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Using My Health Record in Aged Care: case study and demonstration

Catherine Dockrell:
Welcome everyone to today's webinar on using My Health Record in aged care: a case study and demonstration. My name is Catherine and I'm a Project Officer from the RACGP’s Practice Technology and Management team.
So this webinar follows on from our last webinar, which was titled supporting telehealth services in residential aged care facilities: the case for My Health Record. So if you didn't attend that webinar and you'd like to view a recording of it, you can do so via a link that I’ll just pop in the chat box now. There we go. You should be able to see it there. We will also include that same link in the webinar resources pack which each of you will receive following today's webinar.
So I’d like to now introduce you to our host, for today, Dr Steven Kaye.
Steven is Deputy Chair of the RACGP Practice Technology and Management Expert Committee, and has been a member of the committee since 2016. He's previously been the Deputy Chair of the Bayside Medicare Local and Chair of the Bayside GP Network. Steven is a GP Registrar Supervisor for 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, Catherine, and welcome everybody. Tonight's, well, today's webinar is an accredited CPD activity delivered in partnership with the Australian Digital Health Agency. So welcome to all. The webinar is being recorded and will be uploaded to the RACGP website for on demand viewing, like the previous session was that we've just sent you the link to in the chat.
We've placed all the attendees on mute to ensure that the presentation will not be disrupted by any background noise. If you have any questions during the webinar, place them in the Q&A box at the bottom of your screen. We're all incredibly familiar with Zoom these days and we'll try to answer them in the Q& A session at the at the end of tonight's meeting. If you'd prefer to ask a question anonymously then you can select this when posting your question. And you can interact with the panellists and attendees using the chat function as well.
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 respects to them and their cultures to Elders, past, present, and emerging.
And I’d like to introduce our presenter for tonight, Brianna Meawad - Digital Health Educator with the Australian Digital Health Agency. Brianna has a background in public health, primary care reform and specialist practice quality improvement. Through her role at the Agency she's experiencing, supporting, and educating providers across Australia in meaningful use of digital health tools, including My Health Record and electronic prescribing.
So now I hand over to Brianna to commence the presentation, and we'll go from there.
Briana Meawad:
Thank you so much, Dr. Kaye, and thank you everyone for coming along this evening. We hope that the session is a good follow on from the last session. As Catherine said earlier, this is sort of part 2, and if you haven't, yet had the pleasure of listening to that webinar encourage you to do so, and this session will sort of follow on from that with a bit more of a deep dive into the support that My Health Record can provide to clinicians, particularly GPs in the care that you provide in aged care. And we're going to be doing a bit of a live demonstration today. Hopefully. So, having a look now at what we aim to cover in this session, the 2 sort of main points that we want to sort of bring across today is really outlining how healthcare providers in the aged care sector can use My Health Record to improve the health outcomes of their patients. And we really want to develop an understanding of those key core features of the My Health Record system. It's one thing to be aware that it exists, and know sort of the basic, you know, fundamental theory behind what the system is, and it's another thing to actually have a look and see the functionality, and actually understand how to kind of use and navigate through the system itself, and search for documents and things like that. So that's what we aim to focus a little bit more on today.
Now the point of My Health Record in aged care is a huge piece of work at the moment, and there's a lot of work that the agency is doing as well as a range of other organisations across the country in order to improve the access to digital tools in aged care. And there was some research done by the Agency that identified the challenges that providers have in providing care to patients in an aged care setting. And this is really where the aged care program at the Agency started, and was sort of born from here. So some of the research that was done told us that there are limited opportunities for making a medicine reconciliation during that transition of care. So when patients are moving from healthcare setting to healthcare setting that medicine reconciliation task can be quite a pain point.
We also know that there's limited access to complete and current health and social information when we're supporting some of these patients in some of these scenarios there is an inability to recall or articulate medical history properly, whether that's the patient themselves, or the carers or family members of those patients, important information about patients, medical histories on admission to acute care settings cannot be accessed. So in case of an emergency, or where the patient needs immediate sort of health care, with a new health care team or a clinician who they've not engaged with before that important information can be missing.
And the mode and effectiveness of information transmission is variable as well. So the variation in digital health literacy of the staff in the aged care settings as well. All of this contributing to this challenge that we have of being able to access information and provide best care possible to our aged care patients.
So what can we do about that? My Health Record is a solution that can really support in some of these scenarios. And for some of these barriers and pain points, and we're going to demonstrate that today by looking at a bit of a case study.
So I probably shouldn’t call it a case study, because I’m sure you're all used to seeing some very comprehensive and clinically detailed case studies. This is more of a use case, I would call it. But we're going to follow along a bit of a use case for our patient, Caleb.
So let's say you've got a patient like Caleb. He's 86 years old, and has been living at home with his wife. Now Caleb has multiple medications, including Parkinson’s, which is worsening as time goes on, and he's recently had a fall which did result in a hospitalisation. Now, after a brief stay in hospital, it was decided that it would be best for Caleb to actually move into a permanent placement at a residential aged care facility, rather than you know, sending him back home to be with his wife, who is also getting older, and is finding it difficult to care for him.
So Caleb has been placed in in a residential aged care facility. Now this is a common patient story that I'm sure many of you working aged can relate to, and one of the biggest challenges that we know can be the case with these kinds of scenarios is that Caleb may be coming from an area that is not necessarily close to this facility that he is now staying in. So you know, his home could be 30, 40, 50 kilometres from this facility, which means that the GP that he's most likely been saying for the last 20-30 years is likely to not be able to actually continue seeing him now that he's moved to a facility in a different area. So it's not, of course, as we know, viable for GPs to travel to the facilities that are far from there in clinics, just to see a single patient, so Caleb will most likely end up with a new GP. Someone who is local to the facility, and has an association with that facility.
So the same also goes for other members of Caleb's healthcare team. They'll start to see a new pharmacist that they never saw before, potentially as well as any allied health providers and their regular nurse, and also the carer will have to make that trip to the facility to see Caleb and support in the coordination of Caleb's care. So we have this common challenge where there is a bit of a disconnect between the patient's normal environment prior to being placed in the facility at home where the care team has been looking after them for some time to now a whole new care team that needs to support Caleb as well as a range of other residents that are also in similar situations.
So we're seeing this issue of a lack of transition of care, a lack of access to information about patient conditions and their medical history, and often clinical staff are relying heavily on the patients’ carers or family members to get some of this information, and that can often be incomplete, out of date, or that there's significant gaps in the information.
So what I might do is throw to Dr. Kaye at this point before we move on to having a look at some of the key features of the system just for your input around. Can you relate to this scenario? And what have you found to be sort of the main barriers in situations like this from your experience, where do you think My Health Record might be able to support?
Dr Steven Kaye:
Yeah, look, thanks, Briana. And this is this is a really common scenario, as I’m sure our entire audience understands the number one thing that we've got a well, not number one, perhaps, but certainly a very important thing that we've got to understand is that various software systems won't speak to one another. So the medical record in the general practice, the practitioners medical record within their clinic, so the original. First of all has gone to the hospital. So the GP’s medical record is sitting with the GP at location X. Caleb has gone to the hospital and then been transferred to the aged care facility.
The aged care facility has a different software program than the GP. And the GP software more often than not, cannot be transferred directly into the aged care facility. So the information that the GP holds, which is often very rich and dynamic, and as you mentioned has been curated and developed over a number of years, often decades, is therefore not linked to the patient, and the current medical team that's taking care of the patient. So what's needed at a base level is certainly a summary document. So that's where the shared health summary upload from the GP system into My Health Record can then be downloaded into the aged care facility, and likewise the Agency is working currently to develop an aged care transfer summary, where a document will be produced at the aged care facility to go into a hospital and the other way, as well. From the hospital back into the aged care facility. So then, we've got two documents that then can create and develop a meaningful medical history for inside the aged care facility. And it is all about getting reliable, correct, absolute data into the aged care facilities medical record that can then be used by the staff of all of the disciplines inside the aged care facility for the best care of Caleb. Including the medications, and having that correct, including the past history, and having that full and rich and correct, and including the social history, so that there are interactions with other members of the family and other members of Caleb's broader team.
And that's a big issue. The interoperability between software programs has not matured over the last 20 or 30 years. So the My Health Record, we're using that as a transition point in order to make sure the information itself albeit in a summarised form, can make its way to where the patient needs it to be into the patients’ carers.
Briana Meawad:
Thank you, Dr. Kaye. So absolutely. You know the interoperability is a huge piece of work, and you have mentioned a few key documents that I can support in this work, and particularly, you know, shared health summaries, the aged care transfer health summary.
So what we might do now is actually jump in and have a look at how My Health Record can be accessed by a clinician, whether it's the nursing staff at the aged care facility or whether it's the GP using a clinical software system, and how accessing the documents that may be in your patient's My Health Record might be able to support you in getting some of this information that's missing that didn't make its way through to the patient files. So bear with me for a moment. I'll just switch over to the screen so we can have a look here.
What I might do before jumping into the environment is having a look at some of the key features. Now I know, for those of you who came to the session a couple of weeks ago. You might already be across this, but for anybody that's sort of a newer to the My Health Record system and just need a quick refresher around what it is, it's an online summary of an individual's key health information. So it's actually not designed to be a complete history of a patient's health status. So, as Dr. Kaye mentioned, you know your long-term GPs might have a lot of, you know, long term dynamic information in their clinical records. This is not designed to replace those a very sort of detailed and important clinical files. This is there to complement in a way that it contains those key documents and key health information. It's also not there to replace that existing communication between healthcare providers. We want healthcare providers to continue to send letters, transmit information in the way that they usually would. But being aware that a copy of that health data for the patient may also be sitting on the My Health Record simultaneously. And this is a way that clinicians or members of that patient's healthcare team can get access to their health information that they maybe wouldn't have otherwise had access to, you know, checking if something's there that they didn't know existed, or you know something that they specifically looking for, like, say, a hospital discharge summary. So we'll have a look in a moment in regards to what that physically looks like.
The system is personally controlled. There are key patient controls that consumers can put in place to a system in managing their record. So we will skip through that a little bit, because that was touched on in the first session. It's part of a national system, and it's accessible at all times, and this can be particularly useful in the aged care space, because we know that often, you know, patients may have an incident, or there may be a situation where we need access to patient health information at out of hours. So you know their regular GP can't be contacted at the time, or is even busy, or you know we can't access their pharmacy for you know their recent dispense information. So being able to access My Health Record at any time, or at the time that is needed most by the healthcare providers is a really key part of the system, and of course it is protected. There are multiple ways of best practice security in place that underpin the protection of the system. So that's just a brief overview of those key functions of the system. Let's now have a look at some of these key documentations that we've been alluding to. So for those of you who don't know the three categories of information that exist in My Health Record are consumer uploaded documents which is information that flows in from Medicare. That's MBS and PBS data, and I’ll show you in just a moment how useful some of that can be. And then there's provider uploaded documents, which is the bulk of the information available currently in in My Health Record. And there's a range of provider uploaded documents coming from a range of different organisations across the system.
The majority of pharmacy and general practices across the country are already connected majority of public hospitals are connected a lot more private hospitals and out coming and board and getting connected, and a lot of work under way to continue to connect. You know, specialist and allied health space. And of course, the aged care program is working on connecting the aged care sector as well. So, a lot of useful documents already sitting there.
And what we're going to focus on today is sort of how we can most efficiently use the functions and features of the system to benefit us. We know you're all very time poor, you don't have time to sit there and trawl through tons and tons of information, maybe looking for something specific. You may just be looking for general information, because you know there are gaps. But whatever it is, there is a way that the system can be utilised or leveraged to support you, and getting that information very efficiently. So, having a look here and focusing on these five documents in the centre of the screen. These are our overview documents.
Now, these documents are designed to give you the information upfront without you having to pull out this data from a range of different documents that may have made its way to the patient's record. So these will sit at the top of the document list. It looks a little bit different, depending on which software product you're using. So you know, for example, we use some examples of the commonly used software products in general practice it might be Best Practice, Medical Director, Genie, Zed Med, Communicare and My Health Record looks a little bit different. It's not going to be the same across all of the software products. However, there are some common functionality across all of them, and that's what we'll touch on and show you some nuances of the software products as well today. So these overviews are going to save us a lot of time because it's going to pull and aggregate all of the data according to the specific topic into one view for us. So we don't have to go searching through a range of documents, and, you know, over different periods of time we can certainly access a chronological list of all of the data for these specific topics. So, just having a look at an example of visually how is that represented in a clinical software? Here we can see we've opened up Caleb's file in Best Practice and we've clicked on the My Health Record button, and immediately we can see all of those overview sitting at the top of the patient’s record.
So you can see here the medicines view the pathology overview. There's a diagnostic imaging overview, and then the immunisation consolidated view all sitting right at the top as soon as you access that patient's record. Now, if you don't know what you know these overviews are, you might skip through them and think you know that's not going to do much for me because I’m looking for a shared health summary, or I'm looking for a discharge summary. But what I want to highlight today is actually how you can access those kind of documents directly from these overviews in a couple of clicks really easily. So here we can see the medicines view. I might go back to my slide and point out the medicines information view. That's what it's called. Sometimes we call it a medicines overview some times it's called available medicines view. But what this means is that it's a dynamic view that the system generates for the user. So this is what it looks like. We can see here that there's four key parts of this medicines overview. There's the allergies and adverse reactions, which is the first sort of highlighted area. And this is not allergies that just one, or, for you know, added to a document such as a shared health summary and uploaded. It's not coming just from one source. It's any allergies data that made its way to the patient's My Health Record is being pulled from all of those documents that contain allergies data, and it's listed and aggregated there for us in the one view. So we know that any allergies information that was uploaded to this patient's record is going to be visible there for us.
Dr Steven Kaye:
Can I just say just on that exact point is that we can all see that the allergies in this case phenoxy methyl penicillin, and penicillin. And if you go to the bottom of the page there, underneath the yellow, you'll see that the shared health summary produced by the general practice has supplied the penicillin allergy, whereas the specialist letter has supplied the phenoxy methyl penicillin allergy. So they they're in fact, both the same allergy, but because they've been written differently by two different authors they appear as two allergies. But that's better than, that's okay, because that accumulates the number of the bits of information. So that's actually a really interesting feature that it picks up lots of information from different sources within the my health document environment.
Briana Meawad:
Yeah, absolutely. And what this helps us to do as well is if we're interested in the context around that data point, we can actually look at that directly from the document as well. So like you say, there's a specialist letter that was uploaded with this penicillin allergy. If we want to actually read that specialist letter, we can click on that hyperlink there, and it will open up the original source document where that data was being pulled from. Same with the shared health summary. And that will give us information about who the uploading provider was that uploaded the information as well as you know all the administrative details around that. So you know for patients that are new to us that we're not familiar with, this might be a great way for us to figure out who other members of the patient's health care team are, and if we want to, we need to liaise with them to get any more information about the patient. So yeah, absolutely.
And I will make a bit of a disclaimer here. This information is not super clinically accurate, and is really just about demonstrating the functionality I know we talked about Caleb having Parkinson’s, when we look at the medicines in a moment, you're going to look at that and go. this is not typical for a patient that has Parkinson’s or you know all of that good stuff. So please, you know, ignore the clinical irrelevance of some of the data. It's really just about demonstrating that functionality. But yeah, absolutely. An awesome point there about the information that gets pulled from, you know, a range of documents.
Dr Steven Kaye:
Now on this page. Sorry again Briana, if you don't mind, just on this page, one of the regular things that happens is that this is the normal screen that we see when we open up from, in this case, Best Practice. We actually need to scroll down, even though it says, end of section, we need to scroll down to see the next bits, the next sections of the document. So it feels like this is a single pace. There's nothing more. But, in fact, when you scroll down there is more down there.
Briana Meawad:
Yeah, absolutely. And you're reading my mind up to Kaye because this is the next point, you know, scrolling and searching and trying to read and figure out what's in front of you can actually take a lot of time that we don't have. So the hyperlinks are here to help you. You can actually click on this medicines preview to go to that exact section. So you kind of scroll to get there, or you can click on this medicines preview blue hyperlink there, and it will take you straight there. So if I click on that now I can see the medicines preview, and I’ll zoom in on that preview for you in just a moment. But just to really summarise how useful this medicines preview section can be of this document. It's going to pull all of the information that is uploaded to the patient's record from a range of uploading providers and from a range of documents. So this might be medicines coming from that recent hospital stay. It might be medicines from the past prescribers. It might be medicines that were, you know, maybe prescribed, but not then dispensed, because we can see what was dispensed from the pharmacies.
We can see, you know, if the patient entered their own information at one point about you know, supplements or things that they may be taking as well. So it's a great way to aggregate and have a look at all of the medicines data that was uploaded for this patient from all of the different sources and all the different organisations that are sharing this information. Of course, keeping in mind that this is information that has made its way to My Health Record. So if there is a pharmacy that was having an issue with their uploading and get a dispense record uploaded, that's not to say that it was never dispensed. But there will be a great deal of useful medicine information, particularly because we're seeing that PBS data coming through. So if it was claimed through PBS, we will see a record of that as well.
So, zooming in a little bit, you can see sort of the data fields that are in here, we can see that the source and the author of the document is on left and we can see the date of the upload. We can see the medicine active, ingredient, brand dose, and directions as well. So it's giving us a really good idea of the kinds of things that have been prescribed, dispensed, and you know what's being shared by various organisations as the patient moves through the healthcare system, so again, not a complete, accurate list. We still require clinicians to, you know, make clinical judgment based on what they can see, but they certainly can add a lot to what you already know about the patient by having a look at the medicines preview.
I might move on to the shared health summary. So again, we're in the same document. We're still in this medicines overview. We haven't gone out of here. But what I’m highlighting here is the third tile within the medicines overview, and this is the most recent shared health summary for the patient.
Now, the reason why I’m highlighting this is because if you're looking for a shared health summary, because you know how valuable a shared health summary can be, and you're looking for it, instead of having to search through a big, long list of documents and trying to finding the word shed health summary, come straight into your medicines overview, which is sitting right at the page. The top of the patient's record right at the top of their document list and have a look at your Shared Health Summary, which is actually sitting in here in the medicines overview, and it's going to link directly to the latest one. So if there were multiple shared health summaries uploaded over different point in time, it's not going to show those. It's just going to show you the most recent shared health summary that was uploaded for the patient.
Now for anybody who's new to what a shared health summary is. Once we click on that, it will open up a new document for us. We’ll just split it up into two sections here, so you can kind of see everything on the one page. But here you can see there is four key parts of a shared health summary. You've got your allergies and adverse reactions, your medications, medical history, and immunisations. And this is typically uploaded by the nominated healthcare practitioner or the usual GP for the patients. Sometimes it can be uploaded by the nominated registered nurse, and this will give us a summary of a point in time for that patient's health status. So the list of medications that they were taking at that point of time. Their current medical history relevant to that point in time, and you know they might have to choose to include past procedures, or anything that they find is clinically relevant. So the author of this document will be the normal general practice, and it will have these four key health areas that will give us a snapshot of that patient's health status at the time of the upload.
And again, if the patient is new to us, and we don't know much information about them and you know the records haven't made their way from the general practice to the facility yet, or you know there's some gaps in in what we're being told. A recent Shared Health Summary might actually support us in in getting that information in a timely matter, and that's right there for you in the medicines overview document.
Now, the final section in the medicines overview is our discharge summary, and this is again similar to our shared health summary. It's going to be the most recent hospital discharge summary. So if the patient has had multiple stays in hospital over time, it's not going to link to those it's just going to link to the most recent one. So Caleb's instance, we know that this is going to be really handy, because if we don't have the hospital discharge summary in front of us when we're, you know, consulting with the patient, or we're at the facility. This might help us to really access that information in a timely manner. We'd don’t have to wait for the transmission of that information through to wherever we are, you know, gathering the information. So here we can see we click on that hyperlink and open it up. And this is exactly what would have been sent to the general practitioner or the intended recipients for this an exact copy of that is shared to the patient’s My Health Record in many cases. So, it's really a useful thing to keep in mind. And again, you can get to it in a matter of seconds by going through the medicines overview, provided you're looking for the most recent discharge summary.
Before I move on to the next overview document, Dr. Kaye anything to add here?
Dr Steven Kaye:
No, that's exactly right. The information that is stored in My Health Record will be available to look at and to help the clinical course of the patient inside the aged care facility.
We've had a question in the chat from Peter who wonders whether nursing home software packages are able to access My Health Record. And that's exactly right. We're looking currently in Best Practice, which is the very familiar general practice software. And the answer is, yes. There's a list of conformance software packages on the Digital Health Agency website, and those two packages, Peter, are absolutely on the list. Part of the issue is digitising aged care. So as the Royal Commission discovered, it has a very relatively low percentage of digitisation. Most aged care facilities don't have wi-fi, for instance, so utilising digital care internally using an iPad can be challenging. So private hospitals likewise, you know, that's all in the process of developing. This is all relatively new territory, and the Federal government is very aware of this, and will be encouraging aged care facilities to increase their digitisation, and hence connectivity to My Health Record and these documents themselves.
Briana Meawad:
Yeah, Absolutely. Thanks for that question. That's really great. And, as you say, Dr. Kaye, the Agency is working with a range of aged care software. And really it comes down to the willingness of the software vendor to incorporate and conform with My Health Record. And so what we do have as part of the aged care program is an aged care industry offer which allows the vendors to partner with the Agency to work towards implementing the My Health Record functionality through their clinical software products for the facilities. So there are some that are right towards the end of their implementation, and some that are sort of in the pipeline at the moment. But I imagine that over the next sort of a month, years, there'll certainly be a lot more of those software vendors ensuring that their product becomes conformant with My Health Record.
So jumping through to the next overview, immunisation view. Now, I’ll touch on this pretty quickly. But this one is a recent enhancement to the My Health Record system. Of course, fuelled by the recent pandemic events. So the immunisation overview will allow us to not only see information that is sitting on the patient's AIR record, but also any additional immunisation data points from other health care organisations. So if a patient perhaps went to, and not their normal GP to have a particular vaccine somewhere closer to perhaps their workplace, or a different provider was giving that service, then absolutely that may end up there particularly for a useful for pharmacies who are providing a vaccines and immunisations as well. So, having a look here, again, this is just an example in one of the software products where you can see immunisation consolidated you again sitting right at the top of that document list. We've clicked on that. We can open it now, and here we can see a range of useful features in here. It's going to give us due dates for next immunisations, any of the immunisations on the national immunisation program as well as any COVID-19 vaccines that are due or coming up such as boosters and things will be alerted in there. And you can also see everything on that patient’s AIR register as well.
Now, moving over to the pathology. Now, this is something that we know can often be an issue or a pain point. You know, patients have tests done at certain facilities and they don't make their way to the you know, clinical software of the facility, and we can't find that pathology result. They say they've had it, or they may not remember doing it. And we might want to check for some recent pathology results. So, having a look at the pathology reports overview might actually reduce that duplication of testing that we see happening so regularly across the system, because it'll allow us to view that information that was uploaded by the pathology provider.
So another example here of a conformance software. We can see the pathology overview sitting at the top. We double clicked on that, and we've opened the pathology over here now. The pathology overview can be really handy because it can group your pathology results in a number of different ways, saving you a lot of time. We know that our older patients may have a lot of pathology because of multiple conditions, and it might be a bit tricky to sort through and look for what you're particularly after. So, if the patient was diabetic, we might be looking just specifically for Hb1c results. So, having a look here, we can see that there's a way that you can group in chronological order. So you're looking at most recent to oldest. And then you can also select the option that says group by test name. So you can actually group by specifically what you're looking for. In a lot of software products you can also search. So you can start typing in the test name that you're looking for and see what comes up, and then you can sort of hover over or select the report that you're actually interested in. Select it, and then it will open up that pathology result for you, and that can be downloaded and saved into the record. So even though this wasn't sent to you directly, and you know this was something that was ordered by different provider. It can absolutely be often found on patients records and downloaded.
Of course this comes down to whether or not the patient was serviced by a pathology provider that uploads to My Health Record. But there are a lot of pathology providers across the country that are uploading their results to My Health Record by default. So a lot of these results actually ending up in patients’ records. So you might be surprised to find some of the information you're looking for by having a look at this pathology reports overview.
Dr Steven Kaye:
So it's just for everybody's information, each week really more and more pathology companies are uploading into My Health Record. Progressively that's seen to be the norm rather than the exception. And so the more we look into My Health Record for pathology results, the more we will find that there are pathology results there over time. Most of the public hospitals, especially in New South Wales and Queensland are uploading. Many of them in the other states are increasingly uploading. Victoria, in fact, is one of the slowest states, but is increasing their uploading. So it's a progressive process, and it's regional.
I will mention that that the results when we download them from My Health Record into the clinical record of the patient at the moment get downloaded as a PDF, as a document which will go into correspondence in rather than investigations. Now that's a big body of work to change that and make those results go into investigations within the software. But that's certainly under way and over the next period of time we'll find that those results will be automatically inserted into the investigations tab within our clinical software package. So that's all part of the development of My Health Record and the maturation of the system, and any improvement of the digital communication between the various parties.
Briana Meawad:
Yeah, absolutely. Thank you so much for that. So, moving on to one document that I think is quite useful, and may be potentially overlooked. And this is the Medicare overview. Now, this document is going to give us not only MBS data, or you know where patients have been receiving services under the MBS. But also PBS data, and any information that might be saved for Australian organ donor register information for the patient as well.
So accessing that looks a bit different, depending on which software product you use. There are a few different ones on the screen here, and we can see that your Medicare information, because there's a lot of it, especially for patients that access the healthcare system on a regular basis. You know the patients with chronic and complex conditions very much our patients in the aged care sector, there will be a lot of MBS and PBS data flowing through. So a lot of the software is actually excluded by default, and you can go in and actively choose to include that in the information you're looking for. So he's a couple of cheats on, you know for example, if we're looking at you know the Best Practice one you can see. There's an exclude Medicare documents, tick box. If you unclick and click update, then you have your Medicare documents visible, and what this gives us is the item number that was claimed for the patient. We can see the description, a brief description of what the service was that was provided to the patient, and also who the service provider was.
And this is a great summary, because it's again in chronological order, so we can see who else is making up part of that patient's healthcare team, and that might support us in contacting the right people to support the patients care. We can see, you know, which services they've been accessing, or have been provided to the patient. Also, PBS data is really useful as well, because it's going to tell us any medication that was dispensed under the PBS. So, of course it's not going to include our private scripts. But if a pharmacy wasn't able to, you know, share a copy of the dispense record to the patients My Health Record often we can still we can fill the gaps by looking at the PBS data, because anything dispensed under the PBS will show up here, regardless whether it was sent to the My Health Record from the pharmacy through a dispense record or not. So again, we can see the name of the medication, the brand, the prescription date, the supplied date, and we can see the quantity and repeats. And this might help with things like, you know, determining if patients are struggling to take medications or get them prescribed and adhering to medications that have been prescribed to them, and those useful sort of gap fillers when it comes to, okay, this medicine was prescribed on this date. When was it ceased, is the patient still taking this medication and helping you with that very onerous task of medication reconciliation which we know you often have to spend a lot of time on. So certainly, if you want to get a really good look at the services that are provided to the patients and medications prescribed under the PBS, the Medicare overview is a really useful document that you might find can support you.
Dr. Kaye.
Dr Steven Kaye:
Yeah. So that I guess we shouldn't just gloss over these two documents. This is these are not subjective items. These are objective events that have happened, for with the patient so, especially when you have a new patient, or someone who's unfamiliar to you, or you've lost track of for a period of time, to know exactly which specialist, or which provider offered services to that patient can be very, very useful, so that you know where to direct the patient back to to continue that care, rather than having yet another new provider assisting the care of the patient.
And likewise with medication. Patients will often have dose changes by various practitioners along the way, and this allows you to see precisely what was prescribed and precisely the dose and the timeframes. So the reconciliation of what's happened in order to create a new medication chart can be accurate and not fumbling around and looking for subjective oral information. You've actually got objective absolute information coming directly from the PBS. This is not part of the shared health summary that's been uploaded by the previous GP. This is coming from the pharmacy from the PBS itself or coming from the MBS. So we know precisely who the practitioner was, and precisely what the medications were that were prescribed and dispensed.
Briana Meawad:
Absolutely so I hope this look at some of the key features in the system is really solidified the role of My Health Record, and how it can support with your patients in these aged care settings. To summarise, the take home message is if we get into the habit of using My Health Record, if we're using a software product that does allow us to access to My Health Record, and we get into the habit of using it to view our patient's information, it's going to assist us in improving that continuity of care, reducing the duplication and wasting of resources, for the organisation as well it's going to save time if the clinician, of course we want to save your time so you can spend it doing more important things than searching for information and improve your decision making as well. And for individuals it's going to enhance patient self-management. One thing we haven't talked about because it was discussed in the first session was the uploading of goals of care and advanced care plans which consumers can do as well and are particularly useful for our aged care patients, and that can ultimately lead to improvements in patient outcomes if all the members of the patient healthcare team have access to their goals of care or advanced care plan. So being able to view that as well is going to improve the delivery of patient centred care as well.
Dr Steven Kaye:
Which is one of the nuances in the system, because the advanced care plans are not visible through a number of the software packages. I'm not quite sure why, you can get them if you if you log into My Health Record directly through a browser rather than through the software. The patient portal, the patient can see their advanced care plan, but the GPs or the doctors through their software at the moment can't see that. So that's an ongoing discussion about usability and access through the clinical software packages. That will again, that will evolve over the next few years as the system matures.
Briana Meawad:
Absolutely. So what we might do now is see if there are any other questions that we can answer before we close the session with some additional resources or information that might support next steps for anyone online who's interested. Do we have any other questions?
Dr Steven Kaye:
We've got a question which has been popped into the Q&A section. The question is, can the overview specialist letters or other documents be searched for by free text rather than just scroll through. And the answer is, yes, it can. But it depends on the software that you’re using. So it depends on the clinical software package that you're actually using. So again, that will all evolve and be more user friendly as time goes on. You know these are developed by, you know, by a lot of people along the way. And a lot of people like myself are called the digital health advisor. So we get asked the question on how we should design these processes, and then we give our answers, and we say what the designers can come up with in their software development.
Briana Meawad:
And just to add to that, Dr. Kaye, this is a really good question. And again, as you say, it really does come down to what software product you're using to access because all of them kind of build the My Health Record functionality a little bit differently. But what we do have in our repertoire of resources are software summary sheets. So there are a range of software products that have worked with us to develop cheat sheets or summary sheets on how to access specific information and how to do that the most efficient way. So if you're interested in having a look at the website, you might actually find your software product listed in a range of cheat sheets or software summary sheets listed there for you to give you an idea of sort of the best way to access particular types of information, for example, medicines, or whatever it might be, so definitely recommend having a look at that. In addition, we do have a range of e-learning modules and webinars that are both coming up and pre-recorded. So if you're wanting to dive a little bit deeper into certain aspects of My Health Record, there's so much in there around legislation, or if you're looking at, you know the security and cyber security side of things, or whatever it is that you want to sort of learn a little bit more about in the system, or even just usability we do have sort of specific resources for certain software. So it won't be relevant to everyone. But if you're using a specific software product, you might actually find you know, a best practice demo or a medical directed demo, or something which might help you learn how to use My Health Record better in your general practice.
Of course, as we say, there's a lot of work happening with those vendors at the moment for aged care, but at least in your general practice, if you interested in some of those resources, they're certainly available, so the link is on the screen. These slides will all be shared following the session. So I recommend having a look if you're interested in any of our upcoming sessions. There's also a residential aged care fact sheet which might support you in communicating the importance of My Health Record with your colleagues. We know it's often a team effort. You may be working with a facility who's new to My Health Record, or whatever it may be. So if you're interested in sharing this information with your colleagues then certainly feel free to have a look at these resources and share them as well.
Dr Steven Kaye:
Now I've got a couple of questions which have popped up as well just to continue on. Everybody is sort of digesting what's on the screen. So one of the questions from Mario is, how long does the upload take to reflect on the My Health Record? Any sort of upload, whether it's to share a health summary, I guess, or a pathology test. So the shared health summaries and immunisations through the immunisation register are pretty much instantaneous. They should be going through fairly quickly a few seconds to minutes. They should go through really instantly. Pathology results for the clinicians are available as soon as they get uploaded from the pathology company. For the patients there is a 7-day delay for them to see the majority of the results in their own My Health Record. So all results are visible after 7 days, except HIV results in New South Wales and recently some results have seen the 7-day delay has been removed, and specifically those the HBA1C and INR have been removed, and the respiratory panel has been removed. So the COVID tests and other respiratory pathogens test the 7-day delay rule has now been dismissed. That happened as a soft process. It wasn't really announced over Christmas. So if you do a respiratory panel, you can check it out. That will be available as soon as the pathology is uploaded from the pathology lab from the laboratory.
Another question we've got is regarding consent, and absolutely, we need to get consent to utilise My Health Record from the patient or the patients guardian, advocate or responsible party and that's always been the case with My Health Record, and the patient can withdraw consent at any time to either block them My Health Record, or to close their My Health Record, and likewise they can reopen their My Health Record at any time, although if they've closed it will be blank. So they won't have any information in it.
Briana Meawad:
So I can add to that as well. I think you know often with My Health Record, the legislation is surprising to some clinicians, because, as Dr. Kaye said, consumers can choose to apply certain access controls which would essentially be them removing their consent. So the decision is in the hands of the consumer. They can lock their record, they can choose to remove it. In saying that, the current stats are less than every
2 in every 1,000 records have any form of access controls applied to them. So basically 0.2 of records are being controlled by patients currently and 9 out of 10 Australians have a My Health Record. So that goes to show that the majority of records won't have access control. And clinicians are protected by the legislation to view My Health Record at any time, provided that they are doing it for the purpose of providing healthcare to the patients, so the legislation actually protects clinicians to use My Health Record at their clinical discretion. So you don't have to use it for every patient, you're not obliged to use the system, but you are protected when you choose to use the system, you do not need to gain any written or verbal consent from the patient to open their My Health Record in the same way that you have your clinical files on your computer system, and you can open up the patients record, and you know, navigate their health information in a clinical file. You can do the same thing. My Health Record is like an extension of that clinical file, so you can absolutely access a patient’s My Health Record at any time without needing to go through any kind of process of gaining consent, because we know that that's not, of course, a very easy workflow if you've got to stop and get consent to access this information. So the whole point of the system is that you can absolutely view this patient's record at any time and the whole point is, you know, giving the right time in the right place, for you know the right patients. So we want clinicians to feel confident using it.
And this brings us to the next slide around the next session. So there is a going to be a My Health Record refresher training, and this is where we're going to go into all of this. So we don't actually like to use the word consent we use authority to view, because consent sort of indicates that you need to get something written or verbal from a patient. But you have authority to view. So we talk about the legislation. We talk about authority to view authority to upload, and we do a bit of a general refresher around some of these fundamental concepts for My Health Record. So I’d really encourage you if you'd like to hear a little bit more about that, or learn a little bit more about sort of those general concepts to come along to the refresher training. It's not going to be focused on aged care. It's going to be more in general My Health Record use sort of across the whole system for GPS interacting with My Health Record for any of your patients. So yeah, recommend coming along to that if that's of interest to you and sharing that with your colleagues as well.
Dr Steven Kaye:
We're running out of time. But we've got a couple of questions in the in the Q&A as well that we'll try and answer perhaps written questions. So we'll answer them by writing if that's all right. We'll get back to those. So I guess we need to wrap up as it's just ticking over the time frame allowed. So thank you, everybody, for attending tonight's webinar. We hope you've enjoyed it, and thank you to Briana for delivering an amazing presentation. Absolutely fantastic. You can see that Briana has fantastic information at her fingertips, and is able to share that absolutely brilliantly.
The next webinar as mentioned is on My Health Record refresher training. We will go into further about well not consent, but about to usability and access, as well as other nuances. It's a big program now, My Health Record, and it certainly takes a bit of getting used to and takes a bit of time just to utilise it efficiently and effectively, and the next one will be on March 22. So that's in two weeks’ time, and we'll provide a link to the registration details in the chat box and in your resource pack. For further information and support, of course, you can contact the Australia Digital Health Agency through their website or phone or email, and the RACGP Practice Technology and Management team and the contact details, of course, will be sent to you following the webinar.
The RACGP some amazing resources on My Health Record sitting on their website, and we now studiously negotiate those documents, so I can highly recommend them. You know the editorial rights I'll take, the production rights of the team, and they are really amazing specific for general practice, really useful documents and the link again, the resources will be sent to you with all of those links. But there's some fantastic stuff in there about digital health generally.
So thank you, Briana. Thank you to everybody who's attended. Thank you to Catherine, who opened up the evening tonight and we'll wish everybody a good evening and let's see you practice some wonderful digital aged care moving to the future.
Thank you all very much.
Briana Meawad:
Thanks everyone.

Other RACGP online events

Originally recorded:

8 March 2023

My Health Record can provide access to accurate and relevant clinical information uploaded by a range of healthcare providers (GPs, hospitals, pharmacists), that may assist in improving quality of life, care coordination and reduce potential medication misadventures.

This webinar, delivered in collaboration with the Australian Digital Health Agency, will explore the benefits of using My Health Record through a case study to assist attendees’ understanding of how to use the clinical information in My Health Record and apply it to everyday workflow/practice or care in the aged care sector. There will also be an opportunity for participants to ask questions.

A webinar resources pack with links to RACGP and Australian Digital Health Agency resources is available to download by clicking here.

This session is part of the Practice Essentials Webinar Series 2023.

Learning outcomes

  1. Describe the potential benefits of using My Health Record when supporting care for patients in residential aged care facilities
  2. Articulate how residential aged care facility staff can utilise My Health Record
  3. Demonstrate how to access My Health Record when offsite from the practice via the Provider Portal.

This event is part of Practice Essentials Webinar Series 2023. Events in this series are:


Dr Steven Kaye

Steven has been an RACGP Expert Committee member in eHealth / Practice Technology & Management 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 for Eastern Victoria GP Training, an examiner for the RACGP fellowship and the Managing Partner of his General Practice in South East Melbourne. He has worked on many projects in an advisory role, including the ‘Shaping a Healthy Australia’ Working Group, My Health Record education program and the My Health Record External Assurance Committee.


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