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Learning from the “pioneers of ehealth” in general practice

It is fitting that the “pioneers of ehealth” – more than 55 general practices involved in an eCollaborative project around chronic disease care and self management – are using online tools such as wikis and Twitter chats to share what they’re learning along the way.

If you’re interested to hear more, you could always join their Monday night TweetUp, using the #ecollabs hashtag.

In the article below, Samantha Smorgon, Program Officer for eHealth, Quality Improvement and Practice Management at the Inner North West Melbourne Medicare Local, and colleagues describe some of the complexities and challenges of the ehealth agenda.

***

Acknowledging the contribution of the ehealth pioneers in primary health care

Samantha Smorgon and colleagues write:

Medicare Locals (ML) are tasked with ensuring better streamlining of primary health care services, and eHealth is a vital part of our work – and indeed is critical to the success of primary health care.

The Australian Primary Care Collaboratives (APCC) Program has been delivering programs in the area of quality improvement since 2004. The main focus has been on supporting general practices and health services to improve outcomes for patients with or at risk of chronic disease.

Early in 2012, the Improvement Foundation was contracted by the National E-Health Transition Authority (NeHTA) to deliver the eCollaborative – 21st Century Patient Care and Self Management Wave.

The aim of this project has been to innovate and integrate ways that new technology can improve chronic disease care and encourage patients to participate in caring for their health.

As part of the eCollaborative Wave, which began in February this year, 55 general practices Australia-wide have become involved in forging the way for eHealth in Australia. They stretch from Townsville down to Port Lincoln and from Lismore across to Perth – representing various primary health care environments and allowing consideration of care and information sharing in a variety of geographical locations.

These GPs and their teams (other GPs, practice managers, practice nurses and support staff) are our pioneers. They have persevered and taken the time to provide information on the roadblocks, frustrations, learnings, successes and solutions which provide valuable input and information to the various organisations involved in building eHealth infrastructure into the primary health care system.

The pioneers have provided advice to help DHS Medicare  better streamline their HPOS service and the way Healthcare Providers and Organisations register for Healthcare Identifiers.

They have introduced us to patients who are using a shared health summary (SHS), enhancing their care and providing them independence and peace of mind to enjoy their lives. These patients know that future healthcare providers, unfamiliar with the intricacies of their medical history, will have access to important and relevant information in a health summary, no matter where they are.

For example, we’ve learnt about the patient with a chronic disease, reaching the latter years of her life, who is more aware and involved with her own health because of the engagement she has with her GP about her condition and its management.

We’ve also met a man who’s had multiple heart operations, with various complications including medication allergies. He likes to be a ‘grey nomad’ with his wife and the SHS enables gives him the peace of mind to be able to travel around, confident that he or his next of kin can log in any time and know immediately what needs to be factored into care that’s provided.

The practices, Medicare Locals and peak health organisations have collaborated to achieve some fantastic work across many eHealth related areas. And of course with any reform there are challenges.

It’s important that the plight of these pioneers and the commitment they have shown through the eCollaboratives program to better understand and be able to provide eHealth of a high and meaningful standard is acknowledged.

The program utilises the RACGP Standards for general practices (4th edition), which sets the benchmark of quality and safety in Australian general practice, and specifies exactly what information is required to be contained within a patient’s health summary (Criterion 1.7.2). These can only be created accurately from software that has ‘clean data’.

General practitioners use a variety of software programs to record their patients’ health information. The medical software programs used in each practice vary and the reasons for GPs choosing one over the other is based on what best suits their needs.

The important aspect for data quality is content and how/where it is recorded and a significant factor for eHealth in the future and the quality of information available to all health practitioners involved in a patient’s care.

The ability to determine the accuracy and cleanliness of data is now supported by data aggregation tools such as: Pen Computer Systems Clinical Audit Tool (PEN CAT) and the Canning Tool.

In order to be able to contribute accurate information into a patient’s health summary, audits assessing the quality of their own data and the systems within their practice that contribute to this across the healthcare team, need to be undertaken. The work for the eCollaborative practices started here.

The health summary measures become useful and important for a patient to be aware of, able to access and provide to clinicians involved in their care. Both data aggregation tools have been working closely with the eCollaboratives to build in measures that will enable the monitoring of measures considered important to be contained with a health summary.

Practices have shared their experiences in registering for the Healthcare Identifiers service and linking this up with their Public Key Infrastructure certificates. They have informed the group of how the link up between these systems was achieved when using their particular medical software program. They have discussed coding of complex health diagnosis and discussed ways this could be better streamlined for improved outcomes.

All of this has been done through a variety of communication mediums. There are our traditional mechanisms, face to face workshops, email distribution lists for discussion and phone calls.

However, the eCollaborative Wave has also engaged with the 55 practices involved by using Webinars, Podcasts, which all remain available on the Wiki, as well as engaging via Twitter and use of the #ecollabs hashtag.

The “TweetUps” have proven an effective way of sharing and imparting experiences. They allow a more informal discussion, out of hours, for our notoriously time poor GPs and practice staff.

Each week the eCollaborative Social Media Director, David Guest sets a few discussion topics, which are posted to the Wiki and at 8pm EST each Monday.

GPs and their teams, the Improvement Foundation’s Clinical Lead and staff, NeHTA Change Manager and Medical Local support staff contribute to the conversation and share what they have learned.

eHealth in Australia is growing. No doubt it will remain a ‘watch this space’ arena for years to come.

The pioneers are very excited to be part of this foundation work and anyone interested in the conversation is welcome to join the eCollabs group on Monday nights (check the Wiki to confirm whether we’ll be online).

The Wiki is being continually updated, so for useful resources and tips don’t forget to visit to see what’s new.

• Follow Samantha Smorgon on Twitter: @sammismorgs

This post was written in collaboration with:

Dr Tony Lembke @tlembke
General Practitioner – Lismore/APCC Clinical Director

Dr David Guest @zeeclor
General Practitioner – Goonellabah/eCollaborative Social Media Director

Mr Craig Szucs @craigszucs
NeHTA Change Manager

Ms Mini Dhillon @MiniDhillon1
Improvement Foundation (Australia)
National Program Director (Australian Primary Care Collaboratives)

 

 

 

 

Comments 1

  1. ron batagol says:

    It’s great to see individual and group efforts such as these working towards creating a participatory electronic health system record. Howver, as highlighted in the news item –
    Patients reject eHealth Only 5029 people have joined the federal government’s controversial $466 million eHealth system since it was launched on July – Sydney Morning Herald 12/8/12. This is too important an issue to be mucked up ( more pink batts/school hall disasters in the making?

    Also relevant a comment by The Australian Medical Association’s national president Steve Hambleton in this news report, saying that the sign-up figures were evidence the government should have made inclusion in the eHealth system automatic and let patients choose to ”opt out”.

    Of course, I’d go a step further, and make a point that I have made many times previously, and which to me is so “bleedingly obvious”. Why would any self-respecting health professional want to be involved in promoting system that is designed to, at best, include only a hotchpotch of those parts of the vital medical and therapeutic history that a small percentage of the general public decide they wish to make available on their ehealth record!!!

    There needs to be a radical re-think at all levels, including, as I’ve previously suggested, a workable mechanism with appropriate systems in place to enable access to ALL relevant medical and therapeutic data in a situation where it is considered medically necessary to do so, with patients agreeing in writing for this to occur when they sign up to the system. Obviously, this must include appropriate rigorous auditing and checking systems.

    Anything less is simply not going to motivate any health professionals to have sufficient trust in the integrity and reliability of such a system, and to speak to their clients to encourage participation, without having to worry about the medico-legal consequences of not having access to vital excluded clinical and other health information It also goes without saying that all participating health professionals must be appropriately compensated and/or reimbursed on an ongoing basis for their time and effort in helping to set up and work with a reliable, all-inclusive ehealth system.

    ( BTW has any health economist guru done the sums to show the obvious economic and social benefits of lives saved by undertaking a systematic public-private investment to set up and run an ALL-INCLUSIVE electronic e health system ?- I doubt it!)

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death and dying
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digital technology
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Equally Well
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Health Care Homes
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MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
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Pregnancy and childbirth
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#CTG10
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Acknowledgement
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Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
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COVIDwrap
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Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
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Government 2.0
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Health in All Policies
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Media Doctor Australia
media-related issues
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National Preventive Health Agency
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Social determinants of health
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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
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#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
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#ANROWS2016
#ATSISPEP
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#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
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2017 conferences
#17APCC