Technology embraced by rural generalists

In 2000, I came to work in Australia for a software vendor implementing pharmacy systems with decision support, where drug interactions or incorrect dosing were reported, to assist decision making. The system also offered an electronic prescribing system which integrated with pharmacy dispensing systems to remove transcribing errors and provided prescribing decision support to doctors.

Twenty-one years on, the uptake of digital health has been slow and the benefits to patients in accessing better health care that is timely, appropriate and safe has remained a goal to achieve; albeit we are chipping away at sustainable improvements.

In some ironic sense, some of us in the digital health world cheered when the COVID-19 virus arrived. Technology that supports remote and isolated care has been embraced and implemented at a speed never experienced before and most of the changes in workflow have been successful. Importantly, we have also seen patients and healthcare professionals recognising and reinforcing the value of in-person care and that, while technology has been used to aid the delivery of health care in the COVID-19 world, it cannot meet all the personal needs of those giving or receiving care.

A spotlight has been shone on data, recognising that data is information and with information we can make informed decisions. Healthcare and research data is now being shared around the world to enable us to understand the COVID-19 virus, its impact in communities and to track if interventions such as vaccines, medicine, isolation and mask wearing really do help.

Chair of the Australian College of Rural and Remote Medicine (ACRRM) Digital Health Committee, Associate Professor Christopher Pearce says, ‘The importance of having good data, and the ability to interrogate it, is becoming more important.

‘The beauty of the new tools is the ability to tailor and design your own quality assurance activities. Rural practice has often been measured by the standards of urban environments.’

The need for quality data has resulted in new investment in systems and processes that have been waiting in the wings for years, but only now are seen as an important investment. This includes lifting the covers on adverse drug reporting (new vaccines need side-effects to be reported and tracked), who is doing it, who’s not doing it, how can the process be streamlined and what is the key data we need to collect? We have seen improvements to the Australian Immunisation Register, how immunisations are tracked and how patients can access this information to share with others.

ACRRM has been working hard to keep members up to date with the volume of changes that have emerged in the last two years. The introduction of electronic prescriptions for PBS and RPBS medications, MBS funding for telehealth (phone and video) consultations, active ingredient prescribing changing medication names on prescriptions and labels, state rollouts of real-time prescription monitoring for high risk medicines, increased availability of electronic ordering for pathology and diagnostic imaging, improvements to My Health Record in data presentation and vaccination information, and security changes with Services Australia and NASH certificates, are just a few. There will be more to come, with investment in aged care and modernising the pathology sector as examples.

Educating and training the rural generalist and rural general practitioner (GP) workforce to give them digital health knowledge has been recognised by the Australian Medical Council as a key component of medical schools’ and education providers’ curriculums. Digital health has been included and defined as part of the ACRRM Fellowship skill set since the publishing of the foundation curriculum in 1998. To support both training and professional development, the College is building a suite of education and learning opportunities designed to support members to use technology effectively in the care of their patients. This includes services like the Rural Health Outreach Fund Tele-Derm service which provides dermatology diagnosis and treatment advice to upskill rural doctors, minimise referrals and reduce wait times.

Our most recent project is to develop digital health standards and guidelines for digitally connected rural communities. A strength of rural generalists and rural GPs is their connection to a community, and their ability to facilitate the connections within that community.

As Dr Pearce says, ‘The technology plays its part to improve communication and care and these standards are designed to recreate those community connections in a digital environment. The aim is that our Fellows (and interested communities) can be guided towards digital connectivity. Moving to an increased virtual care environment will require standards such as these.’