Electronic Health Records (EHR, EMR)

New figures show that one in 10 Australians have opted out of the My Health Record (MHR) system, leaving participation rates at 90.1 per cent. According to the Australian Digital Health Agency (ADHA), based on the number of people eligible for Medicare as at 31 January, more than 2.5 million people have opted out of the system, amounting to a national opt out rate of nearly 10 per cent. This is a stark increase from the three per cent, or about 900,000 people, who opted out from when the opt-out period began in July to 9 September last year. While the opt-out period ended on 31 January, legislation was recently passed by the Australian Parliament allowing Australians to cancel and have their MHR permanently deleted from the system at any time in future. Similarly, individuals who may have opted out can choose to create a record at any stage. According to the ADHA, records created through the opt-out process will be available shortly. Just a few days ago, ADHA Chief Executive Tim Kelsey took to stage at the AFR Healthcare Summit to say that the MHR system was one of the strategies to get Australia’s digital basics right and quickly, and that more healthcare organisations are getting on board the system. “A recent report identified, quite astonishingly, that in today’s high-quality healthcare in Australia, that 1.2 million Australians will have experienced an adverse medication event in the last six months. 250,000 hospital patients are seen each year because of medications misadventure. A key cause is the absence of real-time medical records at the point of care – a key benefit of MHR,” he said at the event. According to Kelsey, more than 50 per cent of pharmacies are now uploading to MHR – an “enormous shift” from the start of the year. “What this means is comprehensive coverage. A GP will have the most up-to-date information currently available on the patient and in that way, we will reduce the number of accidental misdiagnoses,” he said. In response to the increasing Australian opt-out numbers, Labor Shadow Minister for Health and Medicare Catherine King said the implementation of an opt-out model has “created a range of problems and severely undermined public support” for a system that could deliver health benefits. “We maintain the government should commission an independent Privacy Commissioner review of the system,” King said. [Read more: We need to get the digital basics right and quickly: Tim Kelsey | My Health Record system data breaches rise] As part of the review, Labor calls for the consideration of appropriate balance between utility for clinicians, patients and others (such as carers), and privacy and security for individuals; protections for vulnerable people, including minors aged between 14 and 17 and families fleeing domestic violence; and measures to encourage consumer engagement and informed choice. Most recently, the ADHA also reported that the number of data breaches involving MHR has risen year-on-year, from 35 incidents in the last financial year to 42 incidents this year. The agency’s Annual Report 2017–18 identified that “42 data breaches (in 28 notifications) were reported to the Office of the Australian Information Commissioner (OAIC)… concerning potential data security or integrity breaches”, but with “no purposeful or malicious attacks compromising the integrity or security of the My Health Record system”. MHR has previously come across backlash from the industry, with Harvard Medical School International Healthcare Innovation Professor Dr John Halamka saying the system relies on outdated technology and industry calling for more caution over the system. But the ADHA defended MHR from criticisms, identifying that more than 98 per cent of the content in MHR is machine-readable, including MBS [Medicare Benefits Schedule] and PBS [Pharmaceutical Benefits Scheme] data and a variety of rich clinical resources, and that only one to two per cent of the documents contained in My Health Record are PDFs. “Over 100 clinical information systems are accredited to connect to My Health Record and they consume structured data such as SNOMED [Systematised Nomenclature of Medicine] codes on diseases and AMT [Australian Medicines Terminology] codes on medicines. This functionality is driving decision support and other logic in those systems through those computable codes,” the spokesperson said.

Dr NT Cheung has been the Chief Medical Informatics Officer (CMIO) of Hong Kong’s Hospital Authority (HA) for the past 26 years. The HA is a statutory body established under the Hospital Authority Ordinance in 1990 and has been responsible for managing Hong Kong's public hospitals’ services since December 1991. As the CMIO, Dr Cheung has been key in driving the IT transformation of the organisation from one which began with a very rudimentary use of IT in the 1990s to one which is able to continuously roll out new initiatives, very quickly and at a high degree of standardisation not just to improve the work processes of clinicians, but ultimately for the benefit of patients under their care. “Looking forward on healthcare - the pressures on healthcare, which all of us share in any advanced economy now, it's the same, which is that people live longer, you have more chronic disease, you have more demands, and healthcare people expect more and your healthcare manpower is not growing at the same pace.  You can't just keep on doing more and more healthcare in the old way, you have to change the way that you are doing it – you have to change your service models, you have to add significant amounts of automation to this very labour-intensive sector of the industry. And so again, that's what health IT is able to deliver. And there are very few other options to be honest. So it's becoming an increasingly important part of getting us into a more sustainable model for the whole healthcare in the future,” Dr Cheung explained. HA’s Clinical Management System (CMS) – 1990s till present Currently in its fourth generation, the CMS at HA started off modestly in the 1990s with convincing the frontline to start using these tools with a very basic digitalisation of hospital wards. By the year 2000, the second phase of development for CMS began when HA linked together the various hospitals, as well as linking the outpatient and inpatient records together. More tools were also built to support the healthcare process with features such as order entry and rudimentary forms of decision support. Phase three of the CMS was about rebuilding the entire platform to a more modern one which allowed for a much greater integration/standardisation across the board. “So from CMS two, we had this integrated electronic record but in terms of functionality and functional modules, they were all pretty much stovepipes and they would then contribute data into the central repository but they were separate stovepipes. So CMS three was trying to build it as a platform using the then newest technology of putting the applications on the server side rather than the client side of approach, and then build that platform using a more modern Java-based platform,” Dr Cheung said. The fourth phase of development of the CMS has a ring to it – with a slogan called the 5Ps approach: Paperless – Dr Cheung shared that the HA has hit an inflection point where in many cases, the paper workflows are now going to be more cumbersome than the digital workflows that they can now design, Protocol-based – introducing clinical intelligence from people, guidelines, websites, books into the CMS Closed looP - in a very complex workflow like a high volume hospital, things get missed out, the loop does not get closed because nobody can keep track of everything all the time. Communication tools at the clinical side will be strengthened to make sure everything is followed up and the loop is closed. Personalised - to allow for a greater degree of personalisation for every single individual user across different hospitals, depending on their particular situation. Patient-centricity - a reminder that the patient is still the centre of the healthcare universe. A unified patient app One of the five portfolios under HA’s IT 5-Year Strategic Portfolio is Enhanced Patient Experience & Outcome, which focuses on new patient-centric service models with disruptive technology. Dr Cheung said that one of the key deliverables that HA is working on now is a unified patient app. HA has been releasing patient apps since 2011 and a portfolio of apps have been built but there are simply too many apps for patients to keep up with. “We are building a single patient app that we call HA GO - it does several things more than the previous collection of apps. So first of all, it's a one stop shop. So you would download the single app from HA, and then you would register as an app user once and all the apps will know who you are. Secondly, it functions as a conduit - it's not just a collection of little apps, it is a framework for allowing your health care which is delivered in the hospital or clinic to extend out to the rest of your life when you're in the community or at home,” he added. The HA GO single patient app is slated to be launched this year with a modular design consisting of ‘mini apps’. For instance, diabetic care would be a mini app and the app will be pushed to the phones of diabetic patients who need it.

They'll focus on info blocking, certification requirements, standards for voluntary pediatric health IT certification and the new U.S. Core Data for Interoperability proposal.

With many real-world problems still present in Australian healthcare, the time for change in healthcare is now, according to Australian Digital Health Agency Chief Executive Tim Kelsey. Speaking at the recent AFR Healthcare Summit, Kelsey said the industry must make take the action needed to improve access to digital health instead of disrupting it. “Delivering on digital health is not easy, there are many challenges ahead of us. The reality is, the world of fax machines is not safe and does not empower us to take more control of our health environment. A world of fax machines is not a world for precision medicines,” he said. “The time for action is now. We’ve got the mandate and we have the strategy. We just need to get the digital basics right and quickly.”  A key issue, Kelsey said, was the need for secure digital messaging.  “So far, secure digital messaging has had interoperability issues. But now, we have industry agreements in place to share information securely. That now will be the basis in which secure messaging will be an important step forward,” he said.  Kelsey said this is the result of a new digital health strategy that the federal and state governments committed to 18 months ago in the aim to deliver safe, evolving healthcare and the creation of modern healthcare in Australia. Last year, the governments inked a new four-year inter-governmental agreement to oversee this delivery. The strategy identified seven key priorities, of which providing registered clinicians with the ability to securely communicate with each other without resorting to paper or fax machines by the end of this year is one of them.   “By 2022, providers in Australia will have connected all their care services so that clinicians in and out of hospitals have access to the right patient at the right time.” Another key part of the strategy, according to Kelsey, is the My Health Record (MHR). “A recent report identified, quite astonishingly, that in today’s high-quality healthcare in Australia, that 1.2 million Australians will have experienced an adverse medication event in the last six months. 250,000 hospital patients are seen each year because of medications misadventure. A key cause is the absence of real-time medical records at the point of care – a key benefit of MHR,” he said. According to Kelsey, more than 50 per cent of pharmacies are now uploading to MHR – an “enormous shift” from the start of the year. “What this means is comprehensive coverage. A GP will have the most up-to-date information currently available on the patient and in that way, we will reduce the number of accidental misdiagnoses,” he said. [Read more: The Australian health system “will fail” if the pace of change is not met: KPMG | CSIRO lays out action plan for Australia’s digital health future] he next step for MHR, Kelsey said, is to work closely with the specialist communities and aged care to build connections.  “Recent PSA research found that over half of residents in an aged care facility in Australia are exposed to at least one potentially inappropriate medication. Technology can be a very strong support to reduce those instances,” he said.  “And the MHR provides those rights to citizens to decide with whom they share their data and at what time.”

Janne Pitkänen, CEO of Finnish-based Adusso Ltd., says we must consider cross-border interoperability between healthcare systems, which would also enable benchmarking – especially in the U.S. and the Nordics.

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Intel gives glimpse inside its Connected Care health plans that saved 17% per month. 

Hospitals that reach the pinnacle of the HIMSS Analytics EMR Adoption Model have more satisfied docs, more widespread personalization of EHRs and better teamwork between clinicians, according to a new survey with HIMSS Analytics.

At HIMSS19, DeVore mapped out the five problems that must be addressed to transform the industry.

CMMI Director Adam Boehler details the impact of new interoperability rules from CMS and ONC.