Pulse+IT has been charting the implementation and adoption of the Epic electronic medical record in Australia for many years, pioneered of course by the wonderful team at the Royal Children’s Hospital in Melbourne, which went live with a big bang roll out in 2016.
RCH was followed by its neighbours in the Parkville precinct in 2020 with, you might remember, big bangs in the middle of the Covid epidemic. That all turned out better than expected, and since then, there have been a lot of interesting developments from these EMR implementations, not the least of which is the enthusiastic adoption of patient portal capability in the EMR through Epic’s My Chart portal and Care Companion app.
We were reminded of this at the AIDH’s HIC conference in Brisbane last week when Royal Melbourne Hospital physiotherapist Julie Louie presented on some feedback on the use of outpatient care plans delivered through the portal by the three adult hospitals in the precinct.
Parkville set up a Health Hub about two years ago to provide portal access – RCH has its own portal for the kiddies – and it has been incredibly successful, as we reported from a great presentation by chief allied health information officer Kath Feely at the Digital Health Festival in Melbourne earlier this year. (By the way, Ms Feely won the Don Walker Award for best clinical abstract at HIC for her presentation on using the portal for vulnerable populations.)
Ms Louie presented on a recent study on the experience of both patients and clinicians using the patient portal, which, as she pointed out, provided information from an Australian perspective that is not often found in the literature.
The study found that patients who used the portal were positive about it and felt they were more in control of their health information. They also said they wanted more from the portal itself, including access to more medical information such as scans as well as the ability to share more data more easily with GPs.
Clinicians were more split on the benefits of these sorts of clinical tools, with some saying they thought they were a bit inappropriate and there were some challenges with activating them.
The presentation reminded us of a discussion on last week’s Pulse podcast, when hosts Louise Schaper and George Margelis interviewed Liz Salmi, the communications and patient initiatives director for OpenNotes at the Beth Israel Deaconess Medical Center in the US.
Ms Salmi has been a visitor to Australia in the past – she’s pictured above at the MedInfo conference in Sydney last year – and she is a fierce proponent of the OpenNotes movement, which she describes as the concept that patients should have full access to everything in their records in order to better understand their care.
OpenNotes been around for a long time, but with the introduction of the 21st Century Cures Act, it is now a legal requirement in the US for healthcare organisations to provide API access to electronic medical records for patients.
Ms Salmi recently wrote a book chapter along with an oncologist and an oncology psychiatrist about what patients thought about receiving lab results before their doctor has been able to see them and discuss it with them. This is something of that is of great deal of interest in Australia at the moment, as we move towards sharing pathology and diagnostic imaging results by default on the My Health Record.
The discussion with Ms Salmi was fascinating, particularly about how OpenNotes had changed the way doctors write their notes. This is in the oncology setting, but a third of doctors didn’t change anything they did, a third made their notes longer, and a third made their notes shorter.
With the next generation of doctors studying and practicing in these OpenNotes environments, it got us to thinking about how sharing of information will be affected by another fundamental change – AI.
AI-powered medical scribes have been taken up with alacrity by GPs and medical specialists – the RACGP just this week issued guidance on their use, mainly on the safety and security issues – and they all have the ability to translate a doctor’s acronyms and shorthand into not just letters that another doctor will understand but pretty well written patient notes too.
If AI scribes allow doctors to make a very quick patient note for their own records as well as a specialist letter, a referral or a prescription, can they do for one for patients at the same time and share it with them?
Perhaps through a patient portal rather than printed out and posted, or, God forbid, uploaded to the My Health Record as an event summary. Wouldn’t that be nice?
That brings us to our poll question for the week.
If doctors use an AI scribe for their notes, should they share those notes with the patient?
Vote here or leave your comments below.
Last week, we asked: Should FHIR standards be mandatory for clinical software in Australia?
Yes indeed said 77 per cent of respondents. We also got a great response in our comments. Here’s what you said.
Yes – There are no valid arguments against giving patients access to THEIR OWN health information. There’s a building evidence base from organisations and countries that have been doing it for years that this is a good thing. It’s shocking that people ignore this evidence base, but I suppose it’s not a topic commonly discussed at medical conferences here. Thanks Pulse+IT for informing people that the evidence exists!
Yes – My Health record
No – Notes are written for other clinicians. Most patients would not have the knowledge or context to fullu understand the information within the notes.
Yes – Direct access to their clinical record in the pms via portal. Patient portal should also be able to control access to the record by other healthcare services the patient is engaging with. Those additional healthcare services should be able to directly access the patient record through FHIR APIs on the pms.
Yes – Send the copy via email
Yes – Patient portal with patient having the option of loading it to MHR.
Yes – they need to verify the notes so should share them if they were going to anyway. AI notes should make no difference to this
Yes – The AI can create multiple versions of the transcript, one that’s adequate for clinician notes and one for the patient. They don’t have to be the same thing. But yes, patients need to be given documentation on their health!
No – Using AI scribe (which should be seen as just a new tool for clinical note taking) and sharing notes with the patients has no logical connection with each other.
Yes, it absolutely should and it should all be via My Health Record so people (and HCPs) have it all in one place.
The only way we get on top of medical inflation is to involve people in their healthcare journey and stop treating them as objects to be observed. They need to participate and they will only do so of they understand the whats, whys, and hows.
If people don’t understand the info, then healthcare professionals need to communicate better.
And never forget that ALL data is owned by the person and not by the healthcare provider.
No – For the most part sharing notes with patients may be both appropriate and desired. However there are times when such open sharing may be potentially more damaging than any perceived benefit. Wisdom is needed. The answer lies in the context.
Yes – email in pdf or upload to patient portal
This is a silly question. You are either sharing notes with a patient or you aren’t. It makes no difference how notes are taken.
Yes – Via a patient portal if the patient has access to this, you can see all your notes,lab tests etc if open notes is used.
Yes – I’m not sure this is a useful question? Clinical notes are already accessible by the patient under FOI. Do you mean in real time? The answer is absolutely yes. There is a critically important partnership here which embeds safety and quality directly in the patient role. If this means less jargon will be used, that’s actually helpful across clinical specialties eg less abbreviations and more clarity
Yes – My health record Of course
Yes – My Health Record (one place for everything, please …)
Yes – via a platform is best; however email would suffice.
Yes – Let’s stop thinking the patient’s information belongs to anyone else other than the patient ! MyHealth Record isn’t MyDoctorsHealth Record. My medical information should be mine- I’m the singular centre of every visit, appointment, surgery, recovery and illness.
We have been routinely sharing outpatient notes and test results with patients and their parents since mid 2016 via the patient portal of our EMR.
Around 75% of our more complex patients (“frequent flyers”) are signed up and get this information along with many other features.
Overall the benefits of notes & results release are seen to greatly outweigh any downside. Patients and families give very positive feedback on this feature.
Our clinicians are not inundated with lots of queries from worried families and we have many examples of patients bringing important items to the attention of clinicians which otherwise may have been missed. It is helpful to have the ability for clinicians to control release of individual notes or results in some contexts and for special care with vulnerable families.
There are many positives!
Yes – portal
Yes – Upload to My Health Record – but alert patient that it has been uploaded with a link.
Yes – Make it available via a patient portal and label it for what it is.
at the consultation