My Health Record

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My Health Record has been all in the news media, but when we take our rational breaths, where do we stand as far as prescribing is concerned? I'm Dr David Liew your host for this episode. Today I'm speaking to Shane Jackson, who's the CEO of the Pharmaceutical Society of Australia, and the clinical reference lead for the Australian Digital Health Agency.

Today, we'll be discussing the editorial he's written with Professor Greg Peterson, My Health Record: A Community Pharmacy Perspective, which features in the April 2019 edition of Australian Prescriber. Shane, thanks very much for joining us on the program today.

Thanks, David. Happy to be here.

So, let's get to the heart of this. Why do we need My Health Record? And what actually is it? Because I think there's a lot of misinformation out there about that.

I think what My Health Record does is it puts the consumer at the centre of their care. It allows them access to their information, but more importantly, it allows the consumer to be able to choose what health professionals have access to their information. Those health professionals with clinical information are able to deliver, and I’ve seen this multiple times, just deliver safer, more effective and more efficient care. Because there's nothing worse as a clinician trying to put pieces of a jigsaw puzzle together without the right information and from my perspective, medicine's information is a key component of that.

Absolutely. I think all clinicians can empathise with that. I think we've all spent time trying to piece together and guess what might be between the lines. But let's drag this out in its detail. Perhaps you can explain what kind of data it might capture.

Well, it could capture prescription records, it captures dispense records. GPs can upload shared health summaries, captures discharge summaries from hospital, patient-entered information, diagnostic imaging, pathology results. Specialist leaders and referrals. All of those pieces of information can be really useful in the ongoing care of the patient. And when I reflect on the medications, for example, the Pharmaceutical Society released in January our Medicine Safety Take Care report. It showed the extent of medication-related issues in our society. 250,000 people admitted to hospital each year because of medication-related issues, 400,000 present to an emergency department because of medication-related problems. That actually equates to about $1.4 billion per annum. So we've got a cost to our health care system, because we're not using medicines as well as what we should. And a key component of that is medicines information when patients transfer into and out of different settings. One of those key areas is into and out of hospital and medicines information from the community and what happens in the hospital settings, such as what can be included in discharge summaries, is vital information for people within the primary care environment. It allows us potentially to address some of those medicine safety issues, which are a significant burden on our healthcare system.

That's a lot of important information flowing around the place. How do we work now? How does this go from place to place at the moment?

Well, unfortunately, it doesn't go well from place to place. A lot of clinicians are still using fax, they're still using paper to be able to transfer information. That's just not ideal, when really, we should be working in a digital world. That digital world should allow us to have the access to the information that we need at the time we need it. So, at our fingertips. Instead of thinking, “Where's that piece of paper?”, we're saying, "Where's that piece of information that I know should be available to me."

I think about myself in the community pharmacy access to a discharge summary so that I can provide ongoing medication management care to that person, as they come out of hospital, is actually really vital information. From a community pharmacist perspective, it hasn't been ordinarily available and ordinarily accessible. Now, it is accessible. It just means that a pharmacist can be much more actively involved in those transitions of care.

On the flip side to that is the transfer of somebody who goes into hospital. The treating clinicians on admission to hospital can have access to medication-dispensing information that might allow them to have much greater insight into what the person was taking, so that they can identify whether, in fact, medications are actually causing their presentation into hospital.

I think it's very frustrating going both ways. If we were to look at that, at the moment, you can get that data, can't you? But it's just very difficult and tedious and, in practice, it's impossible to fit into your normal workflow. Would that be fair to say?

Well, what it's about is that it's about having the information in an efficient way. So yes, you could gather all that information. What My Health Record allows, is it's another source of information that can be more accessible and therefore allow the treating clinician to deliver more effective and efficient care because you've got another information source that allows you to put more pieces of the jigsaw puzzle together, especially on admission to hospital for example. So we've got nearly 70% of community pharmacies that are providing description records to the My Health Record system. That will become more complete over time. Therefore, trust in that completeness of information with regards to dispensing records will improve over time. It just means that those treating clinicians for example, in the hospital setting when they're doing a medicines reconciliation, so understanding what medicines the person is actually taking, can be, again, more effective and more efficient in how they deliver the care to that person who's presented to that environment.

Okay. Why are these efficient flows of information so important? The Federal Government spent a lot of money on this project. I think people are naturally a little bit guarded about the flow of information in this day and age. So why is that an important thing for healthcare in this country to have an efficient flow of information?

Well, because our clinicians are generally overworked, and our clinicians need to work in a health environment that's efficient. So that it allows them to deliver more patient care. Instead of spending time on gathering information, it allows them to be better utilised, that's the key point. I talk to my GP colleagues who are incredibly frustrated about having to chase pathology results, or having to chase discharge summaries, or trying to understand well, what's the dispensing of the medicines been for a patient? Now, it just means that over time that this record will become more complete, so that you're not chasing information. You can see more patients, or you can see the same patients for longer and allow you to be more effective in how you deliver the care. It's just about utilising our clinicians as we should in our healthcare system.

I can certainly appreciate the importance of that. But there's something more than that here, isn't there? In improving efficiency, what we're actually able to do as well is give a more accurate version of a patient's medical history.

Well, that's right. One of the studies that we quoted in our editorial, David, and this was a study that I was involved in some time ago now at the University of Tasmania, it just shows that two thirds of initial hospital medication charts that were charted by the prescriber contained at least one error because the prescriber didn't have access to that information. And so we actually showed, by having access to the community pharmacy dispensing records, that it reduced that quite significantly down to, I believe, less than 30%. So, it over halved those inaccuracies in the initial medication chart. I just think that access to information is just vital.

Okay, so it seems like there are avoidable errors, and there's avoidable danger that we can cut out through a health information exchange like My Health Record.

Yeah, again, just referring to our Medicines Safety Take Care report, that indicated that over 50% of that medication harm was actually preventable. From a cost perspective, now we've got the opportunity to deliver back $700 million worth of value annually into our healthcare system by avoiding some of those errors. We've got a big opportunity for some efficiencies, and actually a big opportunity for reinvestment of some of those costs as well into the healthcare system. Because we know that costs are rising in healthcare, so if we can reinvest those savings, we can really deliver some good value to the care that patients should be receiving.

Is this value something that we've seen translated in other systems across the world. Are we guinea pigs on this? Or is this something where we've seen runs on the board?

I think that in closed-loop systems, they're able to do that, where community pharmacies and general practice or primary care are linked in to hospital systems, and largely, some of the data that we get is from the US system. Not that the US system is the model necessarily that we need to go down, but some of their managed care systems actually with their closed-loop electronic medication management and health information exchanges, actually give us an ideal model to understand how we can actually improve the identification of medication-related issues on presentation to hospital or on discharge from care.

We're not guinea pigs, but we're one of the first countries to be able to have really comprehensive, patient-controlled My Health Record system that will over time deliver the information that can improve care of patients.

I think there's a lot of discussion about the risk, and a lot of people will seemingly make decisions they acknowledge are irrational when they are confronted with the risk. So let me ask you this first, what kind of risks exist in the system that are the status quo? What exists at the moment? And what are the risks from the introduction of My Health Record? Is this something that people should be worried about or not?

Well, I think, and that's why we released that report that I referred to before, the risks in doing nothing mean that we don't actually get the system improvement we should, and we continue to deliver suboptimal care because we're not using information as we should. The World Health Organization has released their third patient safety challenge, which is to reduce medication harm by at least 50%. So there's an international challenge to be able to do better. The risk is we actually don't do better because we do the status quo.

The second part is the risk you talked about patients and their perceptions here, well, from their point of view, their information, their health information is sacred to them, and it should be, and they should be in control of who can access that. They're in control with the My Health Record, they can choose the providers that are able to access their health information. What we need to do better is to identify to patients that their care can be improved through the use of systems like this. That's the important thing.

It seems to me at the moment that there's a lot of flow of sensitive information that occurs without the kind of regulation that My Health Record would bestow with a lot more inefficiency in the system, but people can still get access to sensitive information if they want to. That's still a risk that exists at the moment, that doesn't change, well in fact improves with My Health Record.

Well, I think My Health Record has shone a light on health information. That's a good thing. I know that there's been some concerns about records. Might be dispense records that have inadvertently gone to another person's My Health Record profile. But that's because the user, the clinical information system that might have been used in the pharmacy or in the general practice, is actually storing the wrong information. My Health Record's actually shone a light on that. That's actually really good, because what it's shining a light on is the need for clinicians to have really good data within their systems, because the information is the building blocks around My Health Record. Our clinicians need to make sure that their information is accurate because that information is actually delivering the care or guiding the care of patients.

Absolutely. If we were to look at this now, My Health Record is just really getting going now in medicines building information collecting. What would be an ideal system? What does this look like in five years’ time if My Health Record is a success? How does life change in medical practice in Australia?

It largely changes in perception and use. And this needs to be consumer driven. Consumers need to understand the benefits of these systems. That will happen over time because there will be examples of care, and there should be research around care that's been improved because of access to My Health Record. So, that information, whether it be in a community pharmacy, whether it be in a general practice, whether it be in a hospital, we will have the information that shows that there's been system improvement. And so that will drive confidence and trust within the system, because we actually have the examples and we have the research that shows patients and it shows clinicians that this has been beneficial to the healthcare system. So I think system improvements will be driven by trust and evidence of uptake and benefit of the My Health Record system.

Shane, it's been great chatting to you and being able to clear up some of the facts about My Health Record. Thanks for joining us on the podcast.

David, its been my pleasure. Thank you very much.

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The views of the host and the guests on this podcast are their own and may not represent Australian Prescriber or NPS MedicineWise. I'm David Liew, and thanks once again for joining us on the Australian Prescriber podcast.