My Health Record, eight years on

It's birthday time again for Australia's My Health Record system, which will next week celebrate eight years in operation following two years of gestation. And a difficult birth it was, as we not-so-fondly remember. Our reminiscing was inspired not just by its approaching birthday on July 1 but by a press release from the Australian Digital Health Agency, proudly boasting of a surge in use of the system during the COVID-19 crisis.

The term “surge in use” took us back to 2011 and 2012, when we were breathless with anticipation about the new baby, then known as the PCEHR. Some of our first online stories were about how the medical software industry was approaching the impending birth: first with trepidation, followed by alarm, and then with horror.

Not to worry, we were told: the new baby is going to be an absolute knock-out, able to save the healthcare system $11.5 billion over 15 years!.

As it turned out, the actual birth was short and not very memorable, mainly because the system didn't work and no one could sign up for it. General practices were not ready, the software vendors were not ready, even the online registration process was not ready. We found a way nonetheless and joined 800 other people in signing up in the first week, but it was pretty much downhill after that.

Remember when all of the PCEHR clinical leads from NEHTA all resigned en masse because everything was so terrible? Remember when what little information there was on the system was someone else's prescription details on one of our records?

Remember when the first clinical documents couldn't even be uploaded through practice management software as none of it was connected yet? Remember when $8 million was promised to get pathology and diagnostic imaging added and that took another three years? Remember when the Department of Health set a target of 500,000 registrations in the first year, got 320,000 and promptly stopped setting targets?

We remember DoHA's terrible ads for the system in 2013, the long decision on whether to keep the system going in 2014, the change to My Health Record in 2015, the decision to move to opt-out in 2016, the very dodgy decision by the AMA and RACGP to sign compacts to promote the system in 2017, and the completely botched opt out process in 2018.

The last 18 months have seen a little light on the hill, with the hysteria dying down and more documents going up, but the spotlight on the cost of the system and its meagre benefits continue. As of the 2017-2018 budget, direct funding for the system has totalled $1,578,716,000, with an extra $143,915,000 for the Healthcare Identifiers Service and the odd couple of grand here and there funding this and that project. The estimate is that since its go-live eight years ago, the system has cost close to $2 billion. Ongoing funding will be needed in this year's budget.

Returning to ADHA's press release this week, we were pleased to see that there had a been a lift in the “use” of the system during COVID-19. We've put the term “use” in quotation marks as although there has been a welcome uplift in the number of healthcare providers connecting to the system and uploading data – and according to the ADHA the vast majority of the 22 million records now have something in them – actual use is something a bit different. It brings us back to an opinion piece we ran back in May 2012 by Bryn Evans, titled Will the PCEHR have meaningful use?

We have to say that on its eight birthday, that still remains to be seen.

That brings us to our poll question for the week: Has the $2 billion investment in the My Health Record been money well spent? Vote yes or no here and feel free to add in your comments.

Last week we asked: are you concerned about Big Tech firms encroaching on healthcare? 81 per cent said yes, 19 per cent said no.

Tags: PCEHR, My Health Record

Comments  

+1 # Guest 2020-07-03 17:42
I’m a fan. I’ve had people say to me that they won’t have a record because they don’t want the Gov knowing what’s wrong with them. I tell them that the Gov has their MBS & PBS data so they already have a good idea of what wrong with you.(Well Maybe not how paranoid they are!!)
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0 # Guest 2020-07-03 17:43
Only with a ruling like the US’s “meaningful use” will MyHR have the required patient information from the GPs. That would make the record worthwhile.
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0 # Guest 2020-07-03 17:44
Education & poor communication has led to poor take up. Plus limited information inputs & use has led to overall limited value.
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0 # Guest 2020-07-03 17:45
Not all clinical leads reigned, there were a handful who stayed true to the cause!
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0 # Guest 2020-07-03 17:46
Many doctors are not inputting the data necessary for ALL sectors of the medical community to use.
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0 # Guest 2020-07-03 17:47
The poll question has a predictable answer so why ask it! Unless Australia takes a national view on standards and interoperabilit y we are doomed to continue our siloed mediocrity.
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-1 # Guest 2020-07-03 17:49
It offers no meaningful useful benefits to the clinician or the patient. If PulseIT thinks it does then you need to present some hard evidence. All that ADHA has presented to date is a combination of hearsay, marketing fluff and artificially contrived statistics.
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0 # Ian McKnight 2020-07-04 14:57
I've lost count of the number of young public hospital Drs, who when informed of what is available to them through the MyHR indicate how helpful it would be to them in their roles, particularly in the ED setting. And when in recent times I have shown GPs the increasing amount of pathology results that they weren't copied in on but are available to them via the MyHR,....let's just say I have seen some "lightbulb" moments.
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0 # Guest 2020-07-03 17:50
Hardly used by drs and patients. Hospitals dont seem to have utilised it. Yet this was the area of importance touted by promoters. Very very disappointing.
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0 # Guest 2020-07-03 17:53
IMO, whilst the intent of a national, shared, electronic patient record is sound, the evidence is clear. The delivery of the PCEHR/MyHR, as it stands, is a failure. With such poor utilisation and interest from patients and clinicians alike, a $2b investment is a significant waste of taxpayers money, and I doubt any independent or productivity commission assessment of the cost/benefit of the PCEHR/MyHR would disagree. PCEHR/MyHR was doomed from the outset, ignoring key clinician input and concerns, and was extremely clunky to implement at practice level, turning many clinicians off promoting it amongst their patient base. If it wasn’t for the fact the Commonwealth mandated a very modest GP upload of shared health summaries as part of the eHealth PIP (which most practices rely on to remain viable), uptake would be even less than it is now. In my 11 years experience as a general practice administrator/C EO/GM, most patients (ie approx 95% or more) don’t care for it, and a standards-based , interoperable, app-friendly, non-Govt controlled equivalent would have been more user friendly, and likely to have seen greater adoption by providers and patients alike. Oh, and I doubt it would’ve cost taxpayers anywhere near $2bil. To increase provider utilisation of MyHR moving forward, I think providers/pract ices should be offered a financial incentive for demonstrable use, probably on a fee-per-service basis, rather than say the current approach of linking eHealth PIP payments to quarterly shared health summary upload targets. Without a very clear value proposition for health care providers, I fear true MyHR utilisation will remain at rates lower than MBS indexation, for many years to come.
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0 # Guest 2020-07-03 17:53
Aside from the MyHR being a total waste of money and resources. The MyHR is fundamentally unfit for the purpose for which it was intended. It fails from a patient safety perspective and should be discontinued immediately.
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+1 # Guest 2020-07-03 17:54
The general population are ignorant of its potential benefits, and GPs have made no effort to engage consumers, and use the My Health Record to promote personal responsibility for improved health outcomes.
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0 # Ian McKnight 2020-07-04 15:08
Absolutely true. Massive mistake by the government in expecting GPs to educate consumers. For vary reasons most GPs refused to do that. Lack of education of consumers and particularly public sector Drs is a big barrier to benefits of the system being realised.
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0 # Guest 2020-07-03 17:55
Still only being used by a few isolated pockets of GPs. Uploading documents does not equal to being used.
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0 # Guest 2020-07-03 17:56
Stop being so negative Kate!!!
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0 # Guest 2020-07-03 17:56
Just another Government mess, think NBN!
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0 # Guest 2020-07-03 17:57
I wish there was a Maybe category, but as we know the number is now 2 Billion, and that amount of money sent by bureaucrats is rarely prudently done. But I support the system fully, just wish it had cost a little less. The main issue with the MyHR at clinician level is ignorance of what it provides, but that is ever so slowly changing. The more clinicians that educate themselves of what it can provide, the more it will be used and the more useful it will become as a result. There probably aren't enough people wanting to tug at the sleeve of the Dr.
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-1 # Guest 2020-07-03 17:58
For a clinican, it is not usable. Demonstration uploads don't work. Search and find is far too slow. Cheaper to order another set of tests than to look for existing ones.
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0 # Ian McKnight 2020-07-04 15:03
I wouldn't extrapolate your experience across the entire system. Not sure what software you use or how good your demonstration was. Not every lab is uploading, but if they are it will take you moments to find it. My Covid test was available to clinicians who treat me within hours. Hint, they may not know that, but I do.
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0 # Guest 2020-07-03 18:08
Poorly planned and badly developed transition strategy. Too political to be successful.
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0 # Guest 2020-07-03 18:09
It appears that expensive mistakes have been made. Your binary response format to the question doesn't allow for any commentary about whether over time a social dividend has begun to emerge on this investment.
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0 # Guest 2020-07-03 18:09
The business goal, and the healthcare goals were correct. The commitment from doctors was never obtained. None of the touted benefits have been harvested. Lots of well meaning people worked very hard to design and implement something that our political leaders never supported. Today, if I ask any doctor treating me whether activities will be added to MyHealth Record, the answer is almost always, "No." Most doctors I encounter still disdain its use. So my MyHealth Record is full of garbage. Garbage that is not worth any treating doctor's time to retrieve. So, no the money has definitely not been well spent. Such a thoroughly disappointing outcome shows that a programme that does not have proper commitment from its sponsors and major stakeholders is doomed to fail.
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0 # Ian McKnight 2020-07-04 15:14
If your Drs don't upload a shared health summary for you, that doesn't translate to your record being full of garbage. It mean's it will be lacking a really key component though If you don't believe me, check your record yourself and identify the bits you deem are "garbage". Your immunisation records perhaps ? Your medicare sourced medication immunisation? Your advance care directive.?
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0 # Guest 2020-07-03 18:13
MHR is vital for excellence in healthcare across all health professions.
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0 # Guest 2020-07-03 18:13
Government has proven themselves to be untrustworthy in so many ways. I just can’t see that they won’t leverage this info for reasons other than those stated.
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0 # Guest 2020-07-03 18:14
It was far too idealistic and impractical at time of inception. It facilitated a significant increase in employment of IT personnel including a high % with no health background, rapidly destroyed systems that had been in-place for many years and attempted to discredit professionals working in and managing those systems. There was a lack of consultation in the design of MHR for practical implementation and marketed promises of better health without scientific validation.
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0 # Guest 2020-07-03 18:14
What patients want is the ability to dial into their GP's file and extract whatever data is needed dependent on the occasion. With everyone carrying a portable computer in their pocket that should be the long term plan. GPs spend hours building files and are understandably reluctant to load this on to the MHR with no payment and then to witness multiple organisations use their intellectual property without charge. Many GPs are beyond irritated by the telehealth corporates interfering in care and then trying to justify their existence by using the MHR. The corporate telehealth misuse of the MHR has hardened many GPs to stop using it altogether.
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0 # Guest 2020-07-03 18:15
Has it saved any lives yet? I think it has. How much is a life worth?
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+1 # Guest 2020-07-03 18:15
A national electronic record system is required. ADHA could probably have implemented it better, but change management of this scale isn't easy. You have to start somewhere though!
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0 # Guest 2020-07-03 18:15
If a) they hadn't rushed implementation, and b) had checked out the NT MyHR first to see a working system it might have been a different story. Remember the Deputy Health Secretary at HIC 2012 asking people NOT to sign up as even though it had been "rolled out" in July it wasn't ready to use? I do...
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-1 # Guest 2020-07-03 18:15
My GP is not using My Health Record because they would need to ask each patient each visit if they want their record uploaded and they are legally liable if they forget to ask before uploading a patients record.
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0 # Ian McKnight 2020-07-04 14:51
Sorry, you have been misinformed. Nowhere near correct.
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0 # Guest 2020-07-03 18:16
The Ford Edsel had features only coming into American cars now. The PCEHR/MHR is the same. The principles are right. It does need a new architecture.
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0 # Guest 2020-07-03 18:16
Singapore did it way better. ADHA lacks the leadership. My Health Record should be mandatory for all hospitals and general practices. Allied Health should be excluded.
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0 # Guest 2020-07-03 18:16
The implementing committee was and still is incompetent and no progress will be made until this is admitted and rectified. Don't hold your breath just watch another billion dollars go up in smoke while we wait for Mark (x) version.
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0 # Guest 2020-07-03 18:16
Only with a ruling like the US’s “meaningful use” will MyHR have the required patient information from the GPs. That would make the record worthwhile
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0 # Guest 2020-07-03 18:17
It is easy to criticize commonwealth government spending on facilitating improvements to the health system. How does it compare to money spent on Defence projects (to what end)?!? https://www.abc.net.au/news/2019-12-17/billion-dollar-cost-blowouts-and-delays-hit-defence-projects/11805942 . Maybe it is time for the jurisdictions, clinical peak bodies and the medical software industry to take some responsibility for making a world leading system realise its potential?
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0 # Guest 2020-07-03 18:17
You have to start somewhere. For most of the naysayers, we'd still be debating the merits of a centralised record. At least we started with something and whilst it may not be perfect, it proved out the concept and is functional. It can be improved going forward.
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0 # Guest 2020-07-03 18:18
It would appear that only GP's upload useable data and only recently can you read a discharge summary without printing it. None of the hospitals seem to look for the information in My Health Record we are rung daily for patient health summaries.
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0 # Guest 2020-07-03 18:18
Why do Governments never learn from previous experience - a failure at this level of $commitment should result in significant restraints on any Gov’s future ability to commit this level of time and money. Ridiculous waste of resources that could/would have been better spent on frontline healthcare services
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