Syllabus e Health

e-health GPEP Syllabus

www.rnzcgp.org.nz

e-health

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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e-healthwww.rnzcgp.org.nz

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 field 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 finds 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 significant implications for both patients and clinicians. Advances in technology and the development of e-health have many potential benefits 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 National IT Health Board (2010). The National IT Health Plan. Wellington: National IT Health Board.2 http://www.mcnz.org.nz

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e-health

e-health

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-to-face consultations, such as telephone consulting or email

• define 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

• describe to patients, and their family/wha-nau and carers the confidentiality issues around electronic forms of communication, such as texts being read by others, messages left on answer machines

• reflect on personal communication style by using video.

Domain 2: Clinical Expertise


• 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.

Communication Clinical Expertise

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Domain 3: Professionalism


• reflect on using social networking as a doctor and how this can impact on the doctor–patient relationship

• ensure confidentiality 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

• reflect on the boundary issues in doctor–patient relationships when using personal email addresses or phone numbers

• ensure patient records contain sufficient information to describe and support the management of health care provided

• recognise and respect different attitudes to using electronic information among patients, family/wha-nau and carers

• make sure usernames and passwords are kept securely.

Professionalism

Domain 4: Scholarship


• 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.

Scholarship

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e-health

e-health

Domain 5: Context of General Practice


• 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.

Domain 6: Management


• 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.

Context of General Practice

Management

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Learning experiences and assessment

Year 1 Learning experiences Assessment

In practice

Seminar day

Clinical attachments

• Minimum five 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

• Ma-ori providers and aged care: how are electronic forms of communication best used?

In-practice visit from a medical educator

• Direct observation• Record review • Personal reflection

Specialist presentation

Small group learning

• Case-based discussion• Role-play• Video interview• Journal club and discussions• Articles on Ma-ori health inequalities

Registrar presentation of:

• Vignettes on professionalism and electronic communication

• MATCH quizzes• WEBS – research on electronic shared records,

telephone and video consultation

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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e-health

e-health

Year 2 Learning experiences Assessment

In practice

Learning group

Other learning

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’Significant event review

Case-based discussion

Role-playLiterature review and critical appraisal Specialist or guest speaker

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

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

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Year 3+ Learning experiences Assessment

Clinical

Educational

As for Year 2, plus:

Training under vocational scopes – if applicable

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

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

Medical educator visits

Audit

Academic output

Mini CEX

Learning log

Supervisor reports

Multi-source feedback

Previous summative assessments if not completed

Fellowship Assessment

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e-health

e-health

References/resources

e-health is a developing field 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.patientsfirst.org.nz

• New Zealand TelePaediatric Service www.telepaeds.co.nz

• Australian e-health www.ehealth.gov.au

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© The Royal New Zealand College of General Practitioners, New Zealand, 2012

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December 2013

978-1-927240-23-6

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Syllabus e Health