My Health Record videos

Audio Transcript.
 

Amandeep: I think as GPs we've been naturally skeptical about the My Health Record which we tend to err on the side of caution until proven otherwise. As being somebody who's been quite deeply involved in educating people around it, I think it has so many benefits that actually outweigh the disadvantages that we keep focusing on. I think this is the way the rest of the world is going, I think we are being now seen internationally as a leader in this space will be one of the first few countries to have this national record, I think patients are excited about it. With My Health Record, I think it's important to remember it is really about the consumer, it's about the patient. It's for the first time in Australia actually giving the patient their own information.

We really need to understand that anything that empowers our patients is something we should encourage and support. So for patients, they all of a sudden are able to take their own personal medical information with them wherever they go through the health system and across Australia [On-screen text: My Health Record may provide healthcare providers with helpful medical information not already in their local records]. The benefit of this is not just healthcare providers that get to contribute to the content of this record, it’s actually a patient's own information. They can put up their own health summary, they can put in their allergies, they can add in their medication and certainly putting in emergency contact details. Also definitely there's contribution from all parties in that record.

Audio Transcript.
 

Penny: One of the issues that's been a problem over the last few years in disasters, is the availability of information and patient history. With the rollout of the My Health record we now have a wonderful opportunity to change that. So now when a disaster occurs and we're struggling to find information on individual patients, or patients from other practices are presenting, or even patients presenting from out of the area - we now have the opportunity to access those records through My Health Record. So this provides a wonderful opportunity for managing the health of patients much more holistically and with much more knowledge. Previously, we would have had a patient present with no details, they're in distress, they don't really have their list of medications and we're having to manage that, and that can be very time-consuming.

Audio Transcript.
 

Nathan: My Health Record has an interesting and slightly more unique approach to consent. There are three types of consent essentially - implied consent, express consent, and standing consent. So My Health Record uses standing consent, which essentially means that any health care professional who has access to My Health Record can access your health record if you've set one up. The conversation around how this developed was interesting, but essentially the standing consent model was chosen because it was one that was regarded that would lease interfere with workflow and allow for clinicians to do what they normally do. So for the healthcare professional to have to say to the consumer every time “can I access your My Health Record? Is it okay for me to send something up to My Health Record” that would massively interfere with the normal clinical consultation.

Standing consent model was developed as a way of overcoming that. It doesn't impact upon an individual or patient’s rights because at any point they can “say please don't send that information up to My Health Record”, or they could lock their My Health Record down or they could choose to remove documents from My Health Record.

Audio Transcript.
 

Sophie: The GPs aren't obligated to use My Health Record. That's a question that we've had quite a lot. There is no obligation in the legislation for GPs to use My Health Record. The question really is ‘should they use My Health Record?’ And I think the advice that we've been giving is if My Health Record is adopted, and it's clearly been widely adopted with I think 90% of Australians having a My Health Record, if it's adopted to that extent and in five to ten years time everybody's using it - will a GP be deemed to be negligent for not looking at information that's in My Health Record? So it's not mandated, but the duty of care for GPs is really prescribed at common law and that involves looking at what a GPs peer would do.

So if you're a patient and you have a My Health Record, and everyone at the clinic has a My Health Record, and a particular GP decides that they don't want to participate in My Health Record but there's key information in there and they don't look at it when generally Health practitioners are using it it might be deemed to have fallen below the standard of Care by not engaging with My Health Record and potentially missing some key information.

Audio Transcript.
 

Amandeep: The My Health Record, as everybody is aware, is a national electronic health record system. About 92% of our patients in Australia will have one, so it's quite important that as a GP or practice owner that you're quite familiar with it because you will get patients coming in and asking you either to upload information or to look at the record to see if information has been put up there by other health care providers. It's quite a simple process to register in terms of registration. As a practice, it's important that you register with the healthcare identifier system. Make sure that you have an HPI-O and that all of your health care providers have an HPI-I, and that those two systems are linked. Then you have to go through the authentication process, which again can be done quite easily online. That's either getting a PRODA [Provider digital access] or an NASH [National Authentication Service for Helath] PKI [Public infrastructure key] and you go through the process of registering for the My Health Record. There are a couple of roles that you need to assign to people within your practice and they'll be explained online. There's a responsible officer and the ‘OMO’ which is your organisation maintenance officer and those are important roles because they will be the ones that will interact or communicate with the Department of Human Services when you're changing anything or through any sort of maintenance of that registration process. For any practice to have access to My Health Record under the Act, they must have a My Health Record policy within the practice. The RACGP has kindly provided a template which can be used, you may need to modify it for your particular needs and uses in your practice but it’s a great place to start and gives you a lot of information about how you should actually be using and ensuring privacy and security around your use of My Health Record.

Audio Transcript.
 

Amandeep: So My Health Record platform is, you know, the security levels are on par with most of the other government platforms that are used such as Medicare and ATO. We don't really have concerns about those platforms. And I think the My Health Record will be, you know, it's at the same level. So I feel very confident in the security around the My Health Record. There are some safeguards that have been put in place at different levels. So there's safeguards at a practice level, and this comes back to the My Health Record policy that we encourage every practice to put in place. So things like making sure that people have a specific log-on when they go into their patient management system and only that person uses that log-on so that you can keep an audit trail of who's been accessing My Health Record through the conformant software.

There are lots of other things at the practice level, and just protecting your technology systems generally, which we've got a lot of resources on the RACGP website around that. The next level is more around the My Health Record itself. Patients have an ability to control a lot of access and they have some great privacy controls on the My Health Record in terms of being able to put a pin on the record or pin on certain documents. And they can choose which doctors or healthcare providers they wish to share that with. And I think that's important because there are parts of the healthcare system that the My Health Record touches like the pharmacy system or pathology and I think it's important for patients to choose what parts of that they want to share information with. And then the third level is the governance, and this is from a government level - the Acts and legislation that have been passed to protect the public and protect their information and also the penalties that are in place for people that do misuse access to the My Health Record.

I think when we look at that in totality, I think we can feel very confident that this has been taken very seriously by the government, by the Digital Health Agency, by all the stakeholders that have been involved and it's been the number one priority for making sure that if everyone has one, it's safe and secure.

Audio Transcript.
 

Sophie: Another question that we get is whether you have to include information from My Health Record when you get an order from the court or if you get a subpoena. They're slightly separate things, so if you’re issued with the subpoena, you don't have to provide copies of information that's in My Health Record. The subpoena usually is for a patient's health record and that can just be, for a general practitioner, the record they hold for that patient. It doesn't include any material that's in My Health Record. And the primary reason for that is My Health Record as we know is a summary, really, of what should ordinarily be in a patient's record. If on the other hand you’re issued with a court order, which is a court order made under the My Health Records legislation for provision of information in the My Health Record, then you would need to provide that information.

Audio Transcript.
 

Sophie: Practices can disclose health information for the purposes of providing health care to a patient. It's really quite simple the test is ‘are you actually doing something to provide a health service to that patient?’

A secondary purpose is anything other than the primary purpose, which is a typical lawyers answer, but the primary purpose being the provision of healthcare. So for any use other than the provision of healthcare… so a first example might be if you want to use some health information which could be as simple as a patient's email address to send them marketing information, for example, information about diabetes checks for 40 to 45 year old checks or prostate checks things like that - That's a secondary purpose. So it's not providing health care, but it's sort of related to it. So that's a really good distinction of when a practice can disclose health information and when they must disclose health information. And I think there's probably some confusion out there as to the provisions about when a practice can, or health provider can, disclose information for a secondary purpose. The assumption by some general practitioners is that they must disclose information in those circumstances but it's not a ‘must’, it's a ‘can’, it's a ‘may disclose’.

There's very few circumstances in which a practice or health care provider must disclose health information, and that's really with the court order or with the patient's direction, then you have to follow that directive. If there's a court order or a subpoena, and they’re two slightly separate things, then you must comply with that because that's an order of the court. But otherwise, it's not mandatory, it's permission that you can disclose in certain circumstances.

Another question that we get is whether you have to include information from My Health Record if you get an order from the court, or if you get a subpoena. If you are issued with a subpoena, you don't have to provide copies of information that's in My Health Record, the subpoena is usually for the patients’ health record and that can just be, for a general practitioner, the record they hold for that patient. It doesn't include any material that's in My Health Record. And the primary reason for that is My Health Record, as we know, is a summary of what should ordinarily be in a patient's record. If on the other hand you are issued with a court order, which is a court order made under the My Health Record’s legislation for provision of information in the My Health Record, then you would need to provide that information.

Can practices disclose information to third parties? That really depends on what information we’re talking about. So if we're talking about general health information, or if we’re talking specifically about information in My Health Record, My Health Record is actually more restrictive than the rules and legislation that applies to provision or disclosure of information generally in Victoria, New South Wales, the ACT - any of the states and territories. So broadly speaking, just looking at the general provisions in relation to health information and not My Health Record, a practice may disclose – they’re permitted to disclose - information to third parties in certain circumstances. So one example is if there's a serious threat to an individual's health or safety, a serious threat to the public health or safety, for a law enforcement function, again, that could be to provide information… I use example of if there's a siege and someone's been taken hostage, potentially providing information that might identify that person.

If you're a medical practitioner and you're facing a complaint or disciplinary proceedings, you can use it, it says in the legislation, really for the purposes of your professional indemnity insurance. What that means is you can use that health information to respond to a claim has been made against you. If a patient makes a complaint, clearly you need to access their record to be able to respond to the complaint. My Health Record is a little bit stricter, so you can for example, disclose information in My Health Record if there's a serious threat to an individual, but you need to notify the [Australian] Digital Health Agency of that and you need to use and disclose that information within five days of making that notification. That's quite different to the provisions under the general legislation. You can disclose information in My Health Record if there's a threat to the public without notifying the Digital Health Agency and without that time that time frame of five days. You can disclose information again or use information for the purpose of responding to a complaint against you, so again, for the purpose of your professional indemnity insurance. But you can't - and this is quite a significant difference - you can't disclose information to a law enforcement agency or a government agency without a court order. So any information in My Health Record cannot be disclosed to a third party without a court order.