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What’s news in eHealth and practice management?

Creating a mentally healthy workplace-caring for self and practice

By Dr Rob Hosking, Deputy Chair, RACGP Expert Committee – eHealth and Practice Systems

GP self-care and Mental health

It’s easy to forget that our practice ‘systems’ include a human element – the members of the practice team. We have a duty of care to our practice team to ensure they are safe at work; this applies not only to physical safety, but also to mental wellbeing. We all deserve a workplace that promotes and supports good mental health.

Unfortunately, for GPs in the practice, this is an area where we find it difficult to practise what we preach. The recent Crazy Socks 4 Docs day highlighted a simple truth – GPs, whose job relies on getting people to talk about their problems, find it hard to do this themselves.

Even though we work in an often-stressful job, and are more likely to experience very high psychological distress than the general population, there is still significant stigma about discussing our mental health. We might fear being seen as weak or not competent, and perhaps feel we should be able to cope with it on our own. It’s an attitude that no GP would endorse in their patients, so why does it prevail among our profession?

We need to make it normal to talk about these things, and we need to prioritise our own mental health. A little self-care can go a long way, starting with remembering to look after ourselves in the workplace. To not take work home if we don’t absolutely need to; to have regular breaks; to avoid over-committing; to talk to our colleagues and debrief regularly. Perhaps most importantly, we need our own GP – self-treatment and corridor consults can’t replace the care that a regular, objective GP provides.

The RACGP’s Self-care and mental health resources for general practitioners directs GPs to resources and services that specifically support the mental health of doctors. This includes the college’s own GP Support Program, which offers free and confidential advice.

It’s just started, but let’s keep the conversation about doctors’ mental health going.

RACGP members can continue the conversation on shareGP

Getting to know My Health Record

By Dr Nathan Pinskier, Chair, RACGP Expert Committee – eHealth and Practice Systems

My Health Record

With the formal announcement of the dates for the opt-out period for My Health Record, I am hearing more talk in the media and amongst my colleagues about the system and the potential impacts for general practice.

Every person known to Medicare or the Department of Veterans’ Affairs (DVA) who does not already have a MyHealth Record will receive one by the end of this year, unless they choose to opt out of the system. From 16 July, individuals who do not want a record will have a three-month window to notify the Australian Government.

The consumer awareness campaign is set to kick off shortly. With this, you might find your patients are approaching you and your teams with questions about My Health Record. Some might want their very own Shared Health Summary. More people will be adding their own information to their My Health Record and sharing it with you.

Many GPs will have questions about My Health Record too. Common themes I’m noticing among the groups I talk to include issues of safety, privacy and useability. I’m finding that a lot of GPs who haven’t to date invested time getting to know the system often don’t think it’s of significant value.

My Health Record allows you to access information that hasn’t found its way to you through the usual

communication channels. For example, you might find a hospital discharge summary that you haven’t seen, perhaps because you were not identified as the patient’s usual GP. My Health Record is kind of like an enhanced “e” version of the manila folder patients may carry with them that contains their medical reports and other clinical correspondence.

As a participating provider, you can also upload information that might help other health professionals when they see the patient in the future. Preparing this information is another way to care for and support your patients when they are outside of your clinic.

It is my belief that as My Health Record continues to grow and improvements are made over time, it is likely to become a whole lot more useful to us, to our colleagues, and ultimately to patients themselves.

With support from the Australian Digital Health Agency (ADHA), the RACGP is running a national education program on My Health Record to answer your questions and help you decide whether to and how to best use it in your practice. RACGP member led peer workshops are being held in sites across Australia over the coming months. I will be running some of these sessions in Victoria. If you can’t make it to a face-to-face workshop, there are also numerous webinars available.

All the details on how to register for a workshop or webinar can be found at the RACGP 'My Health Record in general practice' website.

RACGP members can continue the conversation on shareGP

Patient Verification Security Check Changes

The Department of Human Services has commenced implementation of the recommendations of the Independent review of health providers’ access to Medicare card numbers final report.

From May 2018, additional questions will be asked as part of the security check required to access the patient verification service and Medicare card information through the provider enquiry line.

The patient’s consent is still required before seeking access to their Medicare card number, and administrative staff have the authority to request the information on behalf of a health provider.

Real-time patient verification services can also be accessed online through the Health Professional Online Services portal.

For more information, visit the Department of Human Services website.

Updating and upgrading practice software: if you think you WannaCry now…

By Nathan Pinskier, Chair, RACGP Expert Committee – eHealth and Practice Systems

Social Media

Be honest: when you receive a prompt to update an app or program, do you usually sigh and click the ‘not now’ button? Updates can be a real distraction and an annoyance. They get in the way of doing what it is you were wanting to do at that moment. And let’s face it, do they really always matter? Maybe yes, maybe no…

What about in your clinical world? How often does your practice run the updates for your management software, clinical information system, secure messaging software and desktop operating systems? Monthly? Weekly? Daily? On-demand? Do you have the latest operating system patches installed right now? Are these patches or updates installed on the server and on every PC in the practice? How do you monitor this? How do you know?

Most organisations either delay these activities or do not have robust systems to monitor the update status. Between the restarts, the install times and data migration requirements, or the cost of purchasing new or updated software and the time it takes to train or monitor staff, updating and upgrading can be a bother. It’s something that can be done later, mañana.

But the consequences of delaying these tasks can be significant and potentially catastrophic.

In 2017, the WannaCry ransomware hit hundreds of thousands of computers across 150 countries. If your computer was infected, you were faced with a nasty choice: pay the hackers a neat little sum within 72 hours, or watch on as they delete all your data. In the UK, the epicentre of the cyberattack, 595 general practices were targeted. Payment is not an option either as the unlock code is rarely provided. Hackers apparently don’t play nice! The Australian Government Stay Smart Online website states, “We recommend that you do not pay the ransom if affected by ransomware. There is no guarantee that paying the ransom will fix your computer, and it could make you vulnerable to further attacks. Restore your files from backup and seek technical advice.”

For businesses affected by attacks like this, there is more at stake than the ransom money. Downtime means lost revenue. For healthcare businesses, patient data may be lost or compromised, a huge issue even before you consider the potential for fines associated with privacy breaches and reputational damage.

The WannaCry hackers preyed on a weakness in old versions of Windows. Microsoft became aware of the problem and released an update to patch it in supported versions of Windows before the hackers unleashed the virus. It spread because many businesses and users hadn’t gotten around to upgrading or updating their systems. Many large companies are still using old and unsupported versions of Windows.

There are other benefits to keeping your software and systems up-to-date. With new releases come new and improved features that can increase operation speed and enhance useability. The latest version of your software will probably have functionality that could improve overall workflow.

Regular maintenance of software and systems is an essential element of practice management. This includes your operating system, clinical information systems, and antivirus or other protective software. An IT consultant can help your practice establish and implement a schedule for updates and upgrades. Your role as a practice owner or manager is to define the terms of the relationship with your IT support consultant and to monitor performance. You don’t need to do it all, but you do need to know that it is being done. The key is to establish a robust and transparent governance process.

In February, the RACGP released Information security in general practice, a guide to assist you to protect your personal information and practice data. It includes information on how to meet relevant requirements for accreditation against the RACGP’s Standards for general practices (5th edition).

Stop delaying those updates, and start thinking about whether it is time to upgrade and how those upgrades can be maintained over time. It might just prevent a major disaster down the line.

Preserve, prevent, protect!

RACGP members can continue the conversation on shareGP

Backups in general practice

Rob Hosking, Deputy Chair, RACGP Expert Committee – eHealth and Practice Systems

Social Media

Imagine walking into your practice tomorrow morning only to discover an overnight power failure has resulted in failure of the server and loss of your practice data. What data would be lost? What data could be retrieved? How quickly could you return to business as usual? What would be the cost to your practice?

Loss of clinical and practice data has the potential to impose significant financial and non-financial costs on a practice. Operational down-time will be dependent on the amount of data lost. Lost bookings can provide for a logistical nightmare. Financial revenue may be affected both short and long term through lack of capacity to operate and reputational loss. Implications for patient safety through loss of complete medical records could be significant and lead to medico-legal risk. Are these risks worth taking?

Emergency response management in general practice is not about laying the sandbags as the flood waters rise or pulling out the garden hose to fight fires. It is about “sandbagging” the infrastructure and resources that allow us to practice by having systems and processes in place that build resilience for such events. In March we celebrated World Backup Day, a timely reminder for us all of the importance of regular and well managed backups in general practice. The RACGP Guide to information back up in general practice provides recommendations, practical advice and checklists, to support general practices achieve secure and reliable information backup and data recovery processes. Well managed data backup is not only sensible, it is a requirement for practices accredited under the RACGP Standards for general practice.

At our practice, where, prior to our landlord finally fixing our roof, we have been affected by flooding rains on a number of occasions, we protect our data by having a nightly backup to portable hard drives that are removed from the premises by our practice manager daily. Our contracted IT support also checks of the integrity of the backups regularly. We also have a UPS (Uninterruptible Power Supply) connected to the server and the main reception computers to allow gradual shutdown and printing of paper appointments for the day in the event of a power fail. Our practice team are all aware of the protocol in the event of power fail and we had to implement this only a few days ago for an hour or two.

I would love to be able to install a large battery to run the whole practice for a while but the current costs of these, our power system (two meters/circuits and old wiring) and a landlord situation make this too difficult at present. We may also move our data back up to the Cloud in future, but have not yet.

How do you manage your backups?

RACGP members can continue the conversation on shareGP

RACGP Technology Survey – 2017 Report

Social Media

In October 2017, the RACGP released its annual survey to explore the views and attitudes on the use of technology in general practice. A 10-minute online survey was distributed to GPs across Australia. In total, 1014 GPs participated in the survey, and 749 responses were considered for analysis.

Our survey indicates that GPs remain optimistic about the use of eHealth technology and its ability to improve productivity and care coordination. We know more GPs are recommending health apps to their patients, but uncertainty about medico-legal issues means that almost 50% have not adopted the use of apps to support patient care. Participants indicated they would like to engage in professional development opportunities in the use of technology and in how to incorporate eHealth technologies and solutions into patient-related work, including education on the use of My Health Record.

The RACGP hopes the results provide a stimulus to discuss increased adoption of digital technologies in general practice while achieving the best health outcomes for patients.

The RACGP Technology Survey – 2017 Report is available here.

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