more_vertThe practice of radiology needs to change for three reasons: subjective decisions about tests are a major contributor to the overuse of services, images are often inconsistently obtained and analysed, and radiology reports often include vague descriptions.
Preference: Administration and Health Services
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Advocating for the best possible My Health Record
I recently had a private meeting with Health Minister Greg Hunt in Melbourne to raise with him growing concerns being raised by AMA members, other doctors, security experts, politicians, patients, and the media about privacy and the My Health Record.
The AMA has a long history of supporting and promoting an efficient and secure electronic health record, but we have also emphasised that it must be the right electronic health record – one that meets clinical expectations, one that respects and protects patient privacy, and one that is acceptable and useful to doctors and patients.
Our priority has always been on ensuring that the clinical expectations of the My Health Record were achieved. However, the public and political debate around privacy and security of the My Health Record is extremely worrying, and must be resolved satisfactorily, or it could undermine the clinical objectives and benefits for doctors and patients, derailing the whole project for many years to come.
The AMA had to act, and we did.
At the National Press Club in July, I declared that I would do ‘whatever it takes’ to force the Government to act to ensure the privacy and confidentiality of the My Health Record and preserve the sanctity of the doctor-patient relationship. Only moments after the Press Club, I spoke to the Minister and arranged the now widely-reported meeting.
One of the major concerns, among others, is the provisions in the My Health Record Act 2012 that permit the My Health Record System Operator to use or disclose patient data to an enforcement body without a court/tribunal order.
So, backed by the AMA Federal Council, I took the following demands to Minister Hunt at our meeting:
- Amend the My Health Record Act 2012 to ensure sensitive health data is not disclosed without a warrant or court order.
- Introduce amendments so that if people choose to cancel their record, even after they opt-out, they will not end up with a permanent My Health Record.
- Develop and rollout a fully resourced, public information campaign to ensure all Australians are aware of the My Health Record and have access to all the information they need to make an informed choice.
- Extend the opt-out period to give people more time to consider that choice.
The Minister and the Prime Minister agreed to all these demands. Minister Hunt immediately issued a media release to that effect following our meeting.
This is a significant victory for AMA advocacy, but clearly there is still a long way to go.
The My Health Record is not new. It was formerly called the Personally Controlled Electronic Health Record and has been available and used since 2012. It is a patient’s own record – a summary of dis-aggregated information from many silos in the health system in the one place under their control.
It promises greater efficiencies in recording, storing, and sharing vital health information. It alone is not the solution, but it will be an enabler to wider platform improvement, allowing more innovation in electronic health records, communication, and information sharing. God knows, it might even spell the end of the fax machine in our health system.
As practitioners, we all know that if health care was simple and predictable, if a patient only ever needed clinical treatment from a single, regular clinician, then we would not need a My Health Record at all. The patient’s doctor would have all clinical information in their software.
But patients’ lives are more complex, dynamic, and unpredictable. Our health system is split across jurisdictions, across primary and acute settings, across private and public systems.
For me, as a GP, coordinating patient care for those with chronic and complex health conditions is one of the most frustrating aspects of the Australian health care system. Where it fails, as it often does, it is to the detriment of patient care.
Uncoordinated care is also wasteful. Tests are unnecessarily duplicated because test results are not always available to the other doctors involved in the care of the same patient. There is a real and immediate need to push for a reduction in medical harm due to things like polypharmacy and avoidable anaphylaxis.
We must solve all the problems and address all the concerns. Then we must push on to make a workable and safe electronic health record a reality, which is enthusiastically embraced. Of course, the time and effort placed on the nominated doctors, especially during the implementation, will be significant and must be recognised by the Government. This will be the focus of significant AMA advocacy going forward. Without this, the implementation will struggle significantly.
There is no doubt that more issues and concerns will arise. Some will be about the legislation and privacy. Some will be about the clinical benefits, or less than perfect interoperability. Some will be a matter for consumers as they decide whether to opt-out. Others will be for other peak bodies in the social services, security, privacy sectors, or other fields to consider.
The AMA stands ready to continue to work constructively to deliver a strong and effective electronic health record that works to improve the quality of patient care and coordination in the Australian health system.
Thank you to all of you who have provided feedback to date. I encourage you to continue to do so as we await the full and formal response from the Government on the next steps for the My Health Record.
Super Saturday for health
The big message from the Super Saturday by-elections is that health remains one of the biggest, if not the biggest, issue on the minds of voters, and will once again be a critical factor in the next Federal election, expected in the first half of 2019.
Labor, which retained the seats of Perth, Fremantle, Longman, and Braddon, – with Mayo being retained by the Centre Alliance’s Rebekah Sharkie – campaigned hard with a local focus on public hospital funding and access to health services.
There is a strong theory in Canberra circles that the controversy around the My Health Record further undermined the Coalition’s health policy credentials.
Writing in The New Daily, political commentator, Paula Matthewson, a former adviser to PM John Howard, said that “… the lesson is that health is more important to more voters than almost any other issue, including the economy. Get health policy wrong and you risk throwing away the election”.
Matthewson said that Labor’s ‘Hospitals, not Banks’ slogan ranked in effectiveness with Labor’s 2016 Mediscare campaign to focus voters’ minds on health policy.
The Federal AMA is already putting together its health policy manifesto for the next election. General practice reform, public hospital funding, private health insurance, the MBS Review, the My Health Record, and medical workforce will feature prominently.
[Viewpoint] Health, transatlantic trade, and President Trump’s populism: what American Patients First has to do with Brexit and the NHS
During Donald Trump’s presidential campaign, he promised to stand up to pharmaceutical companies and, once in office, to adopt measures that would reduce drug prices. After inauguration, he repeated these claims. In May, 2018, the US Department of Health and Human Services published American Patients First,1 a blueprint for how President Trump might achieve his goals via a series of regulatory and policy actions.
[Correspondence] Proposed changes to the Title X Family Planning Program
According to the American Medical Association’s (AMA) Code of Medical Ethics, “truthful and open communication between doctor and patient is essential for trust in the relationship and for respect for autonomy.”1 The doctor’s role is to assist patients in making autonomous, informed decisions about their health care through counselling and to refer for care if the doctor cannot provide it. A new regulation proposed by the US Department of Health and Human Services would require providers in the Title X Family Planning Program to withhold information from patients and therefore violate the AMA ethics code.
Asylum Seeker Death was Preventable
The Queensland Coroner has found that the death of Iranian asylum seeker, Hamid Khazei, was preventable.
In a ruling released on 30 July, the Coroner, Terry Ryan, said: “Consistent with the evidence of the expert witnesses who assisted the court in this matter, I am satisfied that if Mr Khazaei’s clinical deterioration was recognised and responded to in a timely way at the MIRPC clinic, and he was evacuated to Australia within 24 hours of developing severe sepsis, he would have survived.”
Coroner Ryan said it would be possible to characterise the circumstances that led to Mr Khazaei’s death simply as a series of clinical errors, compounded by failures in communication that led to poor handovers and significant delays in his retrieval from Manus Island.
“However, attributing responsibility for those events solely on failures by individual clinicians tasked with his care and others responsible for arranging his transfer from Manus Island is not helpful when looking for ways to prevent similar deaths from happening in future,” the coroner said.
“It is important to consider the broader context in which Mr Khazaei’s death occurred in order to find ways to prevent similar incidents.”
AMA (NSW) President, Dr Kean-Seng Lim, said the Federal Government should accept and implement the recommendations of the Queensland Coroner as soon as possible.
“The first recommendation in the Queensland Coroner’s report is that the health and wellbeing of asylum seekers who need a medical transfer be made the overriding consideration,” Dr Lim said.
“This should have been standard practice before, but it is imperative that the Department for Home Affairs develop and implement this policy now.
“The report also recommends the clinics providing medical services to asylum seekers in regional processing countries be properly accredited.
“Once again, this is something that should have always been the case and needs to be acted on with all haste.
“This is especially important given the description of the initial treating facility Mr Khazaei encountered.
“It has been longstanding AMA policy that asylum seekers should be afforded the same level of care that can be expected in Australia,” Dr Lim said.
[Comment] Peer-delivered self-management programmes in mental health
Facilitating recovery and full lives among people with serious mental illness is a priority for mental health services.1,2 Reducing the use of acute care services is also important, for economic reasons and to maximise personal freedom, by treating people in the least restrictive setting possible. Peer support and self-management programmes are increasingly popular recovery-oriented services that have the potential to improve patient wellbeing, reduce relapse, and decrease burden on formal acute mental health services.
[Editorial] Half measures on children’s mental health
In December, 2017, the UK Department of Health and Social Care and the Department for Education released Transforming Children and Young People’s Mental Health Provision, a green paper proposing changes to the way that mental health services are provided to children. The proposal calls for an additional 8000 staff in Child and Adolescent Mental Health Services (CAMHS), which account for 0·7% of the National Health Service’s (NHS’s) £125 billion budget, to create new Mental Health Support Teams in schools.
Doctors warn Aussies will pay more for less health care
Specialist physicians have sounded a warning that thousands of Australians face a lifetime of chronic pain and second-rate treatment options under the Federal Government’s private healthcare reform.
A group of concerned spine surgeons and other medical practitioners say the proposed policy bands of Gold, Silver, Bronze and Basic will leave thousands of patients having to choose between the spine surgery they need and the one they can afford.
Gold Coast orthopaedic surgeon Associate Professor Matthew Scott-Young said spine surgery was split between Gold and Silver bands under the reforms, with spinal stabilisation and fusion restricted to the top level of cover.
“Splitting funding for spinal conditions between Silver and Gold will result in a patient’s level of private health cover influencing clinical decision making,” Associate Professor Scott-Young said.
“Surgeons will be pressured into offering, and patients will be obliged to accept, suboptimal care based on their level of cover.”
Assoc Prof Scott-Young said the reforms would cause more people to live with chronic pain or to opt for less effective treatments simply because they were the ones they could afford.
“It will increase pressure on the already over-burdened public health system and, ultimately, lead to an increase in the impact of spine disease within the Australian community,” he said.
“There is level one evidence to show spinal fusion is the most effective treatment for a number of elective and emergency spinal conditions. Add to that our 20 years and 6000 patients worth of Patient Reported Outcome Measures data which demonstrates spinal fusion patients have clinically significant reduction in symptoms, with an overwhelming majority able to return to enjoying their everyday activities.”
Federal Health Minister Greg Hunt announced last week that the changes were to ‘empower’ the 13 million Australians with private health insurance by providing a simplified summary of their cover on a single page. Mr Hunt also said the reforms, effective from 1 April 2019, would not lead to a change in policies or a rise in price for private health customers. Private health insurers currently offer top hospital cover as well as spine fusion from as little as $42.70 a week.
Numerous professional medical associations lodged submissions to the Federal Government during its consultation process, highlighting risks and problems with the proposed changes. Concerns about splitting the treatment of a single condition across different levels of cover formed the focus of many submissions. A further round of consultation is underway with submissions due on August 3, 2018.
Dr Bill Sears, Immediate Past President of the Spine Society of Australia and a Sydney-based neurosurgeon, said health fund coverage for spinal surgery should be an all or nothing proposition – you should either be covered, or you should not.
“Australians who choose to take out cover for private spinal surgery are entitled to feel confident that they will receive the procedure that is best suited to their problem,” Dr Sears said. “Things may change at the time of surgery; patients must be assured that they are covered for whatever eventuates and that their care will not be compromised.
Their surgeon shouldn’t have one hand tied behind his or her back.”
Sydney neurosurgeon Dr Marc Coughlan warned the reforms could have ‘draconian consequences’ on thousands of Australians.
“It would potentially impact the lives of thousands of patients who would be precluded from having spinal fusions because of the high costs of the prostheses,” he said.
“Many of these people are younger patients with spinal conditions impacting on their ability to walk, work and remain productive in the workforce.
“My concern is that practitioners will be forced to opt for less effective procedures that in many cases will ultimately lead to multiple operations and increased costs.”
Sydney neurosurgeon Associate Professor Ralph Mobbs said the millions of Australians who have paid for private health insurance for decades – in the face of annual premium increases – deserved to receive the coverage they had been promised.
“Those who have invested for private health insurance for years have a legitimate right to expect the treatments they previously had for the same premium,” Dr Mobbs said.
An estimated 3.7 million Australians have chronic back problems and more than $1 billion in total health care expenditure in Australia is attributed to the condition, according to the Australian Institute of Health and Welfare (AIHW).
In a 2017 report, AIHW found back pain and back problems were the third leading cause of disease burden in Australia.
Gold Coast spine surgeon Assistant Professor Laurence McEntee said public hospitals would feel the weight of thousands of spine surgery patients who were no longer able to receive the care they needed in the private system under the reforms.
“There were about 12,000 people who had spinal fusions in the private system in the past year,” he said. “Offering spinal fusion only in the most expensive level of private health cover will trigger a massive cost shift to state governments because we will see a drastic increase in the number of people moving to the public system for treatment
where there are already waiting lists of up to three years for spine surgery in some regions.”
AHPRA backflip on “black mark” register
DOCTORS have had a win after hard campaigning, with the Medical Board of Australia (MBA) walking back its policy of publishing tribunal and court decisions on the Australian Health Practitioner Regulation Agency (AHPRA) website even when there were no adverse findings against the doctors concerned.
According to Australian Doctor, the MBA “says it has already erased links to court and tribunal decisions where no adverse findings were made against the doctor”, quoting board chair Dr Joanna Flynn as saying that the rethink strikes a “good balance” between transparency and fairness.
Adverse findings against doctors will remain on the AHPRA website, however.
Dr Steel Scott, the Melbourne radiologist who launched the online petition last month, told AusDoc that it was “a fantastic result for the medical community”.
“We have proven that as a community, we can take actions which protect our colleagues and the integrity of our profession,” he is quoted as saying.
“I feel the medical board has really violated the trust of doctors, and more than 16 000 people [who signed the petition] agreed. In effect it’s a vote of no confidence in their policy-making. The medical board now has a lot of work to do to rebuild that trust.”