The pandemic broke down some resistance to the use of My Health Record by consumers and practitioners. The challenge is to keep that momentum going.
Eric Martin reports
Australian governments and many healthcare providers have prioritised digital health as key to improving service delivery and health outcomes, yet with the surge of online information during the pandemic, much of that development seems to have bypassed the very system it was supposed to serve.
My Health Record was touted as “an unprecedented platform for innovation in the provision of digital apps and tools that will support Australians and their health providers to improve health and wellbeing.” But six years and more than $2 billion later, the system is still struggling to reach its full potential.
As the looming end-of-2022 deadlines for its first objectives approach, Medical Forum spoke with the RACGP’s Dr David Adam, the Australian Digital Health Agency (ADHA), and Professor Jaya Dantas, of Curtin University to explore some of the issues impacting My Health Record.
“There has long been an expectation from patients that all the services across Australia should be digitally connected, and I certainly have patients who expect me to be able to share my record completely with another doctor at another practice,” Dr Adam said.
“But I think the community awareness of what My Health Record (MHR) allows is still limited – I have not seen a huge increase in the number of patients who report that they have accessed their own information through the system.”
Professor Dantas explained that MHR was a rebranding of the original digital healthcare system launched in 2012, which had only managed to attract about four million people over four years. The ADHA was established in 2016 to lead the development and implementation of MHR.
“Co-ordinated research, including intervention studies and pilot programs, was undertaken by the agency not only to drive innovation and increase uptake, but also identify the challenges,” she said.
Opt-out
The National Digital Health Strategy established that by the end of 2018, every Australian would have a MHR, unless they choose not to, and by 2022, people would be able to access their health information online at any time, with every health-care provider able to communicate with other professionals and their patients via secure digital channels.
“But unfortunately, as you know, and as most of your readers will know, that’s a nice idea, but it doesn’t really exist,” Dr Adam said. “However, what I will say is that My Health Record is certainly becoming more useful on an almost monthly basis.
“Our practice has been connected to the My Health Record system for a long time, but in the last 12 months we’ve seen the biggest degree of improvement, where it has just become so much more useful.
“For example, the integration with the Australian immunisation record was always a bit hit and miss because the Australian Immunisation Register itself was patchy and there was no requirement for anyone to upload records to it – you were never sure that there was a complete picture,” he said.
“But now that all vaccines must be uploaded, particularly COVID and influenza vaccinations, having access to the immunisation register through My Health Record is much easier than using the register directly.”
COVID has been the biggest driver of Australian’s uptake of MHR and, in January 2022, Acting ADHA CEO Paul Creech said more and more Australians were using the system to help manage the impact.
“COVID test results come from pathology providers and the majority of pathology providers in Australia routinely upload test results to My Health Record,” Mr Creech said. “We’ve seen huge demand since last July, with more than one million views a month by consumers across Australia.”
Record time
People could see their COVID test results as soon as they were uploaded to MHR often faster than they would have received an SMS.
The dashboard was also updated at the beginning of 2022 to include vaccination details and test results, medical conditions, relevant medicines, and allergy information, as well as links to the vaccine clinic finder and side-effects checker.
The AHDA stated at the time that each month more consumers were viewing their own information, with nearly 13.75 million COVID-related documents viewed in January 2022, and a 580% increase in pathology views by consumers from 2020-21.
“For researchers and population health experts, COVID has highlighted the immense need for tele-health and digital health and the information and benefits this provides. Globally, there is increased use of digital technologies to provide better health care,” Professor Dantas said.
“The past 12 months has indicated an increased use of My Health Record by Australians – there are 23.3 million records as of June 2022 and 22 million have data in the records.
“The current statistics indicate that 99% of pharmacies and GPs are registered and have used health care records, 97% of public hospitals are registered and 95% have used My Health Record.”
However, from the January peak of 13.75 million, the number of Australians accessing MHR has dropped alongside concerns about COVID, with figures from June showing that only 4.99 million people retrieved their data – much closer to the monthly average.
“I’m always careful about drawing too many conclusions from that number,” Dr Adam said.
“My experience is that for almost everyone who has a record, yes, it does contain some information, but almost all of that is pulled from automated systems. It’s Medicare data, immunisation data, PBS data and I’m not sure that accurately reflects the number of people who are actually engaged with the system.
Falling short
“One of the main goals of My Health Record was to have patients more empowered and have more understanding of their health care information, but I haven’t seen that translate into real life yet in any kind of significant way.”
Dr Adam attributed this observation to the fact that the information in MHR, although improving, still suffered from the patchwork nature of its implementation.
“We have certainly seen a lot more of the local labs start uploading information to MHR rather than posting patients copies of their results, but all the private radiology firms have their own patient portals and patient systems, and many of the lab providers do as well,” he said.
“We have two parallel ways of doing the same thing, one of which is duplicated many times.”
However, progress could soon be made in addressing this hurdle with the announcement on August 24 this year that ADHA had signed a deal with Health Level Seven Australia Ltd (HL7) to develop specific digital health standards and specifications to improve connectivity – Fast Healthcare Interoperability Resources (FIHR).
Agency CEO Amanda Cattermole said the ADHA’s partnership with HL7 would have a direct impact on consumers gaining better access to their health information.
“Put simply, FHIR is the how-to guide that enables health information movement from one place to another, a freely available and nationally endorsed interoperability standard,” she said.
“The agency and HL7 recognise that different parts of the health system are at different points in the digital journey. The long established V2 and CDA standards are widely used, and these will continue to be supported during the transition to FHIR.”
National uptake
“One of our priorities through the partnership is to more clearly communicate requirements for standards for national acceptance across public and private health and social care.”
Professor Dantas said it was well known that one of the main reasons My Health Record had initially struggled to gain traction was concern for the safety of information shared by Australians. However, trust in the system’s privacy standards had increased.
“We know that about 2.5 million Australians had opted out of the My Health System before the cut-off date in 2019 even though the government had assured people of the security and safety their data,” she said.
“Yet out of the 2.5 million, 240,000 have now registered for the record. Patients know that My Health Record is a safe and secure site. However, the next step would be to have simple information in different languages and for population groups who have low literacy.
“We also need targeted public awareness of the need for the My Health Record and how it can assist us to manage our health, with information provided to our GPs, specialists, pharmacies, and other providers.”
Dr Adam explained that one of the reasons doctors may still be wary of fully embracing the system could stem from the historical approach to protect patient confidentiality.
“Many of us have concerns about information, privacy, and security. I personally have a lot of trust in the My Health Record system from a confidentiality and privacy point of view. But I understand that this is my view, and it is not one that all my colleagues necessarily share,” he said.
“I think some of us are still holding onto the model that our notes are our property: we know we make them, that the patient always has full access to them, except under very limited circumstances; but I think there are still people who would not feel comfortable with everything they write in the notes being seen by other doctors, or by patients themselves.
“I also think there are still a lot of people who have questions and concerns about it, even though the number of people who originally opted out is relatively small, and unfortunately, many of my patients who would get the most benefit out of something like My Health Record, are also the ones concerned about other people accessing their information.
“I understand, and I respect that decision. But, for example, it is much harder to check what dose of drug was administered at another practice – we have to call their pharmacy like we used to do.”
Both he and Professor Dantas also lamented that there was no mechanism to effectively address the necessity to manually enter and upload data, with Dr Adam pointing out the potential for patient misunderstanding between the 15-minute consultation time and a bill showing 25 minutes.
“I generally try to do most of my administration with the patient in the room because they know what’s going on and they know what’s happening about them,” he said.
“The fact that adding information to a patient’s record is considered Medicare billable time was something that the RACGP lobbied really hard for, and I think it has definitely helped.
“The problem more generally is that bulk billing for most practices is no longer sustainable, and GPs need to think about ways of streamlining access.”
“The billable time is a real issue and does impact not only uploading data but also patient consults and interaction. It is an acknowledged problem but there seems to be no movement to address this,” Professor Dantas said.
“The business or corporate model of billable time used by the government is another issue.”
Dr Adam said that he does emergency public work as well as general practice and the MHR proved its usefulness.
“When people have a good summary in their My Health Record, that is hugely helpful, and we certainly rely on it – thank you to everyone who has been working to keep the records up to date.”
myGov audit
The architect of federal public service reforms, David Thodey, will lead a user audit of the newly relaunched myGov portal in a move that could lead to the government’s multiple services and brands finally being consolidated into one website and app.
The user audit was promised by Government Services and NDIS Minister Bill Shorten ahead of the election campaign and comes after the portal was relaunched recently.
Mr Shorten has appointed former Telstra CEO David Thodey to lead a panel overseeing a user audit of the myGov system, which links Australian residents to Medicare, the My Health Record, My Aged Care
and the National Disability Insurance Scheme.
Mr Thodey will report back to the government by the end of the year.
“The current two-year program for improving myGov ends in mid-2023 and the audit will help to inform the next steps for the upgraded myGov platform,” said Mr Shorten, who has made it clear he wants myGov to be the portal for all federal and state services.