It’s cost an estimated $2 billion and taken five years to develop so far, but concerns are growing that the Federal Government’s My Health Record may be at risk of becoming a white elephant as hospital and GP groups claim it is yet to show clinical benefit.
New figures released by the Australian Digital Health Agency, which is rolling out the national repository for health information, show that while 21 per cent of the population has a My Health Record, only 263 specialists were connected to the system, less than 150 hospital discharge summaries are viewed each month by any healthcare organisation, and about 200 GP-generated shared health summaries were accessed by staff working in public and private hospitals in August.
The alarmingly low use of the system by clinicians has amplified the chorus of concerns from healthcare providers and technology experts who claim the My Health Record isn’t fit for purpose.
GPs, who are provided with financial incentives to upload shared health summaries to the system through the government’s ePIP program, said they don’t need to access My Health Record for up-to-date and accurate clinical information.
“GPs have existing, well-developed local systems and software to collect and manage patient medical information,” technology evangelist and chair of the RACGP’s Expert Committee for eHealth and Practice Systems Dr Nathan Pinskier told Healthcare IT News Australia.
Over 137 million general practice consultations take place each year with 85 per cent of Australians seeing a GP at least once a year.
“Most of the clinical information needed by a patient’s GP is usually already available without the need to access an external source.”
But Pinskier said access to a SHS could deliver better outcomes in urgent and unscheduled care situations.
Under the ePIP eligibility criteria general practices must upload shared health summaries for 0.5 per cent of the practice’s standardised whole patient equivalent (a calculation of a practice’s size), boosting the number of documents in the government’s incomplete and largely unviewed data depot while adding to GPs’ administrative burden.
“This is a two-edged sword, as the ePIP requirements have no doubt resulted in increased SHSs being uploaded, but with the adverse effect of a significant number of practices dropping out of ePIP in the past twelve months,” he said.
“The current model of requiring GPs to create a shared health summary to a cloud repository does not in itself provide an immediate value proposition in the eyes of the GP.”
Pinskier claimed that of the approximately 7000 practices in Australia only about 65 per cent are currently enrolled in ePIP.
“The RACGP has consistently warned that there was as significant risk that general practices would drop out of ePIP and that this would affect the broader adoption of ehealth solutions. The ePIP needs to be focused on supporting ehealth adoption and also data relevance and quality as opposed to mere numbers.”
More than 5.3 million people have a My Health Record and almost 3 million clinical documents are held within the system. But even when patients see a healthcare provider who is not a part of their regular care team, or care is sought after-hours or in an emergency, the system isn’t useful, according to CEO of the Australian Healthcare and Hospitals Association Alison Verhoeven.
“I think there are well-founded concerns about the substantial investment that has been made to date in the My Health Record for limited results and the capacity for this to be addressed in a timely and effective manner,” Verhoeven said.
By the end of 2018 every Australian will have a My Health Record unless they opt-out. The decision by the Federal Government to plow ahead in implementing a system that relies on the uploading of PDF documents is attracting mounting criticism.
Ex-ADHA health informatics expert Grahame Grieve recently wrote in Healthcare IT News Australia about his work in developing the open API ‘Argonaut Interface’, in collaboration with some of the giant US electronic patient record vendors.
An open-architecture system that allows data to be searched, prioritised and analysed, making it quick to access in meaningful ways in urgent clinical settings, the Argonaut Interface has generated excitement in the industry as a solution to the interoperability problem.
Yet as the complexity of medical information grows, My Health Record is persisting with a Clinical Document Architecture that requires healthcare providers to push documents into a single repository.
“What’s missing from this picture is any idea of a coherent system. Enterprises don’t automate their systems by collecting a huge pile of PDF documents,” Grieve wrote.
“These limitations have been designed into the system, based on the standards that were available at the time. Hard decisions had to be made in order to meet the government’s original, politically imposed deadline.”
He claimed scaling up My Health Record, including to opt-out, will compound the problems.
Verhoeven said clinicians and health services are not convinced that this substantial piece of health infrastructure can effectively meet their needs and contribute to patient care.
“There is still much work to be done to ensure the record is used by, and useful for clinicians. Issues related to multiple information systems, interoperability and usability also impact on the willingness of clinicians and health services to use the My Health Record,” she said.
The RACGP’s Pinskier said as the platform evolves its usefulness will grow.
“As My Health Record gradually develops increased functionality and enhanced data searchability – as opposed to the current document-centric model – its role and utility in general practice will become better defined.”
However, the ADHA is content with progress. Of the recent figures, including near zero views of some types of documents, and fewer than 20 monthly registrations from aged care providers and private hospitals, an agency spokesperson said usage will build over time.
“While it appears that some of the categories are close to zero, it is important to understand that some features were introduced to the My Health Record in the recent past and adoption by the provider community takes time,” the spokesperson said.
“For example, pathology report uploads began in April 2017 and the Medicines List view began in June 2017. In the case of pathology report uploads, only three healthcare organisations are uploading and since April this year, they have contributed a combined 411,507 reports.”
The ADHA said it is working closely with jurisdictions, hospitals, and peak bodies to drive increased uptake, and the software industry to get My Health Record integrated into clinical software platforms, such as those used by GPs. It is also set to announce the integration of diagnostic imaging to the system.
As a result, it’s too soon to focus on current statistics, the spokesperson said.
“These numbers will have greater relevance by the end of 2018 when the MHR expansion has been completed.”
Meanwhile, last week the agency released its 2016-17 annual report, within which it touted its engagement with healthcare providers.
But as the years add up and costs rise, pressure from within the industry is increasing on the ADHA to solve My Health Record’s problems.
“The work currently underway to address issues such as interoperability, to promote uploading of a broad range of documents, and to engage clinicians and the public is critical. The Australian Digital Health Agency will need to demonstrate some quick successes soon, or trust will be eroded,” Verhoeven said.
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