My Health Record and the confessions of a doctor dodger
A landmark report in Australian healthcare was handed down this week with the release of the recommendations from the independent Primary Health Reform Steering Group on the federal government’s primary healthcare plan for the next 10 years.
The report is very much influenced by the Department of Health’s voluntary patient registration (VPR) model, which seems to have taken over as preferred policy from ideas like Health Care Homes and patient-centred medical homes. (It’s interesting that GPs who have in the past railed against the idea of capitation seem to be quite keen on VPR, but that’s a discussion for another day.)
The model encourages patients to register with one practice and one general practitioner who will know them and their history, and will be responsible for co-ordinating their care with allied health, nursing and specialist support. For that, they will be paid extra service incentive payments (SIP), although how these will be recompensed is not detailed.
What is clear is that GPs may finally be paid for using technologies like patient portals, prescribing wearable devices and paying attention to personal health records, which appear to be encouraged under the proposed new funding arrangements. Great! The steering committee’s recommendations and the department’s consultation plan also both highlight telehealth and My Health Record as being at the heart of VPR, although not essential to it.
However, MBS funding for telehealth that is contingent on consults only with regular GPs is already legislated, and the VPR model would only just entrench this (to the detriment of telehealth as a modality, we think). There is also nothing in either the recommendations or the draft plan on how to improve the use of My Health Record, which while potentially forming the basis of shared care planning, simply is not doing the job at the moment.
Pulse+IT has personal experience of this with a few recent healthcare presentations, unusual for the doctor dodgers amongst us who tend to avoid seeing GPs who tell us terrible things. For example, one of the big benefits touted for the My Health Record was the promise that duplication of pathology tests would be reduced, thus saving the healthcare system millions. This would be great if it actually worked, but quite often it doesn’t.
For example, an expensive full blood count that was taken three weeks ago still has not appeared on My Health Record, despite the lab being listed as connected. COVID tests are also very much hit and miss depending on where they were taken. Some COVID swab results turn up, but others don’t. It’s great to receive SMS messages saying the test is negative, but if this is not recorded officially, how can this be verified?
Medications are also hit and miss. We’ve argued in the past that perhaps PBS information should be removed from the system as errors are so common, but recent experience shows that the Medicare overview section seems to be the only part of MyHR that is actually recorded accurately.
Just recently we were prescribed a medication and it was dispensed within an hour, but there’s nothing in the prescription and dispense repository on our My Health Record explaining it. It turned up in the PBS section within a day, though. Claims must be paid.
As for shared health summaries, a prominent GP pointed out to us recently that these are some of the least viewed documents on the system and seem to be only uploaded to fulfil the quota system to qualify for the ePIP. Should they be revisited, he asks, in that the information contained (conditions, medicines, allergies and immunisations) is recorded elsewhere? In our experience, the only section of the My Health Record that is accurate and useful is the immunisation section, and that is purely down to making COVID vaccinations mandatory on the AIR. The rest of it is most politely described as a work in progress.
Meanwhile this week, vaccination passports have begun to be added to check-in apps, first in Victoria and then in NSW. Vax certificates are also available through myGov, Medicare Express Plus and as ADHA has pointed out to us, they are also available in the two apps linked to My Health Record – Healthi and HealthNow – which of course no one uses. New Zealand is also gearing up for the same.
We pity the staff at cafes, pubs, clubs, restaurants, galleries, shops, sporting venues, GPs, pharmacies and other assorted businesses who will have to check these credentials before admitting aggro customers. Good luck.
That brings us to our poll question for the week:
Are the vaccination passports being rolled out going to be a help or a hindrance?
Vote here or leave your comments below.
Last week we asked: Should PHNs be involved in developing clinical software? Most (70%) said no, but the comments on why are illuminating.