Positive Life NSW Blog

Opting out of My Health Record

Posted by on in Advocacy and Policy

IMAGE: Colourful icons on a screen with a human figure reaching out to select one of them

By the end of 2018 every Australian, including people living with HIV (PLHIV), will have a My Health Record account set up by the Australian Digital Health Agency (ADHA).

This My Health Record account is an online database owned by the federal government of summary information which is uploaded by you or your GP and can include your specialists, pharmacists, participating pathology labs or diagnostic imaging providers, or someone authorised to represent you. This information can be accessed by your healthcare providers like doctors, specialists and hospital staff.  It’s been touted as one of the biggest advances in the Australian health sector since Medicare.

There are many benefits of this national Australian digital health record system. For example, all your health information is in one place. If you change doctors, all of your test results and medical information are easily accessible to your new doctor without the hassles of transferring your file to a new practice. If you’re in an accident or you can’t speak, your healthcare providers can better coordinate your care, and emergency staff will be able to act quickly and confidently with access to all your medical history. Eventually, you’ll be able to organise medication and prescription repeats online and have them sent to your local pharmacist without extra costly appointments for a simple refill. As PLHIV, these are big advantages!

Having said that, there are significant considerations for PLHIV who remain opted in when My Health Record goes live.

Positive Life believes the ownership and confidentiality of your personal electronic health data must remain under your full control as a PLHIV. As confidentiality impacts all of us living with HIV differently, we all need to be fully aware of the details; details such as who has access to our private health data, when they can access it, what the potential implications are and what it might be used for.

Who can view my personal My Health Record and when can they access it?

The digital health record system has been designed with security settings in place, including options to restrict access to certain clinical documents. That means that you have a level of control over what your treating doctors and specialists can see within your record. In the case of an emergency, for example, any advanced security controls previously set by you can be overridden for five days. This might seem reasonable enough to the average person, but there are a broader range of people who can access your health data than is advertised.

Under the current legislation (My Health Record Act 2012) law enforcement agencies can gain access to your health data without the independent oversight of a court or tribunal. If the ADHA is led to “reasonably believe that the use or disclosure is reasonably necessary” in the prevention, detection, investigation, or prosecution of criminal offences, breaches of the law or improper conduct and in “the protection of the public revenue” (e.g. taxes), your health data can be shared to any law enforcement agencies that request it. The impact of this could be huge for many of us living with HIV.

Many PLHIV and other groups of people who are affected by HIV, such as sex workers, people who inject drugs (PWID), Aboriginal and Torres Strait Islanders, immigrants and refugees, and anyone receiving welfare payments, already encounter significant stigma and discrimination and can often be the object of unwarranted law enforcement scrutiny and investigation. PLHIV in these vulnerable groups with a My Health Record will find this is a barrier to engaging healthcare providers when law enforcement agencies have access to their private health data. How can doctors and health services keep confidentiality for PLHIV, PWID, sex workers and other vulnerable populations if law enforcement authorities can access the information? The safe, confidential space of a non-judgemental doctor’s consulting room is now at risk.

We’ve already seen health data being shared for purposes other than primary healthcare around the world. Recently in the UK, the National AIDS Trust joined the Parliament’s Health and Social Care Committee, to call on NHS Digital (the equivalent of ADHA here) to stop sharing immigrants’ personal health information with the Immigration Department. Data sharing for immigration purposes scares people away from healthcare. People living with a range of infectious conditions will avoid diagnosis and treatment which in turn jeopardises public health. While this is just one UK example, we have recently seen a number of Australian and global breaches of data that people previously thought was confidential or protected.

Why is this important to me?

Many of us who are living with HIV have had chaotic times in our lives. When you’re honest with your doctor in the confidential appointment setting to get the physical or mental healthcare you need (eg., for drug use), My Health Record can place you in the criminal justice system, even if your doctor had no intention of reporting you.

Any database holding your personal information is a risk to privacy. In December last year, academics from the University of Melbourne showed how easy it was to take de-identified data and re-identify individuals through a process of relinking publically known details. In this case the re-identified records included “potentially exposing if someone is on HIV medication, has terminated a pregnancy, or is seeing a psychologist.”

While the My Health Record system may provide some security measures, it is not a private database. Any information remains the property of (and available to) authorities for your lifetime or “130 years after the document was uploaded”, even if you cancel your My Health Record account.

While the My Health Record website states that ADHA “has no intention to sell de-identified data from the My Health Record system” it is exploring opportunities to share your health data with app developers, commercial entities and insurance companies. Positive Life raised concerns on the behalf of all PLHIV in NSW, in a submission on ‘secondary use of My Health Record data’, focusing in particular about the lack of individual consent and the full or partial commercialisation of private health data with both the NSW and Federal Health Ministers. We are currently awaiting the report and its findings.

What Positive Life thinks?

Changes must be made to the current legislation to ensure our personal health data cannot be targeted by law enforcement without judicial oversight. Without changes to the law, negative outcomes for individuals and public health will also make Ending HIV a more difficult task. Until then, PLHIV from vulnerable populations, such as sex workers, people who inject drugs (PWID), and others will be better off to ‘opt-out’ of the My Health Record.

You can sign up to My Health Record at any time before December 2018, however by December the national roll-out will automatically enrol you with a My Health Record unless you choose to opt out. If you do not opt-out, your consent is implied. Once you start using a My Health Record account, it’s there for life. If you share any of the concerns we’ve raised, Positive Life is suggesting you opt-out of the My Health Record for now. You will be able to reconsider this in the future, when and if your concerns are allayed.

For more information

There will be an opportunity to opt out if your do not want a record between 16 July to 15 October. The diagram below indicates the sequence of events enabling opt-out to begin.

Subscribe to an email service on the My Health Record website which will notify you by email when the opt-out period begins.

This diagram indicates the sequence of events enabling opt-out to begin.

If you already have a My Health Record and you would like to opt-out of the program, you can during the three month window (16 July to 15 October) by calling the Help line on 1800 723 471, or follow these options under 'Cancel my record'.

Find out more about Opting-Out

If you need further information or support about My Health Record and what this means for you or have more questions about the consultation process re the secondary use of My Health Record data please contact Positive Life on (02) 9206-2177.

Your health date in the electronic era

www.myhealthrecord.gov.au

My Health Records Act 2012

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Comments

  • Guest
    Dr Bernard Robertson-Dunn Thursday, 17 May 2018

    Re: "This My Health Record account centralises all your health information"

    This is incorrect. My Health Record is a government owned database of summary information that you or your GP uploads.. This system is in addition to your GP's medical record system. It may also include discharge summaries, event summaries uploaded by your dentist or pharmacist, none of whom need your consent to upload your health data. In fact the whole My Health Record opt-out initiative is being done without any requirement to gain your consent.

    FYI, the access controls only apply to health professionals, they do not apply to the government itself. There are a number of circumstances detailed in legislation that permit the System Operator (the government) to give data to courts, law enforcement agencies and government agencies in "the protection of public revenue". This will be done without your consent or even knowledge.

    The safest thing to do is opt-out.

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Guest
Guest Tuesday, 22 May 2018

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