Analysis of the 'My Health Record' Campaign

Written by Brittany Wolfhagen, 2019

Introduction

This report aims to analyse the effectiveness of the ‘Your health in your hands’ campaign by the Australian Digital Health Agency (ADHA) (Australian Digital Health Agency, 2018).

Starting on the 16th July 2018, and (initially) running till the 15th October 2018, it was a three-month campaign advocating for the use of the online digital record system entitled ‘My Health Record’ (MyHR) (Australian Government Business, 2018b).

When the opt out period concluded in January 2019 (after being extended twice), ninety percent of eligible Australians had a MyHR (Australian Digital Health Agency, 2019).

Theory

This campaign uses one-way public information messaging and rhetoric to encourage publics to participate (Johnston & Sheehan, 2014, pp. 404-405; Chia & Synnott, 2009, p. 17). A lot of the messages are aimed at informing publics and persuading them that ‘MyHR’ is a good idea. This is done by framing the program/focusing on the positive aspects (Johnston & Sheehan, 2014, p. 401).

There is no presentation of counter arguments to balance their messaging and it aims to convince the reader (Tench & Yeomans, 2014, p. 199).

Perhaps when this campaign was developed, they considered situational theory and decided that stakeholders would generally be unmotivated, meaning they didn’t need to venture beyond one-way top-down communication (Johnston & Sheehan, 2014, pp. 406-407).

Organisational listening

Macnamara says “measurement and evaluation of the effectiveness of communication involve listening to feedback and response and …contingent on what is learned, responding in a way that takes account of the views of others” (2015, p. 10).

Recognition, acknowledgement and responding are three key elements to organisational listening and according to Macnamara, “[m]ost organisations listen sporadically at best, often poorly, and sometimes not at all” (2015, p. 7).

The Campaign

Background and description

The MyHR campaign is a government campaign, advocating the use of a government run program which sits squarely in the ‘political organisations’ field of Mcnair’s Elements of political communication (Mcnair, 2011, pp. 7-8).

One of the tactics used was to have health organisations distribute material in support of MyHR. These organisations sit in the same field as government.

At the time this campaign was running, there were several privacy related scandals in the media, so there was increased scrutiny of the systems security (Lupton, 2019).

Because of the system used (‘opt out’ rather than ‘opt in’) the campaign focused on being an advocate for the benefits of the program.

Example video 1

Example video 2

MyHR Facebook page

The aim was to minimise the number people choosing to opt out, however based on the ‘Evaluation of the My Health Record Participation Trials’ report, they were expecting only a small number (Siggins Miller Consultants, 2016).

Tactics

The tactics used were almost exclusively top down, with opportunities to speak directly with publics ignored (Vromen, 2016).

Social media was kept to a minimum, using their Facebook presence to disseminate messages. This is a missed opportunity, because:
- social media can reach publics previously only contactable via mass media (Johnston & Sheehan, 2014, p. 278).
- Social media platforms are used by 79% of Australians (2018 Yellow Social Media Report, 2018).
Consumer information packs were sent to over 15,000 ‘healthcare locations’ (Australian Government Business, 2018b).
Health providers published campaign statements to their websites in support of the program, reading as endorsements:

MyHR “…is an individual’s safe and secure digital health information, easily accessible by doctors, specialists, and hospitals.” (WayAhead - Mental Health Association NSW, 2018)

“Mental Health Australia urges member organisations and mental health consumers and carers to support [MyHR]…” (Mental Health Australia, 2019)

“Having a [MyHR] means important health information – including allergies, medical conditions and treatments, medicine details and scan reports – can be accessed through one system.” (The Pulse [NSW Health], 2018)

What they didn’t do

As stated previously, there was no use of social media to engage in dialogue with publics.
There was “…no national television, radio or print media campaign to advertise the MHR scheme…” (Kemp, Baer Arnold, & Vaile, 2018).
In a Senate Inquiry the Australian Healthcare and Hospitals Association’s Senior Research Director recommended “letters be distributed to each Australian household explaining the benefits of the platform and how people can set access restrictions” (Minion, 2018). This was not done.

The need for trust

An Australian study focused on MyHR found many participants expressed a “…lack of trust and faith in the Australian government’s general technological expertise… concerns about data privacy and security were also key in many participants’ accounts.” (Lupton, 2019)

Another study found that a “…citizen's decision to use online systems is influenced by their willingness to trust the environment and agency involved.” (Tassabehji, Elliman, & Mellor, 2007).

While a separate study by Kim and Lee found “…there is a positive association between e‐participants’ assessment of government transparency and their trust in the local government providing the e‐participation program.” (E‐Participation, Transparency, and Trust in Local Government, 2012).

The deadline and opting out

The original campaign gave Australians 3 months in which they could opt out before a record was automatically created for them. During this time 1.1 million people opted out of MyHR.

The deadline was extended by the Federal Health Minister from October 2018, to November 2018, then extended until January 2019 (McCauley, 2018; Gothe-Snape, 2018). Between the original October deadline and the end of January, another 1.4 million people opted out of having a MyHR created for them (McCauley, 2019). Bringing the grand total of opt-outers to 2.5 million, or one-in-ten (Gothe-Snape, 2019).

Analysis and Discussion

The anticipated opt-out rate was stated as being 10% (Karp, 2018). This is a much higher rate than what was observed in the 2016 trial which had an ‘opt-out’ rate of only 1.9% - which the report stated “…is in line with international experience with opt-out systems for electronic health records.” (Siggins Miller Consultants, 2016).

If the ‘international experience’ is closer to two percent than the achieved ten percent, it suggests that there is an underlying problem.

The Australian Privacy Foundation suggested that the real number is likely far higher than one in ten. They say that not everyone who may have wanted to opt out would have been able to (Australian Privacy Foundation, 2019). One of the reasons they cited was the level of literacy in Australia: 46% of Australians are not literate enough fill out forms (Australian Bureau of Statistics, 2009).

These concerns are echoed by Walsh (et al.) who said “…the information provided does not cater to people with low literacy levels, communication disability, and/or difficulties in understanding written English… There are also gaps in information provision about how consumers can use [MyHR]...” (2018)

With well-publicised issues such as the website crashing under the pressure and the phonelines being overwhelmed with calls, it is possible some people gave up trying to opt out (Gothe-Snape, 2018; McCauley, 2018).

Recommendations and Conclusions

Relationship management theory should be considered and applied as should organisational listening (Chia & Synnott, 2009) Increasing the public’s level of trust in an organisation, (or in a government program) can be achieved through listening to publics using dialogic communication (Yang, Kang, & Cha, 2015). A commitment to dialogical communication has been shown to improve relationships with publics (Kelleher, 2009). According to a Seoul study run by Porumbescu, “…use of public sector social media accounts is positively related to satisfaction and perceptions of public sector trustworthiness” (2016, p. 291). The campaign around MyHR needed to focus on reassuring publics and encouraging trust in the program. It needed to advocate for its trustworthiness, particularly around issues such as privacy. All of this could have been achieved by engaging publics in dialogic communication.

The recommendation to send information to the homes of eligible Australians was not actioned and it should have been.

References

Australian Bureau of Statistics. (2009, December 23). Adult Literacy. Retrieved from Australian Bureau of Statistics: www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter6102008

Australian Bureau of Statistics. (2018, March 28). Household Use of Information Technology, Australia, 2016-17. Retrieved from Australian Bureau of Statistics: https://www.abs.gov.au/ausstats/abs@.nsf/mf/8146.0

Australian Digital Health Agency. (2018, July 16). WA public awareness campaign for My Health Record opt-out period. Retrieved from WA Primary Health Aliance: https://news.wapha.org.au/wa-public-awareness-campaign-for-my-health-record-opt-out-period/

Australian Digital Health Agency. (2018, May 22). Your health in your hands – the digital evolution of health and care in Australia. Retrieved from Australian Digital Health Agency: www.myhealthrecord.gov.au/news-and-media/my-health-record-stories/your-health-in-your-hands-digital-evolution-health-and-care

Australian Digital Health Agency. (2019, February 22). 9 out of 10 Australians have a My Health Record. Retrieved from My Health Record: https://www.myhealthrecord.gov.au/news-and-media/australians-to-have-my-health-record

Australian Government Business. (2018b, July 9). Pros and cons of using social media for business. Retrieved from Australian Government Business: https://www.business.gov.au/marketing/social-media/pros-and-cons-of-social-media

Australian Privacy Foundation. (2019, March 1). My Health Record . Retrieved from Australian Privacy Foundation: privacy.org.au/campaigns/myhr/

Chia, J., & Synnott, G. (2009). An Introduction to Public Relations: from theory to practice. Melbourne: Oxford University Press.

Digital Rights Watch. (2018). Archives. Retrieved from Digital Rights Watch: https://digitalrightswatch.org.au/?s=my+health+record

Dorf, M., & Sabel, C. (1998). Constitution of Democratic Experimentalism. Cornell Law Faculty Publications. doi:10.2307/1123411

Gothe-Snape, J. (2018, November 14). My Health Record: Greg Hunt bows to pressure and extends opt-out deadline as website hits issues. Retrieved from ABC News: www.abc.net.au/news/2018-11-14/my-health-record-opt-out-period-extended-as-website-hits-issues/10496032

Gothe-Snape, J. (2019, February 20). My Health Record opt-outs top 2.5m as service moves to 'evolving' choice. Retrieved from ABC News: www.abc.net.au/news/2019-02-20/my-health-record-opt-outs-top-2.5-million/10830220

Johnston, J., & Sheehan, M. (2014). Theory and Practice: Public Relations. Crows Nest, NSW: Allen and Unwin.

Karp, P. (2018, November 9). Greg Hunt refuses to give My Health Record update as MPs push to extend opt-out period. Retrieved from The Guardian: www.theguardian.com/australia-news/2018/nov/09/greg-hunt-refuses-to-give-my-health-record-update-as-mps-push-to-extend-opt-out-period

Kelleher, T. (2009). Conversational Voice, Communicated Commitment, and Public Relations Outcomes in Interactive Online Communication. Journal of Communication, 172-188.

Kemp, K., Baer Arnold, B., & Vaile, D. (2018, July 16). My Health Record: the case for opting out. Retrieved from The Conversation: theconversation.com/my-health-record-the-case-for-opting-out-99302

Kim, S., & Lee, J. (2012). E‐Participation, Transparency, and Trust in Local Government. The American Society for Public Administration. Retrieved from https://doi.org/10.1111/j.1540-6210.2012.02593.x

Lupton, D. (2019). ‘I’d like to think you could trust the government, but I don’t really think we can’: Australian women’s attitudes to and experiences of My Health Record. Digital Health, 5. doi:10.1177/2055207619847017

Macnamara, J. (2015). Creating an ‘architecture of listening’ in organizations: The basis of engagement, trust, healthy democracy, social equity, and business sustainability. Sydney, NSW: University of Technology Sydney.

McCauley, D. (2018, November 14). My Health Record opt-out deadline extended after system crash. Retrieved from The Sydney Morning Herald: www.smh.com.au/politics/federal/my-health-record-opt-out-deadline-extended-after-system-crash-20181114-p50g01.html

McCauley, D. (2018, August 10). My Health Record opt-out period extended. Retrieved from The Sydney Morning Herald: www.smh.com.au/politics/federal/my-health-record-opt-out-period-extended-20180810-p4zwot.html

McCauley, D. (2019, February 20). My Health Record opt-out doubles to 2.5 million people. Retrieved from The Sydney Morning Herald: www.smh.com.au/politics/federal/my-health-record-opt-out-doubles-to-2-5-million-people-20190220-p50z3h.html

Mcnair, B. (2011). An introduction to political communication. Abingdon: Routledge.

Mental Health Australia . (2019). My Health Record. Retrieved from Mental Health Australia : https://mhaustralia.org/my-health-record

Minion, L. (2018, September 13). “Not fit for this purpose”: FHIR creator on My Health Record as the Senate inquiry gets underway. Retrieved from Healthcare IT News Australia: www.healthcareit.com.au/article/%E2%80%9Cnot-fit-purpose%E2%80%9D-fhir-creator-my-health-record-senate-inquiry-gets-underway

My Health Record. (2018, July 19). My Health Record. Retrieved from Facebook: www.facebook.com/pg/MyHealthRec/posts/?ref=page_internal

Porumbescu, G. A. (2016). Linking public sector social media and e-government website use to trust in government. Government Information Quarterly, 291-304.

Sensis Pty Ltd . (2018). 2018 Yellow Social Media Report. Sensis Pty Ltd .

Sensis Pty Ltd. (2018). The must-know stats from the 2018 Yellow Social Media Report. Retrieved from Sensis: https://www.sensis.com.au/about/our-reports/sensis-social-media-report

Siggins Miller Consultants. (2016). Evaluation of the My Health Record Participation Trials. Canberra: Department of Health. Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/ehealth-evaluation-trials

Tassabehji, R., Elliman, T., & Mellor, J. (2007). Generating Citizen Trust in E-Government Security: Challenging Perceptions. International Journal of Cases on Electronic Commerce, 3, 1-17. doi:10.4018/jcec.2007070101

Tench, R., & Yeomans, L. (2014). Exploring Public Relations. Harlow: Pearson Education Limited.

The Pulse [NSW Health]. (2018, July 31). My Health Record puts your health in your hands. Retrieved from The Pulse: Western Sydney Health News: https://thepulse.org.au/2018/07/31/my-health-record-puts-your-health-in-your-hands/

Vromen, A. (2016). Digital Citizenship and Political Engagement : The Challenge from Online Campaigning and Advocacy Organisations. Palgrave Macmillan Limited.

Walsh, L., Hill, S., Allan, M., Balandin, S., Georgiou, A., Higgins, I., . . . Hemsley, B. (2018). A content analysis of the consumer-facing online information about My Health Record: Implications for increasing knowledge and awareness to facilitate uptake and use. Health Information Management Journal, 106-115. Retrieved from https://doi-org.ezproxy.canberra.edu.au/10.1177/1833358317712200

WayAhead - Mental Health Association NSW. (2018, July 20). Your health in your han. Retrieved from WayAhead - Mental Health Association NSW: https://wayahead.org.au/your-health-in-your-hands/

Yang, S.-U., Kang, M., & Cha, H. (2015, March 12). Study on Dialogic Communication, Trust, and Distrust: Testing a Scale for Measuring Organization–Public Dialogic Communication (OPDC). Journal of Public Relations Research, 175-192. doi:10.1080/1062726X.2015.1007998