My Health Record use by consultant pharmacists

Automated Introduction: Welcome to the Australian Digital Health Agency podcast, supporting health professionals to realise a healthier future for Australians through connected healthcare. 

Dr. Andrew Rochford (Facilitator): Welcome to the Australian Digital Health Agency podcast, supporting health professionals to realise a healthier future for all Australians through connected healthcare. I'm Dr. Andrew Rochford and I will be your host for today's podcast.    

Before we begin, I would like to acknowledge the traditional owners of the land on which we are broadcasting from and in which you are listening. I wish to acknowledge their continuing connection to land, sea and community, and I pay my respects to them and to Elders past, present, and emerging and extend the respect to any Aboriginal and Torres Strait Islander peoples joining us today. 

On the panel with me today, we have consultant pharmacist Karalyn Huxhagen, a Mackay-based accredited consultant pharmacist, and Jade Kennedy-Deschamps, Senior Compliance Officer for the Agency’s Compliance Outreach team.  

Today, we're going to be talking about the My Health Record use by consultant pharmacists, welcome Karalyn and Jade, thank you so much for joining me. 

Karalyn Huxhagen (Consultant pharmacist): Thanks. 

Dr. Andrew Rochford (Facilitator): To kick things off, Karalyn, I'll start with you. As someone who frequently uses My Health Record, can you please describe to us how and when you use it, and why you find it beneficial? 

Karalyn Huxhagen (Consultant pharmacist): Thank you Andrew. I use My Health Record in my pharmacy business, but then in my consulting business I use it when I'm doing a home medicine review or an aged care review. You often are the detective to try and find why a medicine was stopped or started, and what happened that changed a medicine. My Health Record gives me access to areas such as a dispensing history and also to discharge summaries, which are a wealth of knowledge.  

I find if I'm really trying to find out why did something change for a patient, that reading the most recent discharge summary gives me a wealth of knowledge of their journey through their health. I do use them for those tricky patients that you're trying to unravel, because you often ask a patient: “When did you start that medicine and why was it changed from this previous medicine?” And they say: “I don't know, they just did it in hospital”. So, sometimes you're the medicine detective. 

Dr. Andrew Rochford (Facilitator): It's actually a really good way of putting it because I think for a long time we've relied on handwritten bits of notes and peoples’ and patients’ memories. Now we have an opportunity to have all those documents in one place. In summary, what are those documents and what are the ones you find the most valuable to you when it comes to being the pharmacy detective? 

Karalyn Huxhagen (Consultant pharmacist): The top of my list would definitely be discharge summaries. They give you a wealth of knowledge because they record the medical diagnosis, they record when change is happening. You get the blood work up from the hospital in the discharge summary. Then the next one would be if there's pathology reports available, and then comparing the prescribing list out of the PBS file to what's being dispensed to have a look at compliance.  

Often, and it's probably not as often as it needs to be, but sometimes you'll meet that perfect patient where they really have embraced My Health Record. I had a lovely gentleman that I knew well, and he had had a heart attack while mowing his front lawn. He was totally devastated by the fact that he'd been so hardy, healthy and suddenly wasn't. He really took his health seriously. When I went to see him to do his home medicine review, he said, “Look, I can do this and I can log in here, into the pathology.” For a person who worked in a steam laundry as an engineer mechanic person, he just embraced it and it just helped me to understand what had happened to him, because he had a very severe heart attack. He'd gone to a tertiary hospital and he'd gone a long journey, so it was very helpful information. 

Dr. Andrew Rochford (Facilitator): Such a great example of how empowering it can be as well for the patient. Gives them that opportunity to really take control and clearly that's of value to their health journey, not only in the present, but also into the future. 

Karalyn Huxhagen (Consultant pharmacist): It is, and in the beginning when My Health Record started, we had to get over the barrier of what is this going to do, is this invading my privacy? What's going to happen? Who will look at my records? 

I think he was the epitome for me of a good news story that I can use to patients and say, “Well, this helped me to work out what we needed to tweak in his medicines.” What was going wrong? What we could change. It was really supportive to him to have a better health outcome.  

There was a lot of negativity in the beginning of My Health Record but the good news stories need to be told to show patients just how valuable it is to keep their record healthy. It has to be as healthy as they are. 

Dr. Andrew Rochford (Facilitator): Yes, absolutely. Now we know that community pharmacists can access My Health Record through the dispensing software in their workplace, but what about consultant pharmacists who work independently and operate as a separate business? How can they access the system? 

Karalyn Huxhagen (Consultant pharmacist): You go through the National Provider Portal. It's very easy once you set it up that you can log in and access across to My Health Record and you've got access to whatever is being uploaded for that patient, whether it's discharge or pathology.  

Setting it up takes a little bit of tweaking. To get your PRODA account all set up and then get up there. But once you've got it all in place, it's extremely easy. You just log on through PRODA, put in your username and password and then choose your login details and go across to My Health Record. 

It's once you've got over the nitty gritty of actually putting all the data to get you your account, it's extremely easy. And I was very, very lucky because my Primary Health Network, PHN, had a really robust person that was an IT guru and he really helped me to do that, and that's what PHN's role is. 

Dr. Andrew Rochford (Facilitator): Do you have any advice or encouragement for anyone interested in setting up access to My Health Record? 

Karalyn Huxhagen (Consultant pharmacist): I do and I look after a consultant pharmacist group which, like it or hate it, it's on Facebook and that's the best way to reach everybody these days. 

We really encourage all of the consultant pharmacists to set up their PRODA account and to use My Health Record because they have a two-fold role. They use it in doing a much better job as a medication review person, but they can also show a patient the benefit of why My Health Record helps them to keep a close eye on their health, or to help them. 

I've had instances where I've had to help patients who have come from afar and they no longer live in Adelaide or somewhere, way, way away. But I can still access their records and help them to unravel what's going on without a great deal of effort. I can be quite supportive to them. They're quite blown away that they can be in Mackay having a medication review and I can see what happened to them when they were in Perth and what happened in Adelaide. 

Mackay is the caravan land of grey nomads. So, I actually see a lot of people whose health journey takes them all around Australia, and I've used My Health Record to really go, “OK. this happened when you were in Broome, you were admitted to hospital, and this happened. I can see that, and now you know we need to tweak your blood pressure medications because it's not quite right now that you're living in the tropics and you're getting a lot more things like swollen ankles.” 

It's a tool with a lot of power if you know how to use it properly. 

Dr. Andrew Rochford (Facilitator): Well said. To you now, Jade, as a Senior Compliance Officer at the Agency, what do you recommend pharmacists do before they start using My Health Record? 

Jade Kennedy-Deschamps (Senior Compliance Officer): There's a couple of things that pharmacists should do, and the first is to establish what's called a My Health Record security and access policy for themselves. This requirement comes from the legislation that actually underpins the My Health Record system and the key pieces being the My Health Records Act 2012 and the My Health Records Rule 2016. 

Under this legislation, any healthcare provider organisation that wants to register with My Health Record needs to develop one of these policies before they actually register with the system. The policy needs to cover a number of prescribed topics, and these are set out in Rule 42 of the My Health Records Rule that I just referred. 

As I mentioned, this is a requirement to be able to actually participate in the system, and so when a healthcare provider organisation wants to go on and actually register, it will be required to attest at that time that it has the policy in place. It is really important that they do that before trying to register.  

One thing I do want to point out is that for community pharmacists that work for a pharmacy that's registered with the My Health Record system, the pharmacy will already have its own security and access policy in place, and it should have communicated that policy to all of its staff. But for consultant pharmacists that access the My Health Record system via the National Provider Portal as their own organisation, they'll also need to implement their own policy. 

So that might sound perhaps a little bit complicated, but rest assured there are a range of materials out there to help pharmacists develop a policy for themselves, including a new policy template that's just been developed by the Office of the Australian Information Commissioner in collaboration with the Australian Digital Health Agency. As well as an eLearning module that actually sort of acts as a step-by-step practical guide for establishing a policy, and both of these can be accessed on the Agency's website. 

In addition to establishing a security and access policy, pharmacists should also make sure that they've completed My Health Record training before they use the system for the first time. Similar to the security and access policy requirement, this does also come from the legislation. It's applicable to all healthcare provider organisations that participate in the My Health Record system.  

Again, the training needs to cover certain things, including how to use the system accurately and responsibly and the legal obligations for users of the system and the consequences for breaching those obligations. The Agency also has a lot of resources to help with this, including a number of eLearning modules that cover each of those elements that I just mentioned, and these can be accessed on the Agency's digital health training website. 

Dr. Andrew Rochford (Facilitator): And what are some of those key things pharmacists should consider when accessing the My Health Record to ensure they are complying with those legislative requirements? 

Jade Kennedy-Deschamps (Senior Compliance Officer): There are a few different things that pharmacists need to do. The first, which is really important, is making sure that they're only accessing an individual's My Health Record for the purpose of providing that person with healthcare. Also, any access needs to be in accordance with access controls that might have been set up by the individual because in some cases a patient might have limited access to their entire record or to particular documents within their record. 

This brings me to the next thing that pharmacists need to consider, which is that while it's possible to override these access controls using what we call the emergency access or brake glass function. This can only be done in very limited actual or potential emergency situations and so it's really important that pharmacists have a good understanding of what these limited circumstances are so that they can ensure that they're using that emergency access function correctly. Again, there's lots of guidance material on this on our website. 

The second thing that pharmacists should consider is that there are a number of ongoing obligations that apply once you have registered to participate in the system, and again similar to what I mentioned about the emergency access function, it's really important that pharmacists are aware of and have a good understanding of these obligations so that they can be sure that they're complying with them.  

Some of the key ones, just to point out a few include making sure that their security and access policy is kept up to date and is reviewed at least annually. Making sure that they comply with any request for information or assistance made by the Agency as system operator within the required timeframe and ensuring that they notify both the Agency and the Office of the Australian Information Commissioner as soon as practicable after becoming aware of any potential or actual data breach relating to the My Health Record system. 

Finally, I just want to mention that it's also a really good idea for pharmacists to keep a record of any access that they make to My Health Record via the National Provider Portal. This is important because as I just mentioned, the Agency, as system operator for the My Health Records system, is able to request information from healthcare providers. For example, a request might be made regarding details of access made to an individual's My Health Record. Keeping records of any access made through the system through the NPP will assist in being able to respond to that request if necessary. 

Dr. Andrew Rochford (Facilitator): Jade, with regards to security and access policies, I think it's important for everyone listening to know that your team has recently reviewed the policies implemented by a number of pharmacies around Australia. Are there any key areas you've identified in relation to those policies that pharmacists can note and implement to meet the requirements? 

Jade Kennedy-Deschamps (Senior Compliance Officer): Yes. I think the most important thing as I've already mentioned, is really just making sure that you have established a security and access policy. That it covers all of the matters that are required by the legislation, and also that it's been appropriately tailored to the pharmacist individual circumstances. 

When developing their security and access policy, even if a template is being used, it's really important that pharmacists refer to the legislation to make sure that they've covered all of those required topics. Then once the policy has been established, pharmacists need to make sure that they have a process in place for reviewing it, at least annually, in order to make sure that it stays up to date. 

 Dr. Andrew Rochford (Facilitator): Karalyn, is there anything final that you'd like to add about using My Health Record? 

Karalyn Huxhagen (Consultant pharmacist): Thanks, Andrew. As Jade has pointed out, it is really important that for a consultant perspective that yes, you do have your security and access policy in place. Pharmacies know this, as it's part of our ritual of everything that we do every day.  Dispensing and a pharmacy’s privacy is a really important part of our work. You just have to extend it and make sure that you have it well documented.  

The templates are very much there. The eLearning material is amazing. It's just a matter of making sure that you carry on what would be business as normal from a community pharmacy perspective to being a consultant. 

Dr. Andrew Rochford (Facilitator): And Jade, any final thoughts from you? 

Jade Kennedy-Deschamps (Senior Compliance Officer): Just two. As I've already mentioned, there are a lot of resources available on the Agency's website, so I can't encourage enough that people should go on and have a look at what's there. As I mentioned the templates, the eLearning’s and the emergency access guidance, things like that. Jump on the website, have a look and that will go a long way to helping you, making sure that you're complying with all of the requirements that I've mentioned. 

Dr. Andrew Rochford (Facilitator): Well, thank you, Karalyn, and thank you Jade so much for joining me and giving us your thoughts on how much of a benefit My Health Record can be in the world of pharmacy. Thank you to you for listening, we hope you can join us next time.