News

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Pandemic prompts massive spike in My Health Record use

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The pandemic has had many unforeseen consequences – and one of them seems to be a surge in the use of My Health Record, the digital database intended as a ‘single source of truth’ for patients and health professionals.
 
Figures published by the Australian Digital Health Agency (ADHA), which oversees My Health Record, show an exponential increase in visits to the website in the past year.
 
The ADHA reports a figure of 1.57 million for April last year, which rose to a high of 13.75 million in January. While the most recent statistics have fallen from that peak – in April 2022, they stood at 4.83 million – they still reflect a tripling in use from 12 months previously.

According to the organisation, those statistics ‘are at a total viewing level’ so could include one person viewing several documents. It also clarified that they are views by consumers, not healthcare providers (see update below).
  
Regardless of who is looking, the numbers reflect a huge increase in use and visibility for the patient database.
 
The ADHA attributes much of that to the pandemic, with upgrades last year allowing vaccination certificates and details from the Australian Immunisation Register to be accessed on the database more easily.
 
It explains a 61% month-on-month rise in October last year by the lifting of lockdown restrictions in NSW with residents looking for proof of vaccination. The ADHA also links the January peak to soaring COVID-19 case numbers, which again prompted people to check their vaccination status and PCR test results on My Health Record.
 
One of the most pertinent questions is whether the surge in public familiarity with the database will translate into greater reliability and detail within the individual patient records.  
 
For Western Australian GP Dr David Adam, who sits on the RACGP Expert Committee – Practice Technology and Management (REC–PTM), there are positive signs. A former IT administrator himself, Dr Adam believes there have been noticeable improvements since the system changed from an opt-in database to opt-out in early 2019.
 
‘I’ve definitely found it more useful recently compared to the early days,’ he told newsGP.
 
‘Our public hospitals in Western Australia are being much more consistent about uploading letters and results, and the Medicare, PBS and immunisation views are very helpful at times, especially with new patients.’
 
The My Health Record database has been one of the flagship digital programs under successive governments, although at times it has proved contentious.
 
The Australian National Audit Office reports a Federal Government investment of $1.15 billion from 2012–2016, with another $374.2 million spent from 2017–2020. The Department of Health previously told The Guardian almost $2 billion has been spent on the record since 2009.
 
After ‘opt-out’ legislation came into effect in 2019, the number of patients on the database has more than quadrupled.
 
There are now 23.3 million active My Health Records, the ADHA reports – or more than nine in 10 Australians. Of those registered for Medicare services in the country, around 9.5% are thought to have opted out.
 
In 2018, before the opt-out laws came into place, there were around 5.7 million patients on the database.
 
But while 99% of general practices have also now signed up, GPs report mixed results on the level of detail contained within the records, with around one in every 25 currently containing no data at all.
 
Among those is Dr Rob Hosking, who chairs the REC–PTM.
 
‘It is hit and miss as to whether results and other useful information is on My Health Record,’ Dr Hosking told newsGP.  
 
He believes more legislation is required to make it work better.
 
‘To make it more functional, it should be mandated that pathology and imaging results are uploaded. Currently only some results are uploaded,’ he said. 
 
‘Likewise, hospital discharge summaries should be mandatory to be uploaded as well as sent to GPs.’
 
However, Dr Hosking also sounds a strong note of scepticism about the likelihood of success.
 
‘GPs have been dreaming of receiving timely discharge summaries for years, so it seems even more unlikely that such a mythical thing will find its way to the My Health Record as well,’ he said.  
 
The possibility of automating processes among general practices is on Dr Adam’s radar, although he warns there would be considerable risks if such an approach were ever adopted.
 
‘There’s sometimes a discussion about whether information from GP software should be automatically uploaded, like it is from hospitals,’ he said.
 
‘This would need careful consideration as it would be a massive change and there is no doubt that confidential information could be accidentally shared, which would seriously damage trust and confidence.
 
‘It might also make the system harder to use as we know that the quality of data recording across and even within practices varies a lot.’

 Dr David Adam says design drawbacks can sometimes make My Health Record difficult to navigate.

In the meantime, both GPs reference the importance of convenience for GPs, with Dr Adam describing My Health Record details as ‘one of the many priorities that GPs are constantly juggling’.
 
He also cites design drawbacks that can make the system hard to navigate.
 
‘Learning how to use the filtering functions available in your software is important,’ he said.
 
‘For example, although prescription and dispense records can be helpful, the number of them may quickly overwhelm other information and being able to hide them will make it easier for you to find things.’
 
Dr Hosking in the meantime says he would like GP software adapted to provide My Health Record reminders.
 
Whether or not the spike in access to the system in the past 12 months is an anomaly due to the extraordinary circumstances of the pandemic remains to be seen.
 
It does, however, seem unlikely the shift in numbers will return to pre-pandemic levels – by way of comparison, ADHA’s 2019–20 annual report states 1.75 million people accessed their My Health Record for the entire financial year.
 
‘The My Health Record is like a social network: its utility is dominated by network effects,’ Dr Adam said.
 
‘As more providers start using it, it becomes more useful to us all.
 
‘However, it has taken a decade to reach the point where I am accessing My Health Record every day, and while the trajectory is improving it is not clear that it will ever deliver on its initial promises.’

*Update:
The ADHA responded to several newsGP queries after this article was first published. Part of the response has been used to clarify figures about increase in use above. The rest, along with the original questions, is reproduced below.
 

1. How far can GPs trust the completeness of information on MHR?
ADHA: My Health Record contains a summary of key health information to support the delivery of health care and is not intended to be a comprehensive record of an individual’s health information.  The completeness of the record is growing as more health providers connect to and use My Health Record.

 
2. How much of the increase in use was due to COVID-19 vaccination?
ADHA: While it is not possible to speculate why a person looked at their record, we can assess what has been viewed. In January 2022, the new COVID-19 Dashboard that was launched in late 2021 was viewed more than one million times. Consumers are also viewing pathology reports, with more than 1.7 million views in April 2022 (a 391% increase compared to April 2021). We have also seen significant increases in use – especially by pharmacies using My Health Record to help provide medicines to people during major emergencies like the recent Northern Rivers floods.
 
3. System design is cited as a particular issue. Any thoughts in response to that?
ADHA: GPs experience My Health Record through the clinical information systems (CISs) that they use in their practices. These GP CISs were the first software packages to integrate to the early releases of My Health Record, starting in 2012. Since then, GP CIS providers have made important enhancements to their products, and the functionality and utility of My Health Record has grown significantly. Many GPs have taken advantage of these changes which have enhanced their experience as users, and they have also dramatically increased the amount of clinical content contained in the system.
 
4. Any other context/comments on the use of MHR in general practice, and how you see that evolving in the future?
ADHA: The agency continues to make important enhancements to national digital health infrastructure, including the delivery of a new Health API Gateway. These enhancements will create further opportunities for GP CIS providers to optimise the user experience of their customers. The agency remains committed to collaborating with the healthcare software sector to seize these opportunities as they arise.  

It should be noted that My Health Record cross viewing has grown significantly in the last year. Public hospitals in particular are benefiting from content in My Health Record, with viewing more than doubling in the last 12 months.
 
5. In the most recent ADHA annual report, it reports 2,690,310 people accessing their My Health Record in 2020–21, which is described as a 14% rise. Yet in the 2019–20 report, 1,751,007 people reportedly accessed their My Health Record. I make that as a 54% rise, which tells a very different story. Could newsGP please get clarification?
ADHA: In 2019–20, the reporting was on unique views by an individual (0.5% increase from 2018–19). 

In 2020–21, the reporting was on total views not unique (14% increase from 2019–20).

In 2021–22, reporting will be at both a total and unique view level (unique volume of 5.36 million [until May] – 192% increase from 20/21, total volume 9.02 million [until May] – 235% increase from 20–21).
 
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ADHA Australian Digital Health Agency My Health Record

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