Perceived cost of IoT hindering uptake in Australian healthcare: Philips

A study by technology company Philips found that Australia ranks at the bottom in terms of connected care technology adoption.
By | | Topic: Innovation
Misconceptions about the cost of IoT is inhibiting its uptake in Australia's healthcare sector, according to a recent study by Dutch technology company Philips.
Philips' Future Health Index, which surveyed more than 33,000 individuals across 19 countries, found that while 84 percent of Australian healthcare professionals (HCPs) believe "connected care technology" is important in improving treatment and diagnosis of medical conditions, the nation lags behind when it comes to adoption of such technology.
Kevin Barrow, managing director at Philips ANZ, suspects there are two key reasons for this: The first is there is a perception among 55 percent of HCPs and 53 percent of the general population that the integration and adoption of connected care technology will drive up the cost of healthcare in the long term; and the second is because government funding models don't support the delivery of care via IoT technology.
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Developer Partner Program Launch: Save the Date

The Australian Digital Health Agency is pleased to invite you to the launch of our new developer partner program. The Agency will be introducing the new look developer website and discussing broader developer program activities.
Book this into your diaries – we will be sending out detailed invitations with location and registration details later next week!
This is an excellent opportunity to come and meet some of the key Agency Innovation and Development staff and also network with the digital health community.
When: Tuesday 4 July, 4pm – 7pm AEST
Where: Events will be held in Sydney, Melbourne and Brisbane, with the ability for those in other locations to connect to a live and interactive feed.
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Care concierge services plus telehealth coming to retirement villages

The rollout of NBN is forcing village operators to abandon their copper wire / analogue emergency call systems. They won’t work with NBN and will be turned off by NBN within 18 months of NBN arriving in your area.
This explains two things about why the largest emergency alarm provider to villages, INS, is replacing over 50,000 units for free with existing customers and why they are upgrading their replacement unit to be fully telehealth compatible – because NBN makes telehealth real.
And with telehealth can come full ‘care concierge’ services for village residents and operators – which will change the sector forever.
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NBN users five times more likely to complain about service: survey

Amy Remeikis
Published: June 18 2017 - 12:15AM
National Broadband Network customers are five times more likely to complain about their service than a non-NBN user, as frustrations continue to surround the nation's biggest infrastructure project.
More than 13,406 complaints were made to the Telecommunications Industry Ombudsman about NBN services in the last financial year, which accounted for 11.9 per cent of all complaints received by the TIO, an increase from 5.4 per cent the year before.
Consumer advocacy groups believe a lot of the disappointment around the NBN could be mitigated with more transparency.
Teresa Corbin, CEO of the Australian Communications Consumer Action Network (ACCAN) said clearer information was needed to differentiate between theoretical speeds and what could actually be achieved.
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Enjoy!
David.

Sunday, June 18, 2017

With The MyHR Almost Five Years Old. Why Do We Still Not Have Any Idea If It Is Making A Positive Difference?

I thought I would have a look at the available statistics.
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My Health Record Statistics – at 11 June 2017
Published 11 June 2017
Over 4.9 million people have a My Health Record, with an average of 1 new record being created every 38 seconds.
Over 10,358,836 prescription and dispense records have been uploaded.
Over 10,035 healthcare providers are connected, including GPs, hospitals, pharmacies, aged care residential services, allied health.
Over 2 million clinical documents uploaded.
Dashboard display of My Health Record statistics
This page contains My Health Record statistics to 11 June 2017 .

View statistics as a dashboard - PDF 272 KB
Individual registrations
4,909,983 individual registrations
  • Of those registered, 54% are female and 46% are male.
  • Approximately 20% of Australia's total population is registered.
Age breakdown
The percentage of consumers registered for a My Health Record in a specific age bracket.
Age range (years)
Percentage (%)
20 or less
36%
20 to 39
25%
40 to 64
25%
65 or higher
14%
State breakdown
The percentage of those consumers currently registered for a My Health Record in relation to the total population of each State and Territory.
State
Percentage of state population (%)
Australian Capital Territory
24%
Tasmania
20%
South Australia
18%
Northern Territory
20%
New South Wales
21%
Victoria
16%
Queensland
27%
Western Australia
16%
Healthcare provider registrations
10,035 Healthcare provider registrations
Organisations registered
Total healthcare providers, broken down into common groups that are registered in the My Health Record system.
Organisation Type
Count
General practices
6,099
Public hospital organisations (there may be more than one facility within an organisation)
760
Private hospital organisations (there may be more than one facility within an organisation)
161
Retail pharmacies
1,334
Aged care residential services
166
Other categories of health care providers including allied health
1,251
Organisations with a cancelled registration
264
Total
10.035
My Health Record Usage
Clinical Document Uploads
Total number of clinical documents uploaded to the My Health Record system by healthcare providers.
Document Type
Count
861,035
999,509
267,532
48,226
29
61,998
50,607
Total
2,288,936

Prescription and Dispense Uploads
Total number of prescription and dispense records uploaded to the My Health Record system by healthcare providers and pharmacists.
Document Type
Count
8,051,819
2,307,017
Total
10,358,836

Consumer Documents
Document Type
Count
Consumer Entered Health Summary
85,768
Consumer Entered Notes
36,878
Advance Care Directive Custodian Report
13,479
Advance Care Planning Document
1,071
Total
137,196

Medicare Documents
Document Type
Count
Australian Immunisation Register
1,349,381
Australian Organ Donor Register
475,575
Medicare/DVA Benefits Report
295,373,315
Pharmaceutical Benefits Report
204,426,939
Total
501,625,210
Here is the link where you can see the page:
So what do we see here:
Well first the Government has basically created a great big duplicate database of MBS and PBS records (a little over half a billion of them!) I wonder why rather than just making them accessible?
Second of the 5 million who are registered on the system only 85,000 people (1.7%) have actually added any of their information.
Third – assuming a total cost so far of $1.5 Billion (smallest estimate) - we are have paid $17,647.00 to capture and store each of these records
Fourth it is obvious that Advanced Care documents and the like are a huge hit with the public NOT!
Fifth we have only 0.4% of the documents being something other than PBS / MBS records.
Sixth the Government sees fit to provide NO data on actual access and use of Shared Health Summaries by other than the creators – who have been bribed / paid to place them in the system.
Seventh there has yet to be even one non-anecdotal report of clinical benefit arising from the myHR.
It is clear that after five years the myHR is an expensive and ignored disaster. I wonder what the next five years hold?
A value for money audit is desperately needed.
David