The Problems With EPAS At SA Health Do Not Seem To Be Easing Off Just Yet, But Some Positive Impacts Are Being Seen.

This appeared a few days ago:

EPAS cost blows out again

EXCLUSIVE | The cost of SA Health’s troubled electronic patient records system EPAS has blown out to almost half a billion dollars after the department was forced to ask Cabinet for another $49 million to pour into it, InDaily can reveal.

Bension Siebert @Bension1

Adelaide Friday November 03, 2017

The department approached Cabinet last month to request the extra funding for EPAS, raising the cost to taxpayers from $422 million to $471 million over the 10 years to 2021.

SA Health confirmed the increased cost to InDaily this morning. InDaily understands Cabinet has approved the request.

Doctors have repeatedly warned that EPAS slows down emergency care, threatens patient safety and blows out waiting lists.

In August, almost one in five medical staff using EPAS who responded to an Australian Medical Association survey blamed the system for “serious errors including charting medications for the wrong patient, critical delays in obtaining records on surgical patients and pathology errors such as mixing patients and specimens”.

However, SA Health figures show medication errors have reduced at sites where EPAS has been implemented.

SA Health Deputy Chief Executive Don Frater told InDaily in a statement this morning that the increased budget for the e-health records system would help improve its performance.

“Forecast EPAS expenditure includes the implementation of a major system upgrade to increase efficiencies, provide more advanced security and faster overall system performance,” he said.

“More than 340,000 South Australians have benefitted from having an electronic patient record within EPAS so far, and more than 20,000 staff and students have been trained in the system.

“Implementing the new system is an ongoing process and we continue to work closely with staff and clinicians to resolve concerns and make improvements to EPAS where necessary.”

SA Health expects to install EPAS at Flinders Medical Centre, Hampstead Rehabilitation Centre and Mt Gambier Hospital in 2018.

The system is partially installed at the new Royal Adelaide Hospital, providing administrative support but only some clinical functions.

“As we have previously said, we will implement the remaining clinical functions at the RAH progressively, with a view that all functions will be in use by early 2018,” said Frater.

SA Health figures show sites which use EPAS have enjoyed a significant fall in medication errors since having the system installed.

Errors fell from an average five per cent (one in 20) to 0.003 per cent (one in 3000) at those sites.

The proportion of patients leaving hospital with incorrect medication, without required medication or with medication they did not need fell from 12 per cent before the installation of EPAS to 3.5 per cent afterwards, according to the figures.

And more medical records – 94 per cent at the EPAS sites – now document patients’ medication allergies, up from 84 per cent at those same sites pre-EPAS.

However, an AMA survey, released earlier this year, revealed almost 20 per cent of respondents blamed the system for “serious errors including charting medications for the wrong patient, critical delays in obtaining records on surgical patients and pathology errors such as mixing patients and specimens”.

Forty per cent of respondents who had been using the system for more than two years said their opinion of EPAS was poor, while 18 per cent reported their opinion of the system was worse after they became familiar with it.

In the category of “near misses”, one respondent – who had been using EPAS for more than two years – reported this anecdote:

A patient had a cardiac arrest during a previous anaesthetic and presented one month later for a repeat try. After 90 minutes of searching by several staff members, the previous anaesthetic chart could not be found. The second anaesthetic had to be conducted without full knowledge of what had happened and why during the previous anaesthetic. (2+ years user)

More here:

https://indaily.com.au/news/2017/11/03/epas-cost-blows-out-by-another-50m/

There is a lot to this article of which the least important to be is the cost increase. The positive impacts of some clinical measures and the apparent ongoing frustration with the safety and use of the system are much more important.

The article is worth a close read.

David.

The ADHA Issues Its First Annual Report - Not Much That Is New I Have To Say.

This appeared last week:

Annual Report 2016-17: New momentum for digital health in Australia

Tuesday 14 November, 2017

The first Annual Report of the Australian Digital Health Agency has been tabled in Parliament – it highlights a new partnership between governments, clinical and consumer leaders, industry and the research community to put real momentum behind bringing the benefits of digital health services to all Australians.

Significant progress has been made in the last year, the report says: Australia has a new National Digital Health Strategy endorsed by all health ministers; My Health Record is on track for national expansion in 2018; and new initiatives to enable secure paperless communications between clinicians have been launched.

Agency Chair Jim Birch AM said that the Agency is tasked with improving health outcomes for all Australians through the use of digital health technologies.

“Technology is already transforming our ability to predict, diagnose, and treat disease. But there is much more we can do to realise its full potential for the health of every Australian: giving consumers more control of their health and care, connecting and empowering healthcare providers and promoting Australia’s global leadership in digital health and innovation,” Mr Birch said.

In its first year the Agency has built a new organisation, connected hospitals and health services to My Health Record, improved the user experience for the 5.3 million registered Australians, and grown the volume of clinical document sharing with 14 million prescription and dispense records now uploaded.

Agency CEO Tim Kelsey said: “The Agency is here to serve the patients and citizens of this country – and would like to thank all our partners in the community – leaders in patient and consumer services, in clinical practice, industry and research, as well as the governments of Australia - for their continuing commitment and collaboration to ensure that everybody has access to the benefits of digitally empowered health services.

“Digital information is the bedrock of high quality healthcare and our shared goal is to ensure that all Australians benefit from the increasing number of digital health services,” Mr Kelsey said.

ENDS

Media contact
David Cooper, Senior Media Manager
Mobile: 0428 772 421 Email: media@digitalhealth.gov.au

About the Australian Digital Health Agency
The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia. The Agency was established on 1 July 2016 by the Australian Government as a statutory authority in the form of a corporate Commonwealth entity, and reports to all Australian governments through the COAG Health Council.
www.digitalhealth.gov.au

Here is the link:

https://www.digitalhealth.gov.au/news-and-events/news/new-momentum-for-digital-health-in-australia

In the best NEHTA tradition there are a zillion happy smiling Digital Health Users and a lot of positive reporting.

Fun Facts:

1. As of 30 June, 2017 there were 247 employees (Temp and Permanent).

2. Agency Funding 2016-17. The Agency is jointly funded by the Commonwealth ($120.892 million) and the states and territories ($32.25 million) reflecting the commitment at all levels of government to the delivery of digital health reform. Note is seems the States are paying a lot less than they were under NEHTA! with the Commonwealth paying more.

3. Registrations:

 In 2016-17 the Agency, as System Operator, registered 1,120,817 people for a My Health Record. There were a total of 20,151 cancelled registrations during the year.

In 2016-17 the System Operator registered an additional 1,320 healthcare provider organisations. 89 registrations were cancelled or suspended.

4.Usage:

A total of 664,278 people accessed their My Health Record via the consumer portal in 2016-17.

A total of 2,217 unique healthcare provider organisations, via their clinical information systems, viewed records in the My Health Record system during 2016-17.

A total of 4,538 unique healthcare provider organisations uploaded records to the My Health Record system during 2016-17.

A total of 218,776,890 documents were uploaded to the My Health Record system in 2016-17.

5. Breaches:

35 data breach notifications were reported to the Office of the Australian Information Commissioner as required under Section 75 of the My Health Records Act 2012 (concerning potential data security or integrity breaches). Twenty-nine of these were reported by the Chief Executive Medicare as a registered repository operator under Section 38 of the Act.

6. Complaints:

In 2016-17 a total of 64 complaints were made in relation to the My Health Record system and, as of as of 24 July 2017, one remained open.

7. I could not find a single issue that was seen as a problem and all seems to be going fine.

A small reward is offered for anyone who can find a self-critical comment in the report. Maybe next year?

David.

There Are Lots Of Exciting Visions For Digital Health Out There! I Often Wonder How Real They Are?

Three forward looking articles  appeared last week:

First we had:

How data is ushering in the era of personalised healthcare

AI, augmented reality and vast amounts of data will help drive a new revolution in healthcare, Murray Brozinsky says.

Rohan Pearce (Computerworld) 15 November, 2017 06:00

Roughly every half century, there’s an innovation that drives a revolution in healthcare, according to Murray Brozinsky.

In the 1840s it was the use of anaesthesia in surgery; in the 1870s, germ theory. Then in the 1920s penicillin was discovered, and in the 1970s evidence-based medicine emerged on the back of the use of randomised clinical trials.

“We are at the dawn of the next revolution,” Brozinsky — the chief strategy officer of health technology firm Conversa — yesterday told Commonwealth Bank’s Future of Health conference. More than 100 of the bank’s corporate clients attended the conference, held at Telstra’s Customer Insight Centre in Sydney.

That revolution is the emergence of digital healthcare: Personalised healthcare driven by the availability of an enormous amounts data and the technology to leverage it. In 2020, there will be 25,000 petabytes of health-related data, Brozinsky said — “that’s roughly 500 billion four-drawer filing cabinets that would contain 500 times all of the written words since the dawn of human history”.

“We’re starting to get a glimpse of what that revolution is,” he told the conference. Evidence-based medicine draws on data but treats the “average” patient, Brozinsky said.

“We’re driven by clinical trials, which uses a set of patients to provide a standard of care or a guideline for the rest of the population — many of whom don’t look like those patients. And now we’re moving to a world where instead of treating the average patient, we’ll treat the individual person.”

That shift will be enabled by drawing on a vast array of data — including clinical data, genomic and other omics data, demographic data, data collected from sensors and patient-reported outcome data.

“In oncology we have treatments today that we know don’t work in 70 per cent of cancer patients,” Brozinsky said. “We need to move to a world where we know that the treatment will work 100 per cent of the time in the right 30 per cent of cancer patients. That’s personalised health.”

Artificial intelligence, blockchain, telehealth, virtual and augmented reality, sensors, 3D printing and, further down the track, CRISPR and SENS, are all set to change the face of healthcare, Brozinsky told the conference.

Lots more here:

https://www.computerworld.com.au/article/629990/how-data-ushering-era-personalised-healthcare/

And then we had this:

17 November 2017

Whatever happened to our digital health utopia?

Posted by Felicity Nelson

The digital health revolution has been a long time coming.

Once it arrives, we are told, everything will run at peak efficiency, for less money, with higher quality care, greater transparency and immaculate interoperability.

The digital data trinity – electronic medical records, artificial intelligence and big data – will, futurists claim, metamorphose healthcare.

But this sparkling vision grates uncomfortably against the reality; the dull dialling of fax machines can still be heard in most waiting rooms around the country. Frustrated, sick patients still cannot access their most basic medical records remotely online.

Experts came together this month at the Medical Technology Association of Australia annual conference in Sydney to discuss what is being done to close the expectation gap between what technology can do, and what it is actually doing right now.

Australia has fallen behind much of the Western world in terms of hospital digitisation; while the US has around 2000 “digital” hospitals, Australia currently only has three.

But significant work was under way to push many more hospitals into the digital age, Richard Royle, the national digital health leader at PricewaterhouseCoopers Australia, said

Australia’s first fully integrated digital hospital, St Stephen’s Hospital in Hervey Bay, Queensland, went live in 2014.

Since then, two additional hospitals have reached the highest levels of digitisation (called HIMSS Level 6): the Princess Alexandra Hospital in Brisbane and The Royal Children’s Hospital in Melbourne.

Mr Royle was the man behind the pioneering project at Hervey Bay.

As the former executive director of Uniting Care Health, Mr Royle transformed the Queensland facility using $47 million in funding from the former Gillard government.

Gone were the laborious, time-sapping and inaccurate paper records at this “hospital of the future”. Instead of clinicians at St Stephen’s having to write down the heart rate, blood pressure and temperature on the patient chart, data was automatically fed from monitoring systems into the electronic medical record.

The system nudged clinicians towards best practice by displaying standardised clinical decision-making pathways, Mr Royle said.

Medications used at St Stephen’s were packaged in individual, barcoded dosages and fully tracked to reduce waste and medical errors.

Doctors could also receive alerts about their patients in real-time, including information on allergies, medications, abnormal vitals and test results.

“The ability for the clinician to look on his or her laptop at home for the live vital signs, to be able to review and change the medications, to be able to talk directly with the staff who are treating the patients, that’s gold for the doctors,” Mr Royle said.

While Australian hospitals weren’t exactly embracing a digital future yet, there was significant traction occurring, particularly in NSW. But getting digital projects off the ground required engagement at all levels – from patients, to clinicians, up through management and inside parliament, he said.

A major obstacle was the cost. At around $50,000 to $70,000 per hospital bed, the price of digitisation remained steep. Mustering the political will to fund these projects was difficult, as the investment would only start produce efficiencies well into the following election cycle.

The government was also nervous about disasters in digital health because these could be very high profile and they hurt people, Mr Royle said.

Vastly more here:

http://medicalrepublic.com.au/whatever-happened-digital-health-utopia/11898

and third we had this:

Transform GP care and trash fax machines, new digital healthcare report says

Lynne Minion | 17 Nov 2017

Abandon the idea of continuous GP care and throw away your fax machine - a new Microsoft report has told Australian healthcare it needs to undergo a dramatic change in mindset and get with the digital revolution.

Embracing the Change Mandate: The 2020 Digital Transformation Agenda for Australia’s Health Care Sector gathered input from a number of Australian experts, with GP and president of the Australasian College of Health Informatics Dr Chris Pearce claiming we are on the verge of the most significant shift in how healthcare is delivered since the scientific method arrived.

The ‘GP for 30 years’ care delivery model will disappear, according to Pearce, with patients already seeking primary care from five different clinics and 11 doctors in their lifetime.

“One of the cornerstones for general practice has always been this concept of continuity of care. But the reality for a large percentage of the population is that they are usually young, relatively fit people and there is no need for continuity of care – a vaccination here, a sore knee there – and that’s fine,” Pearce told Healthcare IT News Australia.

More here:

http://www.healthcareit.com.au/article/transform-gp-care-and-trash-fax-machines-new-digital-healthcare-report-says

You can download the report here (with the usual seeking of details to permit pestering you with marketing):

Download: Harvard Business Review Analytic Services Report Embracing the change mandate: The 2020 digital transformation agenda for Australia’s healthcare sector

Sadly I have been reading enthusiastic stuff like this for at least the last 15 years and so far very little of it seems to have come true – will the riskiest saying in finance and elsewhere actually come true in saying ‘this time it is different!” and actually mean it!

We will see! Comments welcome if you are a believer or not!

David.

It Looks Like The New National Cancer Registry Is Still Struggling!

This appeared last week:

13 November 2017

Data delays hinder cancer register

Posted by Ruby Prosser Scully

As the Department of Health delays the rollout of the National Cancer Screening Register yet again, clinicians are being urged to be aware that women’s clinical histories may be separated between state and national registers for several months. 

The transition from two-yearly Pap smears to five-yearly HPV testing has been almost universally praised as life-saving and cost-effective, but the rollout has been beleaguered by repeated delays and cost blowouts. 

Now another partial delay to the program has been confirmed by Department of Health deputy secretary Paul Madden in the October 26 Senate budget estimates hearing. 

As of December 1, women will begin HPV testing and the test results will be tracked on a national register. But the data migration of women’s histories from individual states and territories will not be collated until into the next year, with full functioning of the program promised by the first week of March. 

Several sources speaking to The Medical Republic, who asked not to be named, expressed concern that there was confusion over the staggered rollout, and limited guidance in terms of following up women in the transition period. 

This would be a particular concern for women from interstate or those new to the practice, for whom doctors may need to call state registries over the transition period to ensure they have up-to-date information to provide women with the most appropriate management. 

The full scope of the national program, including the ability to mail out reminders, the telephone and fax system, an integrated and complete history and the analytic capability to ensure women were put onto the right clinical pathway, would not be up and running until March, Mr Madden said. 

Women who have a positive result will be followed up within eight weeks, and other follow-ups take place 12 and 16 weeks after the test. By this stage, the complete program should be operating, Mr Madden said. 

Sources have expressed concern to The Medical Republic that women’s safety could be at risk if continued difficulties with data migration delay the rollout further, impeding the national register’s ability to send out recall notifications within those windows. 

More here – including AMA comments:

http://medicalrepublic.com.au/data-delays-hinder-cancer-register/11837

I wonder will the ship is righted and all will go well or is this going to become yet another health IT disaster being over budget and seriously behind time.

David.

It Rather Looks Like The MyHR Has Broken An Important Rule If Success Is To Be Achieved!

This appeared last week:

21 November 2017

How to succeed with digital innovation in health

Posted by Felicity Nelson

Dr Steve Hodgkinson has a message for digital health innovators: the longer a project takes, the more likely it is to fail.  

Dr Hodgkinson, the CIO at Victoria’s Department of Health and Human Services, has overseen the launch of around 30 new applications in the past 18 months, with products delivered in as little as six weeks, and none taking longer than six months.  

The thinking behind a swift roll-out was that it gave stakeholders a sense of how the application would work and provided an opportunity for feedback early in the process.  

Rather than taking 18 months or two years to develop the “perfect” system, the department used existing cloud platforms to get a working model up as soon as possible and then executed the design based on user feedback.  

This transparency promoted organisational learning and made people feel energised and excited about the project, Dr Hodgkinson said. 

“Just getting started is the thing,” he said, speaking at Microsoft’s “Creating a Digital Difference” event in Sydney this month.  

The department launched a thunderstorm asthma early-warning system in October, in partnership with the Bureau of Meteorology, the University of Melbourne, and Deakin University. The computing work was done by Microsoft’s Azure platform.  

The system gave three days’ warning of a likely event and sent notifications to the public through the Vic Emergency app.  

…..

This strategy, which Dr Hodgkinson named “Platform+Agile”, could be useful for the development of a range of digital health systems, he said. “But electronic health records it is a more complicated conversation,” he said.  

Digital health often feels stuck in the mud, with systems unable to talk to each other and projects such as My Health Record eating into $2 billion without much to show for it.  

Part of the problem was that government was trying to create “a single system to rule them all”, which was neither necessary nor practical in a fragmented sector like health, Dr Hodgkinson said.  

A better solution would be for government to become an “intelligent consumer” of global digital services. 

Lots more here:

http://medicalrepublic.com.au/succeed-digital-innovation-health/12003

As I recall the so called ‘soft launch’ of the PCEHR (as it then was) happened on July 1, 2012 after about 2 years of development.

You can relive the period with this fantastic collection of memorabilia found here:

https://aushealthit.blogspot.com.au/2012/07/weekly-australian-health-it-links-2nd.html

This means rather than taking six months the shambles has so far taken at least 7 years – hardly ‘agile’ .

And now we know it is going further with opt-out and all these new data feeds in 2018.

On the basis of value for money and duration this is really doomed I reckon – we have all been suffering for far too long!

David.

This Looks Like Another Worthwhile Initiative From Government. Worth Knowing About!

This appeared last week:

27 November 2017

New cancer database a key resource for GPs

Cancer Clinical

Posted by Felicity Nelson

Cancer Australia’s new searchable database is giving GPs quick access to population data on cancers.

The National Cancer Control Indicators website, launched this month, brings together information on 17 cancers from trusted sources.

Quick fact cards present up-to-date data on prevention, incidence rates, treatment, and five-year relative survival.

“Cancer is a pretty scary word,” says Dr Liz Marles, the director of the Hornsby GP Unit in Sydney and member of Cancer Australia’s Advisory Council. “Getting a cancer diagnosis is probably one of the biggest personal challenges for people.”

By sharing this kind of contextual information with patients, GPs could shape more realistic expectations and guide decision-making, she said.

“We are dealing with a much more informed consumer these days,” Dr Marles said. “People are going on to the internet, they are finding bits of information that they don’t know what to trust, they don’t know how reliable it is.”

GPs have a role as guardians of truth but, until now, authoritative cancer statistics have been scattered across multiple websites, or buried in reports.

“Every day we have conversations with people around prevention, screening and diagnosis and this is going to give us a whole lot better evidence base to have those conversations,”  Dr Marles says.

The website aims to provide an inclusive picture of changing trends and impacts of cancer over time, according to Cancer Australia.

…..

NCCI is designed to be updated as new data becomes available. The new resource can be found at: www.ncci.canceraustralia.gov.au.

More here:

http://medicalrepublic.com.au/new-cancer-database-key-resource-gps/12070

More can be found about Cancer Australia here:

“Cancer Australia was established by the Australian Government in 2006 to benefit all Australians affected by cancer, and their families and carers. Cancer Australia aims to reduce the impact of cancer, address disparities and improve outcomes for people affected by cancer by leading and coordinating national, evidence-based interventions across the continuum of care.  

Cancer Australia works collaboratively and liaises with a wide range of groups, including those affected by cancer, key stakeholders and service providers with an interest in cancer control. The agency also focuses on populations who experience poorer health outcomes, including Aboriginal and Torres Strait Islander peoples and people living in rural and remote Australia.

As the lead national cancer control agency, Cancer Australia also makes recommendations to the Australian Government about cancer policy and priorities.

Cancer Australia’s vision

The vision of Cancer Australia is to reduce the impact of cancer and improve the wellbeing of people affected by cancer.

Cancer Australia’s mission

Cancer Australia’s mission is to strengthen and provide advice on the Australian Government’s strategic focus on cancer control and care.”

https://canceraustralia.gov.au/about-us

It is good to see at least one Government initiative that has actually been running for a decade and is still funded.

A useful resource.

David.

The AMA Offers Some Input On The Possible Future Of The myHR. They Are Not Yet Convinced By Any Means I Would Say!

It is the season for Pre-Budget Submission for the 2018/19 financial year. Here it the link to that provided by the AMA.

https://ama.com.au/gp-network-news/ama-pre-budget-submission-strong-gp-emphasis

There was relevant comment provided here:

AMA calls for improvements to My Health Record for it to reach potential

Lynne Minion | 15 Dec 2017

My Health Record has the potential to save lives and deliver economic benefits but the system needs improvements and doctors don’t have time to talk patients through the opt-out process, according to the Australian Medical Association.

In its Pre-Budget Submission 2018-19, the doctors’ advocacy group this week claimed the federal government needs to invest in improving the national repository of Australians’ healthcare information for it to reach its potential.

“The AMA believes a fully functioning and widely used My Health Record will not only save money but save lives. Ongoing improvements will help ensure its success,” the submission says.

“Electronic medical records promise much,” the AMA says, with early wins predicted to be reduced adverse drug events and duplication of diagnostic tests. Developing the platform’s functions could lead to additional gains.

“We note government estimates anticipate that the My Health Record will generate savings of around $123 million by 2020-21. Further iterations of the My Health Record could become even more useful to clinicians and patients alike via features such as recording specific prosthesis details, enabling targeted notification of drug recalls, and providing the opportunity for understanding of aged care directives and patient wishes.”

But the submission claims “more work is required” to minimise the burden on doctors and ensure interoperability with healthcare provider software.

Lots more here:

http://www.healthcareit.com.au/article/ama-calls-improvements-my-health-record-it-reach-potential

Here is what the AMA had to say on the myHR (Page 23 on)

10. My Health Record.

The My Health Record will offer digital access to a core summary of important patient clinical data when it matters most– at the time of treatment – irrespective of the clinician’s specialty or physical location in Australia.

Electronic medical records promise much. Early wins are expected in reduced duplication of diagnostic tests and reduced adverse drug events. A recent study estimated that admissions  due to adverse drug events could be as high as 230,000 per year, and cost $1.2 billion per year.  It has the potential to improve the information flow between hospital doctors and general practitioners when patients present to hospital and are discharged.

We note Government estimates anticipate that the My Health Record will generate savings of around $123 million by 2020-21. Further iterations of the My Health Record could become even more useful to clinicians and patients alike via features such as recording specific prosthesis details, enabling targeted notification of drug recalls, and providing the opportunity for understanding of aged care directives and patient wishes.

But more work is required. The return on investment will hinge in the short term on ease of use for medical practitioners who upload the clinical data. Interoperability with the multiple software packages used across the medical profession and broader health sector must be seamless.

Problems uploading specialists’ letters, poor search functionality, time-consuming adaptations   to existing medical practitioner work practices, or inappropriate workarounds will erode clinical utility and deter doctor use – and, more importantly, take time away from focusing on the patient.

Doctors do not have time to talk their patients through the My Health Record arrangements for opt-out, privacy, setting access controls in standing consent for health providers to upload health information. This is the work of the Government. Doctors must be allowed to focus on what they do best – caring for patients. The lack of reliable broadband is also a barrier that will need to be addressed if nationwide, digitised health care is to be achieved.

The shift to opt-out arrangements in mid to late 2018 is also a critical success factor. Some Australians will be surprised to learn that a My Health Record has been created for them without their explicit consent. The communication campaign must reach as many Australians as possible, and promote a positive attitude towards the My Health Record created for them.

Privacy, health data security, and health data disclosure are also hot button issues – for doctors and patients. These will need to be carefully managed to maintain a high level of participation post opt-out.

The AMA believes a fully functioning and widely used My Health Record will not only save money but save lives. Ongoing improvements will help ensure its success.

This forms up to an AMA Position shown on the next page:

AMA POSITION

The AMA calls on the Government to:

•           guarantee that doctors will not bear unnecessary costs for guiding patients through the intricacies of the My Health Record system for arrangements for opt-out, privacy, setting access controls in standing consent for health providers to upload health information;

•           fully fund an opt-out communication campaign to avoid widespread fear-driven decisions to opt out;

•           appreciate the high level of community concern about the My Health Record’s impact on patient privacy and health data security;

•           invest in the ongoing improvement of the clinical utility of the My Health Record so it becomes a value add tool for clinicians in their day to day delivery of quality patient care;

•           provide specific support for specialists to adopt the My Health Record;

•           fund work to achieve a seamless interface between the My Health Record and My Aged Care; and

•           excellerate the establishment of health data standards needed to make interoperability a short-term reality.

When you read what the AMA actually says – typo and all – it seems pretty clear that the AMA thinks:

1. The myHR is by no means fully evolved as far as being useful and user friendly.

2. The Government needs to spend a good deal more to get there.

3. Electronic records hold great promise – i.e. after 5 years we are yet to see realisation of that promise.

4. We are concerned that there may be additional costs that we might see doctors saddled with. For us it all has to be overall cost neutral or better.

5. Much of the populace are concerned about security and privacy and may be somewhat startled by the introduction of opt-out if the communication and explanation is not very well conducted.

6. Given time is money there is concern a lot may be wasted on poor systems and explaining opt-out.

7. Health Information Standards need a lot of work.

I would say their position is as negative as it could be given they have signed a Memorandum of Understanding on all things myHR, among others, with the Government. Here is the link about that:
https://www.australiandoctor.com.au/news/racgp-ama-formed-pre-budget-pacts-govt
and also here:
http://www.health.gov.au/internet/main/publishing.nsf/Content/0FFB2BE666C5627ECA25811B002759EB/$File/Shared%20vision%20AMA.pdf

They clearly see there is a long and expensive way to go with success by no means guaranteed. They also see the move to opt-out as a big risk – as so many of us do!

David.

Making Patient Pathology Results Available Via The myHR May Not Be That Valuable Without Some Extra Work.

This appeared last week:

Study: Online portals fall short on offering context, explanations for test results

by Paige Minemyer 

Dec 13, 2017 11:20am

Patients often do online searches to understand test results posted in portals, according to a new study.

Patients can, and often do, access test results and other healthcare information through online portals, but more work could be done to help them understand what the results mean, according to a new study. 

Researchers interviewed 95 patients who had accessed test results through a patient portal between April 2015 and September 2016, according to data published in the Journal of the American Medical Informatics Association. Close to two-thirds (63%) of those interviewed did not receive any additional explanation on the results through the portal. 

Nearly half (46%) then looked online for interpretation of the test results, and 51% discussed the results with friends and family instead of physicians. Patients who were not given an explanation about their test results were more likely to be upset—sometimes even if the results were normal or positive—and more likely to call their physicians for more information. 

Fifty-six percent said they had a negative reaction to their test results due to lack of explanation, compared to 21% of those who had a negative reaction with adequate explanation. 

'Our findings suggest that current patient portals are not designed to present information on test results in a meaningful way,' the researchers wrote. 'While providing patients with access to their test results via portals is a good start, it is insufficient by itself to meet their needs.' 

Patient portals are viewed by clinicians as one of the most useful patient engagement tools, and at some practices an increased use of portals has coincided with decreased appointment wait times. 

But, the researchers said that the results show how portals can continue to evolve and support patients. Providing clear interpretation of test results for patients should be a best practice, and as patients may search for additional information on results even if an explanation is provided, portals can be designed to steer them to reputable online sources. 

More here:

https://www.fiercehealthcare.com/it/online-patient-portals-engagement-test-results

The full paper is found here:

https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocx140/4689172

Here is the Abstract:

Patient perceptions of receiving test results via online portals: a mixed-methods study

Traber D Giardina Jessica Baldwin Daniel T Nystrom Dean F Sittig Hardeep Singh

Journal of the American Medical Informatics Association, ocx140, https://doi.org/10.1093/jamia/ocx140

Published: 12 December 2017

Abstract

Objective

Online portals provide patients with access to their test results, but it is unknown how patients use these tools to manage results and what information is available to promote understanding. We conducted a mixed-methods study to explore patients’ experiences and preferences when accessing their test results via portals.

Materials and Methods

We conducted 95 interviews (13 semistructured and 82 structured) with adults who viewed a test result in their portal between April 2015 and September 2016 at 4 large outpatient clinics in Houston, Texas. Semistructured interviews were coded using content analysis and transformed into quantitative data and integrated with the structured interview data. Descriptive statistics were used to summarize the structured data.

Results

Nearly two-thirds (63%) did not receive any explanatory information or test result interpretation at the time they received the result, and 46% conducted online searches for further information about their result. Patients who received an abnormal result were more likely to experience negative emotions (56% vs 21%; P?=?.003) and more likely to call their physician (44% vs 15%; P?=?.002) compared with those who received normal results.

Discussion

Study findings suggest that online portals are not currently designed to present test results to patients in a meaningful way. Patients experienced negative emotions often with abnormal results, but sometimes even with normal results. Simply providing access via portals is insufficient; additional strategies are needed to help patients interpret and manage their online test results.

Conclusion

Given the absence of national guidance, our findings could help strengthen policy and practice in this area and inform innovations that promote patient understanding of test results.

----- End Abstract.

Basically what is being said here is that there are a large number of patients who will be confused, out of their depth and possibly scared by gaining access to their results with are not accompanied with some explanation of what they mean and who to ask if they are confused.

I wonder how the guru’s at the ADHA are planning to address this issue as it is clearly a big one for some patients who are not receiving their results from their clinician face to face! Interestingly the same issue also applies to the NSW e-Health Portal as described in this link:

https://www.opengovasia.com/articles/nsw-health-enhances-its-healthenet-clinical-portal-by-adding-discharge-medication-information-via-my-health-record

David.

I Really Feel Sorry For The Academics Who Made A Mistake And Were Jumped On By The ADHA.

This appeared a few days ago:

Why we removed an article on the My Health Record

December 13, 2017 5.07pm AEDT

Author

1. Sasha Petrova  Deputy Editor: Health + Medicine

The Conversation published a story earlier today that was incorrect.

The story, titled “We have less than three months to opt out before the My Health Record system has our details, and no-one told us”, asserted that a three-month period to opt out of being registered for a My Health Record had already begun.

This is incorrect. According to the Australian Digital Health Agency, which is responsible for the My Health Record, the date the period begins has not yet been set.

In a statement to The Conversation, the Agency said:

The opt out period will be set by a Notifiable Instrument which is anticipated to be around mid-2018 […] The Agency will implement a comprehensive communications strategy to advise Australians that a record will be created for them in 2018, unless they tell us they don’t want one.

We are committed to providing accurate and reliable information. Where errors do occur, it’s our policy to correct them promptly and be transparent about what happened.

We apologise for this mistake and greatly appreciate the Australian Digital Health Agency bringing the error to our attention.

Here is the link:

https://theconversation.com/why-we-removed-an-article-on-the-my-health-record-89087

The article wrongly claimed that the period to notify a desire to opt-out had begun – when indeed it will happen / begin some-time mid to late 2018.

Despite the ADHA claims, at this point it is not clear how all Australian citizens will be notified of the period available to opt-out of being given a myHR other than with some social media notifications and posters at various locations.

The offending paragraph was this:

“While the onus is on us to lodge an “approved form” to elect not to be registered, no such form is available. This is despite the fact that the time for opting out began on December 2, 2017.”  The rest of the article appeared sound but it has now been deleted.

The error was a misreading of the regulations I condemned a week or so ago as being incomprehensible. It seems even they were bamboozled by the obscure drafting and I am annoyed by it was not clearer - I am sure the mistake was not deliberate.

See here:

https://aushealthit.blogspot.com.au/2017/12/the-government-and-adha-are-treating-us.html

Understanding was improved when the Explanatory Memorandum became available:

See here:

https://aushealthit.blogspot.com.au/2017/12/explanatory-memorandum-for-mr-hunts.html

I would have preferred the article stayed available after a prominent correction was placed around the error as the rest was useful – but there you go – and I also would have much preferred the regulations were made much more human friendly!! I feel an apology and correction was all that was needed and would have cleared the air. The comments also were valuable.

There is no doubt that the ADHA is very nervous about misunderstanding of their announced plans and are active in seeking corrections – and well they should be - given the risk of the opt-out becoming political and causing great public consternation! (Witness the care.data program debacle led by Tim Kelsey in the UK.)

Frankly I think there is already enough public confusion and ignorance around opt-out to make the need for a major clear communication program with the public more than urgent!

David.