My Health Record (and E-scripts): essential new resource for physicians-a personal perspective.

From a personal perspective of an endocrinologist in private practice: Integration of the My Health Record into everyday clinical practice is time- and cost-saving, allows for more accurate record keeping and most importantly improves overall patient care. The main deficiency at present is incomplete uptake by medical specialists in private and public practice, as well as pathology and imaging service providers. We will all reap the benefits as these entities become engaged and contribute towards making this electronic medical record truly universal.

The effect of My Health Record use in the emergency department on clinician-assessed patient care: results from a survey.

BACKGROUND: The emergency department has been a major focus for the implementation of Australia's national electronic health record, known as My Health Record. However, the association between use of My Health Record in the emergency department setting and patient care is largely unknown. The aim of this study was to explore the perspectives of emergency department clinicians regarding My Health Record use frequency, the benefits of My Health Record use (with a focus on patient care) and the barriers to use. METHODS: All 393 nursing, pharmacy, physician and allied health staff employed within the emergency department at a tertiary metropolitan public hospital in Melbourne were invited to participate in a web-based survey, between 1 May 2021 and 1 December 2021, during the height of the Delta and Omicron Covid-19 outbreaks in Victoria, Australia. RESULTS: Overall, the survey response rate was 18% (70/393). Approximately half of the sample indicated My Health Record use in the emergency department (n = 39, 56%, confidence interval [CI] 43-68%). The results showed that users typically only engaged with My Health Record less than once per shift (n = 15, 39%, CI 23-55%). Just over half (n = 19/39, 54%, CI 32-65%) of all participants who use My Health Record agreed they could remember a time when My Health Record had been critical to the care of a patient. Overall, clinicians indicated the biggest barrier preventing their use of My Health Record is that they forget to utilise the system. CONCLUSION: The results suggest that My Health Record has not been adopted as routine practice in the emergency department, by the majority of participants. Close to half of self-identified users of My Health Record do not associate use as being critical to patient care. Instead, My Health Record may only be used in scenarios that clinicians perceive will yield the greatest benefit-which clinicians in this paper suggest is patients with chronic and complex conditions. Further research that explores the predictors to use and consumers most likely to benefit from use is recommended-and strategies to socialise this knowledge and educate clinicians is desperately required.

The European Union General Data Protection Regulation (EU 2016/679) and the Australian My Health Record Scheme - A Comparative Study of Consent to Data Processing Provisions.

As a general rule, lawfulness of data processing under the European Union General Data Protection Regulation (EU 2016/679) (GDPR) is based on affirmative, unambiguous, voluntary, informed, and specific or "granular" consent to processing of their data, including health data, by individuals referred to as data subjects. The GDPR grants data subjects the legal right to specifically agree to (or refuse) having their data processed in any of the ways statutorily defined as "processing". Individuals also have the legal right to be fully informed about each and every intended use of their data by data processors and controllers, and the right to refuse such use. In Australia, once registered on the My Health Record (MHR) system, "healthcare recipients" as patients-cum-data subjects are called under the MHR scheme, have the right to remove documents from their MHR files and block some health care providers from accessing their data. However, this study demonstrates that the notion of "standing" consent that the MHR scheme appears to have created does not conform to any of the principles and rules governing data subjects' consent rights under GDPR.

Legal and Ethical Issues Surrounding the Use of Older Children's Electronic Personal Health Records.

This article explores the legal and ethical issues surrounding the production, storage, retrieval and use of electronic personal health records of children aged 14 years and over. Specifically, we explore: (1) the capacity, consent and competence issues; (2) privacy and confidentiality concerns; (3) the tension between a child's right to autonomy and his or her parent's or guardian's rights and responsibilities; and (4) outline implications of this for the implementation of Australia's My Health Record system, particularly for children with communication disability who are high users of health systems and have high health information exchange needs.

Patient Access to Health Data: A Review of Philosophic and Healthcare Issues.

In 2012 Australia created a national Personal Controlled Electronic Health Record (PCEHR) known as "My Health Record" (MHR). However, MHR has seen low patient utilization. Debate regarding MHR has centered on utility and moral issues (e.g. data privacy). We conducted a narrative review to assess patient perception and clinical utility of PCEHRs worldwide. Results show patient and clinician support for PCEHRs but little evidence of improved outcomes and patient concerns regarding data providence.

A Log Analysis Exploring the Predictors of Electronic Health Record Access by Clinicians for Consumers Aged ≥65 Who Present to the Emergency Department.

Electronic health records are widely implemented, yet little is understood around adoption and use in the ED setting. Older patients (≥65) are a cohort likely to benefit from use. The primary outcome (MHR access) was explored using logistic regression of 9 independent variables. 28.33% of patients had their MHR accessed within 3 days of presenting. Access is more likely when patients arrive via urgent ambulance and/or are triaged as critical.

Physicians' and pharmacists' use of My Health Record in the emergency department: results from a mixed-methods study.

PURPOSE: This study aimed to explore pharmacists' and physicians' perceptions of use, barriers to use and the healthcare outcomes associated with use of Australia's national personally controlled electronic health record-known as My Health Record-in the emergency department. METHODS: A mixed methods approach was deployed, including surveys and individual semi-structured interviews. All physicians and pharmacists who work in the emergency department at Cabrini Health (a non-for-profit healthcare provider in Victoria, Australia) were invited to participate. Due to the timing of elective blocks, physician trainees were excluded from interviews. RESULTS: A total of 40 emergency medicine clinicians responded to the survey. Over 50% (n = 22) of all respondents had used My Health Record in the emergency department at least once. A total of 18 clinicians participated in the semi-structured interviews, which led to the identification of three themes with multiple sub-themes regarding My Health Record: (1) benefits; (2) effectiveness; and; (3) barriers. CONCLUSION: Participants reported My Health Record use in the emergency department delivers efficiencies for clinicians and has a heightened utility for complex patients, consistent with previous research conducted outside of the Australian setting. Barriers to use were revealed: outdated content, a lack of trust, a low perception of value, no patient record and multiple medical record systems. The participants in this study highlighted that training and awareness raising is needed in order to improve My Health Record use in the emergency department, a need stressed by physician's. Further observational research is required to explores meaningful MHR use at scale.

Pharmacists' Perspectives on the Use of My Health Record.

(1) Background: My Health Record (MHR) is a relatively new nationwide Australian digital health record system accessible by patients and a range of healthcare professionals. Pharmacists will be key contributors and users of the MHR system, yet little is known about the perceived barriers and benefits of use. (2) Objective: To explore pharmacists' perspectives related to potential benefits and barriers associated with use of MHR. (3) Methods: An online survey was developed and face-validated. The survey was advertised to Australian pharmacists on pharmacy professional bodies' websites. This was a cross-sectional study using an anonymous questionnaire. Descriptive statistics were used to describe the distribution of the data. Chi-square, Kendall's tau coefficient (tau-c) and Kruskal-Wallis tests were used to examine the relationships where appropriate. (4) Results: A total of 63 pharmacists completed the survey. The majority of respondents worked in a metropolitan area (74%), and the most common workplace setting was community pharmacy (65%). Perceived benefits identified by responders include that the use of MHR would help with continuity of care (90%), and that it would improve the safety (71%) and quality (75%) of care they provided. Importantly, more than half of pharmacists surveyed agreed that MHR could reduce medication errors during dispensing (57%) and could improve professional relationships with patients (57%) and general practitioners (59%). Potential barriers identified by pharmacists included patients' concerns about privacy (81%), pharmacists' own concern about privacy (46%), lack of training, access to and confidence in using the system. Sixty six percent of respondents had concerns about the accuracy of information contained within MHR, particularly among hospital and general practice pharmacists (p = 0.016) and almost half (44%) had concerns about the security of information in the system, mainly pharmacists working at general practice and providing medication review services (p = 0.007). Overall satisfaction with MHR varied, with 48% satisfied, 33% neither satisfied nor dissatisfied, and 19% dissatisfied, with a higher satisfaction rate among younger pharmacists (p = 0.032). (5) Conclusions: Pharmacists considered that the MHR offered key potential benefits, notably improving the safety and quality of care provided. To optimize the use of MHR, there is a need to improve privacy and data security measures, and to ensure adequate provision of user support and education surrounding the ability to integrate use of MHR with existing workflows and software.

The Twitter Adventure of #MyHealthRecord: An Analysis of Different User Groups During the Opt-Out Period.

My Health Record (MHR), which is an online health summary for Australians, was changed from the opt-in to the opt-out model, and therefore sparked a vast discussion on Twitter. In order to understand the debate, the information dissemination and the levels of engagement, we have analysed tweets posted from July 2018 to February 2019. In this paper, we report on the findings of the patterns of discussion, the hashtags and the numbers of retweets and likes from different user categories. The results show that the discussion was highly political, and the tweets from the MHR official accounts had lower propagation and engagement than other user groups. This work highlights the implications of using social networking sites (SNSs) to promote large-scale mandatory electronic health record systems.

The MyHealthRecord System Impacts on Patient Workflow in General Practices.

Digital health is widely believed to have vast potential in improving patient care. MyHealthRecord (MyHR) is a digital health information system which enables Australian citizens to access their health information centrally, making it available anywhere, at anytime. The aim of this study is to explore the adoption of MyHR in general practices in Victoria and understand its impacts. A qualitative case study research method was used to underpin this investigation. Ten general practices were engaged where MyHR was implemented/used. Detailed interviews with MyHR implementers were held and GPs were engaged in short interviews. Twenty observations were made during GP/patient consultations for health summary uploads. Findings indicate that the practice incentive payment (PIP) funding policy change encouraged the use of MyHR, but the adoption was limited to satisfy funding criteria. Change management was often extemporised. Health summary upload was a quick and easy process but was influenced by clinical system data quality and GP familiarity with the system. Community awareness and GP interest in MyHR was lacking. The conclusion is that MyHR was not well integrated in general practices nor the community. As a result, an improved engagement approach between healthcare organisations, the MyHR system operator and Australians is required.

'I'd like to think you could trust the government, but I don't really think we can': Australian women's attitudes to and experiences of My Health Record.

The Australian government's Australian Digital Health Agency is working towards its goal of enrolling every Australian in My Health Record, its national electronic health record system. This article reports findings from a qualitative project involving interviews and focus groups with Australian women about their use of digital health across the range of technologies available to them, including their attitudes to and experiences of My Health Record. A feminist new materialism perspective informed the project, working to surface the affordances, affective forces and relational connections that contributed to the opening up or closing off potential agential capacities when people come together with digitised systems such as My Health Record. These findings demonstrate that people's personal experiences and feelings, the actions of others such as the agencies responsible for system implementation and function, their healthcare providers and broader social, cultural, technological and political factors are important in shaping their knowledge, interest in and acceptance of an electronic health record system. Even among this group of participants, who were experienced and active in finding and engaging with health information online, uncertainty and a lack of awareness of and interest in My Health Record were evident among many. Affordances such as technical difficulties were major barriers to enrolling and using the system successfully. No participants had yet found any benefit or use for it. Affective forces such as lack of trust and faith in the Australian government's general technological expertise and concerns about data privacy and security were also key in many participants' accounts.

Recommendations for Enhancing the Implementation and Utility of Shared Digital Health Records in Rural Australian Communities.

Internationally, shared digital health records are becoming an important addition to improving contemporary healthcare provision. In 2012, Australia launched its version of a shared digital health record, My Health Record, but enrolment is slow and there remain challenges in its practical implementation. Further, people living with complex and chronic conditions in rural and remote communities often experience challenges in obtaining equitable access to contemporary healthcare provision, including eHealth services. This paper reports on research that explored the experience of and engagement with My Health Record, in a rural Australian community setting. Based on the key research findings, recommendations are presented for improving national roll out of My Health Record. The findings highlight, to understand and engage vulnerable communities and support their adoption and use of shared digital health records, there is a need to move away from traditional models of healthcare delivery toward person-centred care delivered from a digital complex adaptive systems perspective.

A content analysis of the consumer-facing online information about My Health Record: Implications for increasing knowledge and awareness to facilitate uptake and use.

BACKGROUND: Low health literacy, low levels of positive belief and privacy and security concerns have been identified as a significant barrier to personal electronic health record uptake and use. An important tool for overcoming these barriers is the consumer-facing information which accompanies the system. My Health Record (MyHR) is the Australian national e-health record system, for which a large suite of online resources exists to facilitate consumer registration and use. This study uses a number of different measures of health resource quality to assess the MyHR online consumer-facing information and identify any gaps or areas for improvement. OBJECTIVE: To analyse the quality and content of the online consumer-facing resources which support the uptake and use of MyHR. METHOD: Australian information resources aimed at healthcare consumers about the MyHR were included in this study. A comprehensive search using Internet search engines was conducted to locate all online consumer-facing resources about MyHR from both government and non-government sources. Readability (measured by Flesch-Kincaid grade level), year of publication/review, publishing organisation type, presentation style, linked websites, target audience, and themes were identified as important measures of health information quality, and these were recorded and reported on for each resource. RESULTS: Eighty resources met the inclusion criteria. The mean Flesch-Kincaid grade level was 11.8. Most resources were created by Australian government sources ( n = 55), and the most common target audience was the general public ( n = 65). Registration ( n = 51), privacy/security ( n = 49), and benefits of use ( n = 46) were the most common resource themes. CONCLUSION: The authors identified a number of gaps and areas for improvement in the provision of consumer-facing information about MyHR. Readability is too high for the general Australian population, and there are few translated resources, which means that the information provided does not cater to people with low literacy levels, communication disability, and/or difficulties in understanding written English. The target audiences for resources do not reflect priority groups that were identified during the MyHR development processes. There are also gaps in information provision about how consumers can use MyHR as a tool to meaningfully engage with health professionals and services to support their own person-centred care.

Consumer Perspectives on MyHealth Record: A Review.

The vision for Australia's national electronic health record system included empowering consumers to become active participants in their own health care. This paper aims to critically review the literature on consumer perspectives of Australia's My Health Record (formerly PCEHR). The review is based on a subset of articles (n=12) identified in the Australian EHR Repository (N=143), a repository of metadata of Australian Research on EHR located at Flinders University. Results show low levels of awareness and concerns about sharing records and equity of access for all Australians, which in view of the change from opt in to opt out raises concerns about explicit consent. Improved promotion and support, along with different models of access might lead to higher consumer engagement with, and use, of My Health Record, especially for populations at risk of digital exclusion.

An Approach for Enhancing Adoption, Use and Utility of Shared Digital Health Records in Rural Australian Communities.

Internationally, shared digital health records are considered an important addition to improving modern health care provision. Australia launched its version, My Health Record (MyHR), in 2012 but has experienced low adoption and challenges in practical implementation and evaluation. Individuals living with complex and chronic conditions in rural and remote communities often experience challenges in obtaining equitable access to health care provision. They are also supposed to face additional barriers to adopting and using eHealth services. This paper reports on research investigating adoption, use and utility of MyHR, in rural remote Australian community settings. Based on this research an approach for improving national roll out of MyHR is presented. The approach highlights a means to understand and engage communities with complex care needs, to support their adoption and use of digital tools. It also draws attention to holistic methods for evaluating and assessing impact at individual, community and health care provision levels.

Demographic characteristics of Australian health consumers who were early registrants for opt-in personally controlled electronic health records.

BACKGROUND: Differential uptake of, or access to, personal electronic health records (PEHRs) has the potential to impact on health disparities among certain social groups. In 2012, the Australian Government introduced the Personally Controlled Electronic Health Record (PCEHR), an opt-in system operated by the then National E-Health Transition Authority (NEHTA). In July 2016, the My Health Record (MyHR), an opt-out model, operated by the Australian Digital Health Agency replaced the PCEHR, providing additional support for consumers. OBJECTIVE: This research was carried out between 2012 and 2015, covering the opt-in PCEHR phase. The aim of the study was to explore demographic characteristics of Australian health consumers who were first to register for a PEHR, and to identify the age and gender populations less likely to register for a PEHR in the opt-in format. The study aimed to provide early data on registrants and potential methods to encourage individuals to register for a PEHR. METHOD: A cross-sectional study investigated differences in registrations for PEHRs from 2012 to 2015 by age and sex. RESULTS: Results revealed that males were less likely to register than females, and adolescents of both sexes were the least likely to register when compared with any other age group. Similarly, middle-aged males had among the lowest reported registrations, as did older females. CONCLUSION: While e-health has the potential to improve health outcomes and PEHRs the potential to empower consumers to better manage their health and improve their access health services, evidence from this study suggested that some population groups that experience health inequalities (e.g. older people) were underrepresented among registrants for PEHRs. As income, ethnicity and education are major drivers for health disparities in Australia, future research should focus on uptake and use of PEHRs (now the MyHR) from the perspective of these variables.

Patient perspectives on a personally controlled electronic health record used in regional Australia.

BACKGROUND: Personally controlled electronic health records (PCEHRs) are being implemented throughout Australia; yet few studies have investigated patients' experiences of using a PCEHR. AIM: To explore patients' experiences and perspectives of using a locally developed PCEHR implemented in an Australian health service. METHOD: Twelve patients completed individual semi-structured telephone interviews, which underwent inductive analysis. RESULTS: Participants described two main interdependent advantages of PCEHRs: improved quality of healthcare through better information sharing and enhanced patient capacity for self-management. To realise these advantages, widespread acceptance and use of PCEHRs by healthcare providers is required, and PCEHRs need to be simple to use and accessible. CONCLUSION: PCEHRs can produce tangible benefits for patients. However, maximum benefits will be realised when PCEHRs contain a complete collection of relevant health information and are carefully designed for easy use.