My Health Record in emergency departments

Automated Introduction: Welcome to the Australian Digital Health Agency podcast, supporting health professionals to realise a healthier future for Australians through connected healthcare.

Dr Andrew Rochford (Facilitator): Hello, I'm Dr. Andrew Rochford and welcome to the Australian Digital Health Agency podcast.

Before we begin, I would like to acknowledge the traditional owners of the land on which we are broadcasting from and in which you are listening. I wish to acknowledge their continuing connection to land, sea and community, and I pay my respects to them and to Elders past, present, and emerging, and extend the respect to any Aboriginal and Torres Strait Islander peoples joining us today.

My Health Record is a secure online summary of a person's key health information. This can include information uploaded by GPs, pathology tests, diagnostic imaging information, hospital discharge summaries, medicines, Medicare information, or information uploaded by individuals themselves.  

Making sure you can quickly gain an understanding of a person's health history can assist in the treatment of chronic and complex medical conditions, reduce medication errors, and prevent the unnecessary repetition of tests. This all helps you to focus on the person rather than looking for the information that you need to treat them.

Today, we're going to be talking about how My Health Record can be supportive in emergency departments, and it's my pleasure to introduce today's panel on the podcast. Dr. Jaffly Chen, who is a clinical reference lead and junior medical officer. Dr Xiu Lee, emergency physician and Agency clinical reference lead, and Dr. Amanda Stafford, medical doctor at Royal Perth Hospital.  

Thank you all for joining me. To kick things off, I might go to you first Dr. Lee and get your thoughts on how My Health Record is used in an emergency department.

Dr Xiu Lee (Emergency Physician and Agency Clinical Reference Lead): Typically, we would use it after we've seen the patient to try and clarify details about medications and medical history. Emergency is 24/7, and most of the time when we see patients, it's outside of normal work hours. I've done the math and it's about 75% and that means we can't just call their GP clinic to get a summary. My Health Record is available 24/7 and that means in a time critical setting we're not just stuck on hold or waiting for faxes to finally come through.  

Most people also don't realise how siloed medical information is. It's actually a bit different in different states, but here in Victoria, for example, health services are all very separate. If you were admitted to hospital up the road recently, then were brought to this emergency department afterwards that happens to be a different network. We wouldn't actually have access to what happened while you were in the other hospital.

We couldn't see what surgery you might have had or what treatment had been done. This actually makes a big, big difference to the things we need to consider when you come to emergency. Contacting another hospital to get medical work, medical records, unfortunately also doesn't often get your results quickly. It can take hours - to days. My Health Record is a step towards overcoming that separation if the discharge summary has been uploaded. My Health Record also lets us compare external results and again it's the breaking down of siloes.  

For example, if the patients had a blood test in an emergency and we find that they have say abnormal kidney function and other issues, we may need to look for different things depending on whether that's true or not. They may not have had previous results from this hospital to compare, or the last ones may have been a few years ago, but if we have results from their GP from a couple of months ago that gives us a useful baseline for comparison.

Dr Andrew Rochford (Facilitator): Amanda, do you find the same benefits of having the My Health Record in emergency?

Dr Amanda Stafford (Medical Doctor at Royal Perth Hospital): I'm an emergency consultant working in a big city, inner city hospital, but I'm also the clinical lead for our homeless team, so I'm an avid user of My Health Record. I would use it many times during an ED shift. I also use it a lot when I'm drawing up our patient management plans for which I am responsible in our ED.  

I will be on My Health Record for lots of the same reasons that Xiu talked about, finding medications, sometimes finding allergies for people, especially those who can't communicate. Checking doses, checking when medications were last dispensed, checking who the prescribers are, so that can direct me towards a particular GP.  

We have a very complex inner-city population, so where we have people who are coming in asking for scheduled drugs, Schedule 4, Schedule 8, it's very useful to be able to look up if they're actually being prescribed them. I would be using My Health Record a lot, and certainly I see a lot of use of My Health Record around me, it's incredibly useful.

Dr Andrew Rochford (Facilitator): Jaffly, what's your thoughts on My Health in the emergency department?

Dr Jaffly Chen (Junior Medical Officer and Agency Clinical Reference Lead): I think something that continues to surprise me day to day is just how comprehensive My Health Record is becoming. I mean, obviously we still need to talk to the patient and examine the patient, but by looking to the My Health Record, you can basically do all of these things as well in terms of being able to compare their current presentation to what their normal might be.

You'll be able to find things like the history and some of the discharge summaries or the past medical history. You'll be able to look at the medications, their allergies, immunisations. You'll be able to understand their social history, and how that might have evolved over time, and you might even be able to kind of compare their physical examination today to what other specialists or other doctors have seen in the past.

So, I think these days, yes, we still focus on the patient that's in front of us, but you're really much more able to actually compare, understand how today's presentation might be similar to something they've experienced in the past or completely different, cv and that really helps you make sure that your thinking is as comprehensive as possible.

Dr Andrew Rochford (Facilitator): How much does this new way of doing things with the My Health Record benefit patients when it comes to emergency presentations, Amanda?

Dr Amanda Stafford (Medical Doctor at Royal Perth Hospital): I think it means that we make a lot less medication errors. That we can highlight that there are medications that the person should be on that they haven't had dispensed. I think in terms of also seeing medications, seeing over-prescribing of medications by multiple prescribers. The patient might not like us detecting that, but in fact it's better for their health overall.

Certainly, when the person doesn't have a My Health Record, that's a big loss of information. I think there are a lot of benefits in that older population cohort, lots of different medications. What are they actually taking at the moment? Because that's what's being dispensed. But we also help to reduce medication harm through over-prescribing, for example.

Dr Andrew Rochford (Facilitator): Xiu, what are some of the real-world benefits that you're seeing?

Dr Xiu Lee (Emergency Physician and Agency Clinical Reference Lead): So as mentioned there is certainly quite a bit of focus on medications and that's probably one of the earliest uses of it and we've certainly seen cases where patients weren't necessarily taking the right medications or the right doses. Because they've had a few people involved in the care, the GP and the specialist and they, themselves, were confused. And worked out that, for instance, one person had come in with fluid overload because they've not been taking correct medications, because things have been adjusted. We were able to clarify that confusion and got them all the right medications. That was, like mentioned something of benefit to the patient, that was a good, consolidated view that we were able to access due to My Health Record.

Also had another good example recently that illustrates how useful it is to have all the information accessible and together. There was a patient who was sent in by their GP for an abnormal blood test result. They've been phoned at home by their GP and told to come to emergency and that would have been one of those end of the year result checks. So, by the time they got to emergency the clinic was closed, there was no one we could contact. The patient had fortunately had also very relevant medical imaging investigation that same day, but they didn't know that result. Fortunately, again, the result was actually there on their My Health Record.  

So, the patient themselves hadn't actually been aware of this, but what that meant was that after doing some of the blood test checks for a couple of things, the patient was actually able to go home and sleep comfortably in their own bed instead of being stuck in the hospital overnight or having to be brought back the next day. We could verify investigation results or do another panel of tests and investigations and have to be started on a medication just in case of a particular condition we were looking out for. This I think was a win for everyone. Like I said, the patient could be reassured and go home and sleep in their own bed and in the setting of current hospital bed pressures where you know everything is full, where all this access is blocked, that frees up space for another person who needs care to be able to come and be looked after. So certainly, there are benefits to being able to have access to My Health Record.

Dr Andrew Rochford (Facilitator): Jaffly, have you seen any examples of benefits to the My Health Record in emergency?

Dr Jaffly Chen (Junior Medical Officer and Agency Clinical Reference Lead): I think that, well, number one, I really love these really tangible examples of how this innovation of My Health Record has really benefited patients. But I think something that might feel less tangible, but is no less important, is that I think patients just really appreciate it.

Now that the clinician seems to know a lot more about them without them having to repeat the same story over and over again, and to some extent, they almost expect it now, because they know that we have this, My Health Record. They know we have access and they almost expect the organisations or the healthcare organisations that they go to be uploading information to the system. So I think one, it just really helps them feel like we are doing, we are practising a much more personalised type of type of care.

Dr Andrew Rochford (Facilitator): Who do you think should be using My Health Record because it's not just for doctors or patients who do you think, Jaffly, should be using it as well to get some of those benefits?

Dr Jaffly Chen (Junior Medical Officer and Agency Clinical Reference Lead): I truly believe that My Health Record should be something that's very deeply ingrained and incorporated into our everyday workflows. As healthcare professionals and by healthcare professionals, I mean doctors, I mean nurses, I mean allied health, specialists, even if you're mostly in the outpatient setting, I know we're focusing on ED today. But I believe that every time I've looked into someone's My Health Record I've found something that's useful in the context of what I'm working with on the patient today, so it's definitely not a thing that's just for ED doctors or just doctors in general. It's something that I think all healthcare professionals should be trying to use every day.

Dr Andrew Rochford (Facilitator): Amanda, do you agree?

Dr Amanda Stafford (Medical Doctor at Royal Perth Hospital): I agree that it should be widely used in hospital and GP settings too and probably also accessed by the pharmacist, certainly within the hospital, making it a lot easier to provide really safe patient care.

Dr Andrew Rochford (Facilitator): Xiu, what do you wish you knew before you started using the My Health Record in the Emergency Department?

Dr Xiu Lee (Emergency Physician and Agency Clinical Reference Lead): I think one of the things is the preparation, the reality that it's still developing and growing. You know, even now it's not infrequently the case that sometimes the information we wish was there, wasn't there. Things like people don't necessarily have recent shared health summaries. The medications don't necessarily have doses or frequencies and things like that.

That could certainly put some people off using it, because then they go, There's nothing useful here. And then they go away from it and don't really want to come back to it because they can go, "Is this worth my time to add that step of looking at it".  

It is certainly progressing and there's more results and discharge summaries that are uploaded, but it's gradually getting more useful and used more when it has potential to be. I think keep using it with kind of the self-fulfilling thing of the more we add to it and more we use it, the more functional it becomes.

Dr Andrew Rochford (Facilitator): Is there anything you wish you'd known, Amanda?

Dr Amanda Stafford (Medical Doctor at Royal Perth Hospital): I don't think there is. I guess that at first I was sort of dubious about how useful it would be and then as soon as I started using it, I realised it was just a gold mine of information. I've just absolutely leapt into using it, particularly around our very complex cohorts of people that we see at Royal Perth. Anybody, any of the juniors that I'm working with, I'll often tell them to jump on My Health Record and check stuff. I'm in with both feet.

Dr Andrew Rochford (Facilitator): And you, Jaffly?

Dr Jaffly Chen (Junior Medical Officer and Agency Clinical Reference Lead): The thing that I wish I knew before starting to use My Health Record is the fact that it's just so easy to use and so accessible, at least in the hospital setting I know. In the hospital EMR that we use, the software that we use, it's just the button. It's literally a button in the patient's file that you can click and it opens it up and the information that you need is there.

To be honest, I think it's one of those questions that we should just be asking our colleagues whenever they've got a question, "Have you looked into My Health Record?" Just as Amanda mentioned.

Dr Andrew Rochford (Facilitator): If there's one thing that you could say to people to reassure them about using the My Health Record in emergency. What would it be? I'll start with you first, Amanda.

Dr Amanda Stafford (Medical Doctor at Royal Perth Hospital): I just can't see any drawback for doing it. There's so much information there and that I would have to say in WA we have a linked hospital record system so we can actually get discharge summaries and lab results and X-ray results from other hospitals. But there's still a whole lot more information that you can get on My Health Record.

Dr Xiu Lee (Emergency Physician and Agency Clinical Reference Lead): I think from a patient perspective, and I know there's concerns about privacy, but we are not looking at your records unless it contributes to your clinical care. We are constantly busy, no one is sitting around browsing records out of curiosity, we don't have the time or inclination to snoop. We want to use it to make sure we're providing you with the best care we can. Certainly it is of benefit to patient care.

Dr Andrew Rochford (Facilitator): So Jaffly, for you, what would that one thing be that you would say to reassure people about using My Health Record in Emergency?

Dr Jaffly Chen (Junior Medical Officer and Agency Clinical Reference Lead): I think some clinicians used to worry about what if the information was wrong? What if there was a mistake in someone's My Health Record and they would get in trouble for using it and I think to me, these days, My Health Record is no different to taking information that's already in the hospital system and using things like past records or past discharge summaries. I think it's actually quite a secure and well thought out system and to me there really is no difference between using a past test result from My Health Record versus using a test result that's already in the hospital system.

Dr Andrew Rochford (Facilitator): And is there anything else Jaffly that you'd like to add about your experience using My Health Record in Emergency? Or how to encourage people to recognise some of these benefits, not only for them in their workflows, but also for their patients.

Dr Jaffly Chen (Junior Medical Officer and Agency Clinical Reference Lead): Definitely about rather than keeping in the back of your mind as a potential information source, it's about bringing it a bit further to the forefront and thinking this could be a tool that could really make sure that I have that comprehensive view of the patient situation in history. There's no need to just rely on your own history taking any more in that, yes, it's important that you ask the right questions. We're still clinicians at the end of the day that have that responsibility, but it really takes a few minutes out of your day for that patient to just make sure that you've cross-checked it with My Health Record. As I've mentioned earlier it's such an easy process, you don't have to log in, your hospital log-in can access that portal. There's no reason not to have that just one 1-2 minute check.

Dr Andrew Rochford (Facilitator): Xiu, is there anything you'd like to add?

Dr Xiu Lee (Emergency Physician and Agency Clinical Reference Lead): I was going to mention earlier, My Health Record can actually also be the nexus for better coordination between healthcare providers involved in patients' care. I know it's frustrating for GPs when patients come and see them after being discharged from hospital and they don't have discharge summary that's been sent to them yet or conversely, when we see patients who've had advice to implement changes from the private specialists, but we don't have access to correspondence from private rooms.

Besides, face-to-face work I also do some telehealth and when I intend for patients to follow with the GP, I tell them that I will upload to My Health Record for those that have it, and then when they see their GP, they should let the GP know to check My Health Record so they can see what happened in the consult, what I've recommended and what next steps might be for continuity of care. People would be really happy to have that option because it takes the burden off of them having to remember exactly what to pass on to their GP.

I think as a whole, it's about improving care of the person and this is potentially a tool for more two-way communication and certainly where more people are involved it's the same kind of a nexus, so everyone is on the same page with what's going on.

Dr Andrew Rochford (Facilitator): And Amanda is there anything final that you'd like to add?

Dr Amanda Stafford (Medical Doctor at Royal Perth Hospital): I think it would be that My Health Record can be of great help with the patients people in ED dread: people asking for prescriptions for medications they're not sure if they should have. People who have come saying they would like to get back on their medications, they don't know what they are. There are people who are difficult to get the right information about and My Health Record can be incredibly useful and make those consultations really, really easy as opposed to very difficult. Lots of advantages.

Dr Andrew Rochford (Facilitator): Well, thank you very much, Dr. Jaffly, Dr. Xiu, Dr. Amanda. Very insightful. Great examples there of how the My Health Record has been shown to be beneficial for patients and those healthcare professionals working in emergency. So thank you again, for joining and sharing your stories with us today and thank you to you for listening and we hope you will join us again next time.