New week, same shemozzle

One day in the not-too-distant future, communications and business students in universities across the land will sign up for a course called Marketing Disasters 101 and be presented with a case study about the utter train wreck that was the great My Health Record opt-out launch of July 2018.

Pretty much the only thing that could have made this week's debacle worse would have been an actual breach of the system itself. On Monday morning, a huge gang of online activists were just waiting for the clock to tick over to opt out before they let all hell break loose, and my word did they succeed. Social and mass media were dominated in the morning by stories about long delays and system collapses, and by the afternoon it had turned into a veritable production line of tinfoil hats.

One absolute hero got on the phone at 7am to opt out and then for the next few hours martyred himself to the cause by giving 10-minute updates on Twitter about how long he had to wait on the hotline. In the afternoon, he took to claiming that the use of the reCaptcha plug-in on the opt-out website meant everyone's identity verification information was now being flogged off to Google.

Some of his confreres then began to inspect the legalistic language used in the My Health Record privacy statement, in its terms and conditions and the opt-out legislation itself, where they found some juicy references to law enforcement authorities and other third parties being given access to citizens' personal health information.

That set off an explosion in far-fetched fantasies, with everyone from the tax department to private health insurers apparently being granted access to your medical history, even down to your local council. We must admit that gave us pause for thought. What would the council do if it found out about your haemorrhoids? Cancel your library card?

Legitimate concerns over privacy and security were subsumed into mass hysteria, leading to the ABC's Norman Swan sending out an exasperated tweet saying the debate had been hijacked by privacy ideologues. The rearguard kicked in later in the week with some of the peak bodies coming forward but they were very much drowned out by worst-case scenario media reporting. The narrative was all about the bad things that could happen and it appears that the Australian Digital Health Agency and Health Minister Greg Hunt were completely unprepared for the ferocity of the reaction.

They shouldn't have been. Fears over privacy breaches and mistrust in government is at an all-time high at the moment, not helped by continuing revelations about Facebook, Cambridge Analytica and Russian interference in the US and UK elections, all kept in the spotlight spectacularly this week by Donald Trump's comical path of destruction through NATO, Helsinki and even the Queen.

Closer to home, mistrust in our government is also at an all-time high, not helped by appalling examples such as the woman who criticised Centrelink and had her details given to the media by then Human Services Minister Alan Tudge. The fears of many concerned over government control of personal data were summed up perfectly this week by the Guardian's resident cartoonist First Dog on the Moon.

The whole debacle has Labor rubbing its hands with glee. An ALP source told Pulse+IT just recently that the party would not attack the government over the MyHR or opt-out itself – the PCEHR was a Labor initiative after all, and it voted in favour of opt out, as did the Greens – but instead they will be on the front foot about the incompetence of the government's delivery of it.

The people who should have been on the front feet were the promoters, and they failed dismally. Sending out peppy tweets about which obscure peak body supports the My Health Record was not enough. They needed to run a TV advertising campaign at least two weeks ago, announcing opt out would begin on July 16 and here's where you can go to find more information. Consumer packs should have been at GPs and pharmacists long before now. We popped down to our local shopping centre on Saturday, where there are three chemists and one Australia Post outlet, and there was nothing, so it's no surprise that many people are bewildered. The narrative about the positives of the system was lost on the first day.

People of authority should have been out there spruiking the benefits of the system, but admittedly that is quite hard to do when there are no measurable benefits as yet. That fact in itself is an absolute indictment of the people who have failed to properly deliver this initiative over the last six years.

That sad truth was illustrated later in the week with the release of a clinical safety review of the MyHR by the Safety and Quality Commission. It reported that the system needed a streamlined way to present new and pertinent clinical information to clinicians, just like their own clinical systems do. It also found that most clinicians didn't think anyone was listening to their feedback even when it was requested. If you remember back that far, those are two of the main issues that forced the resignation of NEHTA's clinical leads team in August 2013. Five years and nothing much has changed.

The drama will slow down and the chatter will dissipate over the next few weeks, but there's no doubt it will erupt again when 18 million new records are created in November. People who already have a record, even if they didn't know about it, are all having a close look now and discovering some mistakes. One woman reported this week that there was an entry in the MBS section of her record with a doctor she had never visited for a CT scan she never had. With MBS and PBS data full of such mistakes, get set for another car crash come December.

This week's drama will all blow over, as it always does, and the My Health Record will trundle on as usual. Who knows? It might actually work properly one day. What is for sure is that the roll-out of this system, which Norman Swan described as the most important piece of health infrastructure in a generation, has redefined the very word shemozzle.

If you want to see how to have a polite public debate over private health data, take a look at our stories on the ProCare privacy issue in New Zealand this week. Lots of facts, no hysteria.

According to Prime Minister Malcolm Turnbull, about 20,000 people managed to opt out on Monday, although ADHA tells us that they won't be providing a running total. Some people will opt out on a paper form so these need to be reconciled after the opt-out period is over. We're still betting on 500,000 opting out – with 24,000,000 staying in.

That brings us to our poll for the week. Last week, we asked whether you would opt out of the My Health Record. 33 per cent said yes, while 67 per cent said no. Interestingly, the last time we asked this question was in March 2017, when we had 34 per cent saying yes and 66 per cent no. Not much changes.

This week, we'll ask another question we have asked before to see if anything has changed after this week's events. In April, we asked if you thought more than two per cent of the population would opt out or less, remembering that the opt out rate in the 2016 trials was 1.9 per cent. 56 per cent said more, while 44 per cent said less.

After this week, let's ask that one again and see if you've changed your mind. Do you think more than 2% will opt out, or less?

Sign up to our weekend edition to vote or leave your thoughts below.

Comments  

+1 # Chris Ryan 2018-07-21 12:27
Beautifully written as always Kate
# Ian Mcknight 2018-07-22 00:13
Agree with Chris, great article. Hits the nail on the head as promoters of this initiative sit back and watch waves of criticism and exaggeration, with essentially zero response in the popular media from the ADHA or anyone else in the government. Exactly same thing happened a couple of years ago, with much negative written in the media space and a deafening silence in response.... for months and months. Really makes it hard to "win hearts and minds" for those on the ground.
Critics are often individuals writing in an unrestricted way and encouraged by journos looking for a sensationalist "hook". The response is largely in the hands of the bureaucracy who (if they respond at all) do so because someone tells them to and display a characteristic lack of speed and energy along the way. The penny should drop that our opt-out system becomes more useful the more it is subscribed too, so it has to be "sold" for it to work. To be honest pamphlets won't cut it, when you are reading how bad it is in the media.
On that note, our local News Corp offering managed to run it's first "pro" story today, with a 10 cm column on page 22 bottom left with the reluctant and non-specific headline "Health database could be 'lifesaver'.
# Thinus van Rensburg 2018-07-22 17:35
Nice summary of the issues
# Lisa Mcgaw 2018-07-24 08:32
People are being told to go to their G.P. practice to get further information and answers to their questions, but unless we have elected to do information seminars on the My Health Record initiative, we have been given very little information, so it is the blind leading the blind to a degree. It is hard to answer questions to which we don't know the answers and this leads people to mistrust the system even more. The idea behind it is great and will benefit patients, it's just the implementation that has let the concept down. Don't give up on it yet though.
# Cath Kennedy 2018-07-24 11:18
I usually read the blog instead of watching junior footy on Saturday morning (mother of the year votes right there!) - but a nice way to start the weekend with my coffee. This weekend I didn't manage it so only got to it today but it did not disappoint!
I have seen much negative promotion and I too was thinking OUT. But then a security expert reminded me that I have not opted-out of my bank account by scurrying all my savings under the bed. So given the worst thing my health record says is that I'm a fair, fat and forty(-ish), married mother of 2, I'd say I'm OK with it. And how on earth can I extol the virtues of the system to my 76 year old mother (who in the short term will get the biggest benefit) if I don't believe it myself.
But I must admit my biggest disappointed was that a mass marketing campaign did not occur - even ads on the tele in the lead up would have made much more sense than leaving 'Today Tonight' and 'A Current Affair' to singularly stuff up the debate.
There will never be accord in the public health space (think vaccination or fluoridation) but I truly believe the herd mentality will eventually win.
# Ian Mcknight 2018-07-24 11:48
Really well said Cath. Good advice from your security expert, and yes we get on airplanes and we ride in motor cars. Sensible analysis may involve visiting the absolute worst case scenario, but it also requires an assessment of the likelihood of that outcome, balanced against benefits that are not nearly so hypothetical. Otherwise it's scaremongering.
# Ivor Jones 2018-07-25 10:40
Cath,
Your anecdotal reference to your mother is apposite - there are clearly some cohorts for which a shared health record makes perfect sense, i.e. the rewards outweigh the risks. And of course you could have explained the benefits to her without committing to it yourself when the MyHR was opt-in. The trouble is it’s now a one-size-fits-a ll approach, so all of us who fall outside those benefiting cohorts must incur the risks of having our health information shared. The herd metaphor is indeed apt. Ask a sex worker or a vulnerable person how they feel about being ‘herded’ into having an MHR. http://www.abc.net.au/news/2018-07-19/my-health-record-sex-workers-opting-out-wary-prosecution/10008544
The fact that these cohorts have obviously been overlooked is not adequately addressed by Minister Hunt’s dismissive attitude to any criticism of the opt-out approach currently being foisted on us. And I couldn’t agree more with Shetler’s statement - “I think one of the issues that you have right now is that you’ve spent about $2 billion over a decade developing a piece of software without a clearly defined set of needs that it meets, either for the practitioner or for the patient, and as a result you’ve got to now make it mandatory.” And we don’t have to make it mandatory – at least not yet. A better way forward would be to address that question of unclear needs, and this could be done by developing some clinical use cases around benefiting cohorts – the elderly, the chronically ill, perhaps oncology patients - you know better than I – work with those patients and the clinicians treating them to define useful presentations of shared information, and then and only then determine what to do next. Opt-out is being imposed on us primarily for political expediency.
# Ian Mcknight 2018-07-25 17:40
With respect to Ivor, I certainly wouldn't be using ABC news for a balanced view on the MyHR. I've been watching this closely, and the only stories they are interested in are ones highlighting someone's fear or reluctance, irrespective of the basis in fact. Any rebuttal if quoted at all certainly does not receive the big headline and promotion that the other stories get.
If you actually want to know how the government intends to protect and use health data, there is comprehensive information here: http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealth-framework. I don't think sex workers are overlooked as a cohort, and I also don't think people have taken the trouble to read up on how their information is protected and used.
The framework is there to be read, and it's quite comprehensive. The deflectors of course will say that they don't trust the government or believe they will abide by this. In my experiences, bureaucracies generally do abide by their protocols, it's one of the things that makes them infuriatingly slow to respond to anything. And certainly bureaucracies and politicians are massively scared of criticism, the last thing anybody is going to want is a "privacy compromised" story. So yes, I feel many of these fears are unfounded.
By the way, does the average sex worked know that if law enforcement turned up at their local practice with a court order, the information would be duly handed over, irrespective of MyHR.
# Ivor Jones 2018-07-27 09:01
Oh dear Ian, I'm sure the last thing either of us wants is get into a game of ping-pong, but you really have missed the point I was making. I will admit to an averagely severe case of confirmation bias if you will do the same – I think the ABC is raising legitimate concerns, you dismiss these concerns as not based in fact, or already addressed by a high-level framework. You say ‘rebuttal’ I say ‘bland assurances’ – and we could go on until Hades encounters a severe weather event, to no constructive purpose.
You may be right to say that the sex worker cohort is adequately addressed in this framework, I’ll try to make time to read it and form my own opinion on that, but their hypothetical knowledge of the current legal framework for access to clinical records is a canard. The concern is not how access is currently regulated, it is that the sea-change in access to and availability of those records introduced by the MyHR system provides vastly increased opportunities for unregulated access. And this has been expressed (for other vulnerable groups such as DV victims and other 'at risk' persons) on the ABC yesterday, but lest you think I get all my ideas from the pinko ABC, this concern was expressed directly to me by a senior sexual health clinician some months ago, i.e. that the fear of exposure may discourage vulnerable people from seeking needed treatment (if they do not feel their anonymity is adequately protected).
You have rightly enumerated some clear benefits of the MHR, i.e. it can save time for clinicians in many common scenarios, and that there is value in having information at the finger-tips, so to speak. These are real and quantifiable benefits. However the issue of scaring 'at risk' patients away is also real and plausible scenario, and this is a clear dis-benefit. This and other dis-benefits are being ignored in the political drive to enforce opt-out. You are right that govt’s are sensitive to criticism, and you may be right that this is sufficient spur to them to ensure adequate cyber-security, but it also means that they are incapable of admitting that there is a fundamental problem. They have to stay 'on message' and parrot the assertion that opt-out will fix the problems. It won't.
# Ian Mcknight 2018-07-27 14:13
Hi Ivor,
Thanks it was a good reply and also raised more than 1 smile. At the end of the day hopefully amending the legislation to officially state what the ADHA documentation states is their protocol regarding interaction with law enforcement will make people happier. Really the risk to sex workers on having a MyHR is pretty much the same as having a local medical record, i.e.it can be accessed with a court order. And if the record is paper-based, you will never know who has seen it, unlike the electronic equivalent.
I actually don't agree with "vastly increased opportunities for access" because of the MyHR actually. I think the secondary usage framework makes that quite clear. I may be guilty of naivety, but not of parroting someone else's agenda, it may be one of the reasons I am self-employed :-) If I say something I do genuinely believe it. Anyway, this wasn't an attempt at "the last word" on my part, I am heartened that you can see real benefits and enjoyed your post.
# Terry Hannan 2018-07-24 14:52
There is more than a security issue here with the current status of the MyHR. Here are some points that also need to be considered.
Most of the community, across all social spectra have no idea what this MyHR thing is or it even exists. Specialists essentially have no idea.
Last week and an eHealth academic reviewed her daughter's MyHR and stated "it is not a medical record, it is a repository".
The data and information is in such an array of formats -granular pathology, PDFS, etc which does not support timely, at point of care clinical decision support and documentation.
It is documented that GP practices have poor quality data which is to be exported to the MYHR. Use of the that data and information is then fraught with danger.
A Tasmanian paper in 2017 showed the low compliance amongst GPs with eHealth communications and were not using PIP support to facilitate eHealth communications.
As a functional system the philosophy of a national health database is exemplary but the information management infrastructures appear to not align with established, coded clinical databases integrating with other data sources within health care. Good examples of how this works are paradoxically in LMIC like Bangladesh, Philippines and parts of sub-Saharan Africa.
# Ian Mcknight 2018-07-24 15:54
Hi Terry,
As someone who has been helping general practices understand their data since 2008, I can attest that there has been much work put into making this information more accurate. It's a lot better than it was 5 years ago, and 5 years ago it was better than it was 10 years ago. I have literally viewed hundreds of data extracts over this time. If you are saying it is fraught with danger to use that information, they you are also writing off every template driven referral letter that emanates from General Practice, because they use exactly the same information.
Whilst you are vastly more credentialed than me, I fail to see how an accurate health summary containing Allergies, Medications Immunisations and past significant history issues could not be of assistance to a decision maker.
Speaking about Tasmania and ehealth communicatios, specialists are sending over 10,000 documents a month electronically to general practice. Whilst GPs communicating this way is around a 10th of that, it is a number that is growing by the day. And general practice currently uploads a little over 1200 shared health summaries a month on average in Tasmania.
You are right about a lack of awareness in the general public, which is why we should be educating and persuading, rather than scaring them off in the media. You are right about specialist awareness too, but in terms of progression I think General Practice and Hospitals especially should still be the focus of most of the energy around this, with other parts of the sector to follow. Not seeking to diminish anybody, but it's a tough thing to do, all at one go.
I'm stoked that they are doing well in the Sahara, but this is the system we have been given. It's more functional than it was 5 years ago, and it will doubtlessly improve as issues are identified through increased usage and clinical uptake.
# Terry Hannan 2018-07-24 16:41
Ian, I totally agree with this statement of yours, "accurate health summary containing Allergies, Medications Immunisations and past significant history issues could not be of assistance to a decision maker". The research done on these information modalities was confirmed in the 1980s (and has improved with the newer technologies).
Having returned to private practice in late 2017 I am 'daily' receiving summaries with significant functional errors.
Just this morning a patient'd summary in an established GP EMR gave a list of medications (10), some life threatening, that she had never heard of and she was mentally competent.
Recent a patient 5 major allergies and she had NONE. This same patient had a colonscopy, a hysterectomy, a cholecystectomy , a choledochojejun ostomy and a hip replacement all on the same date 1 week before she saw me! She was alive!!
Also from my "focussed perspective" (and that is probably a major issue) the information design is not adequately supporting CDM.
I am not saying I have all the answers but there must be some lessons to be learnt from an extensive EMR that has gone form about 100,000 patients in 2006 to 8.7 million world wide in 5-6 different languages and in >1850 sites around the world.
GPs and patients MUST be the focus to make a dent in the problems. Thanks for the feedback.
# Jon Patrick 2018-07-25 08:45
All the commentators make good points about the current topics but I would like to focus on the topic of usability. My company banks its reputation on building clinician designed and friendly interfaces. One key feature we have learnt is that information must be easily and readily accessible. We know of systems that are comprehensive in the amount of patient content they hold but are unusable because it is too time costly to hunt for the content required by the clinical user. Likewise myEHR will get more and more unsatisfactory and eventually fail as vernal purpose tool as it builds up content, unless it can make finding the target information easier to discover. Solving that problem does not seem to be on the agenda yet ignoring it is the road to gloom and doom for the clinical user.
The whole project would have had much better progress if it had been rolled out to target specific clinical cases that would yield the greatest benefits, e.g. supporting the elderly at ED admissions, and then progressed through other use cases before being thrown open as a whole of population solution.
# Terry Hannan 2018-07-25 20:02
This is a very good and diverse discussion with many reasonable points raised, especially by Ian McNight. Ian, the sole focus on security can distract from the overall good and not so good issues with the MyHR project. Your comments re ABC news, etc., have prompted this question. If the system is so good why is the access and usage so low? What may happen to the security AND accuracy of the data and information if suddenly or in the long term the use and access to the system escalates to much higher percentages? Also how will we know when security and privacy are breached? I hope this adds to the discussion in a positive manner. I am sure there are even more questions that can be asked.
# Kate McDonald 2018-07-25 20:35
I'd submit that one reason why usage has been so low is that so few people have known about it. Shocking marketing.
+1 # Terry Hannan 2018-07-25 20:40
Kate, yes. Also you can take credit for stimulating this discussion. It is good
# Ian Mcknight 2018-07-25 21:53
Thanks Terry, it's nice to hear that I'm not overstepping the mark too much here. I know GP systems really well, but am not clinical, and do not have the world experience in health that you do. I will say this forum has been providing as balanced and as informed discussion as i have seen anywhere on this topic.
In answer to your question, let me just say, I'm not saying it's brilliant, (although I feel it could yield fantastic benefits) I am saying though, it's the system we have been given, and that a lot of the criticism especially around data and privacy is massively exaggerated and devoid of any rational calculation of likelihood. And this seems to be the only stuff in the media, as Kate's article related so I feel compelled.....I don't want that to be the only thing people read, and I don't want a potentially beneficial system to be scuppered because of it.
I read somewhere on the ABC today that as usage grows it will be a mess of documents and it will be really hard to find accurate date relevant information. I can only speak to mainstream GP software, but again, massively untrue. When accessed via these programs, there are totally straightforward filter buttons that let you narrow to a date range or document type. One of the programs defaults to only showing you stuff dated in the last 3 months initially.
Back to your question re lack of signup and uptake. Kate's comment on marketing of course. Some 60 second grabs on SBS instead of those infantile "what's she up to" racism ads would have been beneficial. There are clips showing application of the MyHR in an ED type situation, but sadly they are not being held up to the public.
I must admit, I always figured that the GP would be a trusted advisor for the patient with this issue, but sad to say that hasn't worked. People like me ( ex PHN but now private) have failed to win the hearts and minds of GPs in sufficient numbers for this to work. If anything the opposite has occurred. You can't come up with one reason for GP reluctance, there would be several ranging from less desirable attitudes to misinformation to fully informed disagreement over the benefits. I have total respect for the latter, but I will try and correct the former. GPs are as human as the rest of us and the truth is that 98% of their patients are "their patients", with all the information available on the local record. So for GPs it is a "passing the love exercise" and sadly the doing of what they percieve to be extra work for the benefit of an anonymous clinician somewhere does not resonate strongly with them, if at all.
I'm just trying to summarise, I know that there are fully informed clinicians who don't participate for other reasons. What I will say though, is that over the years some GPs had been operating under a misunderstandin g and when this was corrected, their viewpoint did change. I will also say that when demonstrated via their clinical software, almost all of them realised that it was easier than they imagined. There are also some GPs who view their local software as a way to get from A to B, rather than a medical record that should be maintained to a high standard. For the ones that are like this, any contribution of a health summary means a significant piece of work. On the other hand, I've had a GP brag to me that she can do a health summary in 90 seconds.
I am completely incapable of a brief response, so I apologise again. I refer again to the Secondary Use framework http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealth-framework as a guide for how the agency intends to look after the data. I believe some of the scare-mongering around data and privacy has sadly taken this away from what it should be, which is a discussion first and foremost about healthcare.
# Thinus van Rensburg 2018-07-26 11:21
Ian I have been an early adapter and been running the PCEHR/MHR on my system from when it came out - as a test system not really for clinical reasons. What can I say I am a nerd and like to play.
My systems are current and up to date and as a clinician I will say that the current layout is still terrible. And this is not just my, or the ABC's opinion - refer to the recent ACSQHC report that was featured here on PulseIT.
I could give a long list of reasons why I make the statement but just a few are:
a. The Clinician actively need to move out of their main clinical area of the EHR to open the MHR - just that step adds at least 30 seconds to a consult
b. Once in the MHR it defaults (at least in MD) to only a few documents visible - you need to access dropdown menus to unmask documents and dates - add another 20-30 sec
c. There are very frequent episodes where a document, often a drug dispensed record are clicked upon, a 60 second wait is required and an error pops up - not my configuration or a problem at my side - it is a MHR repository error
d. People are not obliged to replace SHS - they add new ones - this means that over time there will be dozens or even hundreds of SHS in some files. Yes they can be masked and hidden but that takes time and requires skills that many Clinicians don't have the time or inclination to do.

I could go on but the reality is that the system is clunky, not really visually and functionally well integrated with the EHR and this does little to sell the concept to the sceptics.

Thinus
# Ian Mcknight 2018-07-26 14:32
Hi Thinus,
I would suggest the delays you refer to are untypical. I have demonstrated MyHR on dozens of systems usually the delay is brief, occasionally there will be a longer delay than I would wish.
More specifically for the uninitiated.
a) The MyHR access is a menu button at the top of your clinical screen, which opens the MyHR window. If this is really outside your clinical screen then so are around 50 pieces of MD functionality that are also available from menus at the top of the screen. What apparently takes you at least 30 seconds took me 10 seconds in a practice I was just at.
b) MD gives you a default MHR view of only clinical documents created in the last 3 months. I'm sure this helps with efficiency. Unticking the filters to show all documents, at the practice I was just at...6 seconds.
c) Can't comment, haven't seen it. An error to be fixed if true.
d) I can't see how your objection (d) doesn't totally contradict with objection b). In the first hand you are given a summary of clinical documents less than 3 months old, you list this as a flaw. Then you complain that if you unmask the rest of the table there will be too much information to sort through, even though they can be sorted via date or document/creato r etc. Seriously, what would you suggest ? If for example you were compelled to delete one of your previous health summaries before you upload a new one, then you would doubtlessly list that as extra work that you were expected to do.
I'm sure we can agree that clunkiness is a subjective assessment. I have heard it all, some GPs prefer MD, some hate it and prefer BP. Some say uploading a health summary is simply impossible for a GP to incorporate into a consultation, some say it's a piece of cake. Some say, "we are not funded to do this", others admit that in this day and age it is a reasonable expectation. I guarantee you there would be no system realistically conceivable that would make every clinician blissful.
What is never stated is the time saved for a GP in a MyHR world. The queries about your patient from other clinicians that would be vastly reduced by the fact that they could look it up themselves.
For example, you inherit an elderly patient from interstate. You would like to bill a health assessment but cannot be sure if one has already been billed in the last 12 months. You could ascertain this in under a minute using the MyHR. How long would it take using other methods? Similarly to check if pathology test has been done by another provider.
The MyHR interface may be clunky when accessed from other systems, I don't know. But there is a difference between being clunky and the user not being familiar with the tool. As I've offered you previously I have created a small manual for MyHR in both BP and MD, and am happy to make it available to you or anyone else that wants it gratis.
Ian
# Thinus van Rensburg 2018-07-26 17:42
Hi Ian
As I said - the comments made by some in the ABC et al are not just their opinion - ACSQHC said in their most recent review:
""A number of this review’s findings indicate that it is difficult for clinicians to efficiently find
clinical information in the My Health Record system using their CIS. This is due to CISs
having limited search and presentation functionality, and a lack of awareness of new patient
information. In addition, most CISs lack the facility to identify the content of a clinical
document before it is opened. In line with findings in the sixth review, there is variation in
clinical use and context of Event Summaries which further complicates navigation of these
documents. These findings were confirmed by eye-tracking sessions that revealed the
clinicians’ preference for adopting the Health Record Overview in CISs, providing important
patient information and updates at a glance. These outcomes indicate the need for more
streamlined presentation of clinical documents. A preview function and clear titles and
descriptions, for example, would allow clinicians to identify the content of the clinical
document without having to open it"

I am very familiar with the MyHR and would honestly be surprised if your manual shows me something new but am happy to have a look - shoot me a copy at tdmp@ozemail.com.au.
Coming back to the dot points:
1. It is still an exception for me to use MyHR in my clinical management of my patients - when I do access it it is usually as an afterthought at the end of the consult.
My network is well maintained, fast & efficient.
So after I have finished with the clinical work in the consult I clinic I click on MHR - and you are correct that it takes about 8 seconds to open on my system. In a part screen window which is not really useable so a few more seconds to maximise it - so yes I exagerated - it takes about 15-20 seconds
2. Then we get to what we see in the default view:
a. Only "certain" clinical documents created in the last three months - specifically it only shows e-referral, event summary, SHSs, Medicine views and specialist letters by default
b. If I wish to see any of the other 17 types of documents that the system specifically can contain I need to drop down the document menu to add those.
c. Even adding all of those still restricts all documents to the last three months so if I want to find the pdf my 90 year old uploaded at home to show me what his Advanced Care Planning is and/or who his Custodian is, I need to go and fiddle with the date filters.
These are the documents I want to see - not multiple copies of the Shared Health Summaries or reams of previous dispensed medication.
d. Even the Medicare overview documentation is very poorly designed in the layout.
Who would want to see every single PBS/RPBS prescription line by line before they get to the more important stuff such as those CDM item numbers you mentioned?

The reality is that extra work is what it is - even before we unmask things"to get to the hidden stuff. Couple that with the very valid concerns about mistakes, privacy and secondary use and "Houston, we have a problem"
T
# Ian Mcknight 2018-07-26 20:25
Happily the Apollo missions were Opt-In !
Have sent you a copy of my guide for evisceration.
Ian
# Thinus van Rensburg 2018-07-27 08:33
Thanks Ian
It is a good summary - TBHO there was not a lot in there that I had not already bee aware of but I can see how it could be very useful to someone who is unfamiliar wit the system.
Comparing MHR with the Apollo mission ? That rocket would never had been built nevermind taken off. Comparing raisins with watermelons here
T
+1 # Ian Mcknight 2018-07-27 09:32
Hi Thinus,
Was a "witty" reference to the Houston comment. Obviously not my best work :-)
# Terry Hannan 2018-07-26 11:35
Thinus, bottle these remarks and observations, They form the foundation for an accurate review and this is just the start
# Terry Hannan 2018-07-26 15:16
More great discussion. the EMR in the clinic (unnamed) is a PIA unless you want to be a "clicker". Record integration is fraught with errors-often exacerbating mine. Incoming documents require much screen fiddling just to read them and when they display you cannot see most of the pages (range 1-32) so you can easily overlook referred information. It has HealthLink as a messaging system but oh, the Templates and their design. I could go on.
# Jon Patrick 2018-07-27 08:01
Ian, If you have needed to create a small manual for the two GP systems surely this is indicative the ADHA is dropping the ball.
I spoke to my step-daughter today, a mother of 3 children, and she had not even heard of the myEHR, and she estimates she goes to her GP once month. My GP has not spoken to me about it and has nothing in their rooms about it. It seems the AHDA has not recruited any support from the GP practices. Is this a cynical manoeuvre to not inform people so they won't/don't know they can opt out?
# Thinus van Rensburg 2018-07-27 08:50
To be fair Jon every GP Clinic did receive a big box of material from the Gov about this around the time the Opt-out period started.
And there has been a huge amount of media cover about this for Drs and Pts. A lot of media cover before the opt-out period as well but people, Drs & Pts, just ignored those.
T
# Ian Mcknight 2018-07-27 09:40
Hi Jon,
I teach and support GP software for a living, the MyHR manual is just a chapter from my overall manual for using these systems, in there for completion sake. Some people just like some written instruction. Overseas trained drs and registrars especially can find them helpful.
Practices have been sent boxes of pamphlets on more than 1 occasion. I was actually at the post office yesterday and they were on the front counter. There is no cynicism from the AHDA and the MyHR has been around for almost 6 years. Sadly most GPs are not supporters, let alone advocates and promoters.
There are exceptions, I know of a couple of rural practices where they strongly suggest that you sign up for a record and will do it for you. Sadly this is the exception rather than the rule.

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