With doctors still deeply skeptical about its clinical value, the spin needs to end
12th February 2020
By Paul Smith
Published by Australian Doctor News
https://www.ausdoc.com.au/news/29-million-reasons-why-my-health-record-still-wasting-gp-time
48 Comments (At the bottom)
There are still serious issues over the My Health Record and whether the billion-dollar system has a future.
Australian Doctor editor Paul Smith warns nothing is being done to address the crisis of faith among the medical profession.
The number is basic, but it helps tell an unwanted story. In December last year, GPs collectively uploaded 2,996,570 documents to the My Health Record.
Over the same period, the number of documents uploaded by GPs that were actually read by another health organisation was just 16,944.
The statistical disparity is a measure of the shallow depths the system has reached in terms of its relevance to day-to-day clinical practice.
Last month, the CEO of the Australian Digital Health Agency, Tim Kelsey, left for a new job in the US. He had arrived three years earlier to much fanfare, a fat pay packet and a fancy office overlooking the Sydney Harbour Bridge.
His tenure was by no means a disaster in a job engineered to cripple reputations: he dealt with the transition to an opt-out system, and pathology and radiology results are now being uploaded en masse.
He also avoided the political fallout when Australians discovered that police and government agencies were free to access medical information held on the system without the knowledge of patients themselves or any scrutiny from the courts.
But to many doctors, the system remains a white elephant exploding in slow motion.
The digital health agency has spent much time and effort producing big statistics for public consumption — virtually all of them are bubbles, floating in the sky to look pretty.
Yes, 1.7 billion documents have been uploaded, including 1.5 billion ‘Medicare documents’.
Who cares? The only real issue has ever been clinical engagement and its clinical value.
On this, there are fewer numbers. How many non-GP specialists are looking at shared health summaries, for instance? Who is uploading event summaries (sold as a way for after-hours doctors to keep daytime GPs in the loop)? How many hospital and non-GP specialists are resorting to the My Health Record to guide their own decision-making?
The digital health agency won’t say.
The big selling point for the system was that it would save lives in ED. On admission, a patient’s shared health summary would be checked for medication history, for potential allergies to ensure no misadventures.
But again, the digital health agency apparently can’t track whether EDs are looking for this information. The anecdotes suggest they’re not.
It is also an open secret that use by non-GP specialists of the system, at least those in private practice, remains non-existent.
Yet the agency has struggled to publicly acknowledge the depth of the problem — perhaps because this, too, leads to that fundamental question: what is the point of GPs uploading 2,996,570 reports if 99.4% of them are never read? If it is just the PIP payments, then it’s little more than a pantomime.
Australian Doctor is chasing five studies (mentioned in passing by the Australian National Audit Office last year in its fairly positive review of the system). These studies apparently show the system’s benefits on doctors’ workloads and clinical care.
When we asked the agency for the results, it said no, suggesting we lodge a Freedom of Information request. Why the lack of transparency?
Yes, it has to be sensitive to the potential embarrassments of its funder, the Federal Government. But this is becoming a harmful distraction.
The only agenda now is convincing Australia’s health practitioners that the system is of clinical use because clinical use is the only reason why $2 billion has been spent on the My Health Record to exist.
Mr Kelsey’s replacement has yet to be announced. But whoever lands the job, a shift will be needed.
Doctors — in fact, all health practitioners — can’t afford to engage in fantasies in their day-to-day work.
The agency needs to start being honest about the good, the bad and ugly of the My Health Record.
Only then will it convince doctors of the clinical necessity of a system still to deliver on so many of its ageing promises.
Comments
Dr Robert Hoffman
A big problem with all medical histories is that misdiagnosis can often survive as its a brave doc (medico legally) who says that it wrong and should be removed. My experience in many years in ER – you treat the patient in from of you and not the history relatives and faxes from various sources may provide. With Health Record there is the possibility of malicious entries. The notion that it cannot be hacked is laughable – even the CIA gets hacked. My better half thinks that the best privacy protection afforded to her by the medical profession of old is that no-one could read our writing!
Dr Maurice Gunhouse
What a load of rubbish. Read the history. Save on unnecessary errors. Don’t be so lazy and dont insult your GP colleagues just to score points against the MHR system. GPs uploading summaries are curating the record and intend it to be used
Dr Andrew Jackson
I rarely use it, but I must admit that on the few ocassions where I have (at the patient request —– who believe everything is automatically up there), I have only ever once found it updated in any useful manner. And luckily for me, that was very helpful. However, once in over 100 times is not really selling it.
Dr Garry Davis
As an Ophthalmologist in private and public practice My Health Record has had exactly zero impact on my practice.
To my recollection I have received no information on how to register or access the system.
Definitely a white elephant in non GP land.
Such a shame as a well resourced, easy to access, comprehensive system would be of immense value to patients, practitioners and hospitals.
Too many problems to detail them all but
1 Lack of information to potential users
2 Ability of patients to select information included on their record
3 Privacy (or lack there of)
are fatal flaws in my view.
It can’t be of much real use while these issues remain.
Dr Maurice Gunhouse
I think the department need to provide incentives and support to private non-GP specialists or the system flops. It should be as widely used as possible to make it realize it’s potential. At the moment it amounts to a communication system between GPs and public emergency centers, bearing only discharge summaries or GP health summaries. If surgeons and physicians used this as their platform it would make GP and ED functions so much more efficient.
Dr Brian Mansfield
The ability to quickly see the dispensing information of medications at your desktop is useful. It will also provide the practice where the medication originated if it is different to your own
Certainly less clumsy than the previous doctor shopper agencies
Dr Steve Kelly
I also use this, Brian, but it remains far short of a real time monitoring system …. not that the ones in Victoria or Tasmania even hold enough information.
MHR pharmacy dispensing and doctor item numbers is appearing to be last months data ….. nothing re Jan 1 on Jan 20 ….. so if you are after month old information, the person in front of you could change everything in that time …. no longer valium, i am chasing lyrica, now, for example.
It is only PBS data …. no private prescriptions mentioned. Not to mention all the clever folk (drug seekers included) who have opted out, so there is NO information, not even when a code is requested!
It is not quite entirely useless, but it is not even nearly useful or reliable or timely. Not safe.
Dr Carol Webster
Hey Brian, we are getting old, aren’t we? Nice to hear from you. Haven’t manged to download the reunion photos.
Frankly, I find it fantastic! Dispensing records – not always entirely up-to-date but *extremely* useful, as are the full disclosure medicare items which tell you when the patient cannot, who the previous doctor/ specialist was. And the dispensing records certainly allow you to complete the list of medications.
Doctor shopper hotline is pretty useless in practice, but the MHR does the job.
So what if the patient has opted out or hidden entries. **Absolutely** no problem whatsoever. Let me underline that. It just means that they **will not** be prescribed any S8 or benzos. Simple as that, simple and totally effective rule to be followed. Opting out guarantees that they will not need such drugs.
—
Paul B.
Prof Johan Rosman
Are you serious that you do not prescribe any S8 or benzo’s to patients who have out of principle opted out of MHR ? You must be kidding. You think it is in your power to punish patients for a principle. I think you need to consider moving to North Korea.
Dr Ian Colclough
Spending more money in an attempt to fix the system is not the answer. Knowing what to do about the system and knowing how to do it is the answer. I simply cannot comprehend why the ADHA and the Department of Health refuse to discuss this. Perhaps the new Secretary will be prepared to do so.
Dr Peter Bradley
I’m now retired, and also opted out. However, when in practice I never enrolled a single patient. Not one asked for this, and I felt that the big negatives were the security, and the time wasted enrolling the patient, and the time taken to access it, with no recognition from Medicare of the time spent. I reckon if they want this white elephant to develop Jumbo’s wings and fly, they need to ensure the security and refine who has access, remove the option for patients to edit it themselves, and send folk around to the practices to demonstrate the fastest way to enroll a patient, and later access/edit/add to the information. They then need to include an item in Medicare for us to do that. A higher one for enrolling and uploading, then a slightly lower one maybe for accessing, editing, updating, etc. Especially this last issue of payment for the time. Fix that, and then, and only then, might this animal fly.
Dr Ian Colclough
With respect I suggest that nothing which you have suggested here will fix the problem. The problems lie much deeper.
Dr Anthony Tragarz
“Kejserens nye klaeder “
(Danish for The Emperor’s New Clothes)
Dr Con Dassos
My experience: ( as a GP)
1.Patients get a thrill at seeing how easy it is for Dr to access their files,
- Medications listed are never up to date in terms of dose or frequency, and usually extend back to what patient was given in the distant past, without relevance
- But the most important is the medical history, which is nothing more than LABELS without explanation or relevance. It would be easier for the patient to have written the names of the illnesses on a credit card sized piece of paper!… And many do!
Impression:
- A) extremely limited value
- B) high chance of misinformation
Opinion:
Nothing can replace a letter from current GP with details to assist at time of need which are accurate, relevant and provide progress descriptions of illnesses. This should have been the focus all along.
My Health Recoprd summarised by me– “Great never ending business opportunity for those involved in its development and introduction :(“
…just my experience of course.
Ms Evie Paragalli
Medications listed can be extremely accurate.
For example, dispensing histories, including dose, frequency, prescriber and pharmacy is available on many patients MHR.
As a hospital pharmacist, I find it extremely useful and as do the doctors I work with.
Of course there are deficiencies, perhaps it’s more useful for pharmacists than doctors?
Dr Katherine Senior
Agree – the med list in a PCEHR is only as good as the doctor maintaining it, the same as the med list on a patient health summary you might be faxed from a GP clinic. The med lists in the MHRs often have inaccurate doses/frequencies and very frequently have medications that were prescribed years ago and never discontinued on the medical record when they were discontinued in real life – exactly the same as med lists in the patients’ electronic medical records in MD/Best Practice etc. However the PBS dispensing history in the MHR is a very useful, accurate source of information.
Dr Carol Webster
“However the PBS dispensing history in the MHR is a very useful, accurate source of information.”
Important distinction. The dispensing history is an accurate record of what went on the label when the drug was dispensed. If that did not match what was in the box, that is a different problem entirely.
Now, what is in the uploaded health summary is a different matter. This strictly indicates the quality of the doctor’s medial records; one of the *most* important aspects of uploading a health summary is that it is the important opportunity to review the drug list, adverse reactions list and past history. If you fail to do that then it is not only a waste of time, but an indicator of slovenly medical practice. If it runs an otherwise simple consultation into a level C, well that is perfectly appropriate and absolutely covered under Medicare.
Paul B.
Dr Peter Stephenson
I have occasionally accessed a patient’s MHR and of course uploaded enough to get the practice the PIP payment. If only they had listened to us docs who told them that it needed to integrate with our desk top programs! Downloading/uploading a summary in a text file is not integration! Then the elephant might fly!
Dr Robert Hoffman
If you do this the GIGO is a high risk virus
Dr Maurice Gunhouse
It is integrated with the major software. It takes no time at all to prepare and upload a curated history or to download information.
Dr Corne Kriek
I use it on a daily basis. On several occasions it was the only way to see yesterday’s ED discharge summary. I use it to look at medications and pathology of patients visiting from out of town. Its main shortcoming is that it is not embraced widely enough. In my experience many of my fellow doctors simply don’t understand how it works and how to use it properly. Bring it on.
Dr Partha Modak
I use my health record regularly. While I agree that it is a less than perfect system, I believe, considering all the ease, legibility, reproducibility and accessibility by both health professionals and patients this is the best system of dispersion of health information at a national level we have got and I can’t imagine there will be a rival to it but its own evolution. A lot of things that has been said about this system and its woes are due to lack of user participation, I don’t see how government or ADHA can be blamed for those. Whilst system is fallible its not mature, with time and our participation it will be better. I feel we are being unduly harsh to my health record.
Dr Maurice Gunhouse
Totally agree with you. It has huge potential and needs to be supported to evolve.
Dr Maurice Gunhouse
Totally agree with you. It has huge potential and needs to be supported to evolve.
Dr Maurice Gunhouse
Totally agree with you. It has huge potential and needs to be supported to evolve.
Dr Peter Bradley
If you’re so IT savvy, Maurice, how come you triple posted..? Just click on Submit Comment once, and have faith man.
However, I’m beginning to come round to thinking it is something that could be useful, as it evolves over time, as someone above suggested, but most docs just don’t know where to begin. I think the local PHNs need to send folk out to practices that request assistance, and go through the basics with the individual docs as to accessing, uploading, editing, etc. That would help a lot. As it’s not going to go away, I guess docs have to just bite the bullet. However, they do need to introduce a Medicare item to help pay for the extra time it all takes, or it will never be successful in my view.
Dr Maurice Gunhouse
just goes to show that nothing and no one is perfect and it takes time to get things right
Dr Carol Webster
“I think the local PHNs need to send folk out to practices that request assistance, and go through the basics with the individual docs as to accessing, uploading, editing, etc. That would help a lot.”
Ahem.
That is *exactly* what they are doing, and are supposed to be doing. If your PHN is *not* offering that, raise a complaint!
Paul B.
Dr Peter Meggyesy
As a GP in a heavily touristed area I have found the pharmacy dispensed section useful. Every day I get someone coming down having left scripts at home. What dose lipitor are you on is invariably met with a blank look and a response of “it’s the white one”.
The rest of the record is useless. The reason is simple it does not automatically import everything in the GP records. Patients who are happy to have the ehealth records actually expect everything to be available and are puzzled and disappointed that they are not. The Feds need to make the relevant deals with medical software suppliers to make this happen.
Provide a useful product and it will be most certainly taken up.
Dr Joe Kosterich
It is everything we would expect from a government system.
Dr Ian Hargreaves
As a hand surgeon, I still have not received any official communication from the government about this. I asked my software provider (Australian made) and they have no integration with it.
Whatever potential it may have to identify allergies or multiple pathologies, has been completely squandered by the government, so effectively that it is hard to know if it is just negligent, or directly malicious.
Dr Carol Webster
“I asked my software provider (Australian made) and they have no integration
with it.”
Then your software is *clearly* unfit for purpose.
“Best Practice” has it, and I presume “MD” does also. I understand certain large GP companies mandate the use of software that does not. *Not* the government’s fault in this case.
Paul B.
Prof Johan Rosman
Paul, he is a hand surgeon. It is integrated in GP software, I agree. But he will use private practice software. As far as I know, none of the private practice software packages have MHR integrated. This is probably because the government has never spoken to public and private specialists about MHR. That is also the reason why so far it has been exclusively a GP tool. Specialists do not receive a PIP payment, leave alone a Medicare MBS. MHR is a GP tool, as far as I see it. And in that it fails completely.
Dr Ian Hargreaves
I use Genie, a Brisbane-based system which is probably one of the most popular with surgeons, particularly in the hand/orthopaedic spectrum. But AHPRA knows where I am, Medicare knows what I do for a living – still not a peep from any official government channel on MHR.
One of the big theoretical benefits is if a patient sees me with a circular saw/chainsaw laceration on the weekend when his GP is closed, I can check his antibiotic/anaesthetic allergies even if he is struggling to remember them. But not if I can’t access it.
Most reputable Xray companies have a ‘break glass’ feature on an easily accessible website, so I can see the images the patient had done when they fell over in Geelong or Cairns last week.
If they are quietly bleeding out in ED, saying “the doc started me on some new heart pills last week”, I can’t find out from MHR if they were NOACs or diuretics or beta blockers.
If they were setting it up to fail, they are doing that well.
Dr Peter Bradley
Paul B, why are you often posting under someone else’s name, just askin’..?
Dr David Rivett
I have always thought and suggested to government that patients carry their records on a memory stick pluggable and playable on any computer and updatable by a keyboard stroke from their GP/specialist/A&E . This puts the patient in the drivers seat cost government nil and allows scarce health dollars to be spent usefully.
Dr Katherine Senior
I work in addiction Medicine and I use My Health Records every day – I can see what medications the patient has had dispensed on the PBS for several years and, with a bit of detective work, I can usually work out who has prescribed the meds by matching up “date prescribed” with the dates of MBS services. It is enormously helpful in a field where my patients are not always forthcoming about what they are taking, how much/often and how many doctors are prescribing for them.
My consultant or I (the advanced trainee) upload discharge summaries for all of our patients, written by the intern or RMO, finalised by the consultant or myself to make sure they contain all the relevant information, usually within 2-3 days post-discharge. Again, patients in our field are often reluctant to let us know which GP/s they see as they worry they will no longer be able to obtain their BZDs or opioids, or the doctor might think badly of them for having a problem with alcohol or methamphetamines. But it’s very important that the GP knows about their substance use issues and if you see one of my patients, you can access that information even if the patient is not entirely forthcoming about it.
As with any medical record, hand-written or electronic, the information in a MHR is only as good as the person maintaining that info.
Dr Carol Webster
“Again, patients in our field are often reluctant to let us know which GP/s they see as they worry they will no longer be able to obtain their BZDs or opioids, or the doctor might think badly of them for having a problem with alcohol or methamphetamines. But it’s very important that the GP knows about their substance use issues and if you see one of my patients, you can access that information even if the patient is not entirely forthcoming about it.”
And again the simple and clear dictum for GPs: No or no accessible MHR simply means no opioids or benzos *will* be prescribed.
Of course, if the patient is on an OTP, it is *illegal* to prescribe them S8s in any case.
Paul B.
Dr Arnold Dela Cruz
$2 billion dollars! That’s a lot. Don’t want that to go to waste.
Unfortunately , maybe this hasn’t been looked into well enough to be used by the public, doctors and other health professionals.
Why do others don’t have MHR, why do others not identify doctors to access it and why is it not up to date? Why is it controlled by patients who can add , delete , change – do whatever with it?
That money could have been used somewhere else, you think?
Dr Dan Tucker
Rubbish on the Desktop and blocked access to information = Rubbish in the Cloud
Dr Leonie Fromberg
I find it very useful. Discharge summaries are available. Dispensing history. You can track where your patient has had various tests performed and if you have someone passing through you can upload your notes so their own GP can read them when they make it home. It literally takes 20 seconds to upload a summary. So easy to use.
Dr Stephen George
Just wanted to add regarding the Electronic health record that is called Digital Medical record or DMR in Tasmania . I have found the DMR really useful every time . Very user friendly and easy to navigate . It’s been there for many years and almost every patient has one – I have always felt that the DMR team did a great job in Tasmania and I think they should do it for us in the mainland !
Dr David Close
One hopes that its value and usage will be taught in medical schools so that future doctors are very familiar with it. This will only happen when their teachers know enough about it and are themselves convinced of its value.
Dr Clair Langford
I’m a geriatrician and I do look! Helps avoid unnecessary radiology and pathology. If both GP and pharmacist have uploaded it really helps the medication reconciliation and who the prescribers are. Gp’s medication lists are often out of date. It can also help tell you how often the patient is filling the scripts. Unfortunately not yet enough consistently updated and junior staff become despondent looking at it in the ED. It certainly has potential but requires more consistent engagement both uploading and looking. As automation to this effect improves it will be better but if you are in a poor and clunky internet zone it will remain frustrating. This is my woe thanks to our third world NBN.
Prof Johan Rosman
As a specialist in public and in private health care I have never looked at My Health Record of any of my patients, nor uploaded any. I do not know a fellow specialist who does anything with it. And why would we ? It takes time out of my busy day, is difficult to access, my practice software does not have the possibility to upload and I always send the GP who is the primary doctor a full letter.
When MyHealthRecord, by stealth, was introduced as an opt-out method, the first thing my family members and I did was exactly that-opting out. Sooner or later the database will be hacked and when the governement needs money they will sell data or share it with the Health Insurers. Indeed, predictably MyHealth record is a complete and utter failure.
Dr Robyn Cooke
Incomplete records
Too many people have access
Difficult to use
Not actually helpful
Distrust in the system
And how dare the government allow access to others not essential to medical care withoit permission from patients
Dr Con Dassos
Well said Robyn! Very well said.