RACGP calls for urgent national roll-out of ERRCD

The Royal Australian College of General Practitioners (RACGP) has released a discussion paper outlining the computerised systems currently available that can assist doctors with monitoring of potential prescription or doctor ‘shoppers’, but has ultimately supported the national roll-out and expansion of the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system.

The ERRCD aims to provide a real-time monitoring system for both prescribers and dispensers, and is currently in use in Tasmania with plans to roll it out in other states and territories. The Victorian and South Australian branches of the Australian Medical Association (AMA) have also been vociferous in their calls for action.

So far, however, the implementation has been slow. While the federal government purchased a license to use the system for all states and territories almost three years ago, most jurisdictions are still in the planning stage.

In a letter to stakeholders asking for submissions of support, the RACGP national standing committee for health information systems chair, Nathan Pinskier, and the chair of its drug and alcohol committee, Michael Aufgang, say efforts to prevent deaths from overdoses of prescription drugs are being hampered by a lack of a national system that is available to all prescribers, dispensers and regulators.

“The RACGP strongly supports the urgent implementation of the ERRCD,” they write. “Although this system currently only allows viewing of Schedule 8 drug dispensing information, the RACGP believes the system should be expanded to include all drugs, including other drugs of dependence such as benzodiazepines.”

The discussion paper outlines existing systems that could potentially be used but also details their failings. These include the PCEHR, which receives medications information through the National Prescription and Dispense Repository, but this functionality is still in its infancy.

The PCEHR also captures PBS information, but this is not in real time. Few GPs or pharmacists are actively using the PCEHR, and it is also an opt-in system, with only two million consumers registered.

GPs and pharmacists also have access to information through the prescription exchange services that many use. One of those services, MediSecure, is soon to release software called Dr Shop that will allow GPs to be notified if certain Schedule 8 and Schedule 4 drugs have been prescribed in the last 90 days.

As the college points out, however, electronic transfer of prescriptions either by MediSecure or eRx is not used by all GPs and pharmacists, and it will not provide a full medications list.

Dr Pinskier said he could definitely see a role for Dr Shop as an interim measure until a full national system can be implemented.

He also said Medicare’s Prescription Shopping Information Service (PSIS) was available to GPs. This service operates a telephone inquiry line 24 hours a day and also allows GPs to request a full report on a particular patient online through HPOS.

Through this service, GPs are provided with a statement as to whether the person meets the criteria of a prescription shopper, with patient summary reports available on those who do. A prescription shopper is defined as anyone who, within a three-month period, has been supplied with PBS items prescribed by six or more different prescribers or a total of 25 or more target PBS items.

“The Medicare doctor shopping site is really good and the statements they provide now, either directly or through HPOS, are really comprehensive,” Dr Pinskier said.

“But GPs generally don’t know about it. We did some research and people had differing understandings of what was available. They can provide a statement that covers everything … but you have to be registered.”

Medicare’s Prescription Shopping Program (PSP) also has a mail out program to alert a doctor if they have prescribed to a patient of concern, but again, this information is sent out after the prescribing event and is not in real time.

What the Victorian Coroners Court has repeatedly requested over the last few years, and which the RACGP supports, is a real-time system. As far as the RACGP is aware, the ERRCD is the only system available that can provide this service to both prescribers and pharmacists nationally, and can also be used to track prescriptions written by hospital-based physicians that are filled in community pharmacies.

It has its drawbacks – at present, it is only available through a web browser and is not integrated into either GP or pharmacy desktop software, considered essential for GP and pharmacist workflow, and it only tracks Schedule 8 or controlled drugs.

In most of the recent cases reported by state coroners it is the combination of a Schedule 8 drug with prescription or Schedule 4 drugs that has led to the fatalities.

Despite its current limitations, Dr Pinskier said the college was supporting the ERRCD because the coroners are supporting it. “It appears to be the only national solution that could be implemented, noting that it has significant limitations in its current form,” he said.

“Other than expanding it to include more than just Schedule 8 drugs, it needs to be integrated into existing desktop products. If they could agree on a standard approach and a way of integrating it through a B2B interface, that’s what we need.

“However, that doesn’t preclude eRx or Dr Shop or any other vendor from providing ERRCD with additional data.”

Pharmacy Guild national president George Tambassis said the Guild also supports the ERRCD as it will save lives.

“We negotiated funding for the development of it in the Fifth Community Pharmacy Agreement, five years ago,” Mr Tambassis said.

“We support one national system, with the privacy and governance controlled and maintained by government.

“We don’t support a multiplicity of systems run and operated by multiple private companies, especially if they exclude pharmacy.”

uHealth looking at telco and pharmacy partners for QardioArm

Digital healthcare company uHealth has partnered with smart heart health solutions developer Qardio to introduce the QardioArm smart blood pressure monitor to Australia and New Zealand.

QardioArm is a clinically validated and TGA-approved blood pressure monitor that connects wirelessly to an app to allow users to measure, record and share systolic and diastolic blood pressure and heart rate measurements.

QardioArm won a 2014 RedDot product design award for its elegant design, which aims to make a medical device look like a daily object that is simple and convenient to have around at all times for daily measurements.

The Qardio App also works with Apple’s HealthKit, enabling the sharing of blood pressure, heart rate and other health data. Apple’s Health app lets users access all their health and wellness information in one place and keep it under control.

It features an activity view to help track accomplishments and promote consistent monitoring, a place feature that helps monitor how blood pressure changes across multiple locations, and an irregular heart beat history that saves all irregular heart beat notifications to provide a reference history for doctors.

uHealth Australia director Will Knox said the technology was innovative in its design and user interface.

“We believe this digital health technology will provide a platform for our programs focusing on both prevention and management of hypertension amongst Australians and New Zealanders,” Mr Knox said.

“Both our retail and clinical partners see QardioArm as an innovative engagement tool that will help drive their health and wellness programs.”

Mr Knox said uHealth was distributing the product through its website and established partnerships with pharmacies, but is also using it as a testing ground to try out the distribution of a range of the company’s smartphone-based devices through telecommunications retailers.

The aim is to supply devices along with data and phone plans through a telco’s retail stores.

While there are a number of portable, smartphone-based blood pressures out there, Mr Knox said QardioArm is smaller and more elegant in its design.

“It also allows more structured tracking of data, including a GPS function to track blood pressure over multiple locations,” he said.

“The purpose of the technology is to drive those with hypertension to monitor and track their disease more frequently during everyday activities – hence QardioArm is smaller and has a slicker user experience.”

Qardio also has a device called QardioCore, an attractive, wearable ECG monitor that monitors body temperature, stress levels and activity tracking. All measurements are transmitted wirelessly to a smartphone app and stored in a private cloud.

Mr Knox said uHealth plans to distribute QardioCore once it receives TGA approval.

uHealth also distributes other TGA-approved, attractively designed medical devices such as the AirSonea asthma device, the AliveCor heart monitoring device and Dario, an all-in-one glucose meter that plugs into a smartphone.

Patient access to pathology results

This article first appeared in the November 2014 issue of Pulse+IT Magazine.

The ability for patients to access their pathology results through a patient portal or potentially through Australia’s PCEHR has been a topic of intense discussion over the last year or so. However, the evidence for the efficacy of this approach has been mixed. In this article, ACHI’s Program Evaluation Subcommittee (PES) provides a targeted literature review of research and articles published between July 1 2013 and June 30 2014 as part of ACHI’s biannual evidence review (BER).

There is a widespread interest, across Australia and internationally, in the development of person-centred care as a system that places people in the forefront of their health. Person-centred care can be defined as a means to help people make informed decisions about their own health as part of a partnership between providers and patients that caters for individual preferences, goals, lifestyles and abilities.[1]

eHealth developments have played a major role in shaping the person-centred care agenda, providing the technological infrastructure to drive the development of interactive information sources, online support groups, decision aids and self-management applications.[2] It is becoming increasingly possible for hospitals (and community pathology practices) to provide consumers access to information online using a secure electronic patient portal, which in addition to allowing access to appointment and personal clinical information, also facilitates communication with health professionals.

These changes have prompted considerations about patient access to information (including pathology test results), the physician-patient relationship and even the impact that patient access may have on the traditional physician role and authority as the information gatekeeper.[3]

This paper provides a targeted review of eight research articles related to patient access to pathology test results, published in the timeframe of 1 July 2013 to 30 June 2014 and identified by members of the Australasian College of Health Informatics (ACHI) (see Table 1).

The inclusion of three wide ranging reviews (two systematic[4,5] and one realist[6]) highlights the current level of interest internationally in the topic of patient access to information. The reviews provide an expansive and complementary overview of existing evidence related to this issue. They are supplemented by the inclusion of five studies that explored patient experiences and perceptions. Three of these studies were based on surveys[79] and two studies employed qualitative methods using focus groups[10,11]. Table 2 presents additional relevant resources, including grey literature, opinion pieces and news reports.

This targeted literature review is part of a biannual evidence review undertaken by ACHI to help inform the profession and the community about key eHealth issues. The subject of the review is timely given that consultations are currently underway to incorporate pathology reports into the personally controlled electronic health record (PCEHR). This follows the 2014 release of a review of the PCEHR commissioned by Health Minister Peter Dutton recommending the integration of diagnostic imaging and pathology into the PCEHR.[12]

Enhancing the role of consumers

According to the Australian Commission on Safety and Quality of Health Care (ACSQHC)[13], the benefits of increased consumer engagement encompass better quality and safer health care practice. This is relevant to test result follow-up where the failure to inform patients has been described as legally indefensible factors in malpractice claims.[14] Research evidence continues to show that patients are interested in being involved in medical decision making and in being notified of their test results, both abnormal and normal.[3]

Additionally, it is argued that sharing information and engaging patients can also contribute to improvements in the efficiency and effectiveness of the laboratory test process (e.g., decrease in test redundancy) [15] and as a way of helping to reduce diagnostic errors.[16]

The US Department of Health and Human Services has recently enacted legislation which allows patients to access test results directly from the laboratory by request.[17] There are similar moves underway in the NHS in England[18]. Since 2001, Australian consumers have the right to view their pathology results (except in a small number of legal circumstances) under the Commonwealth Privacy Act [19] – also an existing community pathology practice.[20] Since 2001, patient access to pathology results has also been a formal policy of the Royal College of Pathologists of Australasia (RCPA) and Pathology Australia[21].

Findings

Despite the enthusiasm for direct patient access to laboratory and imaging results, the evidence from existing evaluations of electronic patient portals and their impact on the safety, effectiveness and quality of patient care is limited and inconclusive [4,22,23]. There are major questions about how patients use their record and respond to their results alongside concerns about the impact on authority and responsibilities within the current patient-doctor relationship.[15]

Table 1 – Selected articles

Article References
1 Christensen K, Sue VM. Viewing laboratory tests results online: patients’s actions and reactions. J Participat Med 2013,5:e38
2 Davis Giardina T, Menon S, Parrish DE, et al. Patient access to medical records and healthcare outcomes: a systematic review. J Am Med Inform Assoc 2014;21:737-41.
3 Kerns JW, Krist AH, Longo DR, et al. How patients want to engage with their personal health record: a qualitative study. BMJ Open 2013;3(7).
4 Lubick Goldzweig C, Orshansky G, Paige NM, et al. Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes: A Systematic Review. Ann Intern Med 141(3):196-204 2013;159(10):677-87.
5 Otte-Trojel T, de Bont A, Rundall TG, et al. How outcomes are achieved through patient portals: a realist review. J Am Med Inform Assoc 2014:amiajnl-2013-002501.
6 Turvey C, Klein D, Fix G, et al. Blue Button use by patients to access and share health record information using the Department of Veterans Affairs’ online patient portal. J Am Med Inform Assoc 2014:amiajnl-2014-002723.
7 Woods SS, Schwartz E, Tuepker A, et al. Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. J Med Intern Res 2013;15(3).
8 Zikmund-Fisher BJ, Exe NL, Witteman HO. Numeracy and Literacy Independently Predict Patients’ Ability to Identify Out-of-Range Test Results. J Med Intern Res 2014;16(8).

A widely publicised Annals of Internal Medicine systematic review in 2013 by Lubick Goldzweig et al., examined evidence of the effect of patient portals on clinical care since 1990.[23] The review found 46 articles including randomised controlled trials, observational, quantitative and qualitative studies. The authors reported that the evidence about the effect of patient portals on health outcomes is currently insufficient. The majority of positive examples they found related specifically to patients with chronic diseases, such as diabetes, hypertension and depression, where the portal was used as an accompaniment to case management.[23]

Although noting that patient portals are part of a concerted effort to encourage patient participation, they identified disparities in portal accessibility and usability, particularly amongst populations that are ill-prepared to take on personal health record systems. The authors concluded with a strong recommendation for policy efforts to overcome racial, ethnic and literacy barriers to portal use.[23]

The Annals paper was followed by a Journal of the American Medical Informatics Association systematic review by Giardina et al., which proffered similar conclusions.[4] The authors of this review found some examples of increased levels of patient satisfaction, but unclear evidence of any enhancements in the quality of care, or of any impact on safety, timeliness and equity.

They concluded that more rigorous research is needed to evaluate the impact of making medical records available to patients.[4] The findings of both systematic reviews described above, draw similar conclusions to a 2012 review by Ammenwerth et al.[22], which despite noting improvements in patient treatment adherence and the rate of patient office visits, found no changes in health outcomes.[22]

A paper by Otte-Trojel et al. expressed concern that existing research findings on patient portals to date fail to help us appreciate how patient portals contribute to better patient care. The authors undertook a realist review of the evidence in order to investigate how the intervention works, for whom, and the circumstances in which it works. They concluded that it is necessary to identify and study the mechanisms by which patient access to results and their own information, namely: a) patient insight into information; b) the activation of information; c) the continuity of care; and d) patient convenience.[6]

Recent research on the topic has begun to address some of Otte-Trojel et al.’s concerns. For instance, Kerns et al.’s qualitative study into how patients want to engage with their personal health records [10] and Woods et al.’s study of patient experiences of full electronic access to health records and clinical notes,[11] highlight some complementary themes, particularly the importance of integrating personal records into current care, promoting patient-clinician communication, improved patient knowledge, and building confidence in the security and accuracy and privacy of information.

Positive surveys

An email survey of US Kaiser Permanente members’ reactions to online viewing of laboratory results, published in 2013 by Christensen and Sue, reported overwhelmingly more positive than negative patient responses.[7] Similarly, a survey undertaken by Turvey et al. on patients’ use of the Department of Veterans Affairs online patient portal, drew attention to benefits including patients’ ability to understand and share personal information[8]. However, the authors of this study made special note of the importance of educational efforts to address usability issues that hinder adoption.[8]

Patient comprehension of laboratory results was also considered by Zikmund-Fisher et al. who assessed whether adults can identify laboratory blood test values outside reference ranges in a patient portal format and concluded that health literacy and numeracy skills were significant barriers to the basic use of laboratory test result data in patient portals.[9] In their review of personal health records (PHRs) in Pulse+IT in July 2014, Day and Bain drew attention to similar challenges and raised important questions about whether one-size-fits-all is the best approach for the future.[24]

The majority of studies on the topic emanate from the US, which prompts the need for some caution about the generalisability and applicability of the findings, particularly given the nature of the Australian health system, Australian pathology services and the developing role of the PCEHR. For instance, in the US there is a distinction between “laboratory testing” and “pathology.” The US version of “laboratory testing” is what Australia would refer to as clinical pathology (biochemistry, haematology and microbiology), while US “pathology” is what Australians would call anatomical pathology. Laboratories are licensed in the US for certain tests only, while genetics and more sophisticated testing modes (e.g., genomics) are often undertaken in reference laboratories and reported separately.

Challenges for Australia

Concluding themes emerging from the evidence about patient access to laboratory results and the challenges ahead:

Conclusion

Clearly much of the work required to understand, and realise, any benefits of patient access to pathology reports is yet to be done. However, it appears inevitable that rising interest from consumers in their pathology will continue.

In the Australian context much of the focus may be on the PCEHR. However, other new systems which may effectively compete with the PCEHR will likely appear in the market. Private pathology operators and third-party developers may offer such systems to attract customer loyalty and gain competitive advantage. The authors urge all key stakeholders, including consumers, to work together with some urgency to address the challenges set out above.

Additional resources

Article References
1 The National Institute for Health Innovation. Patient Portals PMS Review 2 (Available at: http://www.patientsfirst.org.nz/wp-content/uploads/2014/09/Patient-Portals-for-PMS-Requirements-Review-FINAL.pdf), 2014.
2 McDonald K. Fear and loathing in the early days of patient portals. Available at: https://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2083:fear-and-loathing-in-the-early-days-of-patient-portals&catid=49:new-zealand-ehealth&Itemid=329. Pulse+IT 2014.
3 McDonald K. Patient portals: start simple, start small. Available at: https://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2070:patient-portals-start-simple-start-small&catid=49:new-zealand-ehealth&Itemid=329. Pulse+IT 2014.
4 Shapiro M, Johnston D, Wald J, et al. Patient-Generated Health Data (White Paper). USA: RTI International, 2012.
5 Bikman J. Patient Portals – Patient Engagement: The Holy Grail of Meaningful Use: peer60, 2014.
6 Ricciardi L, Mostashari F, Murphy J, et al. A national action plan to support consumer engagement via e-health. Health Affairs 2013;32(2):376-84.
7 Department of Health and Human Services (US). Part II 45 CFR Part 164 Patients’ Access to Test Reports. Federal Register 2014;79(25).
8 Walker J, Darer JD, Elmore JG, et al. The Road toward Fully Transparent Medical Records. New Engl J Med 2014;370(1):6-8.

References

  1. de Silva D. The Health Foundation – Helping measure person-centred care. London: The Health Foundation, 2014.
  2. Hordern A, Georgiou A, Whetton S, et al. Consumer eHealth – an overview of the research evidence and the implications for future policy. HIMJ 2011;40(1):6-14.
  3. Giardina TD, Singh H. Should patients get direct access to their laboratory test results?: An answer with many questions. JAMA 2011;306(22):2502-03.
  4. Davis Giardina T, Menon S, Parrish DE, et al. Patient access to medical records and healthcare outcomes: a systematic review. J Am Med Inform Assoc 2014;21:737-41.
  5. Lubick Goldzweig C, Orshansky G, Paige NM, et al. Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes: A Systematic Review. Ann Intern Med 141(3):196-204 2013;159(10):677-87.
  6. Otte-Trojel T, de Bont A, Rundall TG, et al. How outcomes are achieved through patient portals: a realist review. J Am Med Inform Assoc 2014:amiajnl-2013-002501.
  7. Christensen K, Sue V. Viewing laboratory test results online: patients’ actions and reactions. J Participat Med 2013;5:e38.
  8. Turvey C, Klein D, Fix G, et al. Blue Button use by patients to access and share health record information using the Department of Veterans Affairs’ online patient portal. J Am Med Inform Assoc 2014:amiajnl-2014-002723.
  9. Zikmund-Fisher BJ, Exe NL, Witteman HO. Numeracy and Literacy Independently Predict Patients’ Ability to Identify Out-of-Range Test Results. J Med Intern Res 2014;16(8).
  10. Kerns JW, Krist AH, Longo DR, et al. How patients want to engage with their personal health record: a qualitative study. BMJ open 2013;3(7).
  11. Woods SS, Schwartz E, Tuepker A, et al. Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. J Med Intern Res 2013;15(3).
  12. Review of the Personally Controlled Electronic Health Record. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/46FEA5D1ED0660F2CA257CE40017FF7B/$File/FINAL-Review-of-PCEHR-December-2013.pdf, 2013.
  13. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. Sydney, Australia: Commonwealth of Australia, 2012.
  14. Casalino LP, Dunham D, Chin MH, et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med 2009;169(12):1123.
  15. Feeley TW, Shine KI. Access to the medical record for patients and involved providers: transparency through electronic tools. Ann Intern Med 141(3):196-204 2011;155(12):853-54.
  16. Graedon T, Graedon J. Let patients help with diagnosis. Diagnosis 2014;1(1):49-51.
  17. Department of Health and Human Services (US). Part II 45 CFR Part 164 Patients’ Access to Test Reports. Federal Register 2014;79(25).
  18. NHS. It’s your record – A guide to accessing health records online (Available at: http://www.myhealth.london.nhs.uk/sites/default/files/u3246/ItsYourRecord.pdf; Accessed 13 October 2014).
  19. Australian Privacy Principles (January 2014). Available at: http://www.oaic.gov.au/images/documents/privacy/privacy-resources/privacy-fact-sheets/privacy-fact-sheet-17-australian-privacy-principles_2.pdf; 2014.
  20. Australian Association of Pathology Practices. Privacy Policy in Community Pathology (Available at: http://www.pathologyaustralia.com.au/wp-content/uploads/2002/05/05_Privacy-Policy-in-Community-Pathology.pdf): AAPP, 2002.
  21. The Royal College of Pathologists of Australasia. Release of Pathology Results to Patients (Available at: http://www.rcpa.edu.au/getattachment/27eda369-6798-48c7-b6b8-af41332e66cc/Release-of-Pathology-Results-to-Patients.aspx), 2013.
  22. Ammenwerth E, Schnell-Inderst P, Hoerbst A. The impact of electronic patient portals on patient care: a systematic review of controlled trials. J Med Intern Res 2012;14(6).
  23. Goldzweig CL, Orshansky G, Paige NM, et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 2013;159(10):677-87.
  24. Day K, Bain C. Opening medical records for patients – A limited literature review. Pulse+IT 2014;2014(7 July ):40-43.
  25. Nettleton S, Hanlon G. ‘Pathways to the Doctor’ in the Information Age: the Role of ICTs in Contemporary Lay Referral Systems. In: Webster A, ed. New Technologies in Health Care Challenge, Change and Innovation. Hampshire: Palgrave Macmillan, 2006:57-70.
  26. Sung S, Forman‐Hoffman V, Wilson MC, et al. Direct reporting of laboratory test results to patients by mail to enhance patient safety. J Gen Intern Med 2006;21(10):1075-78.
  27. ECRI Institute. ECRI Institute’s top 10 patient safety concerns for healthcare organizations. Available at: www.ecri.org/EmailResources/PSRQ/Top10/Top10PSRQ.pdf 2014.

About the authors

A/Prof Andrew Georgiou
BA MSc PhD FACHI FCHSM

Dr Michael Legg
Bsc, PhD, FFSc (RCPA), FAICD, FAIM, FACHI

Dr Glenn Edwards
MBBS, MAACB, MD, FRCPA, FACHI

Associate Professor Andrew Georgiou is a researcher at the Centre for Health Systems & Safety Research at UNSW’s Australian Institute for Health Innovation (AIHI). Dr Michael Legg is a consultant health informatician with Michael Legg & Associates. Dr Glenn Edwards is national medical director of pathology at St John of God Pathology.

Opinion: How medical practices can reduce data breaches

Health records and financial information are juicy targets for hackers, as they can use the harvested data for financial gain or for fraud, creating other accounts using personal data or using that data to compromise existing accounts.

In August of this year, a US-based hospital chain lost 4.5 million health records and these attacks are on the rise, as medical records are more valuable for the non-medical information they contain, which can be used to obtain credit or services using the victim’s details.

Australia has also had its dealings with hackers. In 2012, they used ransomware (a virus or software program designed to block access to a system until a payment is made) to demand $4000 to unlock a Gold Coast medical centre’s data.

However, with a little knowledge and careful planning, it is possible to prevent the majority of these attacks. I say the majority, as even large corporations fail to protect against some highly skilled hackers or a concentrated attack involving thousands of them.

The first step is to identify all possible avenues of attack. Medical practices and clinics are no different from traditional businesses in this respect, despite the value of the data they store. Most businesses, regardless of industry, include some or all of the following data repositories:

Evaluating the security of the business infrastructure is not a job for amateurs and it is always best to involve the services of an ethical hacker or penetration testing company. These companies will evaluate all aspects of the business, including vulnerabilities in physical security.

This is an important consideration as even rubbish is used by hackers to obtain data, making shredding and secure disposal of documents essential for any healthcare practice.

Even visitors can create risk as they peek over the shoulder of staff members to gather specifics (known as shoulder surfing to hackers). This leads to another crucial aspect of security – staff awareness and training.

Your staff are often the weakest link when it comes to security and they are targeted directly and indirectly by hackers. Therefore, it is vitally important that staff are aware of the ways hackers gather their information.

Hacking attacks come in many forms but staff training can reduce the success rate of these attempts.

The most common ways they gather data are:

If all of these tips are employed, then the chances of a data breach are lessened considerably. If strong password and encryption is used at all points in the documentation process, it will make a hacker’s breach attempts all the more challenging.

He or she will more than likely seek an easier target. It is also worth noting that security checks are always ongoing, never sporadic, as the threats evolve all the time. We must be ever diligent to protect our medical data, despite their best efforts to compromise it.

Rob Khamas is an eHealth solutions strategist with REND Tech Associates.

Solution underway to prevent pathology posts to PCEHR

The Department of Health (DoH) says it is working with the pathology sector to develop a way to ensure certain pathology reports are not uploaded to the PCEHR if a patient withdraws consent.

A DoH spokesperson confirmed that the sector had agreed to a model in which pathology and diagnostic imaging reports are uploaded to the PCEHR by the diagnostic provider and made available to healthcare providers immediately.

Patients would then be able to access the reports after a seven-day delay, which would allow the requesting doctor to review the reports and consult with the patient if necessary.

“Following consultation with a range of stakeholders it was agreed that a seven-day delay for release of reports to patients provides a reasonable time frame for healthcare providers to manage communication of results with their patients while minimising risks to safety caused by reports where appropriate follow-up does not occur,” the spokesperson said.

“This position is supported by the majority of stakeholders including pathology providers, the Australian Commission on Safety and Quality in Health Care, clinical peak bodies, consumer groups, jurisdictions and medical indemnity insurers.

“The model is simple without increasing clinical risk for patients. It has limited impact on clinical workflow and reduces the risk that reports are missed and not available on the PCEHR.

“The Department is working with pathology stakeholders on an alternate workflow when there are changes to patient consent.”

As reported last week, the department seems to have accepted the view of the profession that it was necessary to find a way to ensure certain reports are not posted.

The chair of the Royal College of Pathologists of Australasia’s (RCPA) informatics committee, Michael Legg, told Pulse+IT that it was his understanding that work was continuing on how to do this.

“There has to be the opportunity for the patient and requester to decide whether it is appropriate to post it or not at the time of request, even accounting for the current policy of having a time delay before the report could be viewed by the patient,” Dr Legg said.

“In my view it would depend on the nature and policy of the requester’s practice what the default would be but in any event there has to be a way of signalling that this report should not be posted to the PCEHR.

“That means that you have to have a way of being able to post a report at a later time, which may be after review of the results and/or discussion with the patient depending on the agreement they have.”

DoH CIO Paul Madden told the Rural Medicine Australia (RMA) conference in Sydney on Friday that the department had undertaken a range of consultations with the clinical colleges, the private pathology sector, GPs, medical defence organisations and public pathology providers on the ‘high-level design’ of the system.

He said another meeting would be required to finalise some outstanding issues, but that the capability to view pathology and DI reports on the PCEHR would be available in the next release, due next month.

“We have reached the point where we’ve pretty much agreed the high-level design for getting pathology reports to the PCEHR,” Mr Madden said.

“There have been some detailed issues to work through, some just to make sure that all of the parties to that arrangement are in fact happy with the way that clinical risks and access to information are managed to get the best outcome for patient and clinician.

“We have a further workshop and we have been in communication with the Royal College of Pathologists of Australasia to work through some of those issues and I think we’ve reached a point of agreement on the design at the very high level, but we still need to run a further consultation session to bring that to a conclusion.

“I’m expecting that we should be able to announce the final design in a matter of weeks.”

While the capability to view diagnostic reports will be available, it is unclear as to when the information will start to flow. Pathology and radiology practices will need to register to use both the PCEHR and the Healthcare Identifiers (HI) Service before they are able to upload any data.

The department’s spokesperson said DoH understood that some pathology practices have already registered for the HI Service.

“Pathology practices will need to register with both the HI service and the PCEHR system to send information to the PCEHR,” the spokesperson said.

“Changes will be required to pathology and diagnostic imaging software to post reports to the PCEHR system. NEHTA is in early engagement with industry on the required changes.”

Release 5 of the PCEHR – which was originally scheduled for May but was postponed due to the change of government and lack of clarity about the future of the system – is expected next month.

In addition to pathology and DI reports, it will also feature fixes for a number of faults in the system along with some improvements necessitated by the transfer of the Northern Territory’s My eHealth Record (MeHR) to the national system.

The MeHR is able to accept pathology and diagnostic imaging reports already. Pulse+IT understands that the NT government insisted on the capability before it agreed to transition its successful system, which currently has 60,000 patients, hundreds of thousands of documents and between 50,000 and 60,000 clinical views a month.

Release 5 will also feature a Health Record Overview that addresses the needs of NT and other clinicians as well as usability improvements to the landing page.

Doctors’ views on iPads at the bedside

A small study of a group of doctors who used iPads on ward rounds shows that while they like the device and used it to access clinical data, they still preferred to share information verbally with their patients.

The study, conducted at St Vincent’s Hospital in Sydney by a team from the University of NSW’s Australian Institute of Health Innovation (AIHI), followed 10 doctors on their ward rounds and studied their interaction with patients while equipped with an iPad.

The iPads allowed the doctors read-only access to the hospital’s MediWeb results reporting system and the MedChart medications management program, as well as a number of patient education apps that they were free to use. Full access to MediWeb, MedChart and the hospital’s Web DeLacy computerised provider order entry system was available from a number of laptop and desktop computers on the wards.

As manoeuvring a laptop on a trolley was deemed impractical by doctors, the idea of this study was to see whether senior doctors would use the iPad to share information such as test results with their patients during ward rounds, and to explore both patients’ and doctors’ experiences of information sharing events.

What the study showed was that doctors thought information sharing was critical, but they preferred to talk their patients through the results rather than show them.

Visually sharing information with patients has been shown to be effective in other studies in general practice and with physiotherapy students in the hospital setting, but as hospital rounds are usually brief, the study concludes that the iPad at the hospital bedside might not be the appropriate context for patient engagement.

The study doctors were given a 30-minute training session on the iPad 4 as well as training on how to access MediWeb and locate patient lists and patient data.

The research team observed the medical team interacting with patients on routine rounds, with the average doctor-patient interaction lasting four minutes. Computers were used in 61 per cent of these interactions, with the iPad itself used in 15 per cent.

“When doctors used the iPad, they continued to speak while using the device,” the researchers report. “No instances were observed where a doctor stopped speaking in order to attend to the iPad.

“However, use of the iPad did require doctors to break eye contact with the patient and view the screen, which was, in the majority of cases, positioned in such a way that the patient could not see what was being done.

“In only one case was an iPad screen shown to a patient during ward-rounds for the purpose of sharing information (i.e. a test result).”

Seven of the participating doctors were interviewed, and while they thought sharing information with their patients was important, they thought it was better done verbally.

“I didn’t really use it as much interacting with the patient, because with my patient population I prefer to talk to them,” one doctor said.

Another said, “I predominantly use the rounds as a chance to talk to the patient. I don’t think reference material is that helpful, there is so little time, so when you see patient, you don’t want to waste time waiting for something to load or reading through it.”

Some did see the value in using the iPad, with one saying it is a familiar and fun device for patients that was easier to use than a laptop.

Patients were surveyed as well, with the majority saying they were engaged with their care generally and that the use of the iPad had not affected this level of engagement, although “the one patient who was shown information on the iPad reported that they thought the device had increased their engagement in care processes,” the researchers say.

They say iPads might be better when used for patient education outside of ward rounds when doctors are less time pressured.

“Overall, our findings show that iPads were used by clinicians to support their work during ward-rounds. However, the ward-round may not present the most appropriate context for the iPad to support clinicians and patients in information sharing and education.”

The study, led by the AIHI’s Melissa Baysari, Johanna Westbrook and Ric Day, is published in the Internal Medicine Journal.

Sharing health information and the privacy paradox

A survey of consumer willingness to trade digital privacy for greater convenience has found that while Australians and New Zealanders have confidence that governments and organisations will keep their data safe, they are yet to be convinced to give up their online privacy.

The Privacy Index survey, conducted by IDC on behalf of data storage firm EMC, surveyed 15,000 consumers in 15 countries, including 1000 in Australia and New Zealand, to gauge their digital privacy beliefs in six different online areas of activity: consumer, employee, social, medical, financial and citizen.

It asked them the extent to which they would be willing to trade in privacy for greater convenience, what level of confidence they had in institutional ethics and transparency when protecting individual privacy, their confidence in those institutions’ skills and abilities to protect privacy, and their confidence in their level of future privacy.

What the survey found was a number of paradoxes. Consumers want the convenience of technology but are unwilling to sacrifice personal privacy to get those benefits, they rarely take any action to protect their own privacy and rely on governments and businesses to do it for them, and while social media ranked the lowest in terms of confidence levels about protecting privacy, they still shared a lot of personal information quite freely.

Globally, the willingness to trade privacy for benefit was highest when it came to medical and government information, as was the confidence level that governments and businesses had the ethics and skills to protect privacy.

Australia and New Zealand shared this confidence but otherwise ranked quite low – 11 out of the 15 countries surveyed – in the privacy index overall. When it comes to medical information, 41 per cent were willing to trade in privacy compared to 47 per cent globally, despite 74 per cent saying they would value easier access to medical records.

However, we did rank higher when it came to confidence in the ethics and skills of governments and healthcare organisations to protect our medical information, with about 65 per cent showing a good level of confidence.

The conclusion that EMC has come to is that people want the benefits of technology without sacrificing privacy, something that has ramifications for the healthcare industry in particular as it moves to more electronic sharing of patient data.

Clive Gold, EMC’s director of healthcare for the ANZ region, said Australians and New Zealanders showed a general resistance to giving up some privacy for more convenience or the benefits that technology could bring. Australia overwhelmingly rejected the Australia Card idea back in the 1980s and it doesn’t look as if things have changed that much, despite us all having a Medicare card, a tax file number and an Individual Healthcare Identifier (IHI), whether we are aware we have one or not.

Mr Gold said he wasn’t surprised that Australians showed this resistance, but what he was surprised at was the lack of reason for it.

“We can’t really work out what the reasons were, because if you have a look at whether people trust that the information might be abused or that the information would be protected, about 65 per cent … said ‘I think they’ll do it ethically and I think they’ll look after it properly, but I’m not willing to give it up’,” Mr Gold said.

“You often hear people say ‘I’m not willing to share my record because I think people won’t look after it as well as I could’, but that is not true here. There are a lot more people who are saying ‘I do trust people will look after it but I’m still not willing to share it’.”

In healthcare, where Australia and New Zealand ranked below the average, Mr Gold said it appears that consumers do not see the benefit of having their health records and data stored, perhaps because they have not been informed of those potential benefits.

“To me, that is the big pity behind where we’re sitting in Australia right now,” he said. “It probably accounts for why the PCEHR has not had a huge uptake.

“The essence behind trying to measure this is to see whether people’s attitudes are going to change over time and I guess we are at a bit of a tipping point where people are asked to provide the data for a future benefit. Perhaps what is missing here is a bit of the education of what that future benefit is going to be.”

Mr Gold said that as we move to more digital transactions for our healthcare, consumers will require more education on why it is going to be a good thing in terms of improving the quality and even the longevity of our lives.

That education would include efforts to convince consumers that sharing data will improve the services the system can provide, make the system more efficient and make it sustainable,” he said. “The future of health is buried in the data. That’s the convincing that has to be done because what this survey shows is that it’s not a trust issue.”

The survey suggests that about 35 per cent of ANZ citizens have concerns about data security and will need to be convinced that it will be kept safe. “But there is 100 per cent of people who need to be convinced that there is a benefit,” he said.

The survey did show that the majority of people – 81 per cent – believe privacy will erode over the next five years but there is a glimmer of hope for those advocating greater digital transactions, he said.

“I think a lot of people are starting to see that when your supermarket really gets good at understanding what your buying patterns are, the specials they give you are actually worthwhile and they are not just noise and junk mail. As people have discovered that there is value in this, then they will see it is worth their while.”

Momentum builds for increased uptake of aged care IT

This story first appeared in the May 2014 issue of Pulse+IT Magazine.

There is no doubt that increased uptake of ICT can help support the many challenges facing the aged care industry, particularly as the implementation of consumer-directed care (CDC) begins, but there are still multiple challenges facing individual providers and the sector as a whole. However, momentum is beginning to build as advancements such as SaaS, cloud computing and mobile devices help to overcome the main barriers.

Over the coming decades, demographic changes will alter the dynamics of our population and significantly increase the demand on aged care services. As our ageing population increases, and the implementation of Consumer Directed Care (CDC) begins, the impact of the demographic change will see a greater call for complex, personalised services that support individuals and their families to live fulfilling and independent lives in their own communities.

The aged care sector already faces existing financial, compliance and workforce challenges, and when combined with this increased demand on the industry, it is more important than ever that providers utilise all means possible, including ICT, in order to meet these challenges.

The recently released ACIITC report, Digital Care Services, recommended that providers boost their annual ICT spend from less than two per cent to four to five per cent of gross revenue, which would provide the foundations for ICT to play a key role in helping to meet the challenges faced by the aged care industry.

The potential benefits of the greater use of technology in the aged care sector range from the economic benefits of reducing the cost of service and improving overall profitability, to the non-financial benefits that improve the quality of life and care experience for residents, consumers and care workers.

Despite the opportunity of these benefits, the uptake of technology across the broader aged care sector has been relatively slow. Therefore, what are the most common challenges that are hindering the uptake of technology within the industry?

To read the full story, click here for the May 2014 issue of Pulse+IT Magazine.

GP2U partners with SkinByDerms for teledermatology

Telehealth provider GP2U has partnered with teledermatology service SkinByDerms to allow patients and GPs to securely upload clinical photos to GP2U’s platform directly from a mobile phone to be reviewed by specialist dermatologists.

While SkinByDerms also offers a bulk-billed specialist dermatology service on its platform, the new partnership allows GPs to write a referral to a dermatologist and attach clinical photos through the GP2U app. The images are also attached to the patient’s file and stored for future viewing.

The app now contains a QR code that users scan with their device to allow photo uploads. It includes a default setting that means clinical images are not saved locally but removed from the device after they are uploaded, overcoming common privacy concerns.

GP2U founder James Freeman said the new functionality would allow GPs to conduct the referral process completely online, including booking an appointment with a SkinByDerms consultant. As part of the referral process, they will also be able to add standard questionnaires to the referral, send the referral through securely and then add the clinical images using the app.

The SkinByDerms team is led by dermatologists Shobhan Manoharan and Davin Lim, and supported by their team. A SkinByDerms spokesperson said the dermatology referral process is simple and provides a number of templates covering major skin conditions. This focuses the collection of relevant information to add to photos and saves GP time.

“The GP can grab the phone, take a digital image, and send it up to the patient’s file for viewing by the dermatologist using QR code scanning,” Dr Freeman said. “When you scan the QR code, it gives you a security token and patient ID and slips straight to the application for photo uploading.”

Patients can also upload their own photos by going to the GP2U homepage and logging in, he said.

“You see a QR code at the end of the booking process,” he said. “With your smart device, you open our app, click on the barcode scanner and scan the QR code. That will take you into the photo upload widget, and you upload your picture.

“Then if you go to the main site and have a look at your file, you find that it’s there. The doctors can then open the patient account and see the picture. It’s being transferred up to the cloud quite literally off your phone, so it is secure but also useful. It’s not a stand-alone app but a quite useful part of the process.”

Patients also have secure access to their file, including notes on past appointments, any medical certificate issued and medications prescribed. Last year, GP2U launched an online online medications ordering, partnering with Terry White Chemists and Priceline Pharmacy to allow patients to pre-order prescribed medicines from their chosen pharmacy or have them delivered to their home.

It has also built in WebRTC functionality to allow patients and doctors to video conference through their browsers.

Dr Freeman also plans to add some more gadgets to the app, having already added one for weight monitoring. That allows patients to add their measurements to the app, which are then securely uploaded to their file. From there, their weight is graphed over time. He also plans to add this functionality for other common measurements like blood pressure and INR.

HISA sets out challenge for health app developers

Aged care, medication management, the quantified self and clinician productivity are the four categories chosen for the 2014 Health Informatics Society of Australia’s (HISA) Health Apps Challenge, which will be showcased at the Innovation Expo at the Health Informatics Conference (HIC) in Melbourne in August.

Last year’s winner was Sydney medical student Martin Seneviratne, who is currently developing his concept for iResident, a tablet-based app for junior medical officers that acts as a to-do list and which he hopes can be integrated with electronic medical records.

Entrants in this year’s challenge only need submit a concept for an app rather than a working model, as they will receive feedback from eHealth and health informatics experts as part of the competition.

Judging criteria includes the user experience, effectiveness for identified problems, an evidence base anchored in medical research, perceived value in healthcare and applicability to Australia.

For the aged care category, the organisers are looking for apps that can help carers, managers and clinicians to improve efficiency, productivity and quality of care for residents. HISA says some of the key areas already identified as priorities in aged care IT are eHealth, telehealth and mobility solutions; care management; and management information and reporting.

For the medication management category, which is sponsored by Sanofi, the idea is to develop a digital medication management solution to help motivate and guide a person with one or more chronic diseases to become an active participant in their own health management.

HISA says the solution must be able to interface with the patient’s care team, healthcare provider network – including GP, pharmacist and specialists – as well as existing data platforms on which they rely.

For clinician productivity, apps should help clinicians to manage information in a cohesive, comprehensible and easy manner while working in stressful and high-pressured environments.

And for Quantified Self – the consumer movement dedicated to using technology for better self-monitoring, testing and self-sensing – the idea is to design a concept for an app which can be used to improve daily functioning by collecting self-tracking data.

Both individual and team entries are encouraged. The first round of judging will see a panel shortlist entries to be featured on the HISA website, where HISA members will vote on their preferred entry.

Eight finalists will then be chosen showcase the concept at the Innovation Expo before an overall winner will be announced at the HIC gala dinner.

The deadline for submissions is Friday, June 20, at 9am EST. Judging will then take place to into the voting round, with voting opening on July 8. Member voting closes on July 31 and the winners will be announced on August 13.

More information is available at the Health Apps Challenge website, where entrants are asked to complete a submission form and upload the concept.