ADHA batting zero for two on My Health Record

For those among us who have despaired at the bungled, fumbled, laborious roll-out of the My Health Record over the last seven years, have we got news for you! The Australian National Audit Office (ANAO) has decided to take a look at the implementation of the system in all its gory details, and you get to have your say.

The ANAO has announced it is holding an audit to “assess the effectiveness of the Australian Digital Health Agency's implementation of the My Health Record system”. The audit will not cover the merits of government policy, it says, but it does have a role in assessing the efficient and effective implementation of government programs. You have until April 14 to have a say, with a report to be delivered in October.

Our views on the implementation of the My Health Record are not exactly a secret. From the start, we have thought the go-live was rushed, the initial registration process a farce, the support for software vendors and healthcare professionals poor, and the benefits not adequately communicated. We've certainly had a lot to say about the latter in the last few months, with the opt-out process a marketing disaster.

We also have sincere, continuing doubts about the ability of the agency to adequately manage the education and support that the system requires now that the vast bulk of Australians have a record. We are not talking here about the ability of the agency to operate the system or manage its security and privacy; we have a neutral view on that. However, the elements we do have doubts about came to the fore this week during a webinar for aged care providers.

During that webinar, which provided absolutely no practical advice to providers or nurses, we heard from ADHA's education and support lead, who spent most of the webinar explaining in the briefest of terms what the system is, as if anyone didn't know. There was no advice for nurses on how to upload an event summary, when they would upload an event summary, or what benefits, besides a medications list, the system would bring to residential aged care.

Instead, we got a generic spiel about how great the whole thing would be, something that we have heard repeatedly over the last seven years but are yet to see evidence for. During the Q&A session, a provider of home care services asked a good question about whether case workers who visit older people in their homes would be allowed to access the My Health Record.

ADHA correctly replied that the Department of Human Services has a list of professions that can apply to get an HPI-I, which is restricted to healthcare providers.

However, he then said: “Having said that, provided your practice or your facility policy covers who can access My Health Record within your organisation, you can actually have administrative staff accessing My Health Record ...”

This is completely wrong. We approached ADHA on Wednesday for an explanation, and on Friday received a reply clarifying that yes, only registered healthcare providers with an HPI-I can access the system. There are very large fines and very scary prison sentences for those that access it without authorisation.

“We have contacted the training team to ensure they provide this information clearly,” ADHA said.

The 250-strong ADHA team also did not answer three other questions we put to them on Wednesday morning about financial support for aged care and allied health software vendors who will struggle to be able to connect to the system considering their limited resources.

We are well aware that in the aged care software industry, it is companies like iCareHealth, now owned by Telstra Health, and Leecare that have done a lot of the hard yards in educating their customers on how to use the My Health Record in the aged care setting. ADHA still recommends that providers using other software consult iCareHealth's MyHR security checklist, as it's better than anything they've been able to come up with.

It is for these reasons that we despair about the lost opportunities and waste of time and effort that has marked this system's progress. And we have little confidence that things will get much better.

So, if you are thinking of replying to the audit office's survey, perhaps you could use the American baseball term about batting o for two – you've already got two strikes and you have thus far failed to impress.

That brings us to our poll question: Do you have confidence in ADHA's management of MyHR?

Last week, we asked: Do you think health apps and cheap devices will increase demand for unnecessary health services? 61 per cent of you said yes, 39 per cent said no.

Our thoughts are with our New Zealand friends today.

Sign up to our weekend edition or Pulse+IT Chat to vote, or leave your thoughts below.


0 # Paul Campbell 2019-03-17 10:05
A bit harsh Kate. We work at the sharp end of the implementation so it is not just left up to Webinars and brochures to find out about how to work the with the system. .
0 # South Eastern NSW PHN Staffer 2019-03-20 12:17
Hi Kate
Despite the Agency having some, let say, less than clear communication on how this works it is entirely within the law for an authorised user to access the My Health Record despite not being a clinician. This is clearly articulated in section 61 where a participant (defined as an organisation) is authorised to collect, use and disclose. The requirement to have an HPI-I is only relevant when you are authoring a document (Section 45 b 2). Having a clinical staff member (with a HPI-I) in a clinical role is however a requirement for registration.

Happy to run through this in detail if you need, and will be speaking to our contacts within the Agency regarding the advice you received.

Without authorised users there are many parts of the health system that will not be able to meaningfully engage with MHR.

Kind Regards
0 # Kate McDonald 2019-03-20 12:32
This is ADHA's response to my question about the circumstances in which admin staff would access a patient's My Health Record.

“General administrative staff are not able to access an individual’s record via My Health Record through conformant software. Only healthcare professionals who are providing care to a person can access a person’s My Health Record. 
If a person deliberately accessed an individual’s MHR without authorisation, criminal penalties could apply, including $315,000 in fines and up to 5 years’ jail time.
For registered and authorised health professionals to access a patient’s record, they must have a record of the patient on their local clinical information system (as a patient of the practice) and five points of identification.
Registered healthcare providers must also:
•                     Have a valid HPI-I (a Provider Identifier)
•                     Work within an organisation that has registered as a healthcare organisation and received a HPI-O (an Organisational Identifier)
•                     Have conformant software, which has a secure and encrypted connection to the My Health Record system
•                     Have their HPI-I linked to the HPI-O within the administrative system.
We have contacted the training team to ensure they provide this information clearly.”
0 # Ian Mcknight 2019-03-21 11:53
This doesn't exactly fill me with joy and highlights the issue that government departments often don't understand their own systems.
Medical Director is conformant software and if the authorised medical facility has given has given it's employee permission, then that employee can read and browse the MyHR, no HPI-I needed. This is in line with what Rohan says.
Best Practice is conformant software, but you cannot access the MYHR without a HPI-I number. Haven't tested this in the Indigo release, but they don't refer to anything in the release notes.
So 2 conformant programs seeming to interpret this issue differently.

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