Digital Health and the My Health Record in Tasmania: Is there a method to the madness?

Dr Chris MoyGeneral Practitioner (Parkside SA)My Health Record Operations Management Committee

Mitchell KnevettExecutive Director, ICT ServicesDepartment of Health and Human Services, Tasmania

Heather McDonaldDirector Education and AdoptionAustralian Digital Health Agency

Digital Health in Australia

The My Health Record

• Secure, online summary of an individual’s health information

• Can be viewed by treating healthcare providers across Australia

Ian Gillies: case study

Ian Gillies: case study• https://www.youtube.com/watch?v=ZILTEQtU6-w

What it looks like for patients

What it looks like for a GP

What it looks like for a GP

Common concerns

1. “Patient Control” and data quality

2. Privacy and security

3. Usability

4. Lack of useful information

1.“Patient Control” & data quality: “I don’t trust the information because it’s from the GP and because the patient can remove diagnoses”

“Quality of Data”

• Up to us

• Part of Professional standards

“Patient Control”

• Patient CANNOT remove specific diagnosis - can only limit access to entire document

• These are flagged

• 0.01% of people have applied Limited Document Access Codes (LDAC) to their My Health Record

1.“Patient Control” & data quality

Callen J, McIntosh J, Li J. Accuracy of medication documentation in hospital discharge summaries: A retrospective analysis of medication transcription errors in manual and electronic discharge summaries. International Journal of Medical Informatics

2010;79(1):58-64

• 12% of hand written summaries and 13% of electronic summaries were found to contain an error

• Most common- medicine omitted or additional medicine listed

• Error rates equally common whether written by intern, RMO or registrar

0.01% vs 12%: Let’s get a perspective on this issue

1.“Patient Control” & data quality

• Misunderstanding of what the My Health Record is.

• Not "single source of truth"

• Bonus information (e.g. allergies, medications) that might not otherwise have had

• Should apply same standard of care in interpreting the data as for paper based sources of data (re accuracy and currency)

• ”Half full” vs “half empty”- it’ not a perfect record - but better than what we have now- which is usually nothing

2. Privacy and security

• Bank level security

• Has not been hacked

• Risk of local level breaches of individual records, but:

• Audit trail

• Notifications via SMS/email when record accessed

• Penalties for deliberate (not in good faith) misuse

• Must be seen in the context of current privacy risks of:

• Current IT systems (e.g. hospital, GP)

• Faxing

• Paper records

2. Privacy and security

• Broader question of "privacy vs lives lost"

• PCEHR Review (2013)- over 8 years:

• 5200 lives saved

• 310,000 less hospital admissions

• Question: Should we make decisions about the privacy risk of patients who would rather be on the safety side of the "privacy vs lives lost” equation?

• Currently: system "opt in"

• Future: ”Opt-out" –can “get off the boat”- opt out rate in trial <2%

2. Privacy and security

Legitimate bigger picture to the privacy risk issue in terms of:

• Community benefit • Whether we should speak on a behalf of a patient re

the patient's acceptance of privacy risk• All patients can opt out anyway

3. Usability: “I once tried to use the PCEHR 3 years ago and it was terrible”

• NEHTA Clinical Usability Group (CUP) - has led to significant improvements in last 3 years

• Common complaint: “It’s too hard to upload a shared health summary”.

Lets upload one….

4. Lack of useful information: “There isn’t any useful clinical information on there yet”

• “Chicken and the egg” situation- the useful data comes from us

• Experience in NT regarding their successful MyEHR: when they reached 50% connectivity level between health practitioners, the system took off exponentially in terms or use and content

The MyEHR service:NT Department of Health

The MyEHR service:NT Department of Health

4. Lack of useful information:

• Holding their nerve to reach "critical mass" to reap the benefits

• ”Snowball" effect after a slow start

• Benefits: Include lives saved + reduced waste estimated in billions per year

But think: What could it mean for you?

TasmaniaWhat is the current situation in regard to Digital Health in Tasmania?

• Some state-wide information systems (eg PAS, DMR, ARIA)

• Overall portfolio of 400+ information systems across DHHS/THS

• Multiple discipline-specific Electronic Medical Records (EMRs) have been acquired

• Need to maintain underpinning ICT infrastructure to support service delivery

TasmaniaWhat are you doing to improve the connections between systems and between health providers working in different silos?

• Supporting the development and implementation of state-wide models of care through state-wide technology enablers

• Developing an agreed roadmap of investment in information systems that• Aligned to health sectors service delivery needs• Manage risks and liabilities• Underpinned by an architecture (to ensure connectivity)

TasmaniaHow does the My Health Record fit into this strategy?

• My Health Record is a valuable tool for information sharing and improving patient collaboration.

• Current initiatives include• Discharge summaries• Prescribe and dispense • Pathology reports in discharge summaries and shared with My Health Record• Diagnostic imaging reports • Viewing of documents

National

What is happening with the My Health Record nationally?

The following graph shows a comparison of the current pattern of registrations in the previous 3 weeks as compared to averages for April 2016 to June 2016.

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Unique providers uploading to My Health Record

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Unique Provider Organisations (HPI-Os) - My Health Record Only

Unique Provider Organisations (HPI-Os) - My Health Record or NPDR

National

What is being done to involve other health providers?

Count of registered organisations, type, jurisdiction, as of 19 June 2016

Organisation type ACT NSW NT QLD SA TAS VIC WA TotalAged Care Residential Services 4 66 1 38 1 26 20 156Central Government Healthcare Administration 3 2 1 2 2 10Chiropractic and Osteopathic Services 1 12 2 3 10 1 29Dental Services 9 7 3 13 1 33General Health Administration 5 1 3 3 11 4 27General Practice 62 2079 130 1067 346 104 1264 406 5458Hospitals and Health Services Public 1 195 59 219 13 4 19 15 525Hospitals Private 4 18 1 12 6 6 21 1 69Local Government Healthcare Administration 5 5Mental Health Hospitals 4 1 5Optometry and Optical Dispensing 11 5 11 27Other Allied Health Services 3 176 12 46 4 4 86 15 346Other Healthcare Services nec 3 24 21 85 8 4 37 20 202Other Professional, Scientific and Technical Services 1 1 1 3Other Residential Care Services 1 1Other Social Assistance Services 2 4 1 7Pathology and Diagnostic Imaging Services 2 10 3 15Physiotherapy Services 5 49 1 28 2 1 38 4 128Provision and administration of public health program 2 2Retail Pharmacy 1 368 19 237 61 81 351 78 1196Specialist Medical Services 4 43 1 40 8 5 52 8 161State Government Healthcare Administration 1 8 3 17 1 2 1 33Total registered organisations / jurisdiction 89 3073 266 1806 455 222 1949 578 8438

National

What about Secure Messaging (“point to point” communication) ?

National

What about the health provider registry?

National

How does this all fit in with chronic disease management and the proposed “Health Care Homes” model?

Your questions

Thank you