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"Digital Health"

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Megan Walker: Hello and welcome to Market Savvy Conversations. My name is Megan Walker and today our special guest is Dr Chris Moy. Hi Chris, how are you?

Dr Chris Moy: Great.

Megan Walker: Dr Chris Moy is a full-time GP from Adelaide. He graduated from The University of Adelaide in 1991 and has worked in general practice for over 25 years.

Chris' specific interests include age care, palliative care and health communication systems. Chris is the current federal AMA vice-president and prior to this was the Chair of the Federal AMA Ethics and Medico-Legal Committee for four years.

Chris has also recently completed his term as AMA South Australia President. Chris you're involved in lots of initiatives related to age and end-of-life care as I see here.

Very impressive bio including the Expert Advisory Panel of the South Australian Advance Directives Review, the South Australian Health End of Life Decision Making Project, the GP Partners GP Palliative Shared Care Program and the South Australia Health End of Life Prescribing Working Group.

Now, all of that is important because it's led you to your current work. The aspiration of making a patient's advanced care directive available alongside their health information at the point of care led Chris to significantly involve himself in the development of Digital Health in Australia and particular, the My Health Record telehealth and electronic prescribing which is what we're talking about today.

Chris is currently a Clinical Reference Lead of the Australian Digital Health Agency as well as being a member of its Privacy and Security Advisory Committee. Well done. Chris, you're a busy man. I really appreciate you giving us your time today.

Kick us off. Tell us a little bit about what is the role of the Digital Health Agency just to help set the scene. Who does it govern and what's it all about?

Dr Chris Moy: The Australian Digital Health Agency is a government funded organisation, both federal and state government, set up to really promote digital health in Australia for the benefit of patients but also to improve the systems that are currently in health and across health so that they work better and improve the safety of the systems but also to improve the quality of care that's provided to patients by streamlining them and making it more functional over time.

Megan Walker: Okay. Fantastic. A lot of the people watching our video or listening to this podcast will be private practice business owners, specialists, allied health, GPs. What I really wanted to touch on today from your expertise is the obligations of those business owners.

The key things that they need to be across and aware of and have in place to protect firstly against cybersecurity in their practice and then we'll talk about patient security as well. Can you start with cybersecurity as a key point for us?

Dr Chris Moy: Yeah. Essentially with the world right now... I've come from a world where we used to have everything on paper. It was kind of simpler but all the data that we have about patients which is available and important for providing the care is now on these electronic systems.

The key thing is that it must be protected. Now first up, I would say to all those business owners out there is "well done". I think it's incredible and great work to do and I work out in general practice out in the community and I realise how important that that work that you do is.

The thing to realise is that although your patients and your relationship with patients is your greatest asset, I think the second most important thing is actually the data you have about them.

I think you will really feel that if your practice is actually hacked into which does happen sometimes and unfortunately you do hear stories about that or when your system goes down or for example...

Unfortunately, we have been in situations where there have been instances. Things like ransomware and things like that have affected practices. It is such a valuable thing and it's something you must really protect.

Now, certainly there are legal obligations and sort of standard obligations. Those things in terms of your requirements under The Privacy Act for example. To have reasonable protections in that area but also with respect to standards.

Certain things like The Royal Australian College of General Practitioners and other organisations have certain standards. I have here a document "Information Security in General Practice" which is something worth looking from the RACGP about the sort of obligations you have to protect the data that you have about patients.

They're really important but I think the most important thing is understand that having been involved in Digital Health for a long time... I know a couple of years ago there was a lot of focus on the privacy and security of My Health Record.

Look, what I'd have to say is My Health Record is comparatively incredibly well protected. The real concern and vulnerabilities in the system are really out in the community. Out in private practice for example and practices not really focusing enough on this area.

As I said, the biggest single asset is your patients but your second is your data about your patients. Please take it very seriously.

Megan Walker: Yeah. You and I mentioned earlier you have got... Is it in that resource that you just held up where there's a checklist for having a look at your cybersecurity and making sure what's in place? That's a document we'll link to below this video.

Dr Chris Moy: Yeah. Look, I know that for most of us we're not the most IT savvy sometimes. Some of us are but even then, there are people who are far ahead of us and they're particularly the hackers. Now, what I'd say is that when you're setting up your practice, it can be very overwhelming and particularly setting up the IT systems is incredibly complex for many of us.

We often will get private or providers to provide this IT support. Now, the thing about it is we're often at a disadvantage in other situations. They often know a lot more than we do.

It's really important that we feel as though we are getting what we need from them. The Australian Digital Health Agency has worked to develop a really... I think really important sort of documents which is...

A document called questions to ask your IT vendors and also an extra checklist which you can actually give them. This is their paired document. You can actually give this to them or e-mail this to them.

Ask them to fill it out. From this in fact, it'll actually allow you to score the IT providers and actually indicate whether... First up, they know what they're talking about, what they're providing to you is actually... That you feel comfortable about the sort of protections and systems that they're putting in your practice.

Megan Walker: Oh, what fantastic resources. You get it out of the gobbledygook. Get into something that we can check off and go, "Yes."

Dr Chris Moy: Yeah. There's a lot of gobbledygook. I think that part of the problem is that sometimes our minds can get spinning when an IT provider starts talking to us and we get convinced by the gobbledygook.

What we need really is "Are they actually doing what we need them to do as far as protecting our IT systems?" Those two resources are really helpful for people setting up practice.

Megan Walker: Brilliant. The other innovation that I wanted you to touch on is digital prescribing, how that works and how people can get involved with using it if they aren't already.

Dr Chris Moy: Yeah. This is a really great innovation that's come out of COVID really. Although, work in this has been going a long time, I think COVID...

It was the final pushover. Particularly with the situation where we were able to do telehealth with patients and provide care that way but at the same time we still had these manual scripts either faxed or sent by mail which kind of didn't make sense.

Essentially, electronic prescribing involves... and it's really fantastic. You're sitting at a practice who may have just finished a telehealth consult.

Essentially, all they need to do is to essentially set up their scripts as if they're just about to print the scripts but instead of printing it, they'll actually send this out by a QR code.

Very quickly... It will look something like that and it goes instantaneously to the patient's phone and they can take that QR code to the practice and obtain the information.

Now, that's the current system. There is a system that is going to come into effect over the next few months which is possibly even simpler which is called an active script list. The one we've gotten has a token system.

Electronic active script list is essentially what will happen is that a doctor again at the practice will... Instead of actually sending a text with the barcode, what they'll be able to do in fact is to just approve a prescription.

Prescription lists which is in a secure Cloud and the patient if they need the prescription just has to turn up at a pharmacy, provide details and obviously they'll have to provide enough information about themselves in terms of a hundred point check or something like that.

At that point, the pharmacy would then get the approval to link into this script list and see that the script has been approved and they'll be able to dispense the prescription which is even simpler. That's what electronic prescribing looks like in Australia and we will be moving to in the next little bit.

Megan Walker: There'll be so many benefits for that. I imagine long scripts, multiple repeats, scripts from different doctors. The benefits will just go on and on won't they?

Dr Chris Moy: My patients love that at the moment. The thing at the moment is say in the past, what's happened is they may need a prescription and they've rung up for a prescription or they've, hit a telehealth consult and then you'd written it but then you either had to send it or you had to fax it to the pharmacies, door send it or you left it at the front desk and you still have to come in anyway. Now, it goes straight to their phone and they can go straight to the pharmacy and I said, "Sooner, won't even need to do that. I'll just need to go straight to the pharmacy." They won't even need the barcode or QR code.

Megan Walker: Wow. So good. I get asked this question all the time. You're here. You can help me with it. I don't know why I get asked this but fax machines... "Megan, when are we getting rid of fax machines?"

Dr Chris Moy: I think it's starting to come towards us at the moment. The thing we've really needed is a thing called secure messaging to come into being in the next a little bit. In Australia, there have been problems with developing that.

Secure messaging essentially as a securely encrypted e-mail where it's encrypted but also we know that the person sending it is known to the person getting it. It's very clear that every end of this is covered over.

Now, the problem with it has been that to some degree in Australia, there has been not a lot of strategy and development of this. In the absence of that, there's been a lot of different providers and a lot of these have provided different services and it's got a bit confusing. It's become a bit like VHS versus Beta. They haven't talked to each other.

Unfortunately, Australia's made slow progress in this area. Now, the Australian Digital Health Agency has understood all along that this is the big one we need to get to because what we want to be able to do one day is to get rid of fax.

Instead of faxing something, we write a letter for example. We securely message this directly to the hospital or to another doctor or for example, we could also send an e-mail asking a question of them instead of phoning and chasing them.

We can send an email to them. That is getting towards that stage now. There's a lot of work. In South Australia for example, there's a pilot project at the moment for secure messaging of all referral letters to hospitals. There is in fact, getting towards the timeline just turning off fax.

You won't be able to fax your referral letters anymore because that's the way we... Unbelievably, we're still in the 2021 faxing our referral letters to hospitals at the moment. There is a timeline to turn that off.

Essentially what will happen is instead of faxing it, you'll write your letter and you'll e-mail it directly to the hospital. It has so much benefits. You make this no paper. You make sure it gets there and you automatically get a record of...

That it's got there and you know it's got there, whereas at the moment we're faxing into oblivion and I find faxing one of the scariest things we do. We never know who gets it.

Megan Walker: Yeah, absolutely. We've well in truly getting the green light for telehealth to continue post our pandemic world whenever that is.

What are your thoughts and recommendations for clinicians using telehealth in terms of privacy for clients? Double barrel question. Privacy one but also opportunities for them to keep embracing telehealth.

Dr Chris Moy: Telehealth is the silver lining to some degree of COVID because... Certainly organisations that Australian Medical Association had been pushing the government towards moving to telehealth for a long time but there'd been a sort of a reluctance to get there.

COVID has shown the need for it. What's great now is I think everybody really understands not only that it's more convenient but it also actually increases access to care for a lot of people who are for example having been able to access care in the past.

For example, those who can't get out of the house or rural remote areas. That has a place. It's not the solution to everything because there's some things that have to be done face to face.

What I'd say to most practices developing at the moment is that the government's view is it's certainly a tool in the provision of care. It's not the be-all and end-all. Again, it fits in that place of actually providing convenience and also increase access for patients but you also need to build it within...

A good quality practice can also provide face-to-face care because there's definitely a role for that. That's the first thing. The second thing is that there are emerging technologies that are available out there for...

Particularly video conferencing and video taught telehealth which I think the ultimate... It's really much better than just telephones. At the moment unfortunately, most of telehealth is done by telephone and we'd like to move towards video.

Now, certainly at various stages during this pandemic, a lot of practices and a lot of doctors have been forced to use things like FaceTime and things like that which technically don't really comply with the full privacy requirements that really we should be hitting towards.

Now, there are other technologies such as Zoom and Teams and things like that which have better security. To that, I will point towards a document that using online conferencing technologies-

Megan Walker: Very good.

Dr Chris Moy: ... and abused by the Australian Digital Health Agency. They're also other technologies which are being developed right at this moment because of this move towards telehealth.

I'd be looking out for that and just making sure that you start to watch out for this development because I think the move towards via conferencing is going to be very big in the next few years or so.

Megan Walker: Yeah. Okay. Chris, thank you so much for this conversation. As we start to wind up, I've got two more thoughts that I'd like you to touch on. One is innovations for private practice owners to be aware of.

If there's anything you can share from either the AMA or Digital Health Agency of things that are coming and great opportunities and to wrap us up, your final thoughts and advice for people working in private practice. There you go.

Dr Chris Moy: I'll take the first question first which is I think well done and it's great. It's brave. I think we really need you out there.

I think I would definitely point towards resources like these about... because I think for most of us, this is just overwhelming and now we're definitely headed towards this sort of checklist for your IT providers so that you can be much more sure about what you're been provided with because I think it's...

Unfortunately, sometimes you feel as though you've got the... You kind of walk into these with your eyes closed. I would also suggest very strongly that you make a particular point of making sure the data on your systems is as good and as clean as possible particularly with regards to phone numbers and e-mail addresses of your patients over time because as time goes on, they're going to be really critical as you build your practices.

I think that the world is moving towards a better place now in terms of digital health but what I would say is it's going to be this world where... what our aim is and we can't lose sight of this.

This is about good patient care. If you do that first and you try to... First up, make it about good quality care so that they get the best care but also ideally in the most convenient way. That's your main aim. Don't lose sight of that. Don't get too caught up in all the technology.

Sometimes you can kind of lose the wood for the trees and then start to build in things like telehealth and electronic prescribing, secure messaging which are firstly hopefully going to improve access to care, going to supplement good face-to-face care are going to make it also easier for people to be able to get what they want done more quickly.

It also for example save you time as far as being able to contact the... Instead of having to do a phone chase for example in the future, you'll be able to securely message somebody.

I think I have one final thing. I'm just a little final thought is I know that... Maybe you've forgotten we haven't discussed at the most, My Health Record which I think is really the forgotten little thing in there which is... 

I think for many people, I think they thought that it was supposed to just take off a few years ago. No. My Health Record was always built up for the long term.

Essentially, what that is essentially a secure Dropbox where health providers who are registered with AHPRA can obtain information about a patient, which are normally sent by other means like discharge letters or whatever but which you can obtain.

Now at the moment, if we've got a final thought at the moment... One of the big things at the moment is finding out whether your patient has had COVID vaccine already and when they had it and the fastest way to find that out at the moment is through My Health Record because everything is going through...

As they've got a My Health Record, the immunisation's going to the Australian Immunisation Register and it's going directly into their My Health Record. There is a summary now there in My Health Record where you could find that out.

Once you start to find that out... That's a fast way to find out information. You can then go find that other things that may be useful for patient's care where...

For example, if you're unclear about whether they're being prescribed something from another doctor, you can actually look at it on My Health Record and also find out information about from discharge letters from hospital admission.

That's something not to be forgotten in all this. All those bits which are a combination of... First up, telehealth, electronic prescribing, secure messaging, My Health Record are really things that if you can incorporate in practice hopefully make the patient's care better but also your job a lot easier in terms of finding information you need to provide care.

Megan Walker: Brilliant. The system works.

Dr Chris Moy: I think I'll flip it the other way and say that sometimes, we have bad days on electronics. Not every day is a perfect day but when it does work, it could really make things a lot better for you.

Overall, 99 days out of 100... I think the digital products which are coming out now particularly if you use them in the right way, do improve patients care and do improve your ability to get information you need to provide good care for them.

Megan Walker: Wonderful. Chris, thank you so much for your time. Those resources are going to be super helpful. They'll be here where you're watching this video or listening to this recording. Chris, thanks so much again for your time. Really appreciate it.

Dr Chris Moy: It's a pleasure.

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