The digital health dilemma By Gil Abras on 27/02/19 The My Health Record controversy will create a digital divide between the ‘opt-in’s’ and ‘opt-outs’ and ultimately, the delivery of immediate and streamlined 21st century medical outcomes for patients. The introduction of My Health Record in Australia was aimed at helping patients and doctors access timely medical information – referral letters, test results, etc. – but with people’s distrust around data-sharing, and concerns with privacy and security, the public was given the option to opt out by 31 January 2019. Those who didn’t make the choice to opt out by the cut-off date would have a record automatically created in the Government’s online database of health information. Reports state that up to 2.5 million Australians opted out of My Health Record, with a further 300,000 cancelling their records. Does this mean the system implemented will be any different if everyone had adopted digital health records? The answer seems obvious – no. We’ll still need the same privacy and security measures, same functionality and the same quality control processes whether we have one million people using it or 25 million people. So, why are we going down the path of creating two different systems that will operate in parallel? A uniform system for all Australians is an approach where prevention would be better than cure. While the issues of privacy and security raised are valid, the knee-jerk response to give choice only creates more challenges for a health system already under pressure, rather than tackling ways to overcome peripheral issues in the first instance. Late last year, I attended a presentation by Dr. Yossi Bahagon, a medical practitioner who led the team that launched digital health records and services in Israel. Their reasons to digitise health records was the same as many other countries, but what stood out to me was their approach. Israel decided all records would be converted to digital with no option to opt out. It would be one centralised system for all. This made me think about Australia’s journey for introducing and implementing a uniformed digital health system. I’ve had a lot of conversations with medical specialists, clients and industry leaders on this topic, and it’s interesting that even though many of them believe in the benefits of a system like this, they indicated they’d opt out because they have issues with the implementation process. While many in the industry, including the Australian Medical Association (AMA), feel this initiative would improve our healthcare networks and infrastructure, others fear the safety of personal, sensitive information could be compromised if available digitally. Cyber security is a constant and evolving threat for any industry or system, but the reality is many government agencies already use private information in digital form. The Australia Taxation Office (ATO) and Centrelink are two examples of government bodies capturing and accessing personal data. According to Similar Web (www.similarweb.com), the my.gov.au website recorded more than 18 million visits in the last six months, Centrelink more than nine million visits and the ATO more than eight million. Most of us already use internet banking and manage our money using online banking platforms from a variety of devices. Our digital footprints are continually created and updated each day as we give our privacy away. These pieces of data create a profile so extensive to organisations that it can provide a fairly detailed account – whether accurate or not – based on assumptions from your activity. As an example, below is a list of the top five most-visited local and international shopping sites in Australia between January and June 2018: Ebay.com.au – 404.67 million Amazon.com 111.82 million Ebay.com — 80.46 million Jbhifi.com.au — 74.02 million Bunnings.com.au — 68.87 million Source: www.smartcompany.com.au With the government already using personal data (through digital form) to provide services and information, the question stands; if Australians are comfortable using online platforms for shopping and online banking, why opt-out of a health service? Looking back on disruption in the accounting industry, it would be hard to overlook the impact of Xero, a cloud-based accounting software. Xero successfully introduced the concept of one ledger available for multiple users simultaneously. That meant the business owner, the internal finance team of the business and the external accountant could access the same data in real-time. Xero also allowed for the automated import of digital banking transactions and removed the need for any manual data entry. Put simply, it was designed to provide all the basic functions that a small business needed to access, quickly and easily. As users started to adopt the new technology, additional features were created, external parties developed add-ons (compatible software that worked with Xero and provided additional capabilities). The users’ demand for additional functionality was the key driver behind the development of the product ecosystem that exists today around Xero. This makes me wonder why we can’t keep it simple when considering the implementation of our digital health system. Although there is nothing simple in designing and maintaining a system like this, the focus should be on patients and the medical professionals using digital records to deliver outcomes. Through a secure and uniformed platform, it would eventually make healthcare management for patients and their doctors, easier and safer. It could also be life-saving in emergencies. With Australia’s current approach to the digitalisation process, we’re heading down the path of creating two systems – the old and the new. Add to this the challenges around secondary use of personal data and sharing information with third parties – such as the police and insurance companies – and this has further complicated legislation that has not been well-received by consumer-based organisations. Since the scheme was launched in 2012, it appears the debate continues from both sides. One that praises the benefits and the other that warns of the risks. Hopefully, Australia will find a way to be leaders in this field and match our reputation as world-class pioneers in medical research and innovation, with a uniform approach to health records.