My Health Record – What Doctors Need to Know

My Health Record is a digital record allowing a patient to access a summary of their health information securely online. The record can also be accessed by health practitioners who are directly involved with the patient. This year there is a My Health Record Expansion Program being implemented across Australia. We spoke to Katrina Otto, an official My Health Record trainer, to find out more about how the new system will affect patients and practitioners.

What does opt-out mean? When does this come into effect?

“What it means is that a My Health Record will be created for all Australians, which healthcare providers and the people themselves can access. Up until now, people have had to opt-in, which means they had to decide if they wanted a My Health Record, then go to MyGov or Medicare, or to their general practice and have somebody create the record for them.

“That opt-in process, while it has become more efficient over the past few years, still takes time and effort. So, after a trial of approximately 1 million Australians and subsequent evaluation, legislation was passed to allow an opt-out system. The opt-out period goes from July 16 to  October 15 and that’s the time people will be told about My Health Record and also told they can opt-out if they do not want a record created for them”.

Can patients opt-out at any time?

“Yes anyone can opt-out at any time, by phone or by going to myhealthrecord.gov.au and selecting ‘Opt out now’ . They can also opt back in later if they choose. My understanding is it will take about a month after the end date of October 15 to get it all finalised and then by the end of November most Australians should have a My Health Record”.

What type of providers will be uploading information to My Health Record?

“Providers who will be uploading documents to My Health Record are doctors, registered nurses, Aboriginal health practitioners, and allied health professionals who are registered with AHPRA”.

Who has access to My Health Record?

“As well as patients, others who have access to My Health Record are registered practitioners who are providing direct healthcare for the patient. It’s worth noting that there are strict rules and penalties for deliberate and malicious misuse of the system. There are also privacy settings which provide additional protection for a patient should they be worried about unauthorised access”.

Do GPs need to get consent from the patient each time they do an upload?

“No. They don’t need to get consent from patients every time they access the record, but they do need consent the first time.  I would say beyond this, it is really important that clinicians have a discussion with their patient about what My Health Record is, what they may be uploading — while updating the health summary with them — and possibly even discuss that at times they may access the record without the patient being there. For example, if the patient was admitted to hospital”.

Is there an ability for providers to upload information that only providers are able to read?

“No. I want to stress My Health Record does not replace our usual communication. Currently, if information is going from clinician to clinician, that’s secure messaging and that doesn’t change because we have My Health Record. A hospital discharge summary, for example, will still be sent from the hospital via secure messaging to the patient’s usual GP.

“What will happen now though is a copy should also be uploaded to the patient’s My Health Record by the hospital. This could also be very helpful should the patient need to go to another hospital or see a clinician elsewhere as they could access that summary rather than needing to get it faxed, or working without that information.

“This is a really important point because sharing of these health summaries is not new. We do this every day between healthcare providers now, we just do it via paper and fax. My Health Record is the modern way, it allows real time sharing of important clinical information between healthcare providers. What is very new though is the patient having access to their own health information”.

Can patients see who has accessed their My Health Record?

“Patients can see the practice who has accessed their record, not individual providers. I would use this question if I may to gently remind practices now is a good time to audit and improve their local practice IT security — passwords, processes etc — as it’s often at that local IT level that there are security issues”.

Does My Health Record update in real-time?

“It’s a hard question to answer because of both local IT infrastructure plus internet coverage from rural to remote areas etc, but I have not found there to be a lag”.

Whose responsibility is it to ensure the information in the record is correct?

“It is the doctor’s responsibility to ensure that the information they are sharing about their patient is correct to the best of their knowledge at that point in time.

“It is also part of our current standards to check clinical data we are looking at with patients, whether that data is on paper or My Health Record, because the data may no longer be accurate, or patients may wish to share information they have never shared before.

In understanding the enormous change-management challenge of My Health Record, we need to acknowledge that curating health records takes time.

“I see summaries and referrals shared within a practice and on paper every week that have no medical history recorded, inaccurate medication lists, an allergy missing the anaphylactic reaction etc.  I had a GP say to me ‘I don’t have time to update the health summary in my software, the hospital will know the patient can’t possibly be on all that medication’.

“When I’m being very cheeky, I say to doctors, ‘You know, as a business woman, I cannot print or email you an invoice that’s 50% correct, so why is it okay that  my medication list is 50% correct?’

“I am hoping patients seeing their own information and being part of the conversation will drive improvements and I would like data quality to be part of every My Health Record conversation.

Will patients be able to see their test results from their My Health Record?

“Yes, this has started. Certainly, in parts of the Northern Territory test results have been uploaded to My Health Record for a while. It’s also starting to happen in other states with the bigger pathology and radiology providers coming onboard first. Like other areas of My Health Record, there have been special considerations put in place for more sensitive tests and health information.

“I do a lot of training around patients having access to their own results at the moment. While most seem supportive of the concept, some have concerns that are important to work through. I suggest to practices to re-evaluate and improve their practice processes around results. They also need to have a discussion to let patients know the doctor will still get results first but after 7 days they may see their result on their My Health Record and the implications of what they may see.

Have I missed anything?

“I think we need to acknowledge that for time-poor doctors, asking them to spend more time, whether it be having discussions about My Health Record with patients or curating the all-important health summary, is hard. I am hoping My Health Record will quickly become embedded in our practice routine and will save doctors many of those time-consuming telephone calls from hospitals or other clinicians chasing information, or save them the money they currently spend paying staff to chase and send documents.

“Finally, I would like to say we have a great opportunity in Australia now. Instead of localised silos of information, we have one My Health Record system that covers our whole country. I think that’s pretty amazing. Critical information will be accessible for clinicians and patients at the point of care. Let’s use it and use it well”.