Thursday, April 20, 2017

I Wonder Why Discharge Summaries Are Not Discussed With The Patient Before Being Uploaded To The myHR.

This blog appeared last week:

My Health Record in General Practice

Monday, 10 April 2017
Dr Steve Hambleton, MBBS FAMA FRACGP (Hon) GAICD
Follow Dr Steve on Twitter @SteveJHambleton
Amongst my other roles, I've been a GP at the Kedron Park 7-Day Medical Centre in Brisbane for the past 29 years. Many of my patients have been in my care for a long time and I know them very well but I cannot be there for them every day. Like a lot of GPs who have been in the same practice for a long time, I mainly treat people with chronic and complex disease.
I believe one of the responsibilities of General Practitioners is to facilitate patients’ interactions with the health system as a whole, and it’s particularly important for those with chronic ailments. For this reason, I am an early adopter of My Health Record – the secure, online digital summary of a patient’s pertinent medical information, including diagnosis, outcomes, medications, reactions and allergies.
The benefits of the My Health Record cannot be understated. One of my patients with a list of chronic diseases – heart disease, Parkinson’s disease, peripheral vascular disease, kidney disease and chronic myeloid leukaemia – was recently taken to a Queensland public hospital with an acute deterioration in his heart condition. As a result of his various illnesses, the patient had several different specialist doctors attending him, and each of these doctors was able to consult his My Health Record for information on his latest treatments, medications and outcomes. These details informed their own treatment plans. Ultimately, everyone involved, and particularly the patient, benefited from having all of his crucial medical information stored in one accessible digital file avoiding duplicate testing and the inevitable phone calls needed to find bits of information from multiple sources.
Another example benefit of My Health Record adoption involves the automatic inclusion of a patient’s hospital discharge summary. I’ve had patients come to see me so soon after a stint in hospital that their discharge summary hasn’t had time to arrive. Although sketchy on the details, my patient recalled that there were changes in their medications which I should to be aware of. In the old days, I’d have had to chase up the discharge summary, or call the hospital pharmacy, wasting time and resources. Now I can simply check the patient’s My Health Record, which in Queensland public hospitals, now usually contains a recently added copy of the summary that includes all the relevant information – a streamlined system in which, once again, the patient wins.
More here:
Note the last paragraph mentioned: I was given a copy of the discharge summary from my last admission and at the time I said to the intern not to upload the Summary. She had not heard of the myHR etc. so was more than happy to comply.
A day ago I checked and somehow it had been uploaded as there as one detail I was not happy with.
Seems to fascists have taken really taken over.  Looks like automatic does really mean automatic despite consent being specifically being denied.
Might make a call or two and see what is going on.
David.

20 comments:

Anonymous said...

A case of uploading photo to iCloud is not the same approach for eHealth. There is a technical void in ADHA David

Terry Hannan said...

In my situation I do not use the MyHR but all (or nearly all) are given a copy of their record with an explanatory note as to why I do this. The same copy is sent to the GP/Referrer and in my hospital is digitally scanned into the 51 million plus pages of scanned documents in the Digital health record.
The GP, patient or carer can choose to have the record (encouraged) by e-transmission with measures for confirmation of their receipt.
The patients are encouraged to take it with them everywhere and if possible store it on their e-devices.
The patient/carer of GP can add to the record and have direct communication with me via email or phone [Research by Sands shows the number of nuisance calls or communications with this model is leas than with the paper record].
ALL communications are added to and stored IN the record -eliminates ambiguity of communication.
So where should the record be stored and kept for access? With the creators-docs and patients/carers.

Anonymous said...

Will be inspiring to watch how the ADOHA ladies club makes a 'we are doomed without MyHR' from this http://mobile.abc.net.au/news/2017-04-21/confidential-health-records-found-dumped-in-sydney-bin/8460694?pfmredir=sm

Anonymous said...

Does anyone else find it odd that all these blogs there is not one comment. Not exactly demonstrating an organisation focused on creating a community of inspired followers and partnerships

Anonymous said...

Interesting observation 9:37 PM. There are no comments on any ADHA blogs and I checked maybe 80%. Not exactly inspiring stuff. Would be a failure in any other organisation, however ADOHA (which seems a fitting acyrom posted by others), will turn this around as success as the quality leaves the reader fulfilled and speechless.

Personally the MyHR is the problem for these folks, that and some very poor employment choices.

Anonymous said...

For those still interested in the strategy I found this little hidden gem when looking at how engaging (and therefore valuable) the ADHA blogs have been.

https://conversation.digitalhealth.gov.au/

Scroll down to a survey:

How could the use of digital services such as health apps best be managed?

Seems pretty clear apps need to be approved by clinicians, supported by evidence, and not but Government, the ADHA being government that counts them out. So much for Rachael De Sian and the Planet of the Apps. Unless of coarse these surveys and the results count for nothing.

Trevor3130 said...

I tried to append a comment to one of the ADHA blogs the other day. Went thru the registration process, responded to the email, etc. Got into the comment space, wrote it in, pressed 'Submit' ... several times without any noticeable effect. Gave up, won't go back.

Anonymous said...

Dear Doctors More, Frank, Hannan, Colclough, McIntyre and others including many other learned commentators to this widely read informative blog. Please take careful note of Dr Hambleton’s blog on the ADHA website “My Health Record in General Practice”.

Dr Hambleton describes in compelling detail how he has been using My Health Record to manage a patient with multiple chronic diseases, “heart disease, Parkinson’s Disease, peripheral vascular disease, kidney disease and chronic myeloid leukaemia”.

He tells how his patient was taken to a Queensland Public Hospital where several specialist doctors attended him and AND EACH of these doctors consulted the patient’s My Health Record for his “latest treatments, medications and outcomes” thus informing the specialist doctors own treatment plans. He also observed that everyone involved, particularly the patient, benefited from having all the patient’s crucial medical information stored in one easily accessible digital file. This avoided duplicate testing and multiple phone calls to find bits of information from multiple sources.

From this we can deduce that Dr Hambleton uses the My Health Record routinely when caring for those of his patients who are registered. He also points out that the colleagues in his practice can also see the new information (when needed) – whatever that might mean. One has to assume that the practice also has a shared health record on its computer system which his colleagues can also access when needed.

You should be asking that if Dr Hambleton can so readily do this today why then are all doctors not doing so?

Anonymous said...

April 24 12:02 PM. That is a valid point and Dr Hambleton does seem to demonstrate a use case, however does it justify a central document store? Or can the same effect be achieved using more modern methods. We also don't get a viewpoint from those specialists. However, always good to see examples where this works for clinicians, maybe we should refocus its use back to those I trust to understand health information and less on 'citizens'

Anonymous said...

Trevor, perhaps you need to fax it on a PDF?

I tried as well, a bit sloppy from Timmy the communication king, perhaps stick to limited text twitter.

Andrew McIntyre said...

Having accurate reliable information on a patient is essential. There are many ways to do this, but normally a patient has this information in a referral, which should be current. The centralized database does nothing to ensure currency and is a round about way of achieving the aim. Its not to say that it can't work but would not seem to be the optimal path. The optimal path is sharing information as appropriate, on demand in an atomic format, that is known to be current and only sharing with the appropriate clinicians.

john scott said...

Absolutely agree with Andrew.
We need a Communications paradigm not a Medical Records paradigm at the very heart of e-health thinking and acting.

Only in this context can we begin to work out appropriate and acceptable information flows; information flows that are the difference that makes a difference to care and uphold medicine's duty of care AND address the privacy as well as medico-legal issues associated with electronic data flowing within and across the various boundaries of health.

Bernard Robertson-Dunn said...

Re Dr Hambelton's nice little story.

"He tells how his patient was taken to a Queensland Public Hospital where several specialist doctors attended him and AND EACH of these doctors consulted the patient’s My Health Record for his “latest treatments, medications and outcomes” thus informing the specialist doctors own treatment plans. He also observed that everyone involved, particularly the patient, benefited from having all the patient’s crucial medical information stored in one easily accessible digital file."

He can't have been talking about My Health Record. MyHR is only a summary record and, as the government says on its web site, the information should be checked with other sources.

So all those specialists would have had to consult either the patient, who would have been a remarkable individual if he could confirm all that specialist information, of Dr Hambelton, who would have provided all the advice and information missing from the MyHR.

And is Dr Hambelton happy to have many other doctors prescribe treatment for such an obviously sick patient in isolation? And not be able to update the patient's Shared Health Summary? Dr Hambelton being the only one who can.

This last point is critical. It means that as soon as another doctor treats the patient, MyHR is potentially dangerously out-of-date and/or inconsistent. If more than one treats the patient, chaos reigns.

Dr Hambelton is a) not talking about MyHR b) doesn't understand how MyHR works or c) is wildly exaggerating.

Anonymous said...

@4.0 PM. "Dr Hambelton is a) not talking about MyHR b) doesn't understand how MyHR works or c) is wildly exaggerating."

Perhaps Dr Hambleton was mistaken! Or perhaps he has been compromised through his consultancy with the ADHA. Or perhaps he was beating a marketing drum with the dubious intent of promoting the My Health Record as part of his consultancy milestones.

But we know Dr Hambleton "is an honorable man". Consequently we have to assume he was mistaken.

tygrus said...

So taking the information as is and then assuming he has at least 1000 patients, we have 1 successful benefit from 1000 patients. If it costs $400M/yr and 4M people are registered then I'm looking at $100/reg.patient/yr. 1:1000 benefit = $100K per patient with actual benefit.
Until we get real numbers on use and real benefits then these are still wild estimates.

tygrus said...

So, how much is saved.
If he managed to have 20 events of MyHR benefits in the year that saved a total of 10hrs then this could save $1600 in the year ($160/hr similar to levelB consults). However, to have 1000 patients with a MyHR then this could have cost $100,000 to save that small amount.
If ADHA reduce the yearly costs while increasing the number registered then the related costs might be closer to $20,000 per year (the cost of having spent $2B plus funding of yearly digital health expenditure of DoH & ADHA from federal gov & states. closer to 20M registered).
It would require saving 125hrs per 1000 patients in the year to maybe be worth it.

Dr Ian Colclough said...

I agree with Andrew (1.03 PM) when he says “The optimal path is sharing information as appropriate, on demand in an atomic format, that is known to be current and only sharing with the appropriate clinicians.” That is something the MyHR cannot do, it was not architected to do so.

This is further reinforced by John (21.03 PM). The essential paradigm for e-health is the Communications paradigm and the Medical Records paradigm is subservient to it. In fact, there is a considerable amount of information transferred between service providers about the patient which in essence is not truly part of the Medical Records paradigm but very much part of the Communications paradigm. I have seen no evidence to indicate ADHA management and development personnel including Department personnel comprehend these differences.

And Bernard too (4.00 PM) reinforces this with his last observation that as “the other doctors are not able to update the patient's Shared Health Summary (Dr Hambelton being the only one who can)” then “as soon as another doctor treats the patient, MyHR is potentially dangerously out-of-date and/or inconsistent. If more than one treats the patient, chaos reigns.”

Anonymous said...

I would be careful measure the MyHR in cashable benefits, what I would like to see is the value it delivers, can the MyHR data be injected into a clinical workflow? Is it supporting clinical analytics, decision support, population health? And to what level of value, semantic interoperability is still a long way off, ADHA seems focused on intergration, which although a prerequisite for interoperability is not the same nor suffice on its own. Will the MyHR support P4?

The longer it progresses on its current trajectory the harder it will find a value driven role

Anonymous said...

How would we know if the record is current or not (no matter where it is stored)? The only way I can see is asking the patient.

Bernard Robertson-Dunn said...

"How would we know if the record is current or not (no matter where it is stored)?"

Excellent question. That's the Achilles heel of any and all health record systems, apart from those at the end of your bed in hospital, but they aren't really health records, they are treatment records.

"The only way I can see is asking the patient."

And if the patient is unconscious, doesn't understand medical terminology, can't remember the name of the drug they were prescribed, just the fact that it's a blue pill, thinks a stroke is something their nurse/spouse does to calm them down?

To quote that famous philosopher Donald J Trump, nobody knew health care could be so complicated.