It was a red letter day for digital health in Australia on Monday when a great big load of personages gathered together in lovely Canberra to hear about the transformative vision the Australian Digital Health Agency has for Australia’s digital health infrastructure.
In an in-depth, two-hour briefing, ADHA outlined what is a fundamental shift that will take place in the coming years, aimed at finally connecting care in the way that ADHA and its predecessors have been talking about for the last 15 to 20 years.
Time will tell if it works, but the concept of a health information exchange (HIE) built on contemporary standards and technology, underpinned by what ADHA says is very good existing legislation for consent and privacy, will no doubt change the way healthcare information is shared in the future in a good way.
ADHA chief digital officer Peter O’Halloran was the star of the show on Monday, taking the side of the healthcare consumer and leaving some of the more boring techie bits up to others. Mr O’Halloran used the example of the journey of a person at home suffering from a tightness in the chest and calling Healthdirect for advice as an example of what may happen in this new brave new world.
The person is told by Healthdirect to call Triple Zero, and while they’re on the call and an ambulance is dispatched, the call taker is able to see the patient’s My Health Record – now with rich and up-to-date data due to the new modernisation platform it will be using – as well as other sources of information as well, including the latest times from the patient’s one-lead ECG on his Apple Watch.
We are sceptical that any healthcare provider wants to see this sort of data but you never know. It will there for the paramedics to see as they travel to the patient, as well as a volume of contemporary data on the patient from various sources – including hospital and GP data – that is surfaced within their own electronic patient record.
When the ambos walk into the house, they will be prepared for what they find. They will then transport the patient to ED, take a proper ECG, and when the patient is on a trolley heading through the doors of the emergency department, the ED too will have up to date information from a variety of sources surfaced within its own EMR.
This will all be facilitated through the HIE, which will provide the permissions to access this data without the healthcare provider even knowing they are using the HIE, and without having to log into multiple different portals.
Importantly, it will not all be just hospital level or My Health Record data. Mr O’Halloran made a very good point that while many hospitals have up to date electronic medical records that interact with other systems – and he led one of the biggest Australian implementations of a shared EMR in the ACT so he knows all about it – and that a lot of investment has gone into hospitals, health data sharing usually stops once someone steps foot out of the acute care sector.
The vision here is for health data to be provided to the healthcare professional, no matter the setting. In GP practices, in allied health, with medical specialists and diagnostic imaging and pathology, with community pharmacy, and with aged care.
So where does the My Health Record sit in this vision? It will shortly get a fundamental revamp from a document-based system to a FHIR-powered repository, which will be just one that the new HIE can draw upon for information. That’s the vision, anyway, and ADHA made it clear that this was a vision that will change over time.
The briefing in Canberra made it very clear that this new world will only be able to come into fruition by adopting agreed standards and applying them throughout the healthcare system. It was also clear that some older technologies, like the HIPS middleware built by South Australia Health and IT firm Chamonix, which has plugged many a gap between hospitals and My Health Record over the years, will be retired.
Australia’s existing, rigorous legislative framework and its consent systems will be hugely important but they too will need an update, including to the HI Service Act and new legislation allowing for the government’s policy of sharing by default.
But if achieved, Australia’s health information exchange-based system will be a global leader and an exemplar for other federated healthcare systems to follow. ADHA is confident that it has the right building blocks to ensure that when we go down this path, we’ll get it right.
We came away from the briefing on Monday reasonably positive, but we have heard a lot of this before. We do not believe that doctors will ever want to see loads of unsolicited data from consumer devices because they won’t trust it. We also suspect there will be a bit of pushback against this idea of a system that interrogates different EMRs and practice management systems and what doctors will think about all that.
Mr O’Halloran did make a joke that general practices will have to stop their habit of turning off their servers overnight to save on power bills to ensure that the HIE can find information, but some will take this seriously. If we’ve learned anything over 16 years of reporting on health IT, it’s not to get in the way of a GP owner, the server under their desk and their patients’ data.
While there are still a lot of questions and much cynicism, as a country of only 25 million people this is a path we must head down to be able to share information across borders, across care settings, and provide information to healthcare professionals and to consumers when they need it and where they need it. Good luck to ADHA.
We’ll have some more stories on the briefing in Pulse+IT and we’ll talk to Mr O’Halloran in the Pulse podcast next week.
In late breaking news this week, there was an update about the MediSecure data breach, and it’s pretty bad. Yesterday, the MediSecure administrators released a long and detailed update on what had gone wrong and what the situation was, and quite honestly, it’s an outrage. The company has basically washed its hands of its responsibilities for allowing the hack to happen, which it now appears will affect 12.9 million people, but also to cynically blame the media for causing the problem.
According to the administrators, the media and anyone who goes to look for the data are “encouraging the criminal activity that led to the incident and may further the potential harm to Australians” affected. What an absolute load of nonsense. MediSecure’s board allowed this to happen by dropping their guard when they lost out on the contract to provide a sole delivery electronic prescription delivery service.
The service seems to have been left open to attack, and when it happened, they entered voluntary administration, handed over all responsibilities to others, and have simply walked away from it all. They no longer have a website, an email address or a phone number to ask questions, and the administrators say they are unable to identify all individuals who may have been affected.
While the company is in liquidation and there is no money to be had from it, at some stage the regulators may look at sanctions for the former board of MediSecure for allowing this situation to happen. We look forward to that day.
That brings us to our poll for this week. Last week, we got a big response to our question: Are you hopeful that the My Health Record can be successfully transformed?
Most said yes but it wasn’t overwhelming: 64 per cent were hopeful, versus 36 per cent who were not. There were some great comments too: here’s what you said.
This week, we ask:
Do you agree with ADHA’s vision of a national health information exchange?
Let us know what you think. If yes, what benefits will it bring? If no, can you explain your opposition?
Vote here and leave your comments below.
Rumours of my demise have been greatly exaggerated.
Yes – More connected care
Yes – Simple facilitation of health info access
Yes – Sharing is essential to overcome barriers to care
Yes – Interoperability
Yes – This is what the patients expect – as a clinician anaesthetist, patients are often surprised that I have to ask them questions that they have already answered to the hospital and the surgeon, simply because I have no way of accessing anything that isn’t on paper in the hospital, and I don’t have access to this until the day of the procedure. The cost is wasted resources on unnecessarily repeating blood tests and other investigations, and the occasional last minute cancellation because the patient did not stop a medication that they were supposed to stop.
No – Three issues.
1. Every Government and subcontractor database has been hacked in recent years.
2. As a clinician, I know that data overload will not help me.
3. Except for allergy, there are almost no clinical situations in which instant data availability or instant history availability will change the course of that patient’s recovery or death.
Yes – Sharing a patients health data with health proffesionals so they can make informed decisions
Yes – I like how they broke down the different components and promised to work with Australian Startups/Companies to build a system of “microservices” that is government-controlled and scalable rather than just handing to whole problem to one of the big 4. There is actual technical knowledge within the ADHA that is creating a modern architecture. Now it’s all in the execution – the plans are great!
No – The assumption is that some how given the example given that you ring health direct – no you would ring the ambulance who should look up its own data. Also the public when EMR/EHRs are everywhere should be able to log on to app and see their entire health history including viewing results etc which could be shared directly with a GP etc. Its outdated thinking which will cost heaps to the Australian Tax payer.
One of the “No” respondents has actually just given 2 of the reasons why this is a desirable (if hard to achieve) vision for the future:
“you would ring the ambulance who should look up its own data” – unfortunately some, if not all, ambulances services currently have no way to look up any patient data whatsoever, this vision seeks to correct that.
“Also the public when EMR/EHRs are everywhere should be able to log on to app and see their entire health history including viewing results etc” – exactly what this vision is attempting to achieve. There is no “app” capable of pulling your “entire health history” together and there will not be such an app without the implementation of this vision. The best we currently have is the My Health App which can only access the data held in your My Health Record, but if (and that’s a big if) the HIE becomes a full reality then such an app will have access to all of the health data allowed via the HIE.
Yes – More realistic than a central EHR
No – I don’t believe that ADHA will be able to execute on it. They are all talk, no action. Meanwhile jurisdictions & hospitals are forging ahead to try and actually make progress, and at some point they’ll need to try and integrate with something that’s been federally delivered and meets less of the requirements than they’ve been able to implement themselves in their own jurisdictions. To ADHA: show, don’t tell.