Welcome to the ‘open era’ of health information

“When I graduated, my medical notes were an aide-memoire to help me treat my patients. When I joined a group practice, I realised that my notes helped my colleagues and me treat our patients. Since computerisation, my notes and health summaries have helped me to write better referrals so that colleagues outside my practice can assist me in treating patients more effectively. Now that I can share an up-to-date health summary on MyHR, I realise that my notes can help my patients to achieve better outcomes from the health system, even when I am not directly involved.”

Dr Steve Hambleton, AJGP

Five years ago, in 2014, I wrote about OpenNotes because I thought it was a new and fascinating concept. I soon discovered that giving patients access to health records triggered strong emotional reactions: patients loved it and many doctors thought it was one of the scariest ideas ever.

Fast forward to 2019, and about 90% of the Australian population has access to the national My Health Record (MyHR). According to the Australian Digital health Agency over 80% of general practices and pharmacies, 75% of public hospitals, and 64% of private hospitals have registered.

It took a while, but Australia has sorted out most of the digital teething problems. A large part of what doctors do every day – from writing prescriptions to requesting tests – is now recorded and can be viewed by patients, other health professionals and researchers.

This is only the beginning. Secure messaging is one of the next big topics on Australia’s eHealth agenda. By 2022 patients and healthcare providers can communicate and share more health data than ever before via interoperable, secure digital channels.

Nobody is expecting this to be an easy journey, but I’m looking forward to the destination! Welcome to the ‘open era’ of health information.

Is the medical software industry holding us back?

There’s a Dutch theory called ‘De wet van de remmende voorsprong’ which, according to Wikipedia, translates as ‘The law of the handicap of a head start’. The theory suggests that an initial head start by an individual, group or company often results in stagnation due to lack of competition or growth stimuli. This may eventually lead to losing pole position.

General practice was one of the first fully digitalised, more or less paperless, medical disciplines in Australia. The question is, are GP software packages keeping up with the times or is the profession at risk of falling behind and being overtaking by others?

Good job

Overall I am satisfied with the desktop software I use to look after my patients. It does the basics very well such as recording patient demographics and medical history, medication management, printing scripts and investigation referrals.

It also checks if medications agree with each other and if the patient happens to be allergic to a new pill I am about to prescribe.

But compared to, let’s say, ten years ago there haven’t been any breakthrough innovations. Sure, we can now check the national My Health Record and upload a shared health summary, but there’s also a lot to wish for.

GP Desktop Software
Are GP desktop software vendors holding general practice back?

We’re still relying on the good old fax machine and over the years I have seen more and more third-party software solutions appear on our system to perform tasks the desktop software can’t. Occasionally these packages clash with each other or slow the practice system down.

The wish list

Here’s a list of 7 basic things that should be included in all GP desktop software. I believe it would improve patient care and satisfaction.

  1. I’d love to have the option to communicate securely with patients and other providers, asynchronously or via video link.
  2. Our patients should be able to send digital health data or electronic script requests via a secure connection.
  3. An online appointments booking system.
  4. GPs should be able to send scripts electronically to the pharmacy.
  5. It would be really nice if the software would help us to write (and send) smart electronic referrals by automatically inserting the data required by the specialty or provider we are referring our patients to.
  6. Decision support tools offer benefits such as increased diagnostic accuracy and a reduction of unnecessary tests.
  7. We also need integrated data analysis and data cleansing tools to help improve the quality of general practice data, so it can be better used for in-practice quality improvement processes.

What’s on your wish list?

7 online eSafety tips for doctors

It is good to see that social media and eHealth are becoming mainstream topics at national health conferences. At the recent GP Education & Training Conference in Perth (GPET13) I attended two workshops about our professional online presence.

The first one was about the benefits of social media and was attended by GP supervisors, registrars and students. The second one, sponsored by a medical defence organisation, warned about the dangers of the online world, and interestingly there were mainly GP supervisors in the room.

Before I continue I must declare that I was one of the presenters at the first workshop. But it was good to be reminded by professor Stephen Trumble about what can go wrong. His excellent presentation created a lively discussion. Here are seven random points I took home from the workshop:

Tip #1

Doctors should be careful when looking up patients online, eg via Google. In general this is only acceptable if doctors are acting in the interest of patients, for example when trying to find contact information in an emergency.

Tip #2

Privacy settings of Facebook and other social media tools may change or fail, therefore: do not trust these settings. Assume that everything posted online, even in private networks and groups, is public. I have blogged about the elevator test, which is one way to check if something is suitable before posting.

Tip #3

Taking pictures of patients or their body parts is fine as long as the patient has been made aware of the purpose and who will see the picture, has given consent prior to taking the picture and has been de-identified. When doctors publish the picture online, consent must be noted within the publication. If the picture is later used for other purposes, the patient must again give consent.

Tip #4

When doctors collect patient information on their mobile devices, eg when taking a picture with a smart phone or when using a transcription service, these devices must be protected from misuse, unauthorised access, alteration or disclosure. The simple passcode on iPhones is generally deemed insecure (but can be made more secure in the phone settings). If patient information is stored overseas on cloud systems, local security laws apply and they may not meet Australian standards.

Tip #5

Old smart phones, even if factory settings have been restored and the data erased, still contain information. This is of course also true for USB sticks, practice computers, photocopiers with a hard disc etc.

Tip #6

I have blogged about the issues with Skype in patient care. From the handout: “Skype is not recommended for telehealth consultations but has not been deemed ‘unsuitable’. There are privacy, confidentiality and quality issues and many doctors who start with Skype end up upgrading to commercial systems.”

Tip #7

Last but not least: email is not suitable to transfer patient information. Encrypted email is the preferred option.

It is sad that the eHealth practice incentive payments (PIP) by the government are only paid to practices taking part in the PCEHR. As a result costly software, system and security upgrades will not be a budget priority for many practices.

Sources:

  • Online communication for education: risks, responsibilities and rewards. Workshop by Prof Stephen Trumble, Ms Nicole Harvey. GPET 13 Conference, Perth
  • General professionalism online – handout by MDA National
  • Informed consent and Telehealth – handout by MDA National
  • Telehealth tips – handout by MDA National