MHR security under the spotlight


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AMA president Dr Tony Bartone has again defended My Health Record, as up to 20,000 Australians opted out on the first day they could

Prime Minister Malcolm Turnbull reportedly told 3AW radio in Melbourne that around 20,000 people had opted out of the new system on Monday, despite a “glitch” in the system which returned error.

Between 16 July and 15 October, Australians have the ability to choose for a record not to be created for them.

During an interview with Health Minister Greg Hunt, ABC journalists attempted to sign onto the system and received an error message.

Shadow Minister for Health and Medicare Catherine King called the first 24 hours of the opt-out period a “disaster”.

Mr Turnbull told 3AW that he understood the glitch had been resolved.

Speaking to Sky News’ Ashleigh Gillon, Dr Tony Bartone said that “what we need to remember in all of this is that this is a new attempt, or a new system, to try and bring together a lot of information that currently exists in many different parts of the health system into an online, one-repository forum to assist doctors, especially doctors who don’t have a relationship with the patient in front of them in an emergency situation or in an unforeseen circumstance, to do the best they can, and with all of the available information that’s around in the system about that patient”.

“No one can guarantee the ultimate security of any system and I’m not an IT security expert,” he said.

“But it’s a balance between usability and utility versus all the benefits of having that secure, reliable source of summary of all the health data that can be brought together in the one place in time.”

He said that it was vital that Australians understand that individuals cannot use the record to check up on others unless there is “a relationship and an express authority to do that”.

He said that he did not believe private health insurance companies would be able to access the record in the future, “unless obviously the patient wants to share particular parts of his or her file, or his or her journey with their insurer”.

Meanwhile, mental health peak bodies are warning people with mental illness to opt out if they have concerns about privacy.

“We’ve joined together to tell people with mental illness: if you’re in doubt, opt out,’ says Shauna Gaebler, CEO of CoMHWA, the West Australian peak body for mental health consumers.

“My Health Record increases the risk of discrimination and health inequalities for people with mental illness. Until we know there are reliable protections, and answers to our concerns, we can’t ethically encourage people to stay in this system,” Ms Gaebler said.

“Our members face discrimination in almost every aspect of their lives,” said Maggie Toko, CEO of VMIAC, the Victorian peak body.

“We die 20 years younger than the average Australian, in part because many health workers can’t see past a diagnosis of mental illness to look for signs of physical health problems.”

She says that this is a phenomenon called ‘diagnostic overshadowing’, which is well known to contribute to delayed diagnosis of many life-threatening conditions, including cancer.

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1 Comment

  1. Ron Batagol
    23/07/2018

    I completely understand the concerns of the wider community over privacy issues.
    Also, I do agree that some sort of a portable system that is accurate for most of the medical and
    therapeutic episodes is better than no system at all.

    However, the reality is that, even though we live in this “post-Wikil eaks” era, if we are going to set up a form
    of “My Health Record” that will be reliable and accurate, in particular during times of need for urgent medical and therapeutic review ( eg.Emergency department admission), it can ONLY serve its purpose if it includes ALL of the medical and therapeutic information for that patient.

    However, my major concern is that human nature and issues over privacy issues, will often mean that consumers will arrange a “cherry-picking” opt out for specific episodes related to conditions involving medical and therapeutic issues, such as STI’s, conditions associated with depression, anxiety, depression or any other issue that they deem to be sensitive from a privacy viewpoint, about which they hold an unshakeable view regarding, what they deem to be, intrusion of their personal space.

    But, if a patient presents at an emergency department with a serious medical consequence arising from a severe, undiagnosed interaction, or a medical complication not readily discoverable from the “My Health Record”, surely that is the very time that we need access to a complete not an edited partial patient health record!

    In this context, aside from any arising issues concerning medical complications, just from the purely therapeutic viewpoint, as pharmacists it doesn’t take too much to identify a wide range of therapeutically significant drug interactions that could be missed in a cherry-picking exercise that I have described
    (just to name a few obvious ones- think of the various significant warfarin interactions- with metronidazole, anti-retrovirals, warfarin and NOACs with NSAIDs etc., Also digoxin and amiodarone, antihypertensive medication combos of ACE/ARB with diuretic and added NSAID’s – ( this could lead to triple whammy adverse renal consequences).

    So, how could we achieve the desired outcome of identifying and viewing the patient’s entire medical record, whilst still retaining consumer confidence in the integrity and privacy of the information?

    Well, frankly, at this late stage of the bedding down of the introduction of the “my health record”, it’s probably too late to initially achieve this!

    Obviously, what could have been done at the outset, would have been to have a complete universal personal health record, including restrictions to such information as is designated by the patient as “ to be viewed only in a medical emergency”.

    Then, just as we already do with our personal bank and personal online social welfare access files, a traceable single-occasion code, valid for a short period, emanating from the office of a designated senior medical manager of the My Health Record group, would be sent to an authorised medical practitioner’s mobile number, which would release access by a medical practitioner to the “embargoed information”in such a medical emergency. For that purpose the information would also be available to pharmacists, nurses and other health professionals directly involved in the care of that patient.

    OK, it is not a perfect system, and I’ll await for those who want to tell me the obvious- “it’s not a potentially
    perfectly secure system”!. But, given all of that, as just noted, such privacy protection has been shown to work effectively in other sensitive personal contexts, so surely it’s worth considering in setting up a system that will provide critically-needed medical and therapeutic patient information when needed in an emergency!

    At the end of the day, if not now, at some future “iteration” of the program, we need to work towards the long-term, obvious solution to the balance between personal privacy and urgently-required access to patient medical records.

    Ron Batagol

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