Angela Parker:
Hello everyone and welcome to today's webinar on supporting telehealth services in residential aged care facilities: the case for My Health Record. My name is Angela and I'm a Project Officer from the RACGP’s Practice Technology and Management team.
I'd like to introduce you to our host for today, Dr. Steven Kaye. Steven is the Deputy Chair of the RACGP's Practice Technology and Management Expert Committee, and he's been a member of the committee since 2016. He has previously been the Deputy Chair of the Bayside Medicare local and Chair of the Bayside GP Network. Steven is a GP registrar supervisor from eastern Victoria GP training an examiner for the RACGP Fellowship and the managing partner of his general practice in southeast Melbourne.
Welcome, Steven.
Dr Steven Kaye:
Thanks Angela and welcome to everybody around the country.
I've got a fantastic audience today, and a really dynamic discussion to have. Today's webinar is an accredited CPD activity delivered by the RACGP in partnership with the Australian Digital Health Agency for everybody's enjoyment. The webinar is being recorded, of course, and will be uploaded to the RACGP website for on-demand viewing, should you want to go back to it or watch it at a later time.
We've placed all attendees on mute to ensure the learning will not be disrupted, and that there's no background noise throughout the presentation. If you have any questions during the webinar, please add these to the Q&A box at the bottom of your screen and I will attempt to answer those at the Q&A time at the end of the session. If you prefer to ask your questions anonymously, you can select this option when posting your question, and you can interact with the panellists using the chat function as well. So we'll try and monitor that as best as possible, and interact with everybody as much as possible
Before we begin, we'd like to acknowledge the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. We pay our sincere respects to them and their cultures, and to Elders, past and present and emerging.
And I’d like to introduce now our presenter for today Marwa Osman is a digital health educator from the Australian Digital Health Agency. Marwa’s got a background as a pharmacist and is unbelievably passionate about utilising digital health tools to enhance patient outcomes. I'll now hand over to Marwa to begin her presentation and we'll go from there.
Thanks Marwa.
Marwa Osman:
Thank you so much, Dr. Kaye. And thank you for the opportunity to be here and present to you all today.
So to start off with, I’ll just mention briefly our learning outcomes for today's session. We're going to articulate how the My Health Record can support telehealth consultations in residential aged care facilities, and then we're going to look at how to apply the use of My Health Record when consulting via telehealth with patients in residential aged care.
To start off with this morning, we're going to talk a little bit about telehealth. Now we know that telehealth consultations have come a long way, and that was really catapulted by the COVID-19 pandemic and the lockdowns, and the need to be able to perform consultations remotely. And so that's accelerated the technology available for that where, previously, if telehealth was needed, it was more often than not just via phone. We're now seeing that there are other tools that can be embraced, and there is a place for the use of telehealth consultations alongside the traditional face-to-face consultations, of course, that have their place in ensuring quality health care but on a more regular basis. And I guess it's important to discuss, you know, the tools available, the different options. There's certainly a number of providers offering different tools in their products. And it's about choosing what's appropriate for your own practice, what the pros and cons are of each of the different platforms available. There are a number of considerations. So when you're actually conducting a telehealth consultation, consider things, you know, that may be present and visible in the background. If you're using video conferencing technology, you're ensuring that in opening your camera there's no other healthcare data that may be visible that may render someone else's private information visible to others and therefore breaching their privacy, ensuring that you know who you are talking to by confirming their identity, and that there's no other unauthorised people present and ensuring you've got a phone number to utilise to reconnect in case the connection drops out and then you've got that phone call as a backup in case the video conferencing falls through.
Now, the Australian Digital Health Agency has some good resources on the use of secure online conferencing technologies, and how to maintain that secure system and some advice on keeping safe online. So we've got some great cyber security resources on our website as well, and I've also placed there a link for the Medicare privacy checklist for telehealth services that you may find beneficial.
Now, at this point I’d like to invite Dr. Kaye to share with us his take on the use of telehealth consultations, you know, using something like a video conferencing as opposed to just conducting a consult over the phone. So if we were to consider, you know, a patient that you may look after who's a resident in a residential aged care facility that you look after regularly, they've been admitted to hospital because they've had a fall, for example. They've had some changes in hospital. They've been discharged back to the facility, and that chart needs to be reviewed for their medicines to continue. How would you use telehealth in that context? And I guess, touching on the availability of tools like the My Health Record system, which we'll talk in more detail about later on today. Can you start us off on what you may find beneficial to obtain from the My Health Record, and how telehealth can assist as well.
Dr Steven Kaye:
Yeah, thanks Marwa. The workflow that we all use, especially in aged care, is being challenged. Traditionally, what would happen was that would be that a patient would return back to an aged care facility, we would be notified by that facility by the staff, and often there was a lag period of a few days before we were able to generate time to go and visit that patient. And within that time period, of course, the patient is in the facility, medications may have been changed by their hospital doctors, or wherever they’ve been in the past and so they're on a new set of medications that we, as their treating practitioners, are not particularly aware of. The information hasn't been transferred yet from the hospital, there is often a delay. Often the deputising service needs to be called in order to make up a prescription list, a medication chat. So all of these potential errors occur, and fragment the care of the patient. So it's not a seamless transition of patient care, and that fragmentation is, of course, very dangerous with lag periods going on.
So with telehealth and with digital technology, of course we can organise a telehealth consultation with the patient with the assistance of the aged care facility. Of course, we understand that many aged care facilities don't have digital communication tools, like wi-fi, or tablets, or you know proper digital communication. But we're also now supplying funding for that process to occur, I will talk about that shortly.
So with the digital communication platform we can see the patient remotely. We can consult with the patient and discuss the issues with the patient and the staff and the family. We can log in to the medical record of the patient within the aged care facility, presuming that that's digital, and we can therefore see what medication has been changed, make alterations if we feel that that's necessary. We can interrogate My Health Record and see what information is there. Pathology results, diagnostic imaging results, discharge summaries, specialist referrals and letters and various other things. And that's a growing list with increasing the use of My Health Record. And so we can do that in a shorter time period, often from our surgeries, or even from our home, in order to maintain the care of the patient in a timely fashion once they've returned from a hospital, say, back into the aged care facility. And the efficiency that gets created with that then allows that patient care to be optimised, and perhaps we'll organise a face-to-face visit in a few days to review the patient live, rather than remotely. But we've not been disconnected from the patient, and the care has not been fragmented overly.
Marwa Osman:
That's excellent. Thank you so much for sharing that workflow with us much appreciated. As Dr. Kaye mentioned there's definitely improvement happening in the space in terms of technological advancement in residential aged care facilities. And we're going to see the fruits of this hopefully in the coming months. So there is some funding that's been granted from the Department of Health, to primary health networks to assist residential aged care facilities in improving their ability to engage in video conferencing and telehealth. So whether that's through, you know, upgrading their wi-fi networks and improving connectivity throughout the facility or investing in new equipment, such as trolleys that they can utilise to conduct these telehealth consultations around the facility that they can transport it with them from place to place, whether it contains a laptop or an iPad. Whatever suits the needs of the facility. So hopefully we should be, seeing the fruits of that in the coming months lots of work is happening in that space at the moment.
So now I’d like to move on to talk a little bit about the My Health Record, and Dr. Kaye touched on some of the important information that we can find in the My Health Record, and that list does continue to grow because the My Health Record does have ongoing enhancements to the system. It evolves as the needs of Australians evolve, and I’ll talk a little bit about that when I go through some of the documents that can be found in the My Health Record. But essentially the My Health Record is an online summary of a person's key health information. It's personally controlled. So a person can choose how often or how little they interact with the My Health Record, and they can choose to nominate a representative, so they can choose a carer or a family member that can assist them in managing their My Health Record with them or on their behalf. It's part of a national system, so it's available anywhere around Australia, 24 hours a day 7 days a week, and it's protected not only by the highest layers of cyber security, but also by legislation, so that any intentional misuse of the My Health Record is severely punishable by law.
Now, we can think of the documents available in the My Health Record in three broad categories. There’s the consumer documents -so those are things that the consumer or their representative can upload to the My Health Record, so that can be something like a personal health summary containing the medicines that this person is taking or allergy information and emergency contact details, advance care planning documents – if they’ve been completed they can be uploaded to the My Health Record and it’s a wonderful repository to store something like that in because it means that if a situation arises and healthcare providers need timely access to a person's documented wishes in the event that the person is no longer able to make their own decisions, then it makes things easier, not only for the healthcare providers, but also for the person's family members because it means that they're not having to make difficult decisions in those circumstances, and we know that that's something that causes a lot of distress for loved ones.
Now, the next category of documents in the My Health Record is the Medicare documents which are uploaded by Services Australia. So these are things like MBS or DVA item claims. So if a person, you know, has gone to a particular GP or a specialist and there are these item numbers that have been claimed through Medicare, for example, that would be reflected in the Medicare or DVA section of the Medicare overview, so it can be very valuable, and I’ll show you some screenshots of that and how it can be utilised in practice to find out more information.
Organ donor register information is also reflected in this section of the My Health Record, as well as Australian immunisation register data flowing through to the My Health Record as well, and we know that that's really useful. And we saw how valuable that can be to have that timely access to this immunisation information as we travel through the COVID pandemic.
Now the third and final category is the provider documents, and these are documents that are uploaded by healthcare providers to the My Health Record. So things like a shared health summary, which is essentially like a snapshot of a person's health at a particular point in time, and that's uploaded by a person's main healthcare provider so most often that's the GP or their practice nurse at the clinic of that general practitioner, or an Aboriginal and Torres Strait Islander health worker, with a certificate four or above. It can only be uploaded by a doctor, an Aboriginal and Torres Strait Islander health worker, or a registered nurse. It cannot be enrolled by any other healthcare providers or enrolled nurses.
And now discharge summaries from hospitals, pathology, reports, and diagnostic imaging reports from providers that can also be found in the My Health Record. Prescription records for prescribers dispense records from pharmacies, specialist letters, and the list goes on.
Now the image at the centre of the screen shows you documents that aren’t uploaded by a specific healthcare provider. They are actually My Health Record system generated overview documents. And what that means is the dynamic views that pull information from different locations within a person's health record about a specific topic and condense it into a single view. So, for example, the medicines information view collects any medicines information, say, in the last 2 years, for example, that's in a person's My Health Record and condenses it into a single view that's hyperlinked to the source of that information, so that you know, if you read something about a particular medicine and it's dose, and you want to know more about it you click and follow that hyperlink. You'll be able to see who the healthcare provider was that was involved in that episode of care, the date, the organisation. They come from their contact details so that you can reach out to them for further information if needed. Other overviews that are available are the Medicare overview, the immunisation view, the pathology reports overview and the diagnostic imaging reports overview. So I’ll go on to show you a little bit more about these as we progress today.
Dr Steven Kaye:
Can I just say Marwa on that, progressively more and more providers are automatically uploading into My Health Record. So we know, and it's often state-based. So we know that Queensland Health, for instance, is a strong upload of both pathology and diagnostic imaging reports.
Many of the Private DI and Pathology companies are slowly coming onboard to upload their results into the patients’ My Health Record. So what was not there 12 months ago from your local providing service may well be there now. And that's changing every week or two we hear of new providers who are uploading their information into the My Health Record. So you know whether it's the public system, or whether it's the private providers of care, increasing services or results that are being uploaded with increase, as the security concerns and the other privacy concerns are being dismissed, more of the companies are uploading. So we need to keep an eye over that, so that we can be aware of which companies are uploading. And so, from a clinical point of view, we need to just check that regularly and see which patient has their results uploaded.
Marwa Osman:
That's actually a really great point. So thank you for interjecting there, and I’d like to show you… I've just searched for pathology and diagnostic imaging providers uploading to the My Health Record. This is available on the Australian Digital Health Agency website. So you can actually look for that state by state. So, for example, I’m in New South Wales I can go through there and see you know what the which providers are uploading in terms of pathology and in terms of diagnostic imaging. Again, for other states, you can see there. So if you're interested in more information about who's uploading, I can paste this into the chat. There we go. And then you're able to view that as well.
I can see there's a question that's just come through there in the chat, I think. Is there a register of conformity that lists software that conforms with national telehealth requirements?
I'm not actually aware that there are specific requirements, national requirements, for telehealth. Dr. Kaye are you aware of anything? I know that this conformance requirements for the My Health Record, for electronic prescribing. But I’m not actually sure for telehealth.
Dr Steven Kaye:
There's as far as I know, there's not a particular list or a particular conformancy program. The RACGP has guidelines that Angela will post the link to in the chat as well, guidelines for telehealth in order to give everybody as much information as possible for safety and security and privacy.
Marwa Osman:
That's wonderful. Thank you. And also consider some of the resources that I posted earlier from the Digital Health Agency on staying safe online as well.
So I want to touch on how healthcare providers can access to My Health Record. So the majority of general practice software is conformant to the My Health Record, and if you're interested in finding out if your software is conformant, you can go to the Register of Conformity. The link is there on this slide, and you'll receive a copy of these handouts following the presentation. But you can actually see which software providers and products are conformant. And what that means is you can access the My Health Record directly through your software in the patient's profile. And it's wonderful when you do access through conformance software, because the task of uploading information to the My Health Record is a lot more streamlined, a lot more simple because it actually pre populates. So when you're uploading something like a shared health summary that captures a person's key health information it's based on collating that information from the information that's stored about this patient in your local record. Now, of course, for that to be effective, we do need to talk about having to, you know, accurate information. Removing information that's outdated or updating it to ensure optimum data quality that the information that's being stored both locally in your system and upload to the My Health Record reflects the state of the patient.
In situations where you're using a software product that's not conformant with the My Health Record, if you're wanting to access the My Health Record, you'd need to access it through the National Provider Portal, which is web-based access. The downside with that is that it is a whole other system that you're logging into. So you know you'll have your own system with you. You've looked up the patient in that and then you've got to open up the National Provider Portal and enter all the patient details to look them up. And it's a viewing platform only - you can't actually upload information through the National Provider Portal. The good thing is, as I mentioned, the majority of general practice software is conformant. We've gotten over 99% of GPS connected to the My Health Record. So majority of you would be accessing directly through their clinical information system.
Now, I mentioned the overviews in the My Health Record that are generated by the My Health Record system, and this is a screenshot of the medicines information view which collates all of the medicines information in a set period. So in the last 2 years, for example, and as you can see here, the medicines information can come from dispense records, prescribing records, Medicare and PBS information from Services Australia, a shared health summary from a GP, a discharge summary from a hospital, or even information that the patient has entered themselves into their My Health Record will all be collated into this view. And as you can see here there are tiles at the top, so there's allergies and adverse reactions, and if you click on that, it will take you to a summary of the allergies and adverse reactions. And this will actually list what the reaction is, whether it's a hypersensitivity, or it's, you know, something like a rash, and it'll actually say who's uploaded that information, whether it's entered by the patient themselves, or whether it's a healthcare provider when they uploaded this information from what organisation their contact details, so that you can reach out to them if you'd like to know more.
Dr Steven Kaye:
Marwa can I just say something about the allergies and adverse reactions? The reaction itself like a rash or anaphylaxis or whatever the reaction is to a particular medication, is taken directly from the clinical software package. So, it’s seamlessly uploaded in the background before you’ve put a shared health summary in the My Health Record.
So that's as you were saying before the curation of the patient record, to make sure it's accurate and descriptive. Having the correct list of medications sitting in the current medication list, and having the allergies and adverse reactions, including what the reaction is also in the patient record, in order for it to be uploaded into the My Health Record via a shared health summary, and then it will appear in the allergy and adverse reactions tab for everyone's use, including the patient’s.
So we need to be contributing to this information stream with accurate and correct and precise information about particular medications. Very commonly people will have a penicillin allergy listed but without the reaction. So is it a rash? Is it anaphylaxis? Is it a sore toe? Is it questionable, or is it real? And so we, as the patients’ clinicians, need to contribute to that information stream with legitimate information about any of the reactions.
Marwa Osman:
Thank you. Yeah, indeed, they’re some very good points there, because that will lead to more appropriate use of antibiotics and medicines generally in hospitals, you know, knowing the difference between whether someone has just had a side effect or whether it's an allergic reaction can assist clinicians in decision making often with very tight timelines.
Now the next tile that's available is the medicines preview that collates the medicines that a person is on in their My Health Record. You can see the list here that's shown. So these are the medicines that the person is taking. This is reported in an event summary in a shared health summary from a prescription record at the practice, and all of these are hyperlinks, so I can click on these to go to the original document if I needed more information. But just looking at this preview, I can actually see what those doses are. I can see the date it was uploaded. So very valuable source of information, even without going to the source document.
The next tile is a quick link to the shared health summary. So the most recent shared health summary. You can see who the author was, when it was uploaded. And this, can, you know, help you decide whether it is three months ago, so it it's likely relevant. The idea behind the shared health summaries is that when there is a significant change to a person's health, say a new diagnosis, change in medicines, then a new shared health summary is uploaded to the My Health Record, which then supersedes the previous one. And again, when you've got that accurate information in your local software at the end of the consultation, it's as simple as clicking a few buttons. The Agency, the Australian Digital Health Agency actually runs several webinars on how to use the My Health Record from within your clinical software. So, using a variety of test environments, such as Best Practice, and Medical Director, and others because it's quite a simple process. As Dr. Kaye said, it generates and pulls that data, and you simply just skim through to confirm that you're happy with that before uploading to the record.
Now, if the person has been to hospital recently and discharged, then a link to the most recent discharge summary will be there as well.
Next, I've got a screenshot of the immunisation consolidated view. So this consolidates information about immunisations that may be reported in a person's My Health Record, or from the Australian Immunisation register. Both of them will be listed. Here there's notices of, you know, when something's coming up or if something is overdue, it will be listed here as well. It is worth noting that because it contains both immunisations reported in the Australian Immunisation register and those that may be reported say in an event summary or a shared health summary, you may get an immunisation that's listed twice. So you know flu vaccination, if you upload that to the My Health Record in a shared health summary, and it's uploaded through the Australian Immunisation register as well it will appear twice, but the date will be quite clear that it's talking about the same immunisation.
Now, next, I’d like to talk about the pathology reports overview and the My Health Record. And again the link at the bottom of the screen here is what I was sharing earlier today showing the pathology providers. They're uploading to the My Health Record, and as Dr. Kaye mentioned, that's not a static list. It's continuously updated. So keep going back to that website. You will see more and more pathology providers jumping onboard. There's a lot more activity in terms of pathology than diagnostic imaging reports at the moment. But it's achieving great results because it means that healthcare providers that weren't necessarily the ones that requested the testing can obtain access to that. The patient themselves can obtain access to that and it means that, in the event that you're seeing a patient that you may not have seen before, for example, and you need insight into what the general management of the diabetes has been like for example, you can actually group the pathology reports together in the pathology reports overview. So, for example, I can group all of the glycosylated haemoglobin together and have a look at the HBA1C over the last two years. How has that been traveling? So I can group all of the HBA1C and order those by date over the last two years, and I can see how that's been traveling, and understand what this person's background management of their diabetes is like. And this may be the case when you're reviewing someone who's new to a residential aged care facility, for example. You don't have prior medical history available to you, but this would be a great a starting point as to how their management has been. So really good source of information, and it decreases the need for making for those extra phone calls to obtain that information from other healthcare providers or laboratories.
Now I mentioned that the shared health summary is a snapshot of a person's health at a particular point in time that's uploaded by their main healthcare providers so most often that will be their GP. And it has four key areas, so allergies and adverse reactions, medications that they're taking currently, their medical history and immunisations. And at the bottom there is the administrative details section. So who's the healthcare provider that is preparing this document? What are their contact details? The organisation they come from, and of course, the date, all of that can be generated with a few clicks from within conformance software so that it can be reflected in a person's My Health Record. Now, this serves as a great starting point for other healthcare providers who may be seeing your patients. So if you're looking after a residential aged care facility resident and you upload the shared health summary, they have a fall and they're admitted to hospital and they find their shared health Summary on the My Health Record, more likely than not they're not going to need to reach out to you for further information. So it saves you time, it saves them time gathering this information because they've got a great starting point of what this person's background medical history is like, the medicines that they're currently taking. They'd be able to see when this document was uploaded, if there's likely been any changes, they can also view prescription and dispense information in the My Health Record to see if there looks like there's anything new that's been prescribed or dispensed.
So this is a screenshot of that prescription and dispense view. Again, you can see a summary of the medicines information in the medicines overview. But if you wanted to specifically look at the prescription and dispense view, that is a view that's available in the My Health Record, and here you see the condensed view of medicines that have been prescribed when they've been first dispensed, and when their last dispense is but you can actually expand these by clicking on them. And this is what that expanded view looks like. So you can see that there's something that's been prescribed here, and these are the incidents of dispensing. So this is the instruction there for that prescription and this is how many times it's been dispensed. And then you can further click on each of these interactions to view more detail about that dispense record. So which pharmacy dispensed it, if it was substituted or not, what the instructions were, and at the bottom of that again, the administrative details section that shows you who the healthcare provider was that was involved in that and contact details for the pharmacy, so that you can reach out to them if you needed them.
So I did touch on discharge summaries being available. So again, in the context of a residential aged care facility patients when they've been to hospital and discharged, more often than not the discharge summary may not follow them in time before your consultation. So you're having to search or make contact with the hospital or the administrative staff, having to take time to find that information. So the great thing about hospitals uploading discharge summaries - and when I say hospitals I am referring to public hospitals because we've got 97% of them connected to the My Health Record. That number is not as high for the private hospitals, but we are connecting more and more as we progress, particularly as a result of changes and recommendations that are made. Private hospitals do also need to come onboard with this to meet their standards. So we're seeing more and more private facilities come onboard. But in the case of public facilities, that process of uploading a discharge summary once that document is created from the clinicians end in in hospital. The clinician doesn't actually need to do anything different to upload that to the My Health Record, it will automatically, a copy of it will go up to the My Health Record. They don't need to, you know, change anything in their workflow to make sure that's uploaded so more often than not. When you go to the My Health Record for a discharge summary, you will find that there, with 97% of public hospitals connected.
Dr Steven Kaye:
We've got a question now in the chat. Just wondering how to access the discharge summary from My Health Record? It's actually quite simple. You go through your clinical software package and you click on the view document list and that then takes you into My Health Record and the discharge summery should be sitting there in the list. If there has been one in that for that patient.
Marwa Osman:
So what I can do is I actually see if I can quickly bring up that test environment. So the Digital Health Agency has, you can think of it like a sandpit environment, it's just got test patients in there, and it's what we use for training purposes, and it's open to anybody to use for training purposes as well. So My Health Record software simulator on demand training. Oh, no, that's gone to a PDF… one second.
Dr Steven Kaye:
I guess the important bit while you're finding the space for everybody is that there's an enormous amount of information on the Digital Health Agency website tailored to the particular software packages. So Best Practice looks a bit different to Medical Director looks a bit different to Zedmed. So the tailoring of the package is certainly available within the website. And it's worth a cruise through the website to have a little see what's actually available there. It's quite extraordinary.
Marwa Osman:
So I've just popped into the Best Practice environment, and you would have seen me type in a password. That's not a password that's available to me just because I work for the Digital Health Agency. It was actually available on the page before it. So it was ‘Train me’. Now, a little helper icon pops up on the side. I've just gone into Best Practice, because it was the first one that popped up on my list. The little helper icon on the side shows you how to do various functions and guides you through, tells you what the test patient names are. I don't need it. So I’m going to get out of it, because I've been through it a few times, but you're welcome to use that throughout. And it's just reminding me that we're in evaluation mode, and that things may just appear a little bit different to the actual environment.
So what I might do is continue with the presentation while this opens up. It's not usually the slow but just in case, so we don't fall behind, and then I’ll come back to this towards the end.
So now I’m showing the Medicare overview documents within the My Health Record. So this is one of those overviews that I mentioned that's generated by the My Health Record. First section is medicine supplied under the PBS Or the Repat Benefits Scheme listed at the top. Now this doesn't least what the dose is. Just the name of the medicine, strength, date it was supplied, but that doesn't list doses, so doses would be the prescription and dispense view of the medicines view.
Next, I've got this information from the Australian Immunisation Register, then Australian Organ Donor Register information, and the final area is the MBS Or DVA items claimed, and I've got that expanded here on the right-hand side. And the reason I've expanded that is to show you how it can be beneficial in practice. So it may be useful if you've seen someone that you haven't seen before, for example, or they're under the care of multiple specialists, you know, which specialists they've seen if they can't recall. And you're seeing a carer or someone assisting them that's not usually the person that accompanies them as can often be the case. So you can utilise the Medicare overview to look at this because it'll show you the item numbers claimed, a brief description of the service, and who the service provider was. So you can see, you know other GPS or specialists involved in their care, if you know there was a mental health care plan done, or a management plan that that involves a physio. Things like that you can see when that was claimed and it can give you some direction on other people this person may be under the care of as well, so that that can be useful in practice.
Now, I'm going to duck out to see if my training session has come up yet. Yes it has, so I’ll just type in the password again. This was in the helper icon. So I’ll go in and look up a patient, my test patient is Caleb Derrington, and once I'm in their profile there's the My Health Record button, so that's just opening up there. Then once I'm in that I’ll be able to view the various documents available and select what it is that I’d like to view, whether it's, you know, that discharge summary or the medicines view. So here it is, and there's a discharge summary there. I can see the date of that, it's as simple as double clicking. You've got these filter settings on the side, I can actually filter for a specific type of document. So if I wanted to go in, and I knew that I only wanted a discharge summary, I could use that drop down to select a discharge summary, I could hone in on the date I wanted even and fine tune that, and it'll open up, and I’d be able to view that information. So
Dr Steven Kaye:
And just before you close that down, of course you can save the discharge summary into the patient record and the event summary, any of the documents can be saved into the corresponding record.
Marwa Osman:
That's, yeah, very important there, too, so it makes life a lot easier streamlining the process. So that's that.
Dr Steven Kaye:
Yeah. So that's the looking at the discharge summary page. So that's the discharge summary as produced by the hospital. If you go back a page, so close that one, when we get the highlighted discharge summary, righ click that, and then save it. And that'll save it into the patient file in our normal way, the normal way of saving a document to save it, and then it will live in your local patient medical record. Which you can see now. So if you go to ‘correspondence in’ in the patient record, go to ‘correspondence in’ which is down the bottom left on the bottom of the list on the screen right now at the bottom is green past private hospital miles. And that’s the same one which is now stored within the patient record. So you don’t need to access My Health Record to access that in the future.
Marwa Osman:
Thank you so much for that, so I’ll go back to the presentation. So this was just a screenshot of the advanced care planning documents and goals of care, and I touched on this earlier. Why it may be beneficial to document, particularly when we're talking about residents in aged care. It's, you know, highly appropriate to discuss end of life care preferences, so that loved ones aren't forced to make these decisions in a difficult time. Goals of care documents are similar to advanced care planning documents. The difference is that they're actually completed by the healthcare provider in collaboration with the person and their family and the healthcare team and uploaded to the My Health Record by the healthcare provider. They're not available in all jurisdictions, so you may find that they're not available in your jurisdiction, but advanced care directives are uploaded by the person to their own My Health Record, with the assistance of a carer or a healthcare provider.
And so now that we've gone through the various things that we can find in the My Health Record. What are the benefits? You can see here that it really does help with continuity of care, allowing you to access information, less running around to get that information. So you're saving administrative time, and there's reduced duplication and wasted resources. For healthcare providers, again, we're reducing the time gathering, and it helps improve that support with decision making and in the case of individuals and their carers it improves that self-management if they’re in a state to be aware of what's happening in their health, or to have ownership of that they can certainly engage in that process with the My Health Record. And all of these combined lead to improvement of patient outcomes.
So you can see that that the My Health Record can definitely add value to clinical practice in the residential aged care setting, you know, looking at, admission process to residential aged care there. There’s certainly space for the My Health Record to assist in medicines reconciliation tasks by looking at the medicine's information view. If you're looking at a person's history and assessment, that can be gleaned from their shared health, summary and previous hospital discharge summaries. Having access to pathology and diagnostic imaging reports also can assist because if some recent testing has been done it may save the need to repeat testing and, again, having access to that advanced care planning information may help inform end of life care decisions.
Now, looking at My Health Record for residential aged care facility residents, we know that in some cases people may choose to nominate a carer or a family member to assist them in managing their My Health Record. And that is known as a nominated representative. So that's a person that… if it's my record for example, and I have the ability to make my own decisions, so I don't have dementia, for example, I can invite somebody to help me manage that My Health Record and they would be a nominated representative. However, in cases where a person is no longer able to make decisions for themselves then another person can apply to become the authorised representative. And essentially that's a person who's responsible for managing the My Health Record of someone who's not able to make decisions for themselves. So there would obviously need to be documentation provided to allow someone to become a an authorised representative as part of that process. So this could be something like an enduring power of attorney, for example to enable somebody to access that.
Now worth touching on the ‘my health’ app because this can assist patients as well as carers in managing their health information, or managing the health information of the person they're assisting. The my health app is an application that can be used by consumers or their representative to access key health information in the My Health Record. It lets consumers download documents from My Health Record onto their mobile device, and that can be helpful if they need to provide that information to a healthcare provider that is not connected to the record. And then they can share that information with that healthcare provider or that organisation. The my health app is due to be released later this month. So within the next two weeks we're expecting that it will go live. So good for you to know about it, in case you know you come across it and you think what's this that people are producing their information from?
I wanted to briefly touch on privacy and control settings before we come to the end of the session today. So I mentioned that the My Health Record is personally controlled, so a person can choose to limit access to their My Health Record if they wish. The default setting, if they don't change any of the settings which is the case for most people with a My Health Record, is that there are no access controls in place, so it means any healthcare provider seeking to access the system will be able to, unless the person places these access settings by logging onto their My Health Record through mygov and doing that. Now worth pointing out that less than 3 out of 1,000 people with a My Health Record have actually exercised any of these controls. So, more often than not, you won't need these access codes to gain access to a person's My Health Record.
Now, the first type of access control is the limited document access code, or LDAC for short, and this can be used by a person or their carer to limit access to a specific document. So basically, what that means is that healthcare providers won't know that that document in the record exists unless they’re given this access code by the person in their care in a consultation. Once the healthcare provider is given this access code, they will have continuous access to this document for the next 3 years. They won't need to keep re-entering that access code unless the person logs on to their My Health Record earlier and revokes that consent.
The second type of access control is a record access code, and what this does is instead of restricting access to a specific document, it restricts access to the entire record. So if you attempt to access a person's record that has that record access code placed on it, the system will prompt you to enter the record access code before proceeding, or otherwise, to override this because it's an emergency, and I’ll talk a little bit about emergencies in a tick. But again, same rules apply. In a consultation you would be given that access code by the personal or their carer. Once you're given that access code you would have ongoing access to the My Health Record of this person without having to re-enter that access code as with any other healthcare providers accessing from the same organisation for the next 3 years, unless that consent is revoked earlier by that person logging on to their My Health Record and revoking that consent. That's them or their care, their representative essentially.
In addition to this, a person can choose to remove documents at any time from the My Health Record, as would a representative if they have that a level of control. So when a person elects to have a nominated representative, they can choose the level of control or level of access that they grant that person, so they can allow them access to remove documents. If the person is an authorised representative, they can essentially do whatever they like in the record, as if it's their own.
Although a person can choose to remove a document at any time from the My Health Record, they cannot edit a document that they have not authored, so they can't edit something that's been uploaded by a healthcare provider. And worth a mention as well that a person or their carer can choose to receive an SMS or email alert when a healthcare provider organisation accesses their record, and of course there's an audit log of who is accessing the My Health Record that can be viewed by the individual when they log on to their My Health Record through the privacy settings.
Now I’ll touch on emergency access before I move on. In an emergency situation, and that would be a situation where the person's life is at risk, and it's just not practical to obtain the consent or there's a serious threat to public health or public safety, then the emergency access functionality can be used, and that will bypass any access controls that a person has placed on their record. That will then allow a healthcare provider organisation access to the record for 5 days. It's worth a mention, though, that any use of the emergency access functionality is altered by the system operator, which is the Australian Digital Health Agency. So please reserve this for emergency situations only.
There is further information, and e-learning modules on the Australian Digital Health Agency website, links are there. You can complete the training and the e-learning modules in your own time.
And with that I’d like to hand back to Dr. Steven Kaye.
Dr Steven Kaye:
Wonderful! Thank you Marwa. That's a that's a fantastic run-through, and one of the questions that popped up was the focus during the webinar today was on My Health Record rather than purely on aged care, and the reality is that access to My Health Record from aged care has been very low over the journey, and there is a great case for accessing patient information, either from general practice, from the community into aged care, or from aged care to specialists, or from aged care to the hospital situation in either direction depending on what happened. So it's really the value of using my aged care in the aged care facility is really to increase the information stream and to make more information available. And that's certainly what we're trying to encourage for better patient outcomes. Both by use of telehealth as well as by use of the digital form in my aged care. And I’m sure that you'll agree.
Marwa Osman:
Yeah, I'd like to add to that if I can, as well. So we recognise that, and in response to this, the Australian Digital Health Agency has actually released an aged care software industry offer to encourage the uptake by software vendors to enhance their software to allow that conformant access for residential aged care staff as well, so similar to how I showed you, it was seamless to access My Health Record from within Best Practice as an example. We know that when a software is conformant, we’re far more likely to get use in that space. So the aged care industry offer is currently running. We’ve got more and more software providers coming onboard, and, in fact, one of the software vendors has recently finished the conformance testing for a new document known as the Aged Care Transfer Summary, which is designed to capture a residence key health information that will be uploaded to the My Health Record at the transition of care from the residential aged care facility to hospital, for example. So you know, we know that there's a big gap there. That's designed to capture the key information, reduce the burden on hospital staff looking for that information, but also reduce the administrative burden on general practice, because we know that hospitals come looking for the GP and for information from the GP and for things to get faxed and sent. And of course, all of these things lead to delay. As Dr. Kaye mentioned earlier, there is that lag before the information travels with the patients. So we recognise that there’s lots of work happening in that space. Lots of education as well, and there’s actually a My Health Record registration project happening where there’s registration support offices at the agency helping and assisting get facilities connected. The education team is on board to provide education on how to use the My Health Record. So lots and lots is happening in this space, and thank you for raising that for discussion.
Dr Steven Kaye:
And indeed I thank you Marwa for raising that. I wasn't sure if we were allowed to, and that is supposed to be bi-directional, of course. So from not only for transferring patients from the aged care facility into the hospital, but also the reverse. So containing from the hospital into the aged care facility, you know, with much more information than just a standard discharge summary. And it will in some ways replace the yellow envelope that we've all been using for so long. With that bundle of paperwork that goes into the emergency department.
It brings us almost to the close of today's session. So thank you everyone for attending. I hope that you've enjoyed the webinar. Thank you especially to Marwa for delivering today's presentation with such an enormous amount of detail for us all to ponder upon.
For further information and support, you can contact the Australian Digital Health Agency. As you saw, it's a very vivid and full, rich website that's been produced, and the contact details will be on your screen in just a moment they should be somewhere there. You'll also be sent a resource pack. It'll be emailed to you after the webinar. The RACGP’s Practice Technology and Management team, of which I'm the deputy chair, is also available and we have a monthly newsletter to keep up to date, so new changes that happen within aged care, as well as within other facets of general practice from a digital perspective, will be heralded monthly through our monthly newsletter. The RACGP has also got other resources available on My Health Record and telehealth and links to these resources will be included in the resource pack.
So thank you, everybody, for attending. I hope you have a wonderful day, and can envisage a modern digital world in aged care.