My Health Record’s invisible marketing strategy

The My Health Record is based on the invalid assumption that most clinical presentations can be coded in to a simple and straightforwards system.

In fact the same fallacy underpins the assumptions behind protocol driven medicine.

That’s one problem, then the second problem is that regardless of diagnostic category a good deal of rubbish is included in many patients histories, especially for psychiatric admissions ( where the patient is not in control).

My personal experience has been that I have found GPs unresponsive to my needs and also unresponsive to my requests that my history be updated with uncontroversial material like specific, verifiable items of past history. (ie previous operations). I guess that they couldn’t find paid time to complete the history but it was still annoying having to revise my history when referred to a specialist.

Why would anyone want flawed material included in a master file.

There’s some serious misdirection here:

“The analogy with blockchain isn’t by chance. My Health record isn’t built on blockchain (yet), but it employs some of the same principles with the provision of access keys via PKI (Public Key Infrastructure). This system not only regulates access, but like blockchain, ensures the content hasn’t been altered and keeps a full record of every key that accessed a record, what they accessed and what they did with the information.”

The PKI involved in MHR is nothing at all like Blockchain. The only thing the systems share in common is that they both use (different sorts of) cryptographic keys.

But the real weakness with My Health Record isn’t that there’s insecurity between computers accessing the system and the system itself (which is all that either PKI or Blockchain could assure against), but that the computers themselves are poorly guarded. While there’s a log of which computer accessed the system, there are no controls over who, in the clinic, had access. Since logins are shared across clinical teams and within clinics – and there are absolutely no plans to change this – all the crypto in the world isn’t going to help you understand whether it was a doctor, a nurse, the receptionist or the cleaner who looked at your record. It might even be another patient who happens to get access through an unlocked terminal.

And you’ll never know, because there are no individual logins within clinical teams.

“It’s also the first version, and should improve over time.”

Yeah, nah. Clinical systems don’t change that way – the cost of retraining people is prohibitive. I suggest you consult people who work in hospitals before you make claims like that.

I’m really not sure what your goal was in writing this. Was it because you didn’t know enough about MHR that you assumed the objections were unwarranted or overstated?

MHR is a good idea that’s incredibly difficult to execute. Most of the criticism I’ve seen comes from stakeholders who see operational issues getting data into the system, particularly duplication of workloads and a lack of trust that the government can really handle a product like this.

Unless you like seeing ads that spin how good the government is at large scale technology projects, I’m glad they are not spending millions on advertising and (maybe) investing that back into the service itself.

Hi, I am a GP working in both a suburban practice but also in a Y11-Y12 College. We help a lot of young people in the 15-19 year age range and they come to see us seeking non judgemental advice and support but requesting confidentiality. Over the last 10 years we have had thousands of consultations, significantly reducing the pregnancy rate and the spread of sexually transmitted diseases. Not one of the young people that have engaged with our doctors in that time have suicided. Although all services are bulk billed, the Clinics run at a loss but we continue with a grant from the College’s limited resources and the generosity of the doctors involved.

My Health Record (MHR) will now make this work very difficult and downright dangerous in some cases. We will have to stop bulk billing some items, avoid path testing and attempt to provide medicines from funds raised by charity. This will make our work impossible and so we now face closing our Clinic on 15 November. This closure will a very backward step for young people seeking safe and secure health advice.

Unbeknown to most people, MHR will carry information about the whereabouts, dates of birth, Medicare Item numbers, uploaded diagnoses, prescriptions and path testing for all children under 14yrs of age. For those between 14 and 18yrs of age, the Medicare items and generated prescription will not flow to MHR but path test results (such as STD and blood test) and prescriptions dispensed will be visible unless the patients, doctors and pharmacists take extra care and request that this data is not uploaded. There is a great risk of human error in all of this.

About 15% of students attending our clinic have a MHR and most of them do not know that they have one as their MHR was been set up by a parent at some time in the past. After November 15 all the students will have a MHR and when we break this news to them and mention the risks, they are visibly upset and become very worried. We all assume that they are all tech savvy and can get ‘control’ of their record but many do not know where to start and most have difficulty getting access.

As doctors we all have had many cases where young people would have been seriously injured, become distressed and made homeless if their medical records became visible to others. For some young people with problem parents and strict family backgrounds there is a real risk of self harm, possibly even suicide.This is a really serious situation and these possibilities have not been anticipated by the Australian Digital Health Agency (ADHA), their advisers and ‘experts’.

As doctors we all have patients who could benefit from a carefully curated, up to date and relevant MHR, especially older people and those with complex illnesses, allergies and medications. However, as GPs we just do not have the time to do all this extra work and our patients will not be too keen on paying us to maintain an accurate MHR for them.

Many doctors are opting out – both for themselves and their family members and that sends a message….

For young people, apart from a few exceptions, MHR could be a disaster and place many of them at risk. Clearly ‘Opt In’ is better that the current ‘Opt Out’ Plan and only then with the full and informed consent of the young person.

I am saddened by the ill informed support for MHR that is coming from the Governments, academics, the AMA and the Royal Australian College of GPs – they really need to consult with the doctors, nurses, psychologists, social workers and counsellors that currently work with young Australians.

MHR needs to be stopped in its tracks. We need to go back to the drawing board and work towards a fair and just system as a decent MHR could have some benefits. The tragedy is that some $2B has been spent so far – money that could be better spent in other areas.

If anyone reading my concerns can pass them on to relevant decision makers or media people, I will be grateful. My approaches to the Liberal government and the AMA have not met with any success to date.

Bob Walker, Principal, The Lindisfarne Clinic, Tasmania

If the system is so ‘wonderful’ and safe – them make it compulsory (mandatory) that ALL levels of POLITICIANS (Local, State & Federal Government) and government workers to have a Health Record so that the ordinary citizen can see that the leadership is setting the example FIRST.
Then allow the citizen to OPT IN if they can see the benefits of the system ? i.e SHOW me you are doing it first before asking me to believe and trust that the system will work !!!

Ask your sitting Local, State and Federal member if they have a My Health Record account already?