Home The Quarterly 2017 E-Health: Is this the resurrection of a glorious new digital health strategy?
E-Health: Is this the resurrection of a glorious new digital health strategy? Print E-mail
Dr Singithi (Sidney) Chandrasiri 
   
Magical and humorous undertones akin to a mythical ‘Phoenix rising out of the ashes’, abound in Australia’s ongoing dalliance with e-health and EMRs. The almost mythological and unattainable quality of a truly fit-for-purpose e-health record, and the magnificent death of the recently implemented Patient Controlled e-health Record (PCEHR) in a symbolic bursting into flames, is what is left of Australia’s foray into the e-health space today.
 
According to ancient legend, this Greek mythical bird when extinguished did not go silently into the night, but was resurrected from the ashes to start afresh, and forge a new, more powerful and magnificent path –much like the newly reinvigorated My Health Record (myHR).
 
So could this indeed be a time of resurrection for Australia’s national e-Health strategy? Could the MyHR succeed where the PCEHR failed?
 
It was 5 years ago that the PCEHR was launched by the National e-Health Transition Authority (NEHTA), and it was 4 years ago that that the PCEHR failed.
 
Its aim was to create a “platform for health information integration and exchange across geographic and health sector boundaries”. It failed not just in this fundamental objective, but also on multiple other fronts. Most notable of these have been attributed to an inadequate patient and provider uptake and buy-in, poor integration with existing healthcare IT systems and not being conducive to practical clinical use.
 
Following the death of PCEHR, the consequent government-commissioned review found a key reason for its failure was its inherently flawed ‘opt-in’ design. In response, and with the costing of an extra $1 billion health funding into the digital health strategy since then, a new ‘opt-out’ system with improved user friendliness and complete patient control was created.
 
Along with it, a new agency was established to oversee its trial and implementation –the Australian Digital Health Agency (ADHA). These changes have shown some initial potential, with recent trials conducted in parts of NSW and QLD showing nearly 1 million users added to MyHR with only 1.9% of these opting out since trial commencement in July 20161
 
So will the new myHR live up to its promise?
 
MyHR is indeed intended to meet most of the globally recognised benefits of adopting a digital health strategy. Better medication management and reduction of adverse medication events, reduction of duplicate testing and enabling information sharing across health sectors, better reconciliation of health information between health providers and the provision of better, accurate and timely care, are a few of these promises.
 
However, as with most other e-health implementation or transition initiatives, the devil is often in the detail.
 
Common-place issues that are prevalent in the e-health space such as data confidentiality and security concerns, poor integration with existing health IT systems, regional/rural IT infrastructure challenges and the all too nostalgic “resistance to change” by medical practitioners, could present several seemingly insurmountable barriers. Data reliability and accuracy would be of particular concern in this iteration of the MyHR as well, since it allows patients to delete any piece of data from their e-clinical record and allows the use of pseudonyms to create potentially multiple patient profiles, which do not subsequently then integrate to one record.
 
Despite these challenges and barriers to the reinvigoration of a workable national e-health system, utilising some simple and generic strategies could pave the way for a successful e-health resurrection.  Extensive and widespread consultation with the end users, getting the required buy-in from health providers and individual medical practitioners, extensive workflow mapping to support efficiency and convenience of use for clinicians, and a phased and incremental introduction, with the flexibility to incorporate ongoing modifications, could set the scene for successful Australian e-health advances.
 
The revived NSQHS Standards2 (version 2) that is due for implementation in November 2017 is set to further bolster this commitment to the new MyHR. Creation of two new actions items pertaining to ‘healthcare records’ under the Clinical Governance Standard, will require health services to work towards fully implementing systems to provide clinical information into the MyHR system, to establish processes to maintain accuracy and completeness of the MyHR uploads, and to establish processes for complying with legislative requirements in staff accessing the MyHR system.
 
The eHealth Practice Incentives Program (ePIP) is intended to further incentivise the adoption and embracing by General Practitioners and practices of the latest eHealth industry developments. Core requirements such as ensuring that individual practices have secure messaging capabilities, uses software that is compliant with the MyHR system, and enables the uploading of electronic health summaries to the MyHR thus embedding it into the day to day operations of the practice, will allow these practices to be eligible to receive substantial financial incentives. 
 
The ADHA whilst being tasked with the responsibility of clinical safety, functional assurance and usability of the MyHR system, is set to work in collaboration with the Australian Commission for Safety and Quality in HealthCare (ACSQHC) with allocation of specific funding, to undertake regular clinical safety reviews of the MyHR system, throughout its release to the Australian community.
 
Perhaps then, in this new era of healthcare strategy optimisation, a successful resurrection of a nation’s once-fading digital health ambition could quite possibly have the potential to 'rise out of the ashes', in a blaze of renewed hope, and redefined promise.
 
 
Dr Singhiti (Sidney) Chandrasiri
RACMA Candidate 
 
 
 
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Last Updated on Thursday, 29 June 2017 11:23