Each year R U OK? Day reminds us to stay connected, have meaningful conversations and encourage more people to ask R U OK? at work, school and in the community. The website includes suggestions for simple steps that could save a life:
Ask
Listen
Encourage action
Check in
There are conversations tips, videos of how to ask and resources including how to find professional help if needed if the conversation becomes too big for family and friends.
Lifeline provides a directory of free or low cost health and community services available in Australia for areas such as domestic violence, family and children’s services, financial assistance and mental health services at lifeline.serviceseeker.com.au
The BeyondNow suicide safety plan app helps create a safety plan in crisis and distress for those in need, ideally with support us, as health professionals, or someone they trust, to work through when they are experiencing suicidal thoughts, feelings, distress or crisis. The app is available to download and to read further about the app, see beyondblue.org.au
moodGYM is an online self-help program that has been available since 2001, using cognitive behaviour training to develop skills to manage depression and anxiety symptoms. The program allows real-time self monitoring of problem moods, thoughts and behaviours via mobile phone or computer. Those using the programme monitor three symptoms of their choice or three recommended to them by myCompass through answering the profiling questionnaire ( eg stress, depression, confidence, worry, irritability, motivation, diet and medication use) See moodgym.com.au
myCompass is a self-help tool for mental health, providing proven techniques to help manage stress, anxiety and depression.
Here are some of the agencies that offer good support to those in need:
Lifeline, 1311 14 for 24/7 crisis support, the Suicide Call Back at 1300 659 467
kidshelpline at 1800 55 1800 for counselling to young people under 25 years
Haven’t we progressed since the introduction of information technology! We doctors can do everything so much more efficiently nowadays, compared to the old days of pen, ink and card records. That’s what we like to think anyway, but have we actually improved? Have you really advanced and improved your efficiency in parallel with the IT? Are you keeping up? Did you know that Bp Premier features a range of ways in which you can achieve that coveted efficiency?
Your efficiency in generating patient notes, documents, and referrals is determined by your knowledge, understanding and proficiency in the use of the attributes of the software available.
Most people use Microsoft Word or something similar, but few people utilize the full power inherent in Microsoft Word. Templates, Macros, Tables, Nested Tables etc. Similarly with Microsoft Excel. I like to think that I can use a spreadsheet reasonably efficiently, but I was in awe and flabbergasted when I saw my friend, a chartered accountant, generate a business plan in Microsoft Excel within one hour, when is it had taken me the best part of two weeks to generate something that was not nearly as accurate and comprehensive! Figures, formulae and calculations flowed from his fingers with amazing speed. He generated a cash flow analysis with a simple ‘copy and extend’ manoeuvre that was not only amazing, but horrifying when he pointed out the long-term effects of ignoring ‘getting the cash through the door’. But that’s another story, a blog for the entrepreneurs to pursue!
Bp Premier is, without a doubt, the best general practice software available on the market in my opinion. However, I hope further improvements can be adopted (are you listening, development team?).
ACRRM and RACGP demand that we take detailed and comprehensive notes to cover all bases. It is also “best practice” for indemnity purposes to maintain succinct, accurate notes and this is where agile use of IT can help us do so. Let’s just take a quick look at how the layout in Bp Premier lets you do that easily.
On the left, at the top corner, you have patient name and address. Double-click up there (or F10) and you access patient demographics. I frequently check to see if all that info is accurate as you don’t want to be sending an SMS, for example, to an incorrect mobile number!
Moving down sequentially along the left-hand side of Bp Premier, you have the best guide available for ensuring your logical progression through systematic questioning and examination of the patient.
Start at the top and move down:
Allergies and Sensitivities
Current Notes
Past Visits
Past History
Medications
Immunisations (accurate documentation is now legally very important with COVID-19 shots)
Family and Social History
Etc.
It’s all there and laid out in a logical and sensible manner as a reminder to complete a comprehensive examination and history – all extremely important from the dreaded audit and accreditation point of view.
Always Consult Previous Visits
I open this up and quickly scan through the most recent visits to ensure I’m on the right page when the patient comes in. Saves a lot of potential embarrassment.
Past History should, if data has been entered correctly, give you an idea of the current maladies. Make sure you use the database provided when adding PH. Don’t add free text to the main diagnosis – you can’t accurately search for free text entries! If your diagnosis or ‘Reason for Visit’ needs more detail, add that in the comments box at the bottom. Demote resolved issues to ‘Inactive’ to keep the current problems succinct and Up to Date. Make sure you enter the date of diagnosis when adding a problem – otherwise a long-standing history of Hypertension might appear to have been diagnosed in 2021!
The same is true with medications! Always review the medications list to ensure only current medications are included – otherwise any referral will likely contain a long list of pills and potions that haven’t been taken for years.
Next Up - Patient Notes!
Always look at your patient, listen to your patient, interact with your patient – taking time to do so is always well spent as you pick up ‘non-verbal’ communication that can hone your overall assessment. Let the patient talk and help tease out the main issues early in the consultation so that you can prioritise to ensure you address the important issues. Doing this early in the consultation helps to develop an early rapport and avoids that “… and just one more thing Doc” at the end of the consultation which can quickly erode the 15-minute consultation time allocated to your next patient. When you know all the issues, you can get your patient to make another appointment to address the less important problems.
You’ve now spent some time listening and you need to adequately document the consultation. You can save yourself heaps of time using ‘Autofill’. Spend the time to populate all your favorite notes into Autofill initially, and once they are in place you will save yourself heaps of time.
Let’s say your new patient has Hypercholesterolaemia and Hypertension and needs new prescriptions. You might just add those meds to the list, print them out and say ‘goodbye’, and ‘next please’ but it’s valuable for audit purposes to actually document that initial brief interaction. You can type that out long-hand (correcting your spelling as you go) or using Autofill and type:
‘Rpts’ (to generate from Autofill); “Patient presents for repeat prescriptions” for ‘hc’ (to generate “Hypercholesterolaemia”) and ‘ht’ (to generate “Hypertension”) –
That’s just 14 characters typed to generate 70 characters. Very efficient!
Consider the patient with the common presentation of a mild URTI. I type; ‘Li’ (shorthand for “Little to find”) and Autofill completes the following:
Patient presents with URTI symptoms for the past ? days.
On Examination: Little to find. No cough. Dry cough. Throat not red. Throat slightly red. No Lymphadenopathy. Small upper cervical glands. Chest clear. No rash.
Then all you need to do is delete the bits you don’t want to ensure you leave the appropriate documentation. That’s two characters to enable 34 words! Not bad, eh? It does take a bit of practice to remember the short-cuts but after a week or so, you’re off and running.
Here’s another:
‘Knex’ (shorthand for Knee Examination) This Autofill serves as a reminder of the elements of a comprehensive knee examination. Add / Delete or modify after your examination.
Examination of the Knee: LEFT / RIGHT Normal gait / limp? Any swelling or deformity / inflammation Full and free Range of Motion? Active / Passive Flexion limited by pain / stiffness to …Full extension? Patella tap – No effusion / Small effusion Patella crepitus – present / none Anterior draw test; -ve / +ve Lachman test; -ve / +ve McMurray test for integrity of the meniscus Tender on palpation? Joint line pain? Varus and valgus stress to assess collateral ligaments Pivot shift for ACL; -ve / +ve
So, there are a few ideas with some Bp Premier features to get you started if you haven’t already established a repertoire in Autofill.
Given that many GPs move around a lot nowadays, particularly the Registrars, it would be very handy (once again, development team take note!) to have the ability to download Autofill to a flash card to make all your hard work on developing software efficiency with Autofill, portable for your next Registrar assignment!
Authored by:
Dr Stephen Jelbart Guest Blog Contributor for Best Practice Software
Dr Stephen Jelbart is currently practising at Plaza Medical Centre in Kalgoorlie, WA.
Healthcare consumerism is a concept that has existed for some time, but only recently has it really taken hold and started to significantly impact primary care.
There is perhaps no common understanding as to what constitutes healthcare consumerism, and discussions with providers and patients will likely yield two different sets of responses as to what it actually means.
Ask any provider that has had to contend with correcting the misconceptions of a patient’s self-diagnosis and treatment plan (often courtesy of Dr Google, WebMD or the Mayo Clinic) within the constraints of a few-minutes long consult, and you may be confronted by a somewhat less than flattering take on the subject.
However, as a patient, notions of patient empowerment through clinics and a shift towards patient centricity will likely feature very favourably.
Regardless of your individual view on this, in a consumer-centric society, consumerism was always going to find its way into the healthcare sector, and this will influence the sector in many predictable, but also some unexpected ways. The rate of this change has been accelerating as a result of the general societal changes brought about by COVID-19.
Broadly, consumerism itself has many defining features, but fundamental to it is the principle that the consumer is in control (though subject to marketing, social engineering influences and manipulation). They are in control of what they consume, and their patterns of consumption drive the choices that providers of products and services make about what gets produced and how it is produced. In theory, the more informed consumers are, the more their decisions are driven by knowledge.
It is, then, reasonable to conclude that patterns of consumer behaviour and expectations are responsible for the kind of product and service innovations that organisations like Amazon, Uber and Apple have brought about in their respective industries.
Given the level of disruption that has been brought about by the aformentioned powerhouses in their respective industries, one can only speculate about how much of an impact they would have if they turned their attention to serving the needs of the patient in an era of healthcare consumerism. Even if they don’t – they, and others like them have reset long-held, more traditional consumer expectations.
To compete in this environment, and to compete with the concept of healthcare consumerism itself, provider organisations will have to re-assess their entire value streams, and re-image how to leverage their people, processes and technologies in response to this consumer-centric landscape.
To develop an approach and response, one has to consider some of the behavioural changes brought about by this trend. It does, in essence, come down to the fact that patients’ expectations of care delivery have changed, and that they are taking an increasingly active role through a range of actions.
Patients are, of course, not a homogenous group, so their expectations and their responses to this will differ from one group to another. According to the Pew Research Centre, millennials now make up a larger portion of the population than baby boomers, and the long-term transformations of healthcare will be driven primarily by their needs. This generation has grown up in a technology-rich, consumer focused environment where transparency, rapid delivery and convenience is the norm.
A recent study into healthcare consumer expectations resulted in some startling findings:
As evidenced by the rise in social media, consumers have proven to be willing to share increasing levels of personal information for the sake of convenience across platforms – as a trend in consumer behaviour, this will likely apply in the context of healthcare as well.
It would be reasonable to expect that patients will want to share information between providers (evidencing a willingness to share), will want to have tools to aid this sharing of information (evidencing the importance placed on convenience), but will in all likelihood require more sophisticated consent and sharing models than what is the norm with some non-health related personal data.
Some of the other actions that patients are taking to meet their expectations include:
Shopping around, evaluating their options and generally expecting more from providers
Doing their own research about health issues, treatment options and providers
Taking deliberate steps to monitor and improve their health. The proliferation and increasing sophistication of wearable and home monitoring devices bears witness to this
Co-operating with providers to make treatment decisions and more freely sharing information with care providers
Taking cost and quality aspects into consideration in their decision making
Using technology for appointments, telehealth consults, online payments, prescription renewals and a host of other services
If we consider the expectations and consider the actions patients are taking to meet their expectations, a few things immediately become clear:
Patient loyalty will continue to decrease as millennials make up an increasing percentage of healthcare consumers
Providers will face new challenges in attracting and retaining patients, with less loyal patients being more likely to switch providers, and being enabled to do so with the ease provided by technology
This will have ramifications for health outcomes given the impact on continuity of care
So what’s the message in all of this?
The most logical outcome is that due to the rise of healthcare consumerism, it’s in the industry’s best interest to meet the demands of healthcare consumers by designing products and services that meet current and emerging patient needs.
Here at Best Practice Software, we are developing the next generation of healthcare systems that will not only meet the demands of our provider customers, but software that will deliver the tools and meaningful interactions with patients and other stakeholders to address the needs of future healthcare consumers.
Authored by:
Andre Broodryk Product Manager at Best Practice Software
Working on improving workplace communication is paramount for any business, and Medical Practices are no exception.
As a Practice leader, you know that success in your role is dependent on your ability to effectively communicate. But just as important as the quality and value of your own words is the cultural commitment you make to internal communication within your Practice as a busy, high-profile workplace. So how do you make it part of everyday business, and embed it within Practice business strategy to make it “part of what we do around here”?
I recommend promoting the benefits of good workplace communication within your team by outwardly recognising that good communication is fundamental to the success of your Practice as a business. By making communication one of your ‘people pillars’, you’ll ensure less misunderstanding within your team – including Practitioners, Reception, Practice Management, and IT/business support team –, an increased commitment to change, a reinforced role of supervisor as leader, and more active participation in the Practice and its mission.
Think about adopting some shared communication principles within your Practice team, like:
Embedding in your team mission your commitment to open, honest, and meaningful internal communication – at all costs, including the potential to damage fragile egos. Embrace the concept that, as leader, you’ll set the highest standard in being transparent and authentic in your communication with the team and invite members to (respectfully) challenge you anytime they think you miss the mark.
Embrace face-to-face communication foremost while still recognising e-mail and intranet bulletins as a convenient, but ultimately more impersonal, workplace tool. Sunrise (before clinic) and Sunset (after clinic) personal team or individual briefings will always be more valued when they’re localised, purpose-driven, two-way, … and brief.
Utilise the communication tools already built into your business software/systems for instant messaging when you need to raise attention to an urgent or immediate matter – especially between Practitioner and Reception team. There is a great internal messaging feature built in to Bp Premier that many doctors and their Practice team use, providing a useful instant on-screen message if ever required.
Value meaningful two-way engagement with your Practice team, ensuring the team knows you will provide (and you welcome back) genuine and constructive feedback on team achievement towards individual and shared goals. Improving workplace communication is a lot easier when your team knows they’re being listened to.
Recognise the frontline role your Practitioners and Practice leadership team plays in team engagement – and let your Practice leaders know you expect they will make team communication the first and foremost part of their role as leader and use language which is familiar to and understood by their work group.
Ensure your Practice team knows they will be briefed face-to-face on matters which affect their job, and you’ll set that standard yourself. If each employee can’t be consulted and involved in decision-making regarding their job before any major change occurs, they should at least be briefed in person on important matters which change what they do, or how you expect them to do it.
Preference communication that promotes action within your team and Practice. We’ve all sat in a meeting that should have been an email, so ensure any team assemblies have a clear and concise purpose (agenda), don’t linger longer than is necessary, and you note and distribute a summary of key action items and accountabilities before anybody leaves.
Outline to the team your minimum engagement opportunities. Perhaps make a commitment that, for instance, you’ll host supervisor briefings at least monthly, and supervisor-to-Practice team briefings every second day, and informal ‘toolbox’ chats on health and safety matters or reception/patient matters each Friday morning at 7:30am. This helps ‘lock in’ your time together, and shows you’re wholly committed to these engagements, even if you don’t have much news to share.
While these tips provide a good starting point on the topic, improving workplace communication needs and deserves follow through and actions that match your words, from the senior-most level to the people greeting and treating your patients. By sharing team news early and consistently you’ll help ensure your preferred (rather than speculative) message is heard by every member of your team.
Authored by:
Craig Hodges Chief Corporate Officer at Best Practice Software
A common problem in primary care is to be asked for guidance on the care of an irritable baby. In this article I describe non-medical problems which, in my experience, actually dominate over medical problems.
As a GP I have focused on the care of mothers and babies for about 40 years and have seen well over 10,000 families. For the rest of this article, let’s assume that the irritable baby in question is less than 12 weeks old.
To oversimplify the situation, my experience is that in this age group two problems dominate – fatigue and hunger.
So, if you are faced with an overtired mother and an irritable baby who seems to cry excessively, a very simple algorithm is as follows. Exclude poor weight gain and take a simple sleep history.
In this article I am going to focus on fatigue, but in terms of ensuring adequate nutrition it is easy to measure weight, to calculate weight gain per day and percentiles. For children under 12 weeks, I recommend measuring and graphing these three variables at every visit.
Weight or Hunger
Unfortunately, hunger is very common in our culture. If weight gain per day is less than 30 gm per day, if percentiles are dropping, if the baby is irritable at the end of the feed, if feeding times are prolonged i.e., more than a total of 20-30 minutes then a feeding review is needed. Do whatever is needed to ensure that the baby finishes all their feeds fully satisfied. I can address hunger and feeding in more detail in a later article. Today, we are focused on sleep.
Sleep, Fatigue or Over-tiredness
Total sleep volume that is needed to be well in the first few months is almost always more than 16 hours per day. This varies with weight but only a little. Heavier babies can cope with a little less sleep and light babies need more. To put that point in its reverse, lighter babies become over-tired more rapidly and need shorter waking times.
I teach six main points which give a useful and practical understanding of infant sleep.
Sleep is Cyclical
During a block of sleep it is normal and healthy to awaken and resettle multiple times.
For a newborn baby, these cycles are about 45 minutes long. The waking events will last generally 30-90 seconds. The majority should be silent, and you will be unaware that they occur.
In overtired babies they may waken at the 45-minute point and have trouble getting back to sleep. Thus, if your baby is calling for assistance every 45 minutes it may be a sign of fatigue.
In very overtired babies, sleep cycles can ‘break down’ to 20-minute cat naps.
In a block of sleep, a baby awakens and returns to sleep multiple times. What forces drive a return to sleep? To simplify very complex events, I identify two things: Tiredness and ‘cues of sleep’.
Cues of Sleep
It is useful to think of the sleep achievement event as being driven by a combination of tiredness and external cues of sleep i.e., the things which are going on around the baby at the time.
Again, to simplify these cues can be divided into parent dependent and parent independent.
When a baby or child is put to bed at the beginning of a block of sleep tiredness dominates. Cues of sleep achievement are outweighed by tiredness and they are more likely to achieve sleep efficiently.
As a block of sleep progresses tiredness reduces and cues of sleep become more important in achieving a return to sleep.
If a baby is put to sleep using parent dependent cues i.e., holding, rocking, patting, feeding then there is an increased chance that the baby will request those cues be repeated later in that block of sleep.
Cues of sleep which are parent independent are more useful. I use a term ‘parent-lite settling’. So, we prepare a baby for sleep, but the final transition is achieved by the baby alone as often as is possible.
Cues of Sleep are Learned
To make this point I use adult experience. Learning to sleep with a partner. Moving to a new suburb or street with different noises outside the home. Buying a new bed. We have all had these experiences.
So, cues of sleep can be changed and relearned.
Babies actually do this very efficiently.
Sleep Achievement and Sleep Maintenance are Usefully Regarded as Learned Skills
By combining two points i.e., sleep is in part cue dependent and cues are learned I develop a very important point.
Going to sleep and maintaining sleep are usefully considered learned skills.
Fatigue Interferes With the Learned Skill of Sleep Achievement
This point may seem counter-intuitive but almost every single mother that you care for will agree that she has had a personal experience of becoming so tired that while she is desperate to get sleep her mind will not turn off. This is critically important for children.
Therefore, it is important to ensure the child does not become over tired.
A newborn can become overtired in 10 – 15 minutes.
Low weight babies are more prone to fatigue and heavier babies a little more resistant.
For the age group under discussion waking times need to be fairly short i.e., 20-30 minutes over-night and something like 45 minutes during day light. This time includes feeding, changing, cuddles and any social time.
To put it another way in the first month of life my ambitions for a baby are simply feed, sleep, and grow.
Cues of Sleep Achievement That are Parent Independent are the Most Useful for Family Life
A baby who achieves sleep with parental care is preordained to request that care again at some point in the block of sleep. Minimise sleep transitions which involve parental assistance and allow a child to achieve sleep alone.
Adopt a ‘parent-lite’ approach to sleep achievement. Be there and be supportive but keep it minimal rather than the reverse. The baby needs to feel parental love and support but when it is time to be asleep leave them alone to finalise the last steps in sleep achievement.
A parent has a major and positive role to play when the baby is awake and maybe even when sleepy but once the baby is ready to be finally asleep these events are best managed by the baby alone. This is true from the time of birth.
Conclusion to Assessing an Irritable Baby of Less Than 12 Weeks
Take steps to check that a baby is being well fed by whatever technique ensures adequate growth.
Avoid over-tiredness and the following points assist understanding.
Sleep is cyclical with blocks of sleep which include multiple short episodes of arousal followed by a return to sleep
Sleep achievement is in part cue dependent
Cues of sleep are learned can be altered and relearned
Sleep achievement and sleep maintenance are usefully regarded as learned skills
Avoid children becoming over tired as this interferes with the learned skill of sleep achievement
Minimise cues of sleep achievement that are parent dependent. Take a ‘parent lite’ approach.
It is my experience that ensuring complete feeding and avoiding over-tiredness linked to the learning of parent-lite cues of sleep will resolve that large majority of events where the presentation is an irritable infant aged 12 weeks or below.
This article was contributed by Dr Brian Symon. He has more than 30 years’ experience working with parents and babies experiencing problems of sleep, feeding, growth and behaviour.You can find out more about Dr Symon’s work at his website – The Babysleep Doctor.
Telehealth consultations enable clinicians to see patients via a phone call or video chat, and they are claimable under Medicare.
As we know, throughout the pandemic we have seen an increase in telehealth consultations performed in Australia, and the Medicare billing items that have been created are likely to stay for the long term.
Telehealth consultations are here to stay, and the stats say that GPs are largely ‘believers’ in telehealth. In a recent survey by the RACGP, more than 50% of GPs think that up to a quarter of their consults can be done via telehealth post pandemic. 35% of GPs even think that as much as half of their consults can safely and effectively be performed by telehealth.
As most GPs have adopted telehealth, the industry has done well to replicate the traditional ‘in clinic’ physical consult that we all know and love. But is that all there really is to telehealth – shifting an in-clinic consult to a virtual setting?
Healthcare 2.0: Remote Patient Monitoring, AI and Asynchronous Communication
I think there’s way more to it…
The telehealth we see today in General Practice, is effectively Telehealth 1.0. We are striving to replicate the delivery of healthcare the only way we know how – by providing the waiting room and the consult room of a clinic, but just doing it virtually, on the phone or computer.
The problem with that is, it only gets us so far. Now don’t get me wrong, Telehealth 1.0 was a great stopgap solution for when the country needed to quickly implement a safe way to see patients, using the tools we had at our disposal. We saw many nimble technology providers roll out enhancements, updates and addons to their products in record time to enable GPs to perform telehealth consults in their clinics. Also, it is the next logical step to progression, but I feel like there is more work to do.
The implementation of telehealth consultations has certainly been successful – we’ve seen mass adoption, and it’s proven to be safe and effective. But if there is going to be transformational change made in primary care to help more patients across the country that need it most, then one could argue we need to do things differently, or else it will all stay the same.
With Australia’s increasing burden of chronic disease, ageing population, access issues for rural and remote or disadvantaged communities, and let’s not forget the impending tsunami of healthcare issues that GPs will be hit with in the coming months and years from those who put off routine screening – some GPs might be thinking about more tools enabled by technology they could have at their disposal to face these challenges ahead.
There are a number of opportunities that get unlocked when telehealth gets combined with other more progressive forms of healthcare delivery – including remote patient monitoring.
Remote patient monitoring can add depth and perspective to telehealth, and we’ve tried to describe a few scenarios as to how this might work in practice. But first…
What is Remote Patient Monitoring, and How Does It Influence Telehealth Consultations?
Remote patient monitoring is a subset of telehealth and is inclusive of the collection, transmission, evaluation, and communication of relevant patient data by the use of electronic devices. Some of these devices are implanted equipment, wearable sensors, and handheld instruments.
Below are 4 elements of remote patient monitoring that could take telehealth consultations even further than just episodic video or phone calls:
1. Using Wearables to Collect and Transmit Data
Wearables are devices that people wear that collect the data of users’ personal health and exercise. As technology improves, these consumer devices are becoming increasingly considered as potential to be clinical grade monitoring tools for patients.
More purpose-built medical devices are now also available to allow patients to measure, monitor and transmit their latest results to their healthcare provider, allowing patients to be more engaged with their care, resulting in better outcomes. It is also a cost-effective and efficient way for those in rural and remote areas to reduce the need to travel hours into a clinic for something that can be done remotely.
Wearables are cost effective and have potential to be the ‘eyes and ears’ to give clinicians access to current patient information, hopefully avoid patients deteriorating and reduce unnecessary clinic visits.
2. Using Artificial Intelligence for Decision Support and Triage
Artificial intelligence in healthcare is the use of complex algorithms and software, to analyse vast data sets in order to efficiently predict health outcomes and inform decisions with minimal human intervention.
It is exciting to think of the potentials and theoretical use cases for artificial intelligence in healthcare, particularly when it comes to those AI tools that have a diagnostic claim. There is still time for those tools to become mainstream in medicine, as the TGA grapples with the concept of regulating AI software that acts like a medical device. In the meantime, AI can be used in other ways in healthcare on a day to day:
Clinical Decision Support – by analysing large sets of data, AI can suggest to a clinician what diagnosis to look out for based on the data available, and also what recommendations to consider. This pattern recognition takes an element of cognitive load off clinicians in the diagnosing and decision stage to allow more focus time on the treatment and communication with a patient about their results.
Triaging – much like in an emergency department where a nurse might triage a patient to determine the level of severity of their injury or illness, AI could be used as a triaging tool in a GP Practice in the future. With large numbers of results and messages coming into a clinic, knowing what to focus on can be overwhelming and costly. By utilising AI tools to help with this process it again allows clinicians to focus on more value adding tasks.
3. Utilising Technologies That Are Securely Integrated
Requiring patients to connect with a GP when they are not physically in the same place, requires the patient and GP to be utilising some form of technology to do that. The choices of technology platforms to enable communication are vast. When it comes down to it, a common critical factor that many GPs might use to decide on a piece of technology is how well it connects or integrates with the clinic’s Practice management system. There is little point having a super slick and easy communications platform for patients if GPs cannot securely and easily access the information – wouldn’t it be neat if you could just flick images and share videos with patients via WhatsApp or messenger, just like we do in normal life, complete with gifs and reactions? Unfortunately, it does not quite work like that…
Health data is sensitive, and decisions are complicated, so unfortunately many consumer and mainstream communications platforms don’t make for ideal choices for transmitting health data… and they don’t integrate with GP clinic software. So, if a GP was looking for a piece of technology in addition to their Practice management system, we would recommend doing research to confirm how well it integrates securely and appropriately with the clinic’s Practice management system.
4. Engaging With Patients Via Asynchronous Communication
Asynchronous communication is where you transmit a message and don’t expect an immediate response. An example of asynchronous communication is sending an image for review, awaiting the response, and then receiving it once ready.
Thinking about opening up some forms of asynchronous communication as part of the engagement with patients, brings new ideas on how healthcare can be delivered – patients can share notes as they think of them, results can be transmitted and only surface when they are issues.
Some of the benefits of asynchronous communication in healthcare include:
It can help ensure more accurate documentation
It allows a GP to manage multiple tasks at once, not having to wait for a response but at the same time not being overwhelmed with competing priorities
Asynchronous communication promotes thinking more about patient outcomes as opposed to purely about episodes of care
Patients could be more likely to be honest about their health concerns when they have the time and privacy to craft a message to their GP rather than sit in an unfamiliar room and discuss it live in person
As we move to the next stages of telehealth, asynchronous communication will be interesting to watch as it develops. As there is currently no Medicare funding for asynchronous communications with patients, the likelihood of it being adopted widely is low, at least for the time being.
As telehealth consultations become ‘the norm’ in clinics around Australia and are embedded seamlessly into clinic workflows, we watch with interest as additional technologies and approaches like those mentioned above get included in the mix to provide a more engaging experience for patients and a more efficient and effective process for GPs.
Peter Birch is the founder and host of Talking HealthTech, which began as a podcast in 2018 and has since expanded to a membership community and media company focused on healthtech.
Talking HealthTech recently hosted a panel from Best Practice Software for a discussion on Active Ingredient Prescribing. Listen to that episode of the Talking HealthTech podcast here.
You can find out more about Talking HealthTech by visiting their website.
Each year in Australia, February is recognised as Heart Research Month. On average, one Australian dies as a result of heart disease every 26 minutes, and recent research shows that heart attacks – often associated with older men – are increasingly occurring in younger people.
Prof Ben Freedman, the Deputy Director of Research Strategy at the Heart Research Institute in Sydney, in conjunction with several colleagues, has developed a method for patients to self-screen for risk of atrial fibrillation in General Practice.
The following contains excerpts from the complete published study. A link is available at the bottom of this article.
Atrial fibrillation is the most common arrhythmia in older adults, and is associated with thromboembolic disease in major vascular beds. Stroke is also identified as the most debilitating condition associated with atrial fibrillation, with around one-third of ischemic strokes being caused by atrial fibrillation. These are often more disabling or fatal, and the arrhythmia may also lead to other morbidities such as heart failure, cognitive impairment and systemic embolism. Approximately one-third of patients with the condition are asymptomatic, and asymptomatic atrial fibrillation offers a similar stroke risk as symptomatic disease. Unfortunately, a fatal or debilitating stroke may be the first presentation of the condition.
Prof Ben Freedman, leader of the Heart Rhythm and Stroke Group at the Heart Research Institute in Sydney, said that opportunistic screening for silent atrial fibrillation is recommended in guidelines to reduce stroke, but screening rates are sub-optimal in the context of general Practice. His group hypothesizes that patients being able to self-screen while waiting for their appointment may improve screening rates and ultimately, the detection of atrial fibrillation. When atrial fibrillation is found and treated, this should reduce the number of strokes related to atrial fibrillation.
How Does Self-Screening Work?
The study, lead by Dr Katrina Giskes, tests a purpose-designed atrial fibrillation self-screening station which records a lead-1 ECG. This station then seamlessly integrates with Bp Premier in order to deliver the results of the screening to the patient’s electronic medical record.
The software automatically scans the Practice appointment diary for eligible patients – 65 years or older, with no current atrial fibrillation diagnosis
If a patient makes an appointment for a consultation, it will send eligible patients an automated SMS reminder, just prior to their scheduled appointment
The software creates a QR code which is printed out at Practice reception, and is handed to patients upon their arrival. They then scan the QR code at the self-screening station
The screening station has an ECG device (Kardia Mobile), where patients place their fingers. The device transmits and ECG rhythm strip to the iPad attached to the station
Once the self-screening has been completed, the ECG and diagnosis is imported directly into the patients’ electronic medical record in Bp Premier
Between 5 and 8 general Practices in New South Wales will participate in the trial, with the aim of having 1,500 patients undertake self-screening.
The outcomes measured will be the proportion of eligible patients that undertook a self-screening, the incidence of newly-diagnosed atrial fibrillation, and patient and staff experience of the self-screening process. From there, de-identified data will be collected using a clinical auditing tool, and further interviews will be conducted to determine patient and staff acceptability of the process.
An automated self-screening station where patients can undertake a screening prior to the GP appointment is a potentially feasible solution to improving detection of undiagnosed atrial fibrillation in patients. Dr Nicole Lowres suggests that if the trial is initially well received, an upscaling of this system may enable the widespread implementation of the atrial fibrillation screening guidelines, and may achieve higher screening rates, thereby potentially reducing the personal and economic burdens of preventable stokes.
Best Practice Software would like to thank Katrina Giskes, Nicole Lowres, Jialin Li, Jessica Orchard, Charlotte Hespe and Ben Freedman for access and use of this study in the publishing of this article.
Cybersecurity is the practice of defending servers, computers, mobile devices, networks, and data from malicious attacks. Cyber threats continue to evolve at a fast pace, with a rising number of data breaches each year. In fact, according to the Australian Cyber Security Centre’s Annual Cyber Threat Report from 2020, between the 1st of July 2019 and 30th of June 2020, the ACSC responded to approximately 164 cybercrime reports per day. That’s roughly one every 10 minutes.
Historically, medical Practices and public entities experience the most breaches. These sectors are more appealing to hackers because they regularly collect lots of personal information, financial records and medical data.
Following simple but effective cybersecurity best practices can ensure your data is safe from unauthorised access.
Different Types of Cybersecurity Threats
There are a wide range of methods that hackers can use to illegitimately gain access to your Practice’s information. Listed below are some of the more common methods which you may have heard of.
Ransomware – Ransomware is a type of malicious software designed to hold files or data ‘hostage’. Once a Practice’s computer system has been compromised, patient files are inaccessible until a ransom is paid. Paying the ransom does not guarantee that the data will be recovered.
Phishing – This is the practice of sending fraudulent emails that resemble emails from reputable sources. Phishing attacks often target individuals with emails that look like they’re from your bank or financial institution. The aim is to steal sensitive data like credit card numbers or account login information. It is the most common type of cyber-attack.
Social Engineering – Social engineering is a tactic that hackers use to trick you into thinking you’re speaking to a representative from a legitimate organisation, and then getting you to reveal sensitive information. Social engineering is often combined with the methods listed above to make you more likely to click on a link or hand over sensitive data.
IT Security Tips for Practices
The first thing you can do is establish a security culture within your Practice.
The weakest link in any computer system is the user. Protecting patient data through good security practices should be second nature, similar to the Practice’s sanitary measures. Ensuring that your staff are familiar with your cybersecurity measures and how to identify a cyber threat makes your Practice more secure.
Keep Your Practice Software Updated
Taking your entire system offline to perform software updates is a daunting prospect.
However, neglecting to get the latest version of your software leaves devices significantly more vulnerable to attack. Furthermore, any security patches that come with an update will be unavailable to you. Hackers will take advantage of complacency and can remain undetected in an out-of-date system far easier than in systems with the latest software updates.
Maintain Secure Access to Patient Data
You may have seen media reports of victims whose private information was stolen by hackers. Failing to keep your patient data secure can be catastrophic. Hackers can use data from your patient records to commit identity theft and access patient bank accounts.
It is important to control access to patient records and only allow authorised personnel to have access to their details. Have a system in place to audit your system, and regularly verify who accessed which patient records, and when. It’s also important to promptly remove system access from staff who have resigned, or have been terminated.
Computer System Maintenance
Over time, operating systems tends to accumulate and catalogue old information and redundant data unless regular maintenance is performed. Just as your medical supplies must be monitored for expiration dates, material that is out of date on a computer system must be discarded or archived.
Some things you can do to ensure you’re following cybersecurity best practices with regards to computer maintenance are:
Ensuring user accounts for former employees are disabled.
Computers and other storage devices that have had data stored on them are sanitized before disposal.
Old data files are archived for storage, or cleaned off the system if not needed, subject to data retention requirements.
Software that is no longer required is removed from the computer, this includes trial software and any outdated versions of software.
Installation and Updating of Anti-Virus Software
A common way that hackers can access a computer system in a medical Practice is through viruses or malicious software (malware). In addition, computers can become infected by seemingly innocent sources such as email links, USB drives, and web browser downloads. It is important to use a product that provides continuously updated protection, and ensure your staff know how to recognise when your anti-virus has detected something suspicious.
Controlling Access to Patient Information
Familiarise yourself with role-based access permissions, where a staff member’s role within your Practice (e.g., doctor, practice manager, nurse) determines what information they have access to. Care must be taken to assign staff to the correct role within your Practice. Having well structured role-based permissions ensures that your staff can only access what they’re supposed to, which ultimately improves your Practice’s IT security.
Create Strong Passwords and Change Them Regularly
Passwords are often the first line of defense against unauthorised access to your Practice’s computer systems. Although strong passwords will not prevent attackers from trying to gain access to your network, it can slow them down and even discourage them altogether.
Using easy-to-guess passwords or sharing passwords between applications and logins significantly increases your Practice’s risk and vulnerability. Using the same password for multiple logins presents an incredibly high risk. If a hacker gains access to one account, they gain access to all of them. This can have a devastating flow on effect, not just for your Practice, but your staff’s personal lives as well.
Your staff should be aware that legitimate organisations will never ask for their password over email or messaging service. For maximum password security, employ the use of a reputable password storage system.
Strong passwords are ones that are not easily guessed. Hackers will use automated methods to try to guess a password, and so it is important to choose a password that does not have characteristics that could make it vulnerable.
Strong passwords should not include:
Words found in the dictionary.
Personal information such as birth date, your name, or pets’ names.
Some examples of strong password characteristics:
At least eight characters in length.
A combination of upper case and lower-case letters, one number, and at least one special character, such as a punctuation mark.
For many Practices, consistently reviewing and updating IT security measures can sometimes feel a little tedious. However, training your Practice in strong IT security habits is essential when it comes to protecting sensitive patient data.
While it may not be practical to enact all of the above cybersecurity best practices all at once, each of them can be implemented incrementally, and each of them will secure your Practice’s systems as you institute them.
Authored by:
Michael Porter Analyst & Developer at Best Practice Software
Our mental health is something that we’re all aware of, but far too often we don’t do enough to look after it. Mental health during COVID-19 has been something that deserves far more attention than many of us have given it.
If someone asked you to list five words that described how you feel about the year 2020, what would you say? How different would they be, compared to describing your feelings about previous years? Maybe you cannot settle on five words, you keep swapping out one for another as you go through the extent of what has occurred this year.
Twelve months ago, Australia was in the midst of fighting the most extensive bushfires in recent times, colloquially known as Black Summer. The expanse of devastation and death of one billion wildlife animals generated worldwide support and acknowledgement. Australians and International supporters rallied to raise money to assist those affected by the bushfires and frontline firefighters were the heroes of our nation. The resilient Australian spirit kicked in and individuals, families and communities faced the mammoth task of rebuilding and hoping to return to a normal life. Towards the end of the bushfires, storms and flooding affected some parts of NSW, which was a relief for those suffering from some of the still-burning fires, but introduced more stress for communities that were already exhausted by the bushfire crisis.
Within a month of the flooding and weeks of the final fires being extinguished, the World Health Organisation declared COVID-19 a global pandemic, and Australia began shutdown measures. Australians began living under strict lockdown rules and restrictions that have not been experienced in more than a century. International travel to and from Australia was limited with many people still trapped overseas. People were afraid of being locked in their homes without food and supplies so supermarket shelves were stripped bare due to panic-buying. Non-essential services were closed which led to economic and social stress; this saw the cessation of all forms of entertainment, sport, pubs, cinemas, and houses of worship.
Travel within Australia was restricted by internal domestic border controls which caused distress and further strain on mental health during COVID-19 for people separated from their family and friends. Businesses were encouraged to work remotely where possible, and online commerce escalated. Schools were closed and all students were introduced to eLearning which suited some but caused many students and families additional stress. Frontline health care workers became the new heroes of our nation, while acknowledging the efforts of everyone involved in essential services such as emergency personnel, teachers, food supply chain personnel, and cleaning services.
Healthcare organisations and aged care residences restricted entry to visitors, so much so that children could not visit patients, family could not visit their elderly family and women who had birthed were not allowed visitors, including the other parent of the newborn. Not only did these restrictions heighten the strain on mental health already being felt by those affected, but people were also afraid to go to healthcare organisations, in case they became infected themselves.
The Psychological Consequences on Mental Health during COVID-19
The following emotions and numerous others may be experienced by people during the COVID19 outbreak: anger, annoyance, anxiety, confusion, depression, distress, distrust, fear, frustration, helplessness, hopelessness, isolation, loneliness, panic, sadness, uncertainty, and worry.
People:
In affected communities following the Black Summer bushfires were in a heightened state of anxiety and struggled with additional uncertainty, and were prone to more stresses on mental health during COVID-19.
Are afraid of infection, either getting themselves sick or infecting others, especially the elderly and vulnerable.
Worry about not having enough information, or being given the wrong information, therefore high quality, factual information should be accessed from a trusted source.
Experience a variety of stressors, such as financial stress from losing or having reduced employment or retirees’ superannuation funds decreasing; limited social contact leads to feeling isolated, lonely, and not socially connected.
Who are isolated or quarantined, including the elderly and vulnerable population, feel combinations of any of the emotions, particularly depressed, confusion, frustration, anger, boredom, lonely and become worried about having inadequate supplies.
Those with pre-existing anxiety disorders, depression, post-traumatic stress or health anxiety are at risk of experiencing higher anxiety levels and poorer mental health during COVID19, and may require additional psychological support during this time.
Health care workers have experienced increased anxiety and can feel overwhelmed due to possible direct contact with affected patients, lack of personal protective equipment, increased workload, and changing their care delivery from in-person to telehealth.
Students impacted by changing to and from online learning, as well as individuals working remotely from home can experience distress, anxiety, frustration, uncertainty, confusion, worry and become depressed.
Families have faced numerous challenges including working remotely while supervising children and students, being geographically separated, or denied contact with elderly family members. Family events have been impacted such as weddings being postponed and being unable to attend funerals. Family and domestic violence, and child abuse has escalated due to increased household tension, cabin fever, isolation, increased alcohol consumption, and stress. The pandemic is another barrier for people who are exiting abusive relationships, where women and children are forced to remain in violent and unsafe homes.
Think back to those five feelings of 2020 that you identified earlier, and which would you swap out regarding your hopes of 2021? Have you replaced distress with acceptance; fear with determination; isolation with feeling connected; fear with hope; or are you stuck and not optimistic about the future?
Looking After Yourself and Coping With the Rest of 2020
1. Look after yourself physically and mentally After a year of challenges and uncertainty as to when the pandemic will end, current life in Australia is the new normal. At any time, restrictions and health directions may be lifted or imposed so here are some practical things that you can do to help your mood and reduce stress levels. You’ll cope better if you place importance on getting quality sleep, eating healthy, exercising daily, attending to physical health issues, having regular periods of relaxation, ensuring regular self-care and reducing alcohol consumption.
2. Live in the present The uncertainty of the future and concerns whether life will return to pre-COVID normal, can cause varying levels of distress. Focusing on living in the present and taking each day as it comes will reduce the distress about the future and increase appreciation for current activities.
A simple mindfulness exercise is to notice what you are experiencing right now, whether it is doing a task or doing nothing, and using all of your five senses: sound, sight, touch, taste, and smell.
Take a few slow breaths and ask yourself:
What can I hear? (for example, clock on the wall, car going by, music in the next room, my breath)
What can I see? (for example, this table, that sign, that person walking by)
What can I feel? (for example, the chair under me, the floor under my feet, my phone in my pocket)
What can I smell? (for example, flowers in the room, air freshener, the soap on my hands)
What can I taste? (for example, my tea, a cracker, a grape, nothing)
Think of these answers to yourself slowly, one sense at a time and you will be mindfully present.
3. Allow yourself to grieve for what has been lost or what you wish you had Border closures, restrictions on gatherings and physical distancing requirements mean a lack of freedoms that we took for granted pre-COVID. For many, this means separation from family and friends, an inability to travel, being unable to celebrate events how you would like, and feel lonely, isolated and disconnected. It is normal to feel sad during this time as grieving for the loss of something or someone confirms that it, or they, are important to you.
4. Be flexible and creative This year the Christmas and holiday period will not be the same as previous years due to COVID restrictions. At any time, restrictions and new health directions are enacted so expectations need to be flexible, which may be difficult to accept. Identify what is the most significant aspect of this time or event and find a way to maintain it. This might require some creative problem-solving such as moving an event outside, have multiple smaller gatherings or include a digital option.
Everyone has been affected by the challenges of 2020, either directly or indirectly, so people need to acknowledge that everyone is feeling a degree of stress. It is important to not expect too much and be kind to yourself, also, think about what you value in life. Be kind and tolerant of others as you do not know how they have been affected by this year. If you maintain good physical and mental health during COVID-19, and accept the future for what is, the resilient Australian spirit will cope with adversity.
If at any point you feel overwhelmed and unable to cope, please contact Lifeline (13 11 14), Beyond Blue (1300 22 4636), your local GP, or a mental health professional for support and assistance.
Authored by:
Gina Clement (MProfPsych, MMid, BNsgInform, DipHlthSc(Nsg) Provisional Psychologist and Product Manager at Best Practice Software
UPDATE: Please note as of January 2020, all Practices can begin using ePrescribing. ePrescribing has been turned on by default with our latest release, Saffron.
In partnership with the Australian Digital Health Agency (ADHA), Best Practice Software has been gradually rolling out Active Areas of Implementation for ePrescribing since August.
The table below provides a comprehensive list of all suburbs that have been deemed Active Implementation Areas for ePrescribing by the ADHA, as of 15 October.
This means that Practices within these areas are able to download the ePrescribing Utility File from our download page and begin using eScripts within your Practice.
Active Areas of Implementation for ePrescribing
ion
Region
Definition of Active Geography
Population
Victoria
n/a
All of Victoria
6,460,675
Australian Capital Territory
n/a
All of ACT
420,960
New South Wales
Armidale
The Armidale Regional Local Government Area
29,059
Newcastle
The suburb of Mayfield in Northern Newcastle
9,314
South Coast
The suburbs of: Bomaderry, North Nowra, Nowra, South Nowra, Terara and West Nowra. The suburb of Moss Vale & The Municipality of Kiama.
21,209
Sydney
The LGAs of: Bayside, Blacktown, Burwood, Camden, Campbelltown, Canada Bay, Canterbury-Bankstown, Cumberland, Fairfield, Georges River, Hornsby, Hunters Hill, Inner West, Ku-ring-gai, Lane Cove, Liverpool, Mosman, North Sydney, Northern Beaches, Parramatta, Penrith, Randwick, Ryde, Strathfield, Sutherland Shire, Sydney, The Hills Shire, Waverley, Willoughby, Woollahra.
4,574,994
Queensland
Central Highlands
The Central Highlands Regional Local Government Area
29,650
Brisbane
The suburbs of Camp Hill and Inala
31,669
Bundaberg
The suburb of Bargara
7,485
Central Highlands
The Central Highlands Regional Local Government Area
29,650
Brisbane
The suburbs of Camp Hill and Inala
31,669
Bundaberg
The suburb of Bargara
7,485
Townsille
The suburb of Garbutt, Rowes Bay and Belgian Gardens
7,107
Hervey Bay and Marborough
The postcodes of 4655, 4650, 4662 and 4659
79,355
Townsville
The suburbs of Garbutt, Rowes Bay and Belgian Gardens
7,107
South Australia
N/A
All of South Australia
73,836
Western Australia
Metro Perth
The suburbs of Port Kennedy and Woodlands
17,922
Country WA
The Kalgoorlie/Boulder Local Government Area and the Shire of Denmark
35,904
Tasmania
Northern Tasmania
The Central Coast, Launceston and Devonport Local Government Areas
