Digital health in (clinical) practice – Dr John Aloizos
29 March 2019: John Aloizos, an Agency Senior Clinical Reference Lead, reflects on how digital health is empowering patients and enhancing clinical care.
A 2017 international comparison of the health systems of Australia, the US, the UK and several other high income countries ranked Australia number one for health outcomes. This spectacular result could only be achieved through a thorough commitment to excellence and continuous improvement across the profession.
Despite this, there are 250,000 hospitalisations1 due to medicines misadventures each year in Australia. This is a shocking figure, which serves to underline the difficulties faced by even the best health systems.
The culture of continuous improvement that pervades Australian health and care means that clinical practice is constantly evolving in the endeavour to improve outcomes. In addition, other changes arise in response to changing societal circumstances.
Say hello to “Dr Google”
The rise of the internet represents perhaps the most profound societal change in the past decade. People from all walks of life now routinely use it for entertainment, to conduct business, and to obtain information.
This includes medical information. There is now an abundance of health and medical information readily available on the internet, typically of highly variable quality. “Dr Google” has become many people’s first point of consultation, which has pluses and minuses for daily practice. Sometimes it means that my patients arrive in my office highly engaged and well informed about their condition. At other times it means that I have to address a number of misconceptions before we can proceed.
The digital democratisation of health
It is by now a familiar suggestion that the proliferation and increasing sophistication of digital technologies will accelerate a kind of a “democratisation of medicine”.2 This is, on the whole, something to be welcomed, even when we find ourselves combatting misconceptions.3
It has been well understood for some time that patient engagement is an enormously powerful factor in delivering superior health outcomes.4 Health is not just something that magically occurs within a doctor’s office; lifestyle choices and adherence to treatment and among the most critical factors in delivering positive outcomes.
And to engage patients we must, well, engage with them. This means taking each patient’s goals and preferences absolutely seriously, and guiding them through their treatment in a manner that preserves and enhances their autonomy.
In my experience, My Health Record is a great starting point for these kinds of conversations. The patient can see the same summary of information that I can, and from there we can discuss the patient’s needs, goals and preferences. Nothing is hidden from the patient, and I can play the role of a guide and trusted advisor, instead of a paternalistic guardian. And that’s a good thing for both of us.
New ways of delivering care
The availability of My Health Record and other digital health tools and services expands our options for delivering care, which holds out the prospect of improved outcomes, greater convenience, and enhanced patient autonomy. As always, new methods of delivering care need to be rigorously tested for safety and efficacy before they can be implemented in standard clinical workflows around Australia.
The Australian Digital Health Agency has a number of “digital health test bed” trials underway to test digitally enhanced workflows. One of these trials has just gone live – a service that will help patients to manage their medicines better after they leave hospital by meeting with community pharmacists to check their discharge summaries and medicines information via My Health Record. Managing medicines after hospital discharge is a major factor in readmissions, so a successful trial could lead to new ways of delivering care across Australia that could reduce hospital readmissions and possibly even save lives.
Safety is a non-negotiable requirement in healthcare and, as a result, the way that clinicians work is highly resistant to rapid change. But change is coming, rapid or not, and I believe that we will all benefit, patients and clinicians alike.
Dr John Aloizos AM MBBS FRACGP FAICD is a Senior Clinical Reference Lead at the Australian Digital Health Agency
Tang, P.C., M. Smith, J. Adler-Milstein, T.L. Delbanco, S.J. Downs, D. L. Ness, R.M. Parker, and D.Z. Sands. 2016. The Democratization of Health Care. Discussion Paper, Vital Directions for Health and Health Care Series. National Academy of Medicine, Washington, DC. https://nam.edu/wp-content/uploads/2016/09/The-Democratization-of-Health-Care.pdf ↩
De Lusignan S, Mold F, Sheikh A, et al. Patients’ online access to their electronic health records and linked online services: a systematic interpretive review. BMJ Open. 2014;4(9):e006021. ↩