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08 May 2017

BY AMA VICE PRESIDENT DR TONY BARTONE

Just the mention of anything relating to a digital health record is enough to make most health bureaucrats’ eyes glaze over and a politician may even experience a heart flutter! The corridors are littered with the projects and goodwill of many people who have passionately sought to lead the innovation the change the digital transformation in health. Yet in 2017 we are still grappling with the challenge of delivering one of the largest transformational undertakings in health. Ask anyone in leadership where things are at at the current time and you are likely to get many different answers.

Since the National Electronic Health Transition Authority (NEHTA) and the evolution of Australian Digital Health Agency (ADHA) there has been much anticipation about essentially the next round of engagement and subsequent transformation.

With the announcement of the new National Digital Health strategy later this year it is timely to revisit this topic. The My Health Record was never designed to replace an organisation’s patient health record. It could be said that it was to facilitate the communication and sharing of medical information on behalf of patients. It is clearly going to be of most benefit to Australians with chronic and complex illnesses, to ATSI and to mentally ill and older Australians and to rural and regional Australians.

The capability exists now for sharing of simple but important clinical information.  Electronic referrals Allergies, Shared Health Summaries (SHS), Medication, Immunisations and very soon Path and DI all could be shared and recorded in a central location for each patient. However, up to now the number of registered users remained very small and as such the utility minimal.  This is starting to change following a reversal from an “opt in” to an “opt out” strategy following the recent trials of Nepean Blue Mountains and Northern Queensland were undertaken.

Massive communication campaigns enlisted and essentially people in these regions were advised that they all had a digital health record unless they opted out. This success of these trials largely underpinned the announcement made by the COAG Health council Communiqué of March 2017 where the ministers agreed to a national opt out model for long term participation arrangements in the My Health Record system.

The agency (ADHA) rightly points to the figures that some 4.7 Million consumers are registered individuals on My Health Record. (almost 20 per cent of the Australian population), 1.7 million plus clinical documents (including  some 700,000 shared health  summaries with 7 million prescription documents for dispensed medications  and 1 million immunisation documents from Medicare’s ACIR programme.

However  despite 6000 General Practices registered being  incentivised to  upload  SHS  to  the My Health Record as many as 20  per cent  of these practices have not  submitted  the minimal govt  required  SHS uploads which has placed all or some of their electronic health incentive (PIP) payments at risk. There are still ongoing discussions with the Path and DI sectors regarding  the  path  for  uploading results to the  record  (let’s be clear, however, the capability exists right now).  Pleasingly but only just recently NSW Health Pathology announced that it will upload results to the Record.

There is clearly a lot to do still.  The utility and the number of records will be significantly improved by more usage and further incentivised buy in and adoption. The long-term benefits and improvements are worth the challenge but there is a lot of work and effort and disruption required and this needs to be recognised and assisted by significantly rewarding change and facilitating the process and provision of resources.

Organisational transformation requires energy, drive, time and learnings.  Infrastructure for many State hospital systems needs to be significantly up-scaled. Utility will be also driven by novel applications. The task of data cleansing equally daunting in magnitude will further drive outcomes.

There are other potential stumbling blocks now still. Recent Privacy issue regarding setting the privacy settings on an individual file demonstrates that there still is confusion both in the sector and lack of understanding amongst patients.  We need additional resources training all in the sector and informing patients and educating the community as increasingly more healthcare organisations look to upload various elements to the record.

Perhaps, even more pressingly, the negotiations regarding the uploading of pathology and DI results needs to be fast tracked and facilitated.

It is still going to be a while before GPs can start to render their fax machines obsolete.


Published: 08 May 2017