2020 – a year to remember or a year to forget

Dr Steve Hambleton, Independent Clinical Advisor, reflects on the year that has forever changed health in the world and offers a glimpse of what’s to come in 2021.

For most of us life was turned upside down. We had seen pandemics come and go before.

The H1N1 influenza pandemic in 2009 was a good example. In its early days of that pandemic in South America it looked like the case fatality rate was nearly 50 per cent. We heard about potential school closures and devastation in aged care with H1N1.  Well it turned out the early cases then were just the tip of the iceberg – many more individuals with either minor or no symptoms were present in the community. It actually transpired that the staff in aged care were more at risk than the patients because most of the elderly had actually been exposed to H1N1 at some time before in their lives and very few of them became ill of just suffered mild illnesses. The impact of H1N1 turned out to be no worse than the seasonal flu except for some young people and pregnant women.

Nevertheless, a vaccine was produced and rolled out Australia wide through General Practice. There was no Australian Immunisation Register in those days. Schools did not close. Life went on. People continued to go to work sick, cough all over each other and crowd together on public transport. We vaccinated a lot of people, but we really don’t know who was vaccinated, just that we sent out a lot of vaccines. In a normal flu season there are more than 3,000 deaths and more than 13,500 hospitalisations.

2020 started much the same with reports of a more severe strain of the ‘common cold’ emerging. A doctor in China had noticed a cluster of severe respiratory illness and started asking questions. He eventually lost his life treating patients with this disease.

The virus spread. It hitched a ride to Europe and rapidly spread through Spain and Italy and suddenly the world took notice. We had reports of overwhelmed health systems in those two countries with doctors having to ration ventilators – something rarely seen outside a war zone.

Our Asian neighbours had seen this before and knew what to do. South Korea and Singapore and Taiwan and China locked down early and hard. The USA did not follow suit and are still suffering the consequences.

We got the message and shut down hard too. A cruise ship docked in Sydney and spread people and their viral load all around the country. We learned about contact tracing. We learned about the impact on the elderly in aged care facilities and we learned that health care workers were also at risk and that they could also spread the virus to each other, to their families and to their patients.

We were told to work from home to protect ourselves. We told our elderly to stay at home and stopped visiting them. We told the population not to go out if they did not need to. We re-learnt about hand washing and social distancing and cough etiquette and the need to stay home if sick.  We also found out that gathering and singing at church was a super spreading opportunity. We are getting used to scanning a QR code and sharing our contact details with every venue, even our places of worship. Many of us loaded up the COVIDSafe App to allow our phones to ‘talk to strangers’ who were in close proximity for more than a few minutes. At the time of writing this, community spread of COVID-19 is under control and we can socialise again, but we realise that every venue needs a COVIDSafe plan.

When our patients notice a sniffle, they can now consult their doctor via telehealth, present directly for a COVID-19 test, and get results sent directly to them. When required, they can get an electronic prescription sent directly to their phone via SMS or email.

Hospitals allowed consultants to also use telehealth. We suddenly realised there were lots of things we could do safely and remotely. In some cases, the GP, the patient, the patient’s carer and the consultant were able to get together all on the same screen to provide input all at the same time.

With the need for connectivity ever increasing, in Northern New South Wales there was a proof of concept of the Service Registration Assistant (SRA). This SRA effectively delivers a living, self-updating ‘phone book’ that leverages off a number of databases and makes them available all in one place. The future of the SRA is being considered now for national scalability. Locally, it improved the ability to deliver messages to the appropriate provider in the first instance. This significantly decreased time previously wasted by providers when messages were delivered to the wrong place, or not at all.

All the while, more and more useful clinical information was being aggregated by the patient’s My Health Record. Much of this useful information now arrives there as a by-product of clinical activity – medications, pathology and diagnostic imaging results and discharge summaries to name just a few.

Work is underway on the bespoke integration of specialist software to My Health Record 4 systems now conformant. When a specialist practice upgrades one of these Clinical Information Systems to the latest version, or purchases new software to connect to MHR, they will now have seamless access to useful information ‘within’ their clinical workflow and not parallel to it.

Medicines View within My Health Record was a ‘game changer’ (that is where I, as a GP, go the most). I believe fully MHR integrated Clinical Information Systems that can present relevant information when required is the next ‘game changer’. If you are a specialist – this is what you have been waiting for. For more information and tools available, visit the specialists page.

As 2020 draws to a close there is a real prospect that we will soon have a COVID-19 vaccine in Australia. It looks like we will need to provide two doses of whatever vaccine is finally chosen. We are going to need to record this information about every vaccination given in the Australian Immunisation Register. We are going to have to remind people to come in for their second dose and ensure that they get the correct vaccine the second time. To ensure they develop immunity, the vaccinated public is going to need proof they have had that vaccine, and My Health Record can play a vital part in that.

The Aged Care Royal Commission interim report has commented that there is a desperate need for a digital transformation of health care in residential aged care facilities, and that transitions of care are a real pain point. Advanced Care Directive and Goals of Care documents can already be uploaded to My Health Record. We now have the ability for the healthcare provider to assist the patient to upload those documents, and functionality in the CIS that automates this upload would be well received. Last time I was at an Aged Care facility I noticed the fax machine and the Yellow Envelope for hospital transfers. We can and must do better.

Finally, building on our 2020 experience I think next year will be the year of the digital consumer. Activated and involved consumers will demand more and more access to information about themselves and their loved ones that they can share and have interpreted. They are going to need better data quality.

That is the challenge for all of us who have the privilege to contribute to our connected healthcare system.

About the author

Dr Steve Hambleton, Independent Clinical Advisor, Australian Digital Health Agency

Dr Hambleton is an adjunct Professor with the University of Queensland, a General Practitioner in Brisbane, and also serves on the Boards of Avant Mutual Group Limited and the Digital Health Cooperative Research Centre. He is a former State and Federal President of the Australian Medical Association.

Media release - Dr Steve Hambleton appointed as independent clinical advisor