If your dinner party conversation turns to the MHR and you find yourself on shaky ground you aren’t alone Believe it or not some doctors don’t even know what MHR stands for. It’s My Health Record (MHR), previously known as the PCEHR (Personally Controlled Electronic Health Record). What is it? It’s a secure online health […]
If your dinner party conversation turns to the MHR and you find yourself on shaky ground you aren’t alone
Believe it or not some doctors don’t even know what MHR stands for. It’s My Health Record (MHR), previously known as the PCEHR (Personally Controlled Electronic Health Record).
What is it?
It’s a secure online health summary for every Australian theoretically controlled by the patient, but for obvious reasons accessible to most AHPRA registered health professionals when needed. The MHR’s major reason for being is to increase efficiency of the system via important data sharing and increased patient safety.
ADHA
The MHR is being built and administered by the Australian Digital Health Agency, which is also responsible for our national digital health strategy. This agency reports to the Federal Department of Health but also via all the state health governments. Our national digital health strategy is easy to read and very accessible and worth a quick look. Specialists are not mentioned much (only 3 times really, in 63 pages) but you’ll see where you fit in and you should get a sense that specialists need to be a little more pro-active in the national digital health strategy overall, because the government feels specialists are less computerised and digiterally literate so they are concentrating their intitial resources on GPs and hospitals.
OPT OUT
Is the major reason why you’re possibly finally hearing about the MHR in some form. The project is many years old but after a few years of trying to get people interested and only getting a couple of million to opt into an MHR (which is no where near enough to make the initiative work) the strategists at the ADHA decided they’d just automatically opt everyone in the country into a record (it was better thought out, but that’s the sum of it).
The whole idea of the MHR would simply never work with only a small percentage of the population participating and Australian’s are largely apathetic about these things, so someone figured we should just give them all a record, and reverse the onus for those who oppose the idea.
Hows that going so far? Well, you must have seen the news. A lot on unhappy interest groups. On the surface the media has savaged the ADHA for not providing enough warning, not doing enough around privacy concerns, ignoring the issues of security on a giant centralised database, and not consulting doctors better. But the numbers actually tell a different story. Probably 95% of Australians will stay opted in, either voluntarily, or, because it’s not of much interest to them to bother opting out. That means the project is go, as they say. But doctors need to take note. It’s going to get messy again.
DOCTORS’ SUPPORT
Opt out is seen by many doctors as a breach of patient consent. Patient consent is at the base of patient doctor trust. Despite going into the opt out with the support of the AMA, RACGP, RACP and others, many surveys suggest the majority of doctors are very upset with opt out because it breaches the idea of patient consent entirely.
If the majority of doctors don’t support the project, can it still work? Probably, but there are issues to be addressed here. The public may be apathetic towards consent and privacy ,having mostly all got themselves a Facebook account with all the breaches that simply day to day activity brings, but doctors, on their patient’s behalf, aren’t clearly.
IS IT SECURE?
The security implemented for the MHR is among the best implemented for a government project ever. But that isn’t the point. The point is that it’s a huge centralised database kept in one place and which, because of the need for health professional access, has approximately 900,000 “wet” points of access. “Wet” is human points of access. That’s a lot of points og weakness no matter how modern your security tech. The term for the design used by hackers for a big valuable centralised database like this is “honeypot” – lots of sweet data in one place. Almost all serious IT security analysts will say to you what ex head of the FBI, Robert Mueller, recently said about large data stories like the MHR: “There are only two types of companies: those that have been hacked and those that will be.”
PRIVACY ISSUES
Health information privacy is for obvious reasons more sensitive than most classes of personal data. Inappropriate sharing of information can lead to loss of employment, depression, financial issues and even death so there are very important issues in the protection of the vulnerable in the MHR project.
That 95% of the population are likely to remain opted into their MHR might for some be proof that privacy is not the issue it seems. Certainly, most of the population are accepting of very intimate data on themselves being captured and shared by the major global digital social platforms. And for this data to be used to manipulate them. The key issue for opt-out is that the basis of medicine is patient-doctor consent, and the question of whether opt-out sidesteps this consent. Many surveys of GPs suggest that based on this issue alone we might end up with more GPs opted out of the MHR than in and a very unusual skew on the overall low opt out population figure of only 5%. Privacy is and will remain a big and complex issue for this project.
SCREAM FIRE! (FHIR)
In most digital transformation markets, it’s really all about the people and their ability to change, not the technology. The technology is just there. And as far as specialists are concerned, the sort of mobile, cloud based, data sharing technology they will benefit from is available widely today. But not used widely yet.
It’s mostly about the economics of practice infrastructure, and willingness to change –not surprisingly most doctors don’t like change (not surprising because most people don’t like change and yes, specialists are people).
But there is one big technology issue that the ADHA needs to be called on. FHIR. Pronounced FIRE. It’s in the very complex world of healthcare digital data sharing and standards. Essentially FHIR is a standard that takes very complex off-web health data which is shared between isolated groups in isolated health systems – like a single hospital or GP practice – today (mainly in a standard called HL-7) and it makes this data much easier to share over the web, and much more secure.
The MHR is currently centralised and on technology which doesn’t easily allow this sharing or embrace the potential FHIR technology. But the agency has an opportunity to move to this technology in the next platform iteration. If it does then it’s possible that a MHR can become much more secure and entirely mobile, on a patients mobile no less, which talks to FHIR enabled databases which are distributed around the healthcare system.
So when a patient walks into their GP or specialist, it talks to their PMS, or when leave a hospital or path lab. And so on for all other health services. The databases aren’t central. So athey are lot more secure. The patient has a lot more control. And a lot of waste is avoided. So, for once, probably doctors need to get to know the technology and start being advocates for FHIR and distributed database sharing. If you find yourself somehow in a technology meeting and FHIR isn’t mentioned, then scream FIRE!
GOOD OR BAD?
You would be hard pressed to find anyone who thinks the MHR is a bad idea Secure, distributed sharing of key health information with the patient in control is the objective of this project and it’s a great one. The issue is more of how do we get to that end goal without spending too much, transgressing too many people’s personal rights and within a reasonable time frame.
The AHDA comes in for a lot of flak from nearly everyone on most of the above issues. But scoreboard wise, considering effort and failure by overseas countries, what we’ve learned, and where we’ve got to – even having spent a cool $2 billion to get here – the ADHA has a pass mark for what it has managed to achieve so far.
They need help, encouragement and very tough love around what they do wrong – which is usually a lot – going forward. They have a bad habit – learnt we guess from their political minders – of shrugging and saying “it’s all good”. It isn’t. It is a government entity and as such subject to political whimsy from incoming and outgoing governments.
That we have this project going, that we have a great legislative regime in place for patients and data sharing, that there’s so many organisations involved and registered, that the ADHA is bringing to the table hard-to-get big commercial interests, such as the pathology and corporate medicine groups, that it has the nod from the major medical colleges and that it does all this within the constraints of a not-so-stable political background?
Yes, the ADHA is doing OK. But doctors, specialists now more than ever, need to get more engaged about the MHR.
