The Australian Digital Health Agency (ADHA) has defended My Health Record from criticisms from a leading international ehealth figure that the system relies on outdated technology.
Harvard Medical School International Healthcare Innovation Professor Dr John Halamka told News Corp Australia that the $2 billion My Health Record was nothing more than “digitised paper” as it uses such “out-of-date” technology that crucial patient information on test results and diseases are unable to be read or shared by computers.
“The My Health record is a noble idea but the standard they chose is from 1995; it uses PDFs, it’s not computable, it is just digitised paper,” he told News Corp Australia.
However, an ADHA spokesperson told HITNA that the claim of My Health Record being based on outdated technology is incorrect.
“Over 100 clinical information systems are accredited to connect to My Health Record and they consume structured data such as SNOMED [Systematised Nomenclature of Medicine] codes on diseases and AMT [Australian Medicines Terminology] codes on medicines. This functionality is driving decision support and other logic in those systems through those computable codes,” the spokesperson said. 
According to Dr Halamka, My Health Record will only be useful if it adopts new technology developed by Graeme Grieve – the FHIR system.  
The FHIR system is a draft standard describing data formats and elements, as well as an application programming interface for healthcare organisations and clinicians to exchange electronic health records. 
But as it is dependent on having a computer code for each disease, test result and medication, Dr Halamka said it should be made into a legal requirement. 
He said the US and China are leading on this front, requiring all health information to be computer coded from 2019 so that vital information such as allergies, blood pressure, or any other diagnoses is available and can be searched and shared between healthcare providers, clinicians and health apps.
“The FHIR standard is taking the world by storm, it’s being adopted in every country except the country it was developed in,” Dr Halamka said.
The ADHA spokesperson outlined that more than 98 per cent of the content in My Health Record is machine-readable, including MBS [Medicare Benefits Schedule] and PBS [Pharmaceutical Benefits Scheme] data and a variety of rich clinical resources, and that only one to two per cent of the documents contained in My Health Record are PDFs.
“And depending on the software used to view them, many of these are also machine-readable. This fraction of PDF content includes documents such as Advanced Care Directives, which are often written by lawyers and are not conducive to a more structured data format.”
The spokesperson also said with regard to FHIR, Australia is “globally competitive” in solving the challenge of interoperability that many other nations are grappling with and is now working with Grieve to accelerate interoperability. 
“[Grieve] is advising us on how the ADHA can use the learnings from Project Argonaut to give us a head start, backed up by a local Argonaut project that will bring the technical community together in ways we’ve never seen before,” the spokesperson said. 


As a system operator, the ADHA seeks to remain current with technology trends in delivering secure electronic exchange and interoperability. 

“For example, our mobile developer program already uses FHIR APIs. Our secure messaging program is also using FHIR APIs to enable a federated endpoint directory service that is currently being tested in two projects to validate the approach,” the spokesperson added. 
In May, ADHA CEO Tim Kelsey said the My Health Record is a “global innovation in consumer empowerment”. He described it as a “fully consent-based system” with unprecedented consumer controls.
“My Health Record is not the only summary care record system in the world, but it is unprecedented for the way in which it provides the consumer with such comprehensive control of their medical information,” Kelsey said.
Kelsey also addressed the need to look beyond just the technological aspect of My Health Record, but instead at the cultural challenge that it brings. 
“Technology is nothing, and culture is everything. This is not a technology strategy, but a human imperative to improve the health and well-being of every person in Australia,” he said
The FHIR software is currently in use by a number of clinics in Australia, but is not built into the My Health Record platform.
“We’re about to reinvest in a new technical infrastructure for the national system – still based, for the moment, on the same central document repository architecture. That doesn’t make sense. If we’re going to invest, it needs to be in a solution that care providers and receivers want and demand so they can get improved health care and outcomes,” Grieve said previously
“Also, it should be an infrastructure that vendors want to leverage because its benefits are obvious and systemic. Let’s take this opportunity to pivot to a different architecture, one that can break down our silos instead of building new ones.”
Grieve also shared the same sentiments as Dr Halamka, calling for an overhaul of the national health information platform in September, adding that it was built on technology that was state-of-the-art in 2007.
“The design of the system and the standards it is based on were state of the art in 2007. Although a more distributed design was initially planned, it is now, unfortunately, a centralised national database of static summary documents. This was an inevitable consequence of the technical standards used at the time, but now constrains the use, extensibility and therefore the value of the system,” he said
On 26 November, the Australian Parliament passed legislation to strengthen privacy protections in My Health Records Act 2012 without debate or division.
The new legislation means that Australians can opt in or opt out of My Health Record at any time in their lives. Records will be created for every Australian who wants one after 31 January 2019 and after then, they have a choice to delete their record permanently at any time.



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