Will Australia’s EHR have a divine resurrection? The devil is in the detail.
The digital health sector had a lot to say about the Strengthening Medicare Taskforce report handed down last Friday.
While there was a consensus that reform is critical, some key players felt they had heard it all and were not holding their breath. Others expressed alarm that the My Health Record (MHR) will be “modernised,” in yet another a Lazarus-like resurrection.
Tim Blake, Managing Director of Semantic Consulting, said the report is “largely just hand waving” by a group of people who know what needs to change technically but not how the change should happen.
“Digital health experts have been advising the government on this issue for nearly a decade. I can show you a report I wrote for the Commonwealth Department of Health from 2015 where I recommended similar changes,” he said.
Mr Blake said his concern about the Strengthening Medicare Taskforce (the Taskforce) report was that digital health expertise was not properly represented.
The Department of Health and Aged Care told The Medical Republic that advisors included Ms Amanda Cattermole and Dr Steven Hambleton, and Chief Clinical Adviser to the Australian Digital Health Agency respectively. The department said that the Taskforce invited submissions from interested organisations and also received a presentation from NSW Health on the Lumos data linkage project.
From report to action
FHIR guru Grahame Grieve has advocated for interoperability standards in healthcare for over two decades. He said it is “hard to be excited about it”, given the trajectory of the implementation of those ideas.
“It’s basically the blueprint that we’ve been waiting for 20 years to be implemented and all we’ve gotten is a rather useless document database in the sky,” he said.
Mr Grieve said the challenge will be in turning the report into meaningful outcomes for strengthening Medicare.
“We know that if we get better data, it would give us better insights into how the care is inefficient. But insights are not the same as actually leveraging data to make it more efficient, more effective,” he said.
MHR is a centralised model where, in theory, all health records are uploaded and then distributed as required. However, the advent of cloud-based solutions and consumer demand for real-time data opens possibilities for distributed models, such as those in Denmark and the United States.
Patient-centred access
Dr John Halamka is President of Mayo Clinic Platform and has helped various governments plan their healthcare information strategies.
In considering the Taskforce report, Dr Halamka said it is useful to consider all problems from the perspectives of technology, policy, and culture. He posed a few thought-provoking questions.
“Has Australia put the data before the patient? Is this data-centric or patient-centric? Would making the strategy patient-centred, rather than data-centred, change the ambition to retain a centralised library of historical health data?” he asked.
Dr Halamka said that the technology is mature enough with FHIR APIs enabling the exchange of information from any provider to any patient via any app.
He said this kind of interoperability was mandated by law in the United States in the 21st Century Cures Act.
“That’s the policy part. And culturally all patients in the USA expect to receive all data from their providers,” Dr Halamka said.
‘Modernising’ My Health Record
Associate Professor David Rowlands is one of a team of digital health experts who advise the World Health organisation. He said the report didn’t provide enough specifics on what the taskforce exactly intended.
“It’s pretty high level. And with all these sorts things the devil is always in the detail. The big question now is, ‘what’s the process to get that detail?’”, he said.
Mr Rowland said widespread interoperability is preferred, but that he can still see MHR being an important “part of the puzzle”. He said that MHR needed both a technological refresh and data interoperability.
“What you can do is refresh bits and pieces as you go, rather than do it in one big bang, which you might have to wait another 10 years for. And while you’re doing the refresh you can build in provision for data interoperability for health, business and workflows,” he said.
Technical or cultural?
Mr Blake said that significant cultural change would be required to move on the Taskforce report.
“Many clinicians today see documentation, and the sharing of that documentation, as far more of an administrative issue than a clinical one. Until we can change that mindset, it doesn’t matter how much granular data we gather, or how many FHIR interfaces or openEHR archetypes we build,” he said.
Mr Blake said that ultimately interoperability is a clinical issue.
“It’s about continuity of care and clinical safety. Only once documentation is recognised as a clinical need will we begin to solve the interoperability challenge,” he said.
The Department of Health and Aged Care told TMR that interoperability was not just an MHR issue and that all health information systems would need to “operate with the same technical and data sharing standards”.
“We will work with all stakeholders, including states and territories and the health innovation and software vendors will be essential to establish the “national rail gauge” for health information sharing,” a Department spokesperson said.
As MHR appears to be up for yet another resurrection, it remains to be seen whether the end result will be more like Lazarus or Frankenstein.
