e-health

GPEP Syllabus

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e-health

e-health
e-health is rapidly evolving and expanding into everyday general practice. It has been adopted in primary care from an early stage through electronic patient records, recall systems, prescriptions and patient management systems. Developments are under way in New Zealand through the National IT Health Plan1 in partnership with software providers that will include a virtual health record, a shared care record and a national patient portal through which patients will be able to communicate with their clinicians in a secure environment.

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Email, internet and smartphone applications (apps) have quickly become part of everyday life and many patients expect health care providers to adopt this technology. Telehealth, the direct (e.g. video-conferencing) or indirect (e.g. website delivery) delivery of health information or health care is another emerging eld of e-health, which may become more widespread, for example providing care in rural areas. e-health curriculum in the context of general practice Pauline comes in for a visit about her asthma medication. She has not been seen for a year and was sent a text reminder by the nurse that it was time for her annual check-up. Her asthma is under control and she nds that the new Symbicort that you had started her on just before last winter has been excellent. She had very few problems this year and feels that her health has improved. She is pleased that she had followed up on that advert she saw on TV. You examine her chest and there are no signs of wheeze or other chest pathology. She looks well. You look through the screening window on the computer and realise that you do not have data on cervical screening or her smoking status. Pauline is a non-smoker and thinks she has had a smear recently through family planning. You ask if it is okay for you to be sent the information electronically from the cervical screening service. She is happy with this. She would also like you to look at a mole that she has noticed. She has a family history of melanoma with her uncle and grandfather both having one, so is a little concerned. The mole is on her lower leg, measures 4mm diameter and has a darker area on one corner, although is not tri-coloured. She thinks the dark colour has not been there before. You take a photo on the practice camera and ask her permission to send this to the local dermatologist for review. You explain that unfortunately your current system for doing this is not via a secure weblink, but it is the quickest way of getting a response. She feels this is okay but has a long chat with you about the security of information as she works in IT. She would like you to email the response that you get from the dermatologist.

e-health has signicant implications for both patients and clinicians. Advances in technology and the development of e-health have many potential benets for delivering health care. It is important, however, that privacy, security and safety of care are not compromised. General practitioners need to be aware of the risks and potential issues involved in some forms of e-health, for example use of email the Medical Council of New Zealand provides guidance in this area.2 The learning outcomes and expectations listed here will be undertaken over the three years of training in no particular order but at every opportunity that presents itself.

1 2

National IT Health Board (2010). The National IT Health Plan. Wellington: National IT Health Board. http://www.mcnz.org.nz

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Communication
Domain 1: Communication Throughout vocational training a registrar will develop a variety of competencies and be expected to: develop communication skills required for non-face-toface consultations, such as telephone consulting or email dene the difference in communication skills things lost or gained when consultations are not done face to face describe ways of reducing misinterpretation of information that is sent electronically -nau and carers describe to patients, and their family/wha the condentiality issues around electronic forms of communication, such as texts being read by others, messages left on answer machines reect on personal communication style by using video.

Clinical Expertise
Domain 2: Clinical Expertise Throughout vocational training a registrar will develop a variety of competencies and be expected to: demonstrate a working knowledge of the practice management system used within the practice describe the security measures used when transferring patient information to other health professionals extract information from the practice management system to enable audit and primary care objectives to be met demonstrate safe and competent use of internet resources for patient care and educational purposes describe the pitfalls of receiving and sending electronic information, such as lab results allocated to the wrong person, and how these can be reduced describe how consent is obtained for using electronic media for communication, such as email and text, and how this is recorded in the practice describe and demonstrate using electronic decision support tools used within the practice demonstrate the ability to use all aspects of the practice management system, including billing and booking systems demonstrate competent telephone consultation and triage skills and record these accurately develop competent typing skills.

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Professionalism
Domain 3: Professionalism Throughout vocational training a registrar will develop a variety of competencies and be expected to: reect on using social networking as a doctor and how this can impact on the doctorpatient relationship ensure condentiality of all electronic records in the clinical setting, and consider how records can be accessed by a nominated proxy provider as a back-up describe the measures taken to ensure security of patient information sent to other health providers or patients reect on the boundary issues in doctorpatient relationships when using personal email addresses or phone numbers ensure patient records contain sufcient information to describe and support the management of health care provided recognise and respect different attitudes to using - nau electronic information among patients, family/wha and carers make sure usernames and passwords are kept securely.

Scholarship
Domain 4: Scholarship Throughout vocational training a registrar will develop a variety of competencies and be expected to: ensure they are skilled in using the various decision support tools and undertake training as required demonstrate knowledge of appropriate and reliable websites for patient information use search engines, such as Pubmed, Ovid and Cochrane, when undertaking internet-based research describe the patient and the reasons for referral in electronic format, not just relying on cutting and pasting the patient notes.

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Context of General Practice

Domain 5: Context of General Practice Throughout vocational training a registrar will develop a variety of competencies and be expected to: describe the variety of practice management systems available to primary care demonstrate knowledge of the various agencies that are accessed electronically through the practice, for example laboratories, radiology, ACC ensure information on shared records is accurate, such as palliative care shared records.

Management
Domain 6: Management Throughout vocational training a registrar will develop a variety of competencies and be expected to: ensure the electronic recall system and decision support tools within the practice management system are easy to use by staff and training is readily available describe the system for back-up and retrieval to protect electronic patient information participate in auditing patient information on electronic databases to enhance care and improve health outcomes, for example high-needs cervical screening rates describe the enhancements to clinical practice that e-health provides establish protocols for policy around electronic records.

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Learning experiences and assessment

Year 1 In practice Learning experiences Clinical attachments Minimum ve patients per half day One on one teaching Role-play of cases involving electronic decision support tools Discussion of email consultation and other electronic forms of communication with patients Video/direct observation teacher to registrar, registrar to teacher Community visits Pharmacy faxing of prescriptions, shared records e.g. warfarin monitoring - ori providers and aged care: how are electronic Ma forms of communication best used? In-practice visit from a medical educator Direct observation Record review Personal reection Seminar day Specialist presentation Small group learning Case-based discussion Role-play Video interview Journal club and discussions - ori health inequalities Articles on Ma Registrar presentation of: Vignettes on professionalism and electronic communication MATCH quizzes WEBS research on electronic shared records, telephone and video consultation Assessment In-practice visits Video/direct observation Vignettes WEBS MATCH questions Patient satisfaction survey Skills log Online quiz Learning record Summative GPEP written GPEP clinical Academic output Further details about academic output in Year 2

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Year 2 In practice

Learning experiences As for Year 1, plus: Increase in patient numbers seen daily Attention to PHO performance parameters recording in the PMS Practice team meetings and input into these Audit Medical educator visits Video/observation Case discussion Record review Involvement in CORNERSTONE accreditation if occurs electronic record information, under clinical effectiveness processes Signicant event review

Assessment Medical educator visits NZRC resuscitation course Audit project Professional development plan Mini CEX Collegial support eLearning modules Patient satisfaction survey Summative GPEP written GPEP clinical Academic output

Learning group

Case-based discussion Role-play Literature review and critical appraisal Specialist or guest speaker

Other learning

NZRC resuscitation course minimum level 5 and appropriate for practice environment CME Professional development plan Collegial support case discussion Academic output Enhanced audit Research University paper

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Year 3+

Learning experiences As for Year 2, plus: Training under vocational scopes if applicable

Assessment Medical educator visits Audit Academic output Mini CEX Learning log Supervisor reports Multi-source feedback Previous summative assessments if not completed Fellowship Assessment

Clinical

Management of electronic media in: outpatient clinics referrals review, shared record, discharge summaries virtual clinics, e.g. dermatology Work with allied health professionals ensuring accurate electronic communications and other e-health interactions: Rehabilitation specialists Hospice carers shared records Physiotherapists ACC referrals Pharmacists e-prescriptions Occupational therapists Social workers shared notes Multidisciplinary team meetings, teleconferencing

Educational

One-on-one teaching Departmental teaching Journal clubs Peer groups

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References/resources
e-health is a developing eld and resources will be added with time. The following are a guide: Medicine and the Internet www.mcnz.org.nz/assets/ news-and-publications/coles/chapter_15.pdf Social media and the medical profession https://ama.com.au/social-media-and-medical-profession Manage my health www.managemyhealth.co.nz/home IT Health Board www.ithealthboard.health.nz Patients First www.patientsrst.org.nz New Zealand TelePaediatric Service www.telepaeds.co.nz Australian e-health www.ehealth.gov.au

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978-1-927240-23-6
The Royal New Zealand College of General Practitioners, New Zealand, 2012 The Royal New Zealand College of General Practitioners owns the copyright of this work and has exclusive rights in accordance with the Copyright Act 1994. In particular, prior written permission must be obtained from the Royal New Zealand College of General Practitioners for others (including business entities) to: copy the work issue copies of the work, whether by sale or otherwise show the work in public make an adaptation of the work as dened in the Copyright Act 1994. December 2013