1. My Health Record system and Providing Enhanced Consumer Support in your Health Service
‘Opt-out’
2 July 2018

2. The eHealth Journey
July 2012, Australians could choose to register for their own personally controlled electronic health (PCEHR) record. November 2015, Legislation was passed to rename the PCeHR to the “My Health Record” and to implement trial ‘opt-out’ sites. Following successful opt out trials in FNQ and the Nepean Blue Mountains, the My Health Record Expansion Programme commenced. Every Australian will be offered a My Health Record unless they choose not to have one during the three month opt out period that will run from 16th July to 15 October 2018 Records will be created mid November, 2018

3. What is My Health Record?
The My Health record is a secure electronic summary of an individuals important health information that can be shared securely online between the individual and registered healthcare providers involved in their care to support improved decision making and continuity of care.
The My Health Record system can be accessed by registered Healthcare Organisations, Healthcare Professionals and individuals.
This means that, whether someone is visiting an ACCHO for a check-up, or are in hospital, healthcare providers involved in their care can access important health information, such as:
•allergies
•medicines they are taking
•medical conditions 
•pathology test results such as blood tests
•hospital discharge summaries

4. Benefits of My Health Record
Improved health outcomes for Aboriginal and Torres Strait Islander peoples to help Close the Gap
Improved chronic disease management and health outcomes
Improved use of medicines and reduced adverse drug events
People don’t have to keep retelling their story and health professionals spend less time gathering information from different sources
Improved capability for best practice and preventative care
Increased efficiency of health care with duplication of services avoided
Tracking of child development and immunisations
Better communication between health care providers

5. More information, more benefits
Information can be added from three sources:
1. Health professional
Shared health summary
Event summaries
Discharge summaries
Medication prescribing and dispensing view
Medicines information view
Medication prescribing and dispensing history
Diagnostic imaging reports
Pathology reports
eReferrals
Specialist letters
Child development information
2. Medicare
Medicare claims data
Pharmaceutical Benefits Scheme
Repatriation Pharmaceutical Benefits Scheme
Australian Immunisation Register
Australian Organ Donor Register
DVA claiming events
3. Patient
Personal health summary
Personal health notes
Advanced Care planning information
Advanced Care custodian
Emergency contact details
My Health Record brings together health information from healthcare providers across the sector, allowing important patient information to be shared between them.
Electronic access to these clinical documents supports the continuity of care, and improves the interactions between healthcare providers and patients.
My Health Record does not replace existing health records. Rather, it supplements these with a high-value, shared source of patient information.
Information available through My Health Record can include:
A patient’s shared health summary (e.g. diagnoses, current medications, allergies and adverse reactions)
Medication and  prescribing and dispensing history
The medicines information view
Discharge summaries
Specialist letters
Referrals
Advanced Care Planning information
Information about a patient’s past health events
Pathology reports
Diagnostic imaging reports
Child development information
Consumer-entered information
Medicare overview 
Consumer entered information
Personal health summary – individuals can enter information about allergies and adverse reactions, and current medications into their My Health Record. This data can be viewed by healthcare providers.
Advance care directive custodian – individuals can enter the contact information of a person or organisation who is the holder of their advance care directive (or "living will").
Emergency contact details – individuals can create a list of important emergency contacts in their My Health Record, which is visible to healthcare providers.
Personal health notes – individuals can enter information to help them keep track of their health, i.e. like a health journal. The system dates each note, which includes an entered title and the entered text. These notes are not visible to healthcare providers.
Child development – Parents can record results of their child's scheduled health checks, childhood development and other useful information. The objective is to provide an integrated view of a child's health status for the parents/guardian and healthcare providers involved in the child's care.
The Child Development section of a child's My Health Record contains: an Achievement Diary, Personal Observations, Immunisations, Child Health Check Schedule, Child Growth Charts and Information for Parents.
This information is currently only visible to healthcare providers through the National Provider Portal, as clinical information systems have not yet built this functionality into their systems.
A healthcare provider’s ability to use these features depends on whether the functionality is included in their clinical information software (CIS).
Medicare overview
When an individual’s My Health Record is created, they can choose to have their Medicare data included in their My Health Record.
This can include past (up to two years of prior transactions) and future MBS and PBS (and RPBS) transaction information, their organ donor status (sourced from the Australian Organ Donor Register) and details from their Australian Immunisation Register (AIR) records.
These records may be viewed individually or in summary via the digital health record Medicare overview.

6. Patient Control A patient can control:
Whether to have a My Health Record
Which information is shared
Which healthcare events are entered
Which healthcare organisations have access
Who can search for or see their record
When to re-register their My Health Record (If they choose to cancel at any time)
To opt out of secondary use of My Health Record data
A patient can verbally request a health care provider or professional does not access their record or they can set access controls through MyGov

7. The My Health Record is secure!
Privacy and Security
The My Health Record is secure!
It is protected by:
Secure technology
Legislation
Audit trails
Secure data transfer
My Health Records system legislation includes civil penalties for intentional misuse or reckless misuse of the My Health Record System that apply to:
Individual healthcare professionals
Healthcare organisations that authorised it
All healthcare providers in Australia have professional and legal obligations to protect their patients' health information.
Establishing and maintaining information security practices is an essential professional and legal requirement when using digital health systems in the delivery of healthcare services.
Your organisation must document and implement internal practices and procedures that it uses to protect personal information when using digital health systems to deliver healthcare. In addition, healthcare organisations that access digital health records need to meet the requirements under the My Health Records Rule.

8. Audit Logs
All access and use of the My Health Record is captured in an audit trail showing:
Patient…
Date…
Time…
Health Centre…
Emergency?
New document created
Date and time a patient’s My Health Record was accessed or edited
Details of person who accessed it
Details of the organisation that accessed or edited the eHealth record
Whether the My Health Record was accessed due to an emergency
Details of the action and/or actions that occurred [e.g. Clinical document created or deleted, patient contact details amended]
Audit logs
All access and use of the My Health Record system is captured in an audit trail. Activity relating to an individual healthcare consumer’s My Health Record is listed in their access history record, which can be viewed by the individual, their representatives or authorised healthcare providers at any time.
The audit log displays:
The name of the healthcare organisation that accessed the record;
When it was accessed;
The nature of the access, such as viewing a document or uploading a shared health summary; and
The role of the person who accessed the record, such as General Practitioner (if available).

9. How can people opt out?
Between 16 July -15 October 2018 there are three ways people can opt out of having a My Health Record created for them
1. Call the My Health Record system Contact Centre to opt-out yourself and your dependants 2. You can elect to opt-out yourself and your dependants online by visiting and going to the external Opt-Out Portal. 3. Attend an Aboriginal Community Controlled Health service offering enhanced consumer opt out and complete an Election not to be registered (opt-out) for a My Health Record form

10. Enhanced Consumer Support
The Enhanced Consumer Support (ECS) model is similar to the current assisted registration model except ECS is to help people opt out of having a My Health Record created for them
The Enhanced Consumer Support Services model is aimed at providing support to people that do not have access to, choose not to, or are unable to, use the phone or online channels to elect not to be registered for a My Health Record

11. Who CAN you offer support to
Staff may only assist patients to opt out only when they have specifically asked for help.
If a patient has asked for assistance you can help them to opt out if;
They are a current health service patients aged 14 or over
They are a new patient with 100 points of ID
Someone with parental responsibility for a minor, whose name also appears on their Medicare card
Someone with parental responsibility for a minor who does not appear on their Medicare card but the health service can confirm they are the authorised representative for that minor
You must be able to verify the patients identity to support them to opt out

12. Who CAN’T you offer support to?
You cannot offer opt out support to anyone whom you cannot verify their identity
You cannot offer opt out support to any adult who does not have capacity
You cannot offer opt out support to someone acting on behalf of an adult in their care if they do not have the documentary evidence of guardianship
You cannot offer support to anyone under the guardianship board as this responsibility lies with the nominated board representative

13. Opt out process- Individual
Patient requests assistance to opt out
Patient identity is verified
Health service staff assist patient to complete “Election to not be registered (opt-out) for a My Health Record Individual” form with:
Patient last name and first name, sex, date of birth, Medicare card details, address and contact phone number
Verified IHI (obtained from CIS)
Patients signature and date
Health Organisation name and contact details
Form can be scanned and ed to: OR: posted to My Health Record Reply paid Sydney NSW 2001

14. Opt out process-Dependant
Health service staff may assist patient to complete Election to not be registered (opt-out) for a My Health Record opt out dependant form
Dependant last name and first name, gender, date of birth, Medicare card details, medicare address,
Verified IHI (obtained from CIS)
Parent/guardian last name and first name, contact phone number and question relating to dependant and adult relationship
Parent/guardian signature and date
Health organisation name and contact details
Completed form is scanned and ed to or, posted to My Health Record Reply paid Sydney NSW 2001

15. Verifying Details
You can check the individual’s Communicare Clinical record to make sure that the information they provide on the form matches the information you have
If an adult has parental responsibility for a minor who is not on their Medicare card, if they have presented at the health service previously, and you know they have responsibility for the child(ren) you can verify their responsibility to opt out the child from having a My Health Record created for them.
You should only support an assertion of parental responsibility if you are confident that the individual has responsibility for the dependant and is acting in their best interests.
The health service needs to complete the name of the person at the health service who assisted to complete the form, the name of their organisation, a contact number and signature. This will help if there is a problem when the form is processed.

16. Individual Health care identifier (IHI)
Where possible you should provide the Individual Healthcare Identifier (IHI) available in the patients biographic details in Communicare, you should complete the section on the form with the individual’s IHI.
This will help make sure that the individual can be uniquely matched to their IHI and that the form can be successfully processed.

17. Example forms
Note these are drafts and have been amended

18. What will be in My Health Record?
When you record is created approximately mid November there will be no clinical information in your record.
After mid November:
When you visit a health service, or set up access via myGov your past 2 years of MBS and PBS information will be uploaded.
Your Australian immunisation register information will also be uploaded.
When you receive healthcare, clinical information can be uploaded.
Past medical history, such as older tests and xray reports, will not be automatically uploaded to the My Health Record system.
Only new reports can be uploaded by participating pathology labs or diagnostic imaging providers.

19. Cancel My Health Record
You can change your mind and cancel your record at any time
You can cancel you record two ways by calling  or by logging in to your My Health Record through myGov  and following the steps to cancel your record.
When you cancel your record it means that:
Healthcare providers will not be able to upload documents to the record, or access the record - even in an emergency  
Once your record is cancelled, it will be retained for a period of 30 years after your death or, if the date of death is unknown, for a period of 130 years after the date of your birth.
Your My Health Record may be accessed by the System Operator for the purposes of maintenance, audit and other purposes required or authorised by law
Your health information cannot be used for secondary purposes after you cancel your record.

20. Secondary Use of Data
In the future there will be the functionality for people who have access to their My Health Record via MyGov to select ‘opt out of secondary use of data’. If a patient does not have a MyGov account and wants to opt out of secondary use of data, or select any access controls for their My Health Record they can call and ask for controls to be put on their record or secondary use of data to be opted out. No secondary use of data will commence until 2020.

21. Need more support or training?
If you would like more training, support or information please contact Nicolle Marchant at AMSANT (08)