My Health Record Research Articles

Using personal health records for medication continuity during transition of care: An observational study.

Background: National Personal Health Records (PHRs) have been proposed to improve the transfer of medication-related information during transition of care. Objective: To evaluate the concordance between the medications captured in the Australian national PHR, My Health Record (MyHR), and the pharmacist obtained best possible medication history (BPMH) for patients upon hospital admission. Method: This prospective observational study used a convenience sample of hospital patients. For newly admitted patients, the investigating pharmacist obtained a BPMH and then compared it to the medication list captured in MyHR. Upon comparison, the medications were categorised into either complete match, partial match or mismatch. Medications with a complete or partial match were grouped together. Medications with deviations were then assessed for risk based on their potential consequence, and reported descriptively. A multivariable logistic regression was conducted to assess the factors associated with a drug being mismatched. Results: A total of 82 patients were recruited, with a cumulative total of 1,207 medications documented. Of the 1,207 medications, 714 (59.2%) medications were documented as a complete/partial match. The remaining 493 (40.8%) medications were mismatched. Of the 493 mismatched medications, 442 (89.7%) were deemed low-risk deviations and 51 (10.3%) were deemed high-risk. A medication was more likely to be mismatched, rather than completely/partially matched, if it was a regular non-prescription medication, or "when-required" prescription medication, or "when required" non-prescription medication, or if it was administered parenterally. Conclusion: National PHRs may be a secondary source to either confirm a patient's medication history or be used as a starting point for a BPMH.

CHIME-GP trial of online education for prescribing, pathology and imaging ordering in general practice – how did it bring about behaviour change?

BackgroundThere is a need for scalable clinician education in rational medication prescribing and rational ordering of pathology and imaging to help improve patient safety and enable more efficient utilisation of healthcare resources. Our wider study evaluated the effectiveness of a multifaceted education intervention for general practitioners (GPs) in rational prescribing and ordering of pathology and imaging tests, in the context of Australia’s online patient-controlled health record system, My Health Record (MHR), and found evidence for measurable behaviour change in pathology ordering among participants who completed the educational activities. This current study explored the mechanisms of behaviour change brought about by the intervention, with a view to informing the development of similar interventions in the future.MethodsThis mixed methods investigation used self-reported questionnaires at baseline and post-education on MHR use and rational prescribing and test ordering. These were analysed using multi-level ordinal logistic regression models. Semi-structured interviews pre- and post-intervention were also conducted and were analysed thematically using the COM-B framework.ResultsOf the 106 GPs recruited into the study, 60 completed baseline and 37 completed post-education questionnaires. Nineteen participants were interviewed at baseline and completion. Analysis of questionnaires demonstrated a significant increase in confidence using MHR and in self-reported frequency of MHR use, post-education compared with baseline. There were also similar improvements in confidence across the cohort pre-post education in deprescribing, frequency of review of pathology ordering regimens and evidence-based imaging. The qualitative findings showed an increase in GPs’ perceived capability with, and the use of MHR, at post-education compared with baseline. Participants saw the education as an opportunity for learning, for reinforcing what they already knew, and for motivating change of behaviour in increasing their utilisation of MHR, and ordering fewer unnecessary tests and prescriptions.ConclusionsOur education intervention appeared to provide its effects through providing opportunity, increasing capability and enhancing motivation to increase MHR knowledge and usage, as well as rational prescribing and test ordering behaviour. There were overlapping effects of skills acquisition and confidence across intervention arms, which may have contributed to wider changes in behaviour than the specific topic area addressed in the education.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12620000010998) (09/01/2020).

Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study

BackgroundWeb-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries.ObjectiveWith limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR).MethodsA population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire.ResultsA total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR.ConclusionsThis study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.

Automated Decision Support For Community Mental Health Services Using National Electronic Health Records: Qualitative Implementation Case Study

BackgroundA high proportion of patients with severe mental illness relapse due to nonadherence to psychotropic medication. In this paper, we use the normalization process theory (NPT) to describe the implementation of a web-based clinical decision support system (CDSS) for Community Mental Health Services (CMHS) called Actionable Intime Insights or AI2. AI2 has two distinct functions: (1) it provides an overview of medication and treatment history to assist in reviewing patient adherence and (2) gives alerts indicating nonadherence to support early intervention.ObjectiveOur objective is to evaluate the pilot implementation of the AI2 application to better understand the challenges of implementing a web-based CDSS to support medication adherence and early intervention in CMHS.MethodsThe NPT and participatory action framework were used to both explore and support implementation. Qualitative data were collected over the course of the 14-month implementation, in which researchers were active participants. Data were analyzed and coded using the NPT framework. Qualitative data included discussions, meetings, and work products, including emails and documents.ResultsThis study explores the barriers and enablers of implementing a CDSS to support early intervention within CMHS using Medicare data from Australia’s national electronic record system, My Health Record (MyHR). The implementation was a series of ongoing negotiations, which resulted in a staged implementation with compromises on both sides. Clinicians were initially hesitant about using a CDSS based on MyHR data and expressed concerns about the changes to their work practice required to support early intervention. Substantial workarounds were required to move the implementation forward. This pilot implementation allowed us to better understand the challenges of implementation and the resources and support required to implement and sustain a model of care based on automated alerts to support early intervention.ConclusionsThe use of decision support based on electronic health records is growing, and while implementation is challenging, the potential benefits of early intervention to prevent relapse and hospitalization and ensure increased efficiency of the health care system are worth pursuing.

Can existing electronic medical records be used to quantify cardiovascular risk at point of care?

Using electronic data for cardiovascular risk stratification could help in prioritising healthcare access and optimise cardiovascular prevention. To determine whether assessment of absolute cardiovascular risk (Australian absolute cardiovascular disease risk (ACVDR)) and short-term ischaemic risk (History, ECG, Age, Risk factors, and Troponin (HEART) score) is possible from available data in Electronic Medical Record (EMR) and My Health Record (MHR) of patients presenting with acute cardiac symptoms to a Rapid Access Cardiology Clinic (RACC). Audit of EMR and MHR on 200 randomly selected adults who presented to RACC between 1 March 2017 and 4 February 2020. The main outcomes were the proportion of patients for which ACVDR score and HEART score could be calculated. Mean age was 55.2 ± 17.8 years and 43% were female. Most (85%) were referred from emergency for chest pain (52%). Forty-six percent had hypertension, 35% obesity, 20% diabetes mellitus, 17% ischaemic heart disease and 18% were current smokers. There was no significant difference in MHR accessibility with age, gender and number of comorbidities. An ACVDR score could be estimated for 17.5% (EMR) and 0% (MHR) of patients. None had complete data to estimate HEART score in either EMR or MHR. Most commonly missing variables for ACVDR score were blood pressure (MHR) and high-density lipoprotein cholesterol (EMR), and for HEART score the missing variables were body mass index and comorbidities (MHR and EMR). Significant gaps are apparent in electronic medical data capture of key variables to perform cardiovascular risk assessment. Medical data capture should prioritise the collection of clinically important data to help address gaps in cardiovascular management.

Medical Records in Community Pharmacies: The Cases of UK and Australia

Background: Lack of access to patients’ digital health records by community pharmacists can negatively impact pharmaceutical care. Access to these records by community pharmacists is only available in some countries. Thus, the study aim was to compare and discuss the shared patients’ health records between the National Health Systems and Community Pharmacies in UK and Australia. Methods: Two platforms were selected: Summary Care Records (SCR) (UK) and My Health Record (MyHR) (Australia). A qualitative and descriptive study was carried out. The type of shared health records was collected in public/official websites. Qualitative classifiers/descriptors were created to classify the shared health records. Results: The common classifiers/descriptors between both SCR and MyHR were medicines, medicines/immunization, and medical history. However, MyHR seems to comprise more details/information, such as patient’s discharge summaries, specialist letters, or documents to communicate significant patient information from one healthcare provider to another. Conclusion: Community pharmacists can update or consult SCR and MyHR to provide direct patient care in UK and Australia, respectively. The profile of shared health records with community pharmacies was not equal between SCR (UK) and MyHR (Australia). More studies are recommended to evaluate the benefits and risks of using these platforms on patients’ outcomes.

Diversity via datafication? Digital patient records and citizenship for sexuality and gender diverse people

In 2018, the Australian Government adopted an ‘opt-out’ strategy to increase participation in My Health Record (MHR), the national digital patient record system. Opt out was rationalised through discourse on the universal right to health. Media controversy ensued due to privacy fears, security and commercial exploitation of patient information. LGBT community organisations warned that people with complex health needs should consider their privacy and legal situation when deciding whether or not to opt out of MHR. With reference to the health needs of sexuality and gender diverse people, we examine MHR’s rights universalism, possessive individualism, and state-based rationalisation of health governance. MHR hails all but no-one in particular, erasing diversity and straightwashing data medicine. It is a technological solution to state-based imperatives for health governance, an emphasis that does not serve minority communities or address health needs that attract stigma and prejudice. We counterpose these effects with citizenship framings seated in critical approaches to data assemblages and sexuality and gender diversity. We suggest ways in which data medicine, of which MHR is but one example, can be made more relevant and effective for individuals and communities whose healthcare is poorly served by mainstream health systems.

Clinical and healthcare improvement through My Health Record usage and education in general practice (CHIME-GP): a study protocol for a cluster-randomised controlled trial

BackgroundThere is an international interest in whether improved primary care can lead to a more rational use of health resources. There is evidence that educational interventions can lead to improvements in the quality of rational prescribing and test ordering. A new national platform for shared medical records in Australia, My Health Record (MHR), poses new opportunities and challenges for system-wide implementation. This trial (CHIME-GP) will investigate whether components of a multifaceted education intervention in an Australian general practice setting on rational prescribing and investigation ordering leads to reductions in health-service utilisation and costs in the context of the use of a national digital health record system.MethodsThe trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of components of a web-based educational intervention for general practitioners, regarding rational use of medicines, pathology and imaging in the context of the use of the MHR system. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of each education component in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre/post interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the 6 months following the intervention compared with 6 months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering 6 months pre- and post-intervention, and comparison of knowledge assessment tests pre- and post-intervention.DiscussionThe trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, in the context of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice.Trial registrationClinicalTrials.gov ACTRN12620000010998. Registered on 09 January 2020 with the Australian New Zealand Clinical Trials Registry

Use of My Health Record by Clinicians in the Emergency Department: An Analysis of Log Data

Objectives: Leverage log data to explore access to My Health Record (MHR), the national electronic health record of Australia, by clinicians in the emergency department.Materials and Methods: A retrospective analysis was conducted using secondary routinely-collected data. Log data pertaining to all patients who presented to the emergency department between 2019 and 2021 of a not-for-profit hospital (that annually observes 23,000 emergency department presentations) were included in this research. Attendance data and human resources data were linked with MHR log data. The primary outcome was a dichotomous variable that indicated whether the MHR of a patient was accessed. Logistic regression facilitated the exploration of factors (user role, day of the week, and month) associated with access.Results: My Health Record was accessed by a pharmacist, doctor, or nurse in 19.60% (n = 9,262) of all emergency department presentations. Access was dominated by pharmacists (18.31%, n = 8,656). All users demonstrated a small, yet significant, increase in access every month (odds ratio = 1.07, 95% Confidence interval: 1.06–1.07, p ≤ 0.001).Discussion: Doctors, pharmacists, and nurses are increasingly accessing MHR. Based on this research, substantially more pharmacists appear to be accessing MHR, compared to other user groups. However, only one in every five patients who present to the emergency department have their MHR accessed, thereby indicating a need to accelerate and encourage the adoption and access of MHR by clinicians.

An equitable approach to enhancing the privacy of consumer information on My Health Record in Australia.

Australia's national electronic health record (EHR), My Health Record (MHR), raises concerns about information privacy and the presumption of consent to participation. In contrast to the "opt-out" framework for participation, consumers must "opt-in" to obtain additional privacy features to protect their health information on MHR. We review ethical considerations relating to opt-in and opt-out frameworks in the context of EHRs, discussing potential reasons why consent for additional safeguards is not currently presumed. Exploring the implications of recent amendments to strengthen consumer privacy, we present recommendations to promote equity in health information security for all Australians using MHR.

Exploring adolescent and clinician perspectives on Australia's national digital health record, My Health Record.

Adolescence is often a time when risk-taking behaviours emerge and attendance at primary health care is low. School-based health services can serve to improve access to health care. Clinicians play a key role in improving adolescents' health literacy and capacity to make informed care decisions. Australia's national digital health record, My Health Record (MHR), has posed significant challenges for both clinicians and adolescents in understanding impacts on patient privacy. Guidance is required on how best to communicate about MHR to adolescents. This exploratory qualitative study aims to examine adolescents' understanding of MHR, clinicians' knowledge of MHR and their use of MHR with adolescents. Focus groups with students, school health and well-being staff and semistructured interviews with GPs and nurses were undertaken in one regional and one urban secondary school-based health service in Victoria. Transcripts from audio recorded sessions were examined using thematic analysis. Resulting themes include minimal understanding and use of MHR, privacy and security concerns, possible benefits of MHR and convenience. The results suggest opportunities to address gaps in understanding and to learn from adolescents' preferences for digital health literacy education. This will support primary care clinicians to provide best-practice health care for adolescents.

Pharmacists' Perspectives on the Use of My Health Record.

(1) Background: My Health Record (MHR) is a relatively new nationwide Australian digital health record system accessible by patients and a range of healthcare professionals. Pharmacists will be key contributors and users of the MHR system, yet little is known about the perceived barriers and benefits of use. (2) Objective: To explore pharmacists’ perspectives related to potential benefits and barriers associated with use of MHR. (3) Methods: An online survey was developed and face-validated. The survey was advertised to Australian pharmacists on pharmacy professional bodies’ websites. This was a cross-sectional study using an anonymous questionnaire. Descriptive statistics were used to describe the distribution of the data. Chi-square, Kendall’s tau coefficient (tau-c) and Kruskal–Wallis tests were used to examine the relationships where appropriate. (4) Results: A total of 63 pharmacists completed the survey. The majority of respondents worked in a metropolitan area (74%), and the most common workplace setting was community pharmacy (65%). Perceived benefits identified by responders include that the use of MHR would help with continuity of care (90%), and that it would improve the safety (71%) and quality (75%) of care they provided. Importantly, more than half of pharmacists surveyed agreed that MHR could reduce medication errors during dispensing (57%) and could improve professional relationships with patients (57%) and general practitioners (59%). Potential barriers identified by pharmacists included patients’ concerns about privacy (81%), pharmacists’ own concern about privacy (46%), lack of training, access to and confidence in using the system. Sixty six percent of respondents had concerns about the accuracy of information contained within MHR, particularly among hospital and general practice pharmacists (p = 0.016) and almost half (44%) had concerns about the security of information in the system, mainly pharmacists working at general practice and providing medication review services (p = 0.007). Overall satisfaction with MHR varied, with 48% satisfied, 33% neither satisfied nor dissatisfied, and 19% dissatisfied, with a higher satisfaction rate among younger pharmacists (p = 0.032). (5) Conclusions: Pharmacists considered that the MHR offered key potential benefits, notably improving the safety and quality of care provided. To optimize the use of MHR, there is a need to improve privacy and data security measures, and to ensure adequate provision of user support and education surrounding the ability to integrate use of MHR with existing workflows and software.

Improving accessibility of the Australian My Health Records while preserving privacy and security of the system.

Australian My Health Record (MyHR) is a significant development in empowering patients, allowing them to access their summarised health information themselves and to share the information with all health care providers involved in their care. Consequently, the MyHR system must enable efficient availability of meaningful, accurate, and complete data to assist an improved clinical administration of a patient. However, while enabling this, protecting data privacy and ensuring security in the MyHR system has become a major concern because of its consequences in promoting high standards of patient care. In this paper, we review and address the impact of data security and privacy on the use of the MyHR system and its associated issues. We determine and analyse where privacy becomes an issue of using the MyHR system. Finally, we also present an appropriate method to protect the security and privacy of the MyHR system in Australia.

Privacy concerns of the Australian My Health Record: Implications for other large-scale opt-out personal health records

Personal health records offer the convenience of accessing medical history and personal health information, but also raise a range of privacy concerns which affect their adoption. In 2018, the Australian nationwide personal health record, My Health Record (MHR), was changed to an opt-out model, meaning that users are automatically enrolled unless they opt out. This significant change sparked wide-ranging and vociferous discussions of the privacy concerns of MHR on Twitter thus provided a lens into people's concerns. This lesson offers useful insights for improving MHR and better implementing future large-scale health records. By using qualitative coding and topic modeling on Twitter data, we categorized the stakeholders who participated in the discussions and the privacy concerns expressed. We have identified 10 categories of stakeholders and 9 types of privacy concerns in the discussions, and our analysis finds that these stakeholder groups focused on different privacy aspects of MHR. This work implies that, for future provisions of similar systems, it is important to involve these stakeholders in the design and address their privacy concerns early, as they are interested in providing input and their strong opinions may influence the uptake of such systems. Based on the lesson gleaned from this case, we propose that system owners can proactively communicate the privacy and the security aspects of their PHRs with different parties on social media. We also highlight some suggestions for improving the consent model and third-party access to personal health records in this paper.

Utilisation of the Australian government initiative MyHealth Record to support the clinical approach to factitious disorder

AbstractRecently, the Australian Digital Health Agency launched MyHealth Record to the public. As of July 2019, 90.1% of Australians hold records with this service, allowing 16 400 health organisations access to >28 million clinical documents. The streamlining of patient data was intended to facilitate sharing of information and improve communication between medical providers, while promoting efficiency in clinical practice. We have identified a hitherto unrecognised application of this infrastructure in the identification and management of factitious disorder, a rare yet highly diagnostically challenging condition involving intentional feigning of illness, which presents a significant resource burden to the Australian health system.

Systematic Literature Review of My Health Record System

Background: On 2010 Australia launched a personally controlled electronic health record (PCEHR) later renamed and augmented by the My Health Record Act 2012 Cth. The main goal of the present systematic literature review was to assess if the system has improved Australia’s healthcare system according to the objectives stated by the federal government in the My Health Record Act 2012 Cth. Methods: This systematic literature review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Despite the MyHR system being available for seven years, there is limited empirical evaluation regarding its progress in achieving the stated goals. The results were segregated in four themes: (1) health information fragmentation, (2) Health information quality and management, (3) adverse medical events and duplication of treatment and (4) coordination of care. Regarding theme 1, it was evidenced that the system could reduce health information fragmentation; however, gaps in the workforce adoption were identified as a problem. About topic 2, improved access to information and possible misinterpretation were found. Theme 3 lacked research and theme 4 presented contradiction in the results. 
 Conclusion: The My Health Record (MyHR) system is founded on four key objectives. However, there is insufficient evidence that any outcomes have been achieved relating to any of the objectives. Research is required to determine whether the MyHR system helped improve Australia’s healthcare system according to the objectives stated in the Act 2012.

Evaluating the Contextual Integrity of Australia's My Health Record.

My Health Record (MyHR) is Australia's national personally-controlled electronic health record. Initially established in 2012, it moved from an opt-in to an opt-out system in 2018. This paper considers the privacy aspects of MyHR shared health summary. Drawing on Nissenbaum's theory of privacy as contextual integrity, we argue that the shift in the event-specific nature of information sharing leads to MyHR breaching contextual integrity. As per Nissenbaum's decision heuristic for contextual integrity, we evaluate this breach through a reflection on the changing nature of health care, including patient empowerment, and the greater complexity of care. It is evident that more needs to be known about the benefits of shared health summaries, as well as the actual use of MyHR by clinicians and patients. Though we focus on MyHR, this evaluation has broader applicability to other national electronic health records and electronic shared health summaries.

The MyHealthRecord System Impacts on Patient Workflow in General Practices.

Digital health is widely believed to have vast potential in improving patient care. MyHealthRecord (MyHR) is a digital health information system which enables Australian citizens to access their health information centrally, making it available anywhere, at anytime. The aim of this study is to explore the adoption of MyHR in general practices in Victoria and understand its impacts. A qualitative case study research method was used to underpin this investigation. Ten general practices were engaged where MyHR was implemented/used. Detailed interviews with MyHR implementers were held and GPs were engaged in short interviews. Twenty observations were made during GP/patient consultations for health summary uploads. Findings indicate that the practice incentive payment (PIP) funding policy change encouraged the use of MyHR, but the adoption was limited to satisfy funding criteria. Change management was often extemporised. Health summary upload was a quick and easy process but was influenced by clinical system data quality and GP familiarity with the system. Community awareness and GP interest in MyHR was lacking. The conclusion is that MyHR was not well integrated in general practices nor the community. As a result, an improved engagement approach between healthcare organisations, the MyHR system operator and Australians is required.

Assessing the information quality and usability of My Health Record within a health literacy framework: What's changed since 2016?

Background:This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016.Objective:To examine whether Australia’s MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016.Method: Content analysis: Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation: An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified.Results:Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use.Conclusion:This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR.Implications:This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.

Diagnostic information in the my health record

A design for including diagnostic reports (pathology and diagnostic imaging) in the My Health Record (MHR) was agreed in 2014 by representatives of key Australian medical colleges and peak organisations. A PDF generated by the diagnostic provider, based on the report that the diagnostic provider produces for the requester of the service is required. An accompanying HL7 Clinical Document Architecture (CDA) document is generated by the diagnostic provider, which contains the structured and coded information required for the PDF to be indexed within the MHR1 for subsequent search and retrieval.