MHR delay dropped in another win for convenience medicine

Against the advice of peak medical bodies, DoHAC will drop the week-long delay before pathology results are uploaded to My Health Record.

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Patients will soon be able to access their pathology results instantaneously via My Health Record, in what some GPs are warning is a short-sighted play for political points by the Health Department.

There has historically been a seven-day window between pathology tests being completed and patients being able to view the results on My Health Record.

In theory, the week-long gap left time for a patient’s regular GP to follow up on the results or break bad news in person.

Around six months ago, the Department of Health and Aged Care announced plans to make it mandatory for pathology providers to upload results to the program.

This part of the plan was broadly welcomed by colleges and peak bodies.

The more controversial aspect of the My Health Record modernisation plan was to remove the seven-day delay.

Multiple stakeholders, including the Royal College of Pathologists of Australasia, were against this idea.

Submissions closed in October, with heated protests from the RACGP and RCPA continuing into January.

Last week, the Department quietly updated its page on the My Health Record modernisation project, seemingly confirming that the changes would be going ahead as planned.

The exact time frame is still unknown; a previous version of the webpage stated that the changes would come into effect some time in 2024.

“There’s a number of scenarios here that are potentially concerning,” RACGP practice technology committee chair Dr Rob Hosking said.

“If a patient were, for example, to find out the results of a scan or biopsy that tells them they’ve now got cancer and they haven’t had a chance to talk to their doctor … that could be alarming.”

Dr Hosking, along with 23 other representatives, sits on the Clinical Reference Group providing strategic advice for the My Health Record modernisation project.

Perhaps even more alarming, he told The Medical Republic, is a scenario where a relatively well patient – say, a man in his 50s – gets a blood test that reveals iron deficiency.

The patient sees this on his My Health Record and decides to rectify the problem with over-the-counter iron supplements.

Thinking he’s got it figured out, he cancels follow up appointments with his GP and ignores calls from the practice.

“Until we prove otherwise, [that patient] has got bowel cancer,” said Dr Hosking.

“But he won’t know that because [lay people] don’t interpret pathology results that way.

“We really need some sort of nuance to this, and unfortunately the government doesn’t get that.

“They think: we will just do what the voters want, and the voters want access to results.”

The tension at the heart of the issue is between patients who want convenience and doctors upholding clinical standards.

It’s a pattern that is repeated across primary healthcare, from online-only telehealth startups offering medical certificates and prescriptions to pharmacist-led prescribing trials for common conditions.

The phenomenon has not escaped the notice of immediate past RACGP president Adjunct Professor Karen Price.

“The death of expertise is a current megatrend,” she told TMR.

“What we are going to get is people doing their own internet research.

“We are a developed country with one of the best healthcare systems in the world, and [successive governments] are constantly undermining it for popularity reasons.”

The counter-argument here is that medicine is overly paternalistic and that patients should be trusted to act sensibly with their health information.

Professor Price stressed that the concern from health professionals was more than a power grab.

“It’s not about withholding information from patients … this is about professional clinical expertise needed to interpret the context of a pathology test,” she said.

RCPA president Associate Professor Trishe Leong compared the seven-day delay to seatbelts – an inconvenience 99 times out of 100, but extremely useful that one time.

“It’s down to that argument of convenience versus protecting that small segment of the population that actually might experience harm from this,” she told TMR.

“And that’s what we’re all about as doctors, we’re keen to avoid causing harm to people.”

She also questioned the value of removing the seven-day period.

“People should have access to their results, that’s what My Health Record is for,” she said.

“But as a college, we’re not sure that it’s going to be an improvement to healthcare for patients to have access to these results immediately.”

DoHAC has allowed that there “may be some circumstances where there will still be a delay, such as where there is evidence of clinical safety or other risks”.

These are yet to be determined but will be based on clinical and consumer advisory group advice.

“We’re making sure that we work with the government now that they have decided they’re bringing this in … to try and come up with guardrails that will put a bit of rigour around this and make sure everybody’s protected,” AMA president Professor Steve Robson told TMR.