A research partnership between Cabrini and Monash sheds new light on the underutilisation of My Health Record in emergency departments

Personal electronic health records (EHRs) support patient health information to be shared with consumers and authorised healthcare providers. Consequently, EHRs are considered pivotal in the transformation of healthcare as they provide access to information about patients that may be otherwise unavailable.

The benefits of EHRs are anticipated to be prominent in the emergency department setting as clinicians are often required to make decisions without historical patient information.

The Australian Department of Health designed and implemented a national EHR system, My Health Record (MHR), in 2012, investing close to $2 billion to support implementation, adoption and digital infrastructure. Individual healthcare services – such as Cabrini Health – and state governments also invested significant funds into infrastructure and to optimise implementation and adoption. However, despite the sizable investment and promise, use and outcomes associated with MHR across emergency departments in Australia are inadequately understood.

As part of the Monash University Graduate Research Industry Partnerships (GRIP) program, Alex Mullins’ (pictured) PhD was codesigned with the Cabrini Health Emergency Department to generate knowledge regarding the use and utility of MHR in the emergency department. More specifically, Alex set out to explore:

What were the key drivers encouraging use and barriers discouraging use of MHR; how often MHR is being accessed in the emergency department, and changes in access over time; and the key clinician and patient-related predictors of clinician access of MHR.

Although Alex’s research was mainly conducted at Cabrini Health, her research has generated knowledge that can be generalised outside of the emergency setting and Cabrini Health. Alex has published a number of novel studies as part of her thesis, shedding new light on how the MHR is being significantly underutilised, despite enormous investment and its likely value to clinicians:

• Surveys and interviews conducted with emergency department clinicians enabled Alex to explore if and how MHR is used in the Australian setting, the barriers and benefits to use, and how use impacts patient care. The results exemplified that only half of all pharmacists, physicians and nurses in the emergency department (who participated) had used MHR one or more times. A lack of training, clinicians forgetting and low-quality records were identified as key barriers preventing use in the emergency setting.

• Alex undertook an analysis of secondary routinely collected data, identifying that MHR is accessed by a pharmacist, doctor or nurse for only 20 per cent of all emergency department presentations, and almost entirely by pharmacists (18.31%). Doctors and nurses were found to barely access MHR at all (2.88% and 0.47% of all emergency department patients, respectively). While a small but significant increase in access observed across the three user groups (pharmacists, doctors and nurses) during the two-year study period, the underutilisation remains a concern.

• Alex undertook another study exploring patient and presentation context factors associated with MHR access by emergency department pharmacists, doctors and nurses. The analysis revealed that emergency department clinicians are more likely to access a patient’s MHR if the patient is older in age and likely to be admitted – suggesting more complex conditions are associated with access.

The research undertaken by Alex throughout her PhD has contributed significant knowledge to an area that has been scarcely explored in the Australian setting.

The findings highlight how underutilised MHR is by doctors and nurses in the emergency department, even though there appears to be value in using MHR (as pharmacists who are repeat users demonstrate).

Patients who are older in age or who present with more complex conditions are also likely to benefit the most, when compared to consumers who present with lower acuity health conditions. In addition to training, education and reminders for clinicians, continuous improvements across data quality, policy and clinical guidance (for example, mandatory uploading) are required. A whole-of-system approach is needed to improve the quantity and quality of data within MHR and to support meaningful use of MHR by consumers and clinicians.

22(1):1-9 doi: 10.1186/s12911-022-01920-8.