OVER the next 3 months, people around Australia are being offered an important choice about how they want to interact with their own health information. By the end of 2018, all Australians will have a My Health Record created for them, unless they choose not to have one.
Their decision will be just that: one for them to make after considering the benefits of having immediate online access to their own data about their health and care, and being able to have their clinicians see that information too. They will have access to information such as their medicines and allergies, hospital and GP summaries, investigation reports and advance care plans — this could save their life in an emergency and help their clinicians find vital information more quickly so that they can make safer health care decisions. This information will empower them as they carry their health care history with them in their pockets, on their mobile phones.
Australians will make their choice in the context of our digital world, where the privacy and security of personal information is paramount. In other parts of our lives, we have already made the digital transition. The health sector has been naturally cautious in its adoption of online technologies, awaiting the availability of systems that can adequately ensure the privacy and security of our health information.
Trusted health care providers – GPs, specialists, pharmacists and others – are likely to find that their patients will want to talk to them about their decision. The My Health Record system is here to support better, safer care, but it’s not here to replace our current systems for clinical record keeping and professional communication. Neither will it somehow replace the patient–doctor relationship and our clinical judgement. It’s simply a secure online repository of health data and information that we wouldn’t have had access to otherwise. The data flow from securely connected clinical information systems in hospitals, general practices, pharmacies, specialists’ rooms, and pathology and radiology providers. It also provides access to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data, the Australian Immunisation register and the Australian Organ Donor registry.
People will want to be assured that the Australian Digital Health Agency – the operator of the My Health Record system – holds the privacy and security of their health information as its first priority. The security of the system has not been breached in its 6 years of operation. There is no complacency however – My Health Record system security operates to the highest standards, working with other leading security operations such as the Australian Cyber Security Centre. It undergoes constant surveillance and threat testing, protecting the health data of the 5.9 million Australians who have already opted in and chosen to have a My Health Record today.
The legislated privacy controls that My Health Record offers people are world-leading and easily accessed on the consumer portal. They include features such as a record access control, which is similar to a PIN that a person can apply to their entire record so that it can’t be viewed unless they share it with their clinician. In an emergency, the legislation allows a clinician to “break glass” and see vital medicines and allergy information; however, all instances of this are audited and people can choose to receive a text or email to let them know in the event that this happens.
There are many other privacy features. People can turn off Medicare data flows such as PBS and MBS information, and they can see a complete audit history of anyone who has ever interacted with their record in real time. They can pick and choose which information they’d like to keep entirely private with a limited document access control, which is an additional PIN that they can apply to specific documents. They can block health care provider organisations from viewing their record, and effectively delete documents in their record completely. They can enable an alert so that they receive a text message or email if a new health care provider organisation views their record for the first time.
The steps required for a health care practitioner to view the My Health Record are robust and require a number of security authentications to take place. For a provider to access the My Health Record via their clinical information system, they must be a registered health care provider – for example, registered with the Australian Health Practitioner Regulation Agency. They must also have a valid provider identifier. They must work within an organisation that has a valid organisational identifier. They must have conformant software that has a secure and encrypted connection to the My Health Record system. In addition, the patient must have a record on the provider’s clinical information system as a patient of the practice. Following this, the conformant system must use five pieces of information to validate the patient. Only then can the clinician see whether the patient has a My Health Record and the clinician’s access will depend on their patient’s individual privacy settings.
There is compelling evidence that we need to modernise our systems and embrace the benefits of digital technologies in health care. People are being subjected to avoidable harm and death as a result of data silos and their clinicians being unable to access critical pieces of health information. We know that Australia delivers a world-class health system ranked among the highest globally for efficiency and health outcomes. However, we know from consultations with thousands of Australians who contributed to the National Digital Health Strategy that we could do better – that people want access to their own health information and that they want their health care providers to have access to it too.
We also know that a staggering 230 000 hospital admissions occur every year as a result of medication misadventure, costing the Australian taxpayer $1.2 billion annually. Many of these admissions could be avoided if people and their clinicians had better access to vital medicines and allergy information.
The “Medicines View” is a recent addition to My Health Record that has been applauded by clinicians using My Health Record. It provides a consolidated summary of the most recent medicines information from notes entered by GPs, hospitals, pharmacies and consumers, allowing previously siloed medicines information to be brought together into a single view.
In addition to improvements in the features of My Health Record for people and clinicians, over the past 12 months, the system has undergone a significant transformation in terms of the richness of its clinical content. We have now seen the connection of public and private pathology and imaging providers, and a vast increase in connected pharmacy systems as well as hospitals around the country. The addition of this valuable clinical content will accelerate the realisation of benefits as clinicians find that they now have access to a more comprehensive source of information within the My Health Record system.
This week, a national communication plan has been launched to ensure Australians are well informed when making their decision about whether or not they would like a My Health Record. Our peak clinical and consumer bodies including the Australian Medical Association (AMA), the Royal Australian College of General Practitioners, the Pharmaceutical Society of Australia (PSA), the Pharmacy Guild and the Consumers Health Forum are among numerous organisations who have given their public support to the system and its benefits. Former AMA President Dr Michael Gannon described the system as “the future of medicine”. Guidelines on the use of My Health Record from the PSA have recently been published and the AMA will be releasing its revised guidelines in the coming weeks.
Our role as health care providers is to be our patients’ advocate, to support them in making the decisions and choices that will lead to better health outcomes and ensure that they have access to safe and effective care. My Health Record isn’t here to solve all of our problems, but it is an important step forward in our ability to deliver a safer and better connected health care system.
Clinical Professor Meredith Makeham is Chief Medical Adviser of the Australian Digital Health Agency.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.
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