Investigation of My Health Record (MyHR) adoption in General Practices of Victoria, Australia

Introduction. Health information accessibility whenever and wherever is one of the primary goals in Australia’s National Digital Health strategy 2017. MyHealthRecord (MyHR) is the system to facilitate this goal and has been the focus of Australia’s digital health (DH) platform for the past decade. A change in funding policy was introduced in July 2016 for meaningful usage of the system. As the outcomes of MyHR adoption in general practice organisations (GPOs) were little known, this research was commenced. The study focused on evaluation of MyHR adoption in GPOs, identifying challenges and recommendations for adoption sustainability.

Method. A qualitative case study research approach was used to underpin this research, focusing on 10 clinics in which staff and patients were engaged in three data collection activities (during Jan–Dec 2017). Interviews were held with GPOs and observations of MyHR transactions were made during GP/patient consultations. A survey was conducted for staff and patients attending GPOs state-wide. Data collection and analysis was based on a proposed MyHR evaluation model of user acceptance. Thematic analysis was performed to describe findings and discussions.

Findings. Eight themes were identified in the results of interviews, observations and surveys. (i) Patient workflow review approach varied among participants, often ad hoc and immature. (ii) Roles, policies, procedures and training updates were not always organised (iii) User engagement improvement was suggested to be driven by patients/consumers to encourage GPs towards system use, practice management to support and system operator to offer sufficient education to consumers and GPs/nurses (iv) MyHR upload process and time consumed was simple and quick (v) GP/patient experience during observations changed from being hesitant to comfortable (vi) Perspectives about MyHR potential impacts to offer easy and fast (but not safe) patient care was mostly understood (vii) Experience using MyHR reflected lack of awareness among consumers, whereas others surveys reported good or neutral experiences (viii) Encouragement to MyHR use was rated higher with ideas for improvements.

Discussion. Although MyHR statistics demonstrated that changed funding policy encouraged the usage of MyHR usage, the impact on the patient workflow and its associated roles was not always considered practically. These organisations were going through the change management process informally, and not everyone was well-equipped to handle it. Their system usage was limited to satisfy funding policy, questioning the sustainability of such implementation and the delivery of intended benefits. Challenges in organisation, technology and people factors were explored, influencing the adoption, use and its fit perception. Needs of improvement were identified based on participants’ views; it included more education / promotion / interaction opportunities, change management and benefits realisation. Three recommendations were developed (1) identification of needs (2) enhancing support structure of users’ engagement, GPE framework and change management approach (3) reviewing incentive scheme to increase percentage of use and efficiency of MyHR.

Conclusion. This research suggests a focus on details is required when drawing a bigger picture. MyHR organisational impacts/change management, its internal perception of task-fitness and DH cultural shift is essential. Patient workflow, usability, security, promotion, education, usage-policy and benefits-evidence review must be considered with user engagement strategies for sustainable MyHR adoption in GPOs.