This coming Monday in Canberra, the Australian Digital Health Agency is holding an information session on progress on the modernisation program for the My Health Record system, promising some in depth information on how it will move from what is a clinical document-based architecture to what ADHA is calling a data-rich platform.
This has been on the cards for a number of years now: ADHA first went to market in September 2019 for ideas about the future of the national digital health infrastructure and how it should operate as part of the national infrastructure modernisation program, which we liked to call the NIMP and which also involved an approach to market and a grand meeting in Canberra.
It was during that process that it was first mooted that a new approach was needed and that FHIR would form the basis of a renewed infrastructure, as well as a new API gateway to replace Oracle’s ageing technology, which has since been completed by Deloitte.
Five years on and under new management, ADHA’s meeting next week is expected to help shape its procurement activities and market engagement approach. You’ll remember that My Health Record was allocated a big chunk of funding in the now famous 2023 budget, including $429 million over two years to build a new national repository platform along with investment to improve the sharing of pathology and diagnostic imaging data.
The full $1.1 billion also included dedicated funding for standards development through the Sparked accelerator.
ADHA chief digital officer Peter O’Halloran told Pulse+IT last year that it was this new national repository platform that would underlie the modernised infrastructure and would be built using FHIR. He more recently said the agency “has had great success with the establishment of a new API gateway and transition to cloud storage”.
The next step, he said, is to implement a new FHIR-based repository, which will allow storage of key records that form part of each consumer’s My Health Record.
All sounds great, but after 12 years in operation and several billions of dollars in funding, you get the feeling this really is crunch time for My Health Record. While it was built using contemporary architecture at the time, it has never really achieved its main aim of better sharing of data.
It has seen better uptake recently with immunisation data added, particularly during COVID, and there is no doubt that mandating the sharing of pathology and imaging data will help with views, both from consumers and from clinicians. The nice little myhealth app should also help.
But it remains the case that while acceptance by clinicians has improved and that the system does contain useful data, it also remains largely unviewed by consumers, untrusted by many health professionals and it has never got close to achieving its potential.
Anecdotes abound that GPs remain highly reluctant to upload a shared health summary or event summary simply because they don’t have enough time, or simply because they just don’t want to.
This was brought home to Pulse+IT this week while reading a fascinating thesis by RMIT University PhD candidate Trevor Stone, who despite being in the business and IT faculty, takes a philosophical look at My Health Record.
Over the last 10 years, Trevor has interviewed 20 clinicians, mainly GPs but some specialists too, in depth about their thoughts on centralised databases of health information, their own use of technology in clinical practice and other areas such as privacy. Trevor also asked about their emotional response to things like My Health Record, and for the majority, there was a visceral dislike of the very idea of the system that comes through in the interviews.
Many doctors simply do not trust the system, do not want to use it and never will. The resistance is still there and may never be overcome.
For My Health Record and for ADHA, there is a lot depending on what they come up with in terms of procuring a repository that will make the My Health Record useful and sustainable. We think they probably have the right idea in the technological approach they’re taking – although it has taken a lot of time and a hell of a lot of money – and there’s no doubt the My Health Record will not go away, despite repeated calls by certain people for it to be canceled.
That horse bolted a long time ago, but ADHA does have to get it right this time or the project will be finally be called an outright failure. A lot is riding on it.
We’ll have up to date news on Monday about the information session in Canberra, and we’ll bring it to you as quickly as possible. In the meantime, the second episode of the new Pulse podcast was released today. Louise Schaper and George Margelis had a lovely time discussing all sorts of matters in digital health and health innovation, both here and elsewhere, and they also did a really good interview with Productivity Commissioner Catherine de Fontenay about the commission’s recent report into digital health.
We still take great issue with the finding that $5 billion per year can be saved with better use of EMRs, but the report is a substantial one, and the interview is really interesting. Take a listen here.
That brings us to our poll question for the week:
Are you hopeful that the My Health Record can be successfully transformed?
If yes, what will be the main indicator of success? If no, what are your main reasons?
Vote here and leave your comments below.
Last week, we asked: Do you support the aged care data and digital action plan? Most did: 66 per cent were positive. Here’s what you said.
Yes – Usage by consumers
Yes – Better interoperability
Yes – That the concerns around privacy be resolved
Yes – Early inclusion of all patient information from all sources
Yes – Atomic data that can be exchanged with practice records in real time; mandate FHIR standards for requisite minivan dataset uploads
Yes – the ability to share atomic data from source systems
Yes – use by GPs, specialists, and public hospitals
Yes – information that meets needs of the person
Yes – Granular pathology and radiology registry is a primary milestone within 12 months along with digital health summary. Public funding of health services should mandate this.
Yes – Plans to develop a discrete database version
Yes – Quantitative and qualitative data on its use. The number of documents uploaded and viewed is important, but equally important is the anecdotal stories on how it is being used for safer, more efficient health care.
No – Initial rollout was unsucccessful. So many data hacks I just don’t think the commonwealth govt can guarantee it won’t be hacked as I don’t beleive their their cyber security is as good as big private corparations offer because they take it more seriously
Yes – Atomised data coded to FHIR standards with API to general practice EMRs, allowing realtime interoperable exchange of information between clinicians during consultations
Yes – Need to look at the people who are turning 14 and can take control of it. Tech needs to be accommodate future users.
No – It’s been so long and there are still major issues — unless they rebuild so it’s fit for purpose and re-brand completely I think it will be a very long time before it’s used the way it could be. It’s certainly still highty problematic for Aboriginal Medical Services due to the original assumptions made about who would be using it and how
No – It may be migrated to newer technology, but the same issues with acceptance will remain
No – The ADHA has not considered the resourcing implications required to add appropriate data to the system by australian hospitals. Many contracted doctors run their own practices and do not upload any information or utilise the hospitals system to upload information. More resources are needed in an already resource limited system to provide the staff to upload accurate patient information into MHR.
Yes – better engagement with MHR by health workers and of course, more timely and better health outcomes for patients