Moving to a digital future

E-health has long been hampered by political and bureaucratic buck-passing, and has been a source of frustration for all practitioners, and no doubt to most patients as well

The AJP recently spoke to two of the key leaders from the Australian Digital Health Agency to find out
the latest about the My Health Record program.

Dr Monica Trujillo (MT) is chief clinical information officer and executive general manager, Clinical and Consumer Engagement and Clinical Governance at the Australian Digital Health Agency. Prior to this role, Dr Trujillo was Australia’s first chief medical information officer at UnitingCare Health.

Vicki Ibrahim (VI) is a Brisbane-based pharmacist and Medicines Safety Program director at the Australian Digital Health Agency.

AJP: Has there been a lot of growth in pharmacies signing up since more software providers rolled out My Health Record (MHR)?

VI: The growth in pharmacy registration remains organic at the moment, as the registration process is multi-layered and requires input from several organisations. We signed six contracts in May 2017 to very important vendors. Three of them have completed technical development and are now connected to My Health Record.

It’s one thing to develop technical capability for the software to connect to the MHR system, but the next and probably most important stage is to actually connect the pharmacist. To do this there are a couple of technical hoops we need to jump through. We’re envisaging that the actual increase in pharmacy registration will start to show through in early February and onwards.

Providing support: Dr Monica Trujillo says e-health changes will help pharmacy
Providing support: Dr Monica Trujillo says e-health changes will help pharmacy

AJP: Why should pharmacists take the time to use MHR?

MT: I’ve been around every corner of the country and spoken to many different pharmacists about what the value proposition is. At the end of the day, as clinicians, we all have a patient in front of us and have to make a decision at the point of care.

For pharmacists, the medicines reconciliation process is what they do at the point of care, and in some
of these situations they do not have information at their fingertips to do that meds rec.

What we’re offering the pharmacist is not an extra task, it’s a decision support tool so that when they have the patient in front of them and they require more information to support them through the transitions of care, they can go and get that without having to then put everything down, ring the GP, ring the emergency department, ring the specialist and say, “what is the latest? What are we doing here?” MHR is not meant to be there as an admin burden on anyone.

AJP: Is there a risk of gaps in information? How will errors be picked up?

MT: MHR is an additional feed of information to support decisions, rather than a be-all and end-all
tool where everything is. If they see something in there that is not correct, that would be a good trigger
to have a discussion with the patient.

MHR has a copy of anything that is in other systems, and by increasing transparency allows both clinician and patient to say, “Hang on a minute, what’s happening there?”, and to actually fill in those gaps.

I don’t think any paper file or any digital file replaces that unique patient and clinician interaction. We have
an ability to actually drill down and establish the best course of action for your patient. [Patients] actually value that interaction with their clinicians really highly, but they want to have the tools to have that discussion in an informed way.

AJP: Can you tell us more about the opt-out model?

MT: That’s coming out this year. MHRs will be created by the end of 2018 unless people choose not to have one.

In a review done in December 2013, one of the key points was that without wider uptake of the system, it doesn’t add value to health professionals and their patients. A key recommendation was that it would be more successful if it was opt out rather than opt in.

The trials that we conducted in 2016 were about finding out about how many people wanted to opt out.

We learnt that there was a bit less than 2% of people decided to opt out. And further to that, what they’re seeing is that some of the people that decided to opt out are starting to come back into the system.

They’re realising that having information is better than what we have at the moment. Transitions of care are really vulnerable, and at the moment we’re actually reliant on paper systems, on faxes getting to people. Imagine if you’re waiting for that to actually provide care in an emergency department—that is crazy. No other industry is like that at this moment.

When you think about it, the current system is not actually supporting that fast pace that consumers expect with everything else.

As we go, people are realising that paper-based health is so archaic in supporting good, modernised healthcare.

My colleagues around the country all know the future of medicine is around digitally supported systems, and it’s just a matter of getting there.

I think now we’ve got all the elements in place for us clinicians to not only take it up, but to lead it as
well. The Pharmacy Digital Health Leaders is a great program we’ve set up to have pharmacists that have
been identified as leaders and actually have a little bit of a wider toolkit and peer-to-peer support.

VI: We are very excited about the program because we see these guys as the ambassadors of change. And the beauty of bringing people from the profession—those nominated by the
PSA, Guild and SHPA—they really are leaders in the field. We’re having calls with them on exactly what we’ve just discussed, value propositions and providing meaningful responses for the pharmacy profession.

The group includes 37 digital health leaders, nationwide, and they’re there for leading the change as well and advocating clinical views of the pharmacy profession across the sector.

MT: Our objectives are to have people trained, tools to be there, champions out there, and I think it’s all coming together in order to support the profession.

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