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INSIGHTS

My Health Record:
An Evolving Work in Progress

Legislation passed by the Senate in November 2015 brings a longstanding work in progress – the national electronic health record – that much closer to completion.

The legislation shifted consumer enrolments in the system to an ‘opt-out’ basis in trials running in Northern Queensland and the Nepean Blue Mountains region of New South Wales. Shifting to an ‘opt-out’ basis as well as changing the system’s name—from PCEHR (‘pecker’) to My Health Record (MHR)—follows recommendations from the 2014 Royle review.

Shifting enrolment from an ‘opt-in’ to ‘opt-out’ basis also reflects more fashionable public policy thinking: the notion of the ‘nudge’ and the application of behavioural economics.i The underlying thinking here is that policymakers can easily influence people by changing the ‘choice architecture’ to make more desirable choices—while still providing the flexibility to choose otherwise.

Pending the outcome of the trial, this ‘nudge’ goes some way to addressing past criticisms of the MHR around low take-up. Yet there are still divergent views about the system. On the one hand, sector stakeholders agree that a national electronic medical record is desirable in principle. But many have been concerned about whether the MHR is ‘the one,’ after estimated expenditure of $1.5 billion and issues around system security, access, control and ownership. What are the key implications of changes around the MHR?

Incentives to get with the programme

A lack of financial incentives for medical practices to use the MHR system has been a core criticism. For many years the Federal Government has used financial incentives to encourage the adoption of digital technologies in medical practices through programmes such as the Practice Incentives Program (PIP). Reworked for the MHR, the PIP eHealth Incentive continues that approach.ii A quarterly payment tied to uploading Shared Health Summary records for 0.5% of patients, the eHealth Incentive, has been effective since 1 May 2016. Practitioners should be taking advantage of this financial incentive to defray costs that may be incurred in using the MHR system, such as upgrading IT infrastructure, staff training as well as for time spent managing records.

Eligibility requirements for the eHealth Incentive should also prompt medical practices to reassess their investments in IT infrastructure and training. Secure messaging capability, clinical coding of records, use of electronic transfer of prescriptions, and compliant practice software are all mandatory requirements. Like the myGov project, the MHR project is intertwined with the broader governmental pursuit of efficiencies from digitalisation. With this trend prevailing, and significant ongoing investment in the project, it is reasonable to expect that the MHR opt-out trial could be expanded to nationwide implementation. Hence, all practices should be ready.

Anecdotally at least, practitioners and practice staff in the MHR trial suggest that they are achieving efficiencies in using the MHR—and in some cases better quality of care outcomes for patients, having effectively cut time between consultations.iii Practices participating in the Northern Territory trial, for example, report benefits in not having to send back patients because communications did not arrive. They also identify gains in freeing administrative staff from time and effort lost to handling hard copy communications with hospitals. At the practice level, reducing such burdens on administrative staff could save tens of thousands of dollars in cumulative staff time.

Greater scope for patient engagement

Proponents suggest that the MHR can deliver benefits to patients to the extent it encourages better health self-management. This could be particularly relevant to patients faced with the challenges of managing multiple chronic conditions. To that end, it makes sense that active use of the MHR is interwoven with the pending Health Care Homes trial.

Table 1: Significant e-health projects underway or recently completed

State Project Key features Funding allocated
NSW Western Sydney Integrated Care Demonstrator: LinkedEHR care plan
  • Hospital-based clinicians’ get read-only access to GP-generated care plan—a potential model for Health Care Homes
  • GP can create care plan in desktop software
  • Other care team members, including allied health practitioners, can access and update record online
n/a
Vic Ballarat Health Services (BHS): MyHR 'opt-in' trial
  • GPs get integrated single view of MyHR together with locally deployed electronic medical record
n/a
Qld Specialist Outpatients Strategy
  • GP referrals via secure electronic messaging to Queensland’s largest public hospitals
  • GP partial access to their patient’s public hospital medical record by 2018, access to an online directory of public hospital services
  • GP clinical decision support tools [clinical prioritisation criteria (CPC)] to standardise and improve referrals.
  • Patient access to an online specialist appointments management portal
$361.2 million over four years
SA Expanded rollout of Enterprise Patient Administration System (EPAS)
  • Queen Elizabeth Hospital (TQEH) in Adelaide gets combined patient administration and electronic medical record system, already used in a number of other SA hospitals, super clinics and health centres
$422m including operating and support costs over 10 years
Auckland region eReferral system
  • Auckland, Counties Manukau and Waitemata district health boards (DHBs) serving the Auckland region are phasing out fax and postal mail referral letters from GPs, specialists and allied health providers; all referrals into the DHBs’ hospitals and health services must go via electronic platform from March 2017.
n/a

Source: Pulse+IT

Core concerns remain about the completeness and accuracy of records, however. The unprecedented degree of control that the MHR gives patients over their own records triggers much of this concern. Patients’ decisions not to disclose information in their MHRs may inadvertently lead to adverse health outcomes. Yet a counterargument here is that non-disclosure with unintended consequences could occur irrespective of whether a patient possesses an MHR.

Further nudges or additional incentives required?

A national electronic health record—relevant information, accessible to all, whenever, and whenever required—is not here yet. Enrolments have been boosted by the addition of consumers in the ‘opt-out’ trials, but available statistics imply that clinical and consumer usage remains relatively low.iv Achieving more active use of the system could require further nudges or additional incentives. Aside from changed behaviour, technology changes in the form of improved coding of records, easier storage and transmission of scans could also encourage use. Such changes could take the MHR closer to the original vision of a system designed to support better decisions and patient health outcomes, reducing waste and improving efficiency.

Australia’s national electronic health record still remains at a relatively nascent stage while a patchwork of electronic health record systems is emerging across the country. Over time, that patchwork of systems could be increasingly integrated with the MHR system. A scan of significant e-health projects underway or recently completed in Australia and New Zealand hints at some possibilities (see Table 1). In light of such developments, it seems likely that the MHR system will continue to evolve as a part of a larger organically evolving digital health ecosystem. All MHR users may have to contribute more to derive greater benefit.

 

[i] Reuben Finighan, 2015, Beyond Nudge: The Potential of Behavioural Policy, Melbourne Institute of Applied Economic and Social Research, Policy Brief No. 4/15, Melbourne, accessed 26 September 2016

[ii] Australian Digital Health Authority, 2016, Practice Incentives Program eHealth Incentive, accessed 26 September 2016

[iii] Train IT Medical, 2016, My Health Record Webinar, accessed 26 September 2016

[iv] Australian Digital Health Authority, 2016, My Health Record Statistics–at 11 September 2016, accessed 26 September 2016,

© Australia and New Zealand Banking Group Limited (ANZ) 2016 ABN 11 005 357 522 AFSL 234527.

The information contained in this document is of a general nature only it does not constitute financial advice. It should not be used as a substitute for consultation with professional advisers.

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