Information technology systems and RACFs

In Australia, each RACF has its own patient medical record systems and technical infrastructure to manage patient health information and medications in the facility. Some facilities have an electronic medical record system, whereas others have paper-based or hybrid systems to manage clinical notes. The RACGP’s Standards for general practices (5th edition) and the Standards for general practice residential aged care (1st edition) recommend electronic medical record systems be used rather than a paper-based or hybrid system. The implementation of electronic health records in the aged care sector has been shown to improve the efficiency and quality of care, as well as administrative and funding processes¹ (refer to Part B: Medical records at residential aged care facilities).

Current patient medical record systems used in RACFs are not compatible with those used in general practice or hospitals.² It is important that data and information are accessible, accurate and up to date to support effective communication between RACF healthcare providers, as well as to support patient safety. Medical record systems should be digitised and made interoperable with the clinical information systems used in general practice.

Transition to new, interoperable digital systems will incur considerable financial costs and impost to end users. It will require a transition plan and adequate training with GPs and RACF staff. Due to its limitations, My Health Record should be used to complement a general practice’s clinical information system to enable the sharing of health information among aged care and healthcare providers and relevant government agencies.

When people enter residential aged care, it is important that RACF staff seek consent from them (or their substitute medical decision maker) for health information to be disclosed to all relevant service providers involved in providing their medical care. Staff could also provide information about how to appoint an authorised representative and initiate advance care planning in anticipation of future changes that may occur in the resident’s health and/or capacity to make decisions (refer to Part B: Advance care planning).

Information management aids continuity of care between the RACF and healthcare professionals who provide care to people in RACFs (refer to Part C: Clinical handover and continuity of care – medication management).

Practitioners who have access to current information about medicines can implement best practice prescribing. Reviewing medicines and having an up-to-date medicine list for residents reduces the risk of errors when prescribing or referring.

Medication safety is an important issue in RACFs. GP access to shared electronic health records and regular review of medicines is important in reducing the risks associated with these medicines (see Part A: Medication management and Part B: Principles of medication management).

Residents in RACFs face barriers in accessing their preferred GP, and this is often more prominent after-hours. A medical deputising or after-hours service may be required to provide this care (refer to Part B: Provision of after-hours aged care services).

After-hours services require access to an RACF’s medical record system and advance care plans to provide appropriate patient care, transfer and to prepare an event summary for a patient’s regular GP and document any investigations ordered.

One of the challenges for GPs working in residential aged care is the process of prescription and medicines management for their patients. The ordering and supply of medicines to RACF residents from external GPs and pharmacists creates inefficiencies and risks to patient safety. Most RACFs use some form of the national residential medication chart to manage patient medicines, and these include information on:

• medicines previously prescribed, dispensed and administered
• patient allergies and adverse reactions
• any special needs, such as difficulty swallowing or cognitive impairment
• prescription due dates.

The benefits of the national residential medication chart include:

• improving patient safety by reducing medicines errors and preventing adverse medicine interactions
• supporting communication between everyone involved in a patient’s care
• continuity of medicines
• making prescribing and dispensing easier and more efficient.

The Royal Commission into Aged Care Quality and Safety recommended ‘universal adoption by the aged care sector of digital technology and My Health Record’.³ To support this recommendation, the Department of Health and Aged Care is supporting RACFs to transition to an electronic national residential medication chart (eNRMC). The rollout of the eNRMC will reduce the administrative burden and the risk of medicines errors by connecting RACFs with prescribers and pharmacists in real time, resulting in greater efficiencies and enhanced medicines safety, including:

• clinical decision support tools such as alerts and reminders regarding allergies, medicines interactions and prescription due dates
• streamlined access to patient details for prescribers and dispensers
• support for all healthcare professionals to better understand a patient’s medicines history and individual care needs
• improved privacy and security for patients
• increased efficiency in medicines reporting, auditing and reconciliation.

The My Health Record provides healthcare providers access to another source of information. The use of My Health Record in RACFs can improve access to residents’ health and medicines information to support better and safer care.

My Health Record allows RACF residents and their healthcare teams to share immunisation information, details about allergies and medicines, as well as pathology and radiology reports, where available.

My Health Record can contain clinical content data from government sources such as Medicare and the Pharmaceutical Benefits Scheme (PBS), documents that are uploaded by healthcare providers and health information that is added by the consumer.

Many patients who enter aged care facilities have information about their health status missing due to the transition of care from hospital or the move to a different geographical location, where they no longer have access to their usual GP. As My Health Record is more widely adopted in aged care, and the data and information available in the system increase, there is the potential for My Health Record to become a powerful tool to provide better and safer care.

• Supporting telehealth services in residential aged care facilities: the case for My Health Record
• Aged Care Quality and Safety Commission Standard 4. Services and supports for daily living
• Aged Care Quality and Safety Commission Standard 8. Organisational governance