Model of Care describes how best to provide healthcare across the many specialty
areas required to address the transitional complex care requirements of people and communities living with CCCs. By linking these categories, model of care should
support the evidence-based characteristics of practice required for health provision to
a population at risk, to bring about changes in their experience of and engagement with MyHR-A and health provision that satisfy the individual and community
requiring care.
At interviews and group meetings during phases two and three of data collection, the partners provided data that were indexed to four labels, charted to the category model of care, and mapped to the theme access. These are presented in Table 31, which
links them to the research objectives and provides a brief description of each label, category and theme. A research perspective and an example of narrative follow.
Table 31. Model of care
THEME Description
ACCESS Connects, provides a flow of information between subjects and
objects
Category
Model of care A guide how best to provide equitable care across multiple domains, transitional, complex, integrated, a continuum (right care, right time, right place, right team)
Research objective
Label
Ro1.3 Patient/health practitioner relationship
Historical, paternalistic, patient dependent on health
professional’s authority, struggle over patient’s role in medical decision making
Ro1.3 Communication Explain, plan, informative, person-centred, partnership, increased personal involvement
Ro1.2.3 Health management Bridging the healthcare professional and the service-delivery system
Ro1.3 Service provision Complex, challenging, types of services, flexible treatment and support for patients and carers, requires planning
Patient/health practitioner relationship was indexed from the identification of the continued practice of paternalistic, siloed models of healthcare delivery. The model of care delivered by healthcare provider(s) impacts on the partner’s personal
involvement in and commitment to their healthcare provision: I don’t feel I’m in a position to tell the doctor (CH16).
[H]ow many doctors really want to read our journey? (OFG2).
[I]t can’t just be health professionals, it has to be us and our input is crucial (CHFG2). I have seen the ENT specialist and physio and plastics and GP and nobody has bothered to look at it [MyHR] so therefore what’s the point? (CH16).
The continued paternalistic, siloed model of engagement with health practitioner(s), affects the patient/health practitioner relationship; healthcare users become disinterested and detached from involvement in their healthcare provision.
To experience and engage with healthcare provision via MyHR, communication must be facilitated digitally. The research community narrated a readiness and willingness to engage with healthcare provision via their MyHR. However, there are those who are challenged not only by living with CCCs and by their limited computing skills, but also by service delivery: in rural communities there is limited availability of and connectivity to personal, regional and national digital communication. This needs ongoing consideration; otherwise the inability to communicate digitally in an efficient, timely manner may lead to further healthcare user disengagement:
[T]he commuter is old and so slow it’ll take 30mins so I think will I do it now, and then I forget about it (LGFG2).
I don't have Internet access at home so my visits to the Internet are limited to the online centre [volunteer] or friends often (CH28).
[T]hey (NEHTA) said to me they would send me a SMS with details, well I would be stuck I would have to walk to get the message (CHFG3).
This is also evident from the researcher’s journal notes and memos recorded at the time. On a number of occasions during phase two, registration and early engagement with MyHR ‘wireless connectivity’ was noted as ‘very weak, lost or unavailable’. ‘ADSL connectivity’ however, ‘provided no problems’.
Health management indexed positive experiences of and engagement with MyHR. As a digital object or resource, MyHR can improve the timely flow of information when it is integrated within a contemporary model of care. The research community
narrated positive perceptions of the benefit of MyHR in their health management: CCCs would be a lot easier to manage if the electronic health record were used (CH6). [C]hildren that have to go to hospital. There are so many instances where this can be brilliant (CH23).
At personal, community, regional and national levels MyHR can play a role in service provision:
[A]n essential part of this electronic health record is if I went to see a Dr in QLD or fell ill (CH16).
However, not all who require transitional complex healthcare provision will require or even want to personally input information to their MyHR:
[M]y mother is 93. She still carries money and goes to the Post Office and pays her bills, she’ll still want her Dr to do it (CHFG3).
although MyHR should remain central to their service provision:
[We want to] stay at home, so this [MyHR] will play a big role, all health professionals in the community will be linked and communicate (CH21).
MyHR is viewed as an essential part of service provision. There is a service provision role for MyHR at personal, community, regional, and national levels, but unless they are supported, not all healthcare users will view or personally add to their MyHR.
The data indexed to four labels: patient/health practitioner relationship,
communication, health management and service provision, and charted to model of
care. Model of care charted a requirement for a comprehensive digital approach to
transitional complex care, which advocates the contemporary characteristics of quality healthcare provision required for a population at risk. A contemporary model of care can bring about change in the experience of and engagement with healthcare
provision that satisfies the person requiring care. The relationship people have and their ability to communicate with their health provision requires a proactive,
integrated, person-centred model of care that offers equitable access via MyHR-A,
which in turn influences the availability, capacity, and overall quality of their health provision.
4.3.5.2 MyHR-A
MyHR-A describes the digital ability to support the delivery of person-centred quality health provision and provide for a digital transitional complex model of care for
people and communities living with CCCs. At interviews and group meetings during each phase of data collection the partners provided data that was indexed to four labels, charted to the category MyHR-A and mapped to the theme access. These are
brief description of each label, category, and theme. A research perspective and an example of narrative follow.
Table 32. MyHR-A
THEME Description
ACCESS Connects, provides a flow of information between subjects and
objects
Category
MyHR-A Australia's electronic health record; has the ability to digitally support the delivery of equitable, person centric, integrated healthcare provision
Research objective
Label
Ro1.3 Access to health information No longer only a health professional requirement but also an individual’s requirement
Ro1.2 Diverse access needs A diverse population has diverse needs—one size does not fit all
Ro1.3 Opportunity The value of inclusive healthcare
Ro1.2.3 Access to MyHR Connection to MyHR
Access to health information was indexed from the expression of a need to connect with, view, and interact with health information. MyHRcan facilitate this:
[T]he remoteness can make it harder to access medical information. It [MyHR] makes it available … and if the records are there you’re all on the same page (CH23).
The frustration with the current access to health information was overt:
[S]o now I have to ring back and get a break down of the [results], whereas if I had it in there [MyHR] I could see them … (LFG2).
I would have thought the Dr to see your own notes [Personal Health Note] about your current state of health is a fairly important thing (CHFG1).
Diverse access needs was indexed from experiences of and engagement with MyHR: [It] has to have a user-friendly site. If the site is not user friendly if I have to keep pushing buttons [I’ll] go off and do something else (CH12).
[I]t’s [MyHR] overcomplicated … the fact people have to ask how to use it, means it’s not right (CH16).
[E]verybody has different needs … you need time (L2).
Diverse access needs indexed the experience of and engagement with MyHR. The
research community narrated that gaining access to the site was frustrating. However, at group meetings the verbalised negativity was responded to with practical positive solutions:
[S]tart with [my.gov.au] and work through, this could be rolled out by libraries (OFG3). [O]nline centres could be used far more effectively; have trained personnel in these centres offering assistance (LFG3).
[S]omething that places could run information session groups where people come together and get through that process … there is a role for rural primary health to play in support of that … at the online centre or in a health centre, attached to a computer (CHFG3).
Opportunity indexed the necessary elements for engagement with MyHR and the envisaged value of a future ability to be involved in inclusive healthcare provision:
Grey nomads this is an excellent way forward, an opportunity, a portable GP (CH11). [A] wonderful way for health, you got the person and the Dr involved, helping and giving the Dr the best chance to help you (CH28).
Access to MyHR indexed discussion focusing on security, privacy, and consent for access to MyHR. The research community did not indicate a concern about lack of or too little privacy or security. The researcher envisaged that there might have been hesitancy about privacy and security when uploading personal details online, however this did not prove to be a concern. In contrast, the community expressed concern with the overwhelming level of password protection, describing it as too much security and challenging the cumbersome, and in some cases confusing, processes that are required for regular interaction with MyHR. Access to MyHR indexed to research community frustration. However, as the researcher’s journal recorded ‘facilitation identified where support was required and solutions were offered’:
It's fast enough to get username. I still keep losing it. I need to store it somewhere (CH1). The security is a bit too much. Username, password then three questions and then the government one, username I’ll never remember it makes no sense (CH12).
I have tried to get on and got onto the government website and couldn't find it [MyHR] and wondered am I going on to the right thing? So I stopped … I was afraid it was the wrong place and I’d put too much in the wrong place (CH23).
The data indexed to four labels: access to health information, diverse access needs,
opportunity and access to MyHR that charted to MyHR-A. MyHR-A charted an
opportunity to support the delivery of quality healthcare provision. MyHR-A
transitional health requirements of all users and provide flexible options to interact with comprehensive quality health provision and health information.