Electronic health records

WEEK 6 and 7
1. Electronic health records and My Health Record

Introduction
A rapidly evolving digital health platform supported by the Australian Digital Health
Strategy has seen emergence of multiple opportunities for digital health innovation. Student
nurses and registered nurses alike must continue to build their knowledge and capabilities
in digital technology to provide person-centred safe care. Contemporary professional
nursing practice demands knowledge of the practice implications of different innovations in
digital health.
In this module your learning experiences will address the following outcomes:
Learning Outcomes:
1. Outline key digital health technologies and the opportunities they create for personcentred care
2. Interact and explore digital health platforms to seek patient data, building capabilities
in digital health navigation
3. Discuss the past, present and future of digital health
4. Summarise the digital health services and requirements, including need, in their local
community.
Electronic health records
The practice of recording health information is not new, and in fact goes back many years: a
point that Evans (2016) establishes: “Translation of ancient Egyptian hieroglyphic
inscriptions and papyri from 1,600-3,000 BC indicate the use of medical records….”
(Paragraph 1). The EHR is continuing to rapidly evolve, stimulated in part by advances that
have accompanied the Covid-19 pandemic. Maintaining understanding of these changes is
one of the salient challenges facing health professionals now and into the future.

This interesting article traces the evolution of the EHR. Although situated in the US, a largely
parallel pathway was followed in Australia. The author poses some insightful issues to
ponder for the future. Have a look at Table 4 and consider the author’s expectations. Are
they realistic?
Evans, R. S. (2016). Electronic health records: then, now and in the future. Yearbook of
Medical Informatics, (Suppl 1) S48-S61, doi: 10.15265/IYS-2016-s006
Separate record systems- a key challenge
Nurses working in partial digital settings (a combination of paper and digital) need to engage
with a variety of processes to provide safe person-centred care. The transition from paper
to electronic records brings challenges.
The average healthcare system will have the following programs to interface with:

·
·
Patient management system (all patient data:name, address, bed movements, alerts)
Pathology
·
·
·
·
Medical Imaging
Charting (combination of paper and electronic)
Reporting situations – such as incidents in care
Scanned medical records
· Journey Boards
Paper copies are often:
·
·
·
·
Progress notes
Observation charts
Risk assessment charts
Medication charts
·
·
·
·
·
Fluid balance charts
Intravenous fluid orders
Plans of care
Resuscitation paperwork and Goals of Care
Referrals

 

·
·
Deterioration charts
Any many more

Different formats between organisations and health services can compound this complexity
further. Digital health including electronic health recording is clearly an evolving field.
My Health Record
My health record as a key outcome of the Australian Digital Health Agency is a particular
type of electronic health record used in Australia.
My Health Record supports individual
control of personal health care information and its access to healthcare providers.
My Health
Record
as a repository for health information, provides a convenient way for individuals to
share current health information, which may include results of diagnostic tests and
medications for example, with healthcare providers. For individuals with chronic conditions
the ability to minimise retelling of story and answering a series of questions creates more
comprehensive and safe care (Australian Digital Health Agency, 2018a).
In Australia the introduction of ‘
My Health Record’ has faced many challenges. The biggest of
these is the accessibility of an individual’s health data and how this data will be used. As a
response, the Australian government has permitted each individual Australian to have the
ability to control their information. After an admission to hospital, attendance at a health
clinic or interaction with a health care professional an entry is made into an electronic
record. The individual determines what information is available to those at another
organisation / facility and which information they wish to keep to themselves. It is worth
noting that Australia is the only country that offers individuals an opportunity to opt-out and
have control over their health information.
My Health Record (2020, September 11) Registered Nurse Rachel Roy on the positive impact
of digital health on patient care.[Video] You Tube https://www.youtube.com/watch?v=USFxKt2UCg
My Health Record is not the only electronic health record in use in Australia. Hospitals, clinics
and other health providers use electronic health records (referred to in the above section)

to record patient data, that may not be accessible to patients in the same way as My Health
Record.
These multiple separate health records and systems are not always able to be
integrated, and therefore a lack of seamless transmission of data from one to the other can
reduce the efficiencies and effectiveness of the electronic system.
My Health Record, as a
National innovation, has wider access, with the patient’s permission, and can be accessed
through Smart phone technology. However, not all details are uploaded into
My Health
Records
and it may be incomplete. Clearly the system is not yet perfect.

DID YOU KNOW?
One of the biggest barriers to the implementation of digital health platforms is cost. The Queensland Government is e
spend $1.2 billion dollars on an electronic medical record system across only 27 public hospitals (Hamilton-Smith, 20

Digital health is changing the way that nurses and health practitioners are providing care.
The increased accessibility to digital health has meant that healthcare providers are moving
away from paper-based files and processes to digital platforms that interface and talk with
My Health Record. The following video presents a good example of digital health in practice.
AuDigitalHealth (2018, April 5) Digital health hits the road with the Awabakal Medical Service
April 5 2018 YouTube Video

DID YOU KNOW?
Australia has made steady progress regarding the implementation of digital health. The My Health Record program ha
capacity and is now integrated with clinical information systems across the healthcare sector. As of May 2021, 22.87 m
Health Records existed and more than 20 m contain data.
By June 2021 there were over 16 million Australian’s with their Immunisation Register uploaded and more than 1.9 m
had their Organ Donor Register Uploaded.
(Australian Digital Health Agency (2021) My Health record:

The My Health Record played an important role in the management of COVID-19 in 2020.
Doctors and nurses were able to see patient pathology results (including COVID-19 swabs),
see what imaging had been undertaken and medications that were ordered and their
dispensing. This meant patients who were unsure or too unwell to communicate were able
to be cared for in their own homes. This minimises risks of cross infection, medication
errors and repeating of tests, some of which often have significant time delays in reporting
(Australian Digital Health Agency, 2020).
By November 2020 the top three documents loaded by individuals themselves were health
summaries, health notes, advanced care directive and custodian reports, with over 339,000
documents loaded. Healthcare providers are also using
My Health Record with over 99% of
pharmacies now registered and 89% using this service. There are 95% of General
Practitioners registered with 85% actively using the service (Australian Digital Health Agency,
2020).
You might wonder how often records are accessed in hospitals from the
My Health Record.
Between November 2019 and November 2020 there were 455,000 documents uploaded
into the system. In the same timeframe there were 452,000 documents accessed and
viewed, an increase of 9% (Australian Digital Health Agency, 2020).
Browse statistics presented in the following website, and study in particular how health
professionals are using the MyHealth Record. What are the implications for nursing
communication?
Australian Digital Health Agency (2021) My Health record: The big picture.
Access your own My Health Record. What information is in there about you? Is there enough
should you be admitted to a hospital and unable to speak? Will the information there
minimise you having medication errors, adverse drug reactions or repeated testing with
delays in treatment while waiting for results? What is your opinion on the usefulness of this
tool?

The following activity is essential for your learning in this unit of study as it
introduces you to the practice applications of My Health Record
Pre reading
Read Chapter 10 from Kozier and Erb’s 2020 5th edition (available as an e book in the CDU
library) that discusses Health Informatics with special focus on ‘The evolution of e-health
reform in Australia’ (from p. 597), including the electronic health record.
Then read the following short summaries:
Australian Digital Health Agency (n.d.) Overview of My Health Record for nurses (note the
statement made by the Australian College of Nursing, p. 2)
Australian Digital Health Agency (n.d.) Overview of My Health Record for community nurses.
E learning course; Using My Health Record in Nursing
To start the training, please click on the link below, read the course aims and then under
‘Learning resources’ click on the link to start the training.
https://training.digitalhealth.gov.au/course/view.php?id=37#section-1
Note: it is best to use Google Chrome for this program. The program is equivalent to 4 hours
of work / Continuing Professional Development.
(Australian Digital Health Agency Online Learning portal 2015-2021
1. Electronic health records and My Health Record
3. M Health
Telehealth
Historically, humans have invented ways of communicating information across distances.
Gogia (2019) recounts strategies such as smoke signals and carrier pigeons from earlier
points in civilisation (OK, we’re going back a long way….). Moving forward, the discovery of
electricity and use of technology to enable communication, from telegraphs and telephones
to computers and internet established the basis for more advanced communication
strategies (Gogia, 2019). Overcoming challenges of distance and access, and more recently
the Cobid-19 pandemic have served as primary stimulus for the development of
telemedicine, although other challenges including security, training and reimbursement

have emerged. (If you are interested in the history of telemedicine Gogia’s work is available
in the CDU library as an online text)
Telehealth is an innovation that enables patient care to be provided through a video or
telephone instead of face-to-face. Telehealth draws on telecommunications to provide care
such as clinical advice, consultation, education and training. Telehealth can be used in many
ways. It can be used to create frequent remote monitoring of a patient, to store and forward
images or information from one healthcare provider to another and as means to facilitate a
consultation between a patient and one or more healthcare professionals using audio or
video.
The following explanation of telehealth has been taken directly from the Australian Digital
Health Agency website:

“Telehealth consultations provide patients with a consultation through video or telephone inste
uses the transmission of images, voice and data between two or more sites using telecommunic
health services, such as clinical advice, consultation, education, and training services. There are
telehealth can be used:
Most practices in Australia tend to now use telehealth in consultations, particularly since the sta
pandemic. ”
(Australian Digital Health Agency, 2

1. Remote patient monitoring – monitoring patient health and clinical information at a dist
2. Store-and-forward – transmission of images or information from one healthcare provide
3. Consultations – connection between a patient and one or more healthcare providers thro
video-enabled device.
The following short video explains the meaning of telehealth.
Australian Digital Health Agency (2021, January 13). Telehealth.
What is Telehealth? [Video]
YouTube
https://www.digitalhealth.gov.au/healthcare-providers/initiatives-andprograms/telehealth.
https://www.youtube.com/watch?v=3TCIIqwJkPI&feature=youtu.be
Telehealth is not new; it has been around for many years. However, the worldwide
pandemic of COVID-19 meant that healthcare providers needed to adapt quickly in order to
ensure ongoing care to individuals. Those that relied heavily on face-to-face embraced
telehealth and consumers of healthcare benefited as a result. Telehealth means that those
with a healthcare need, living in both rural and remote areas as well as major towns and
cities, can access healthcare without having to travel. The benefits of telehealth are
considerable. Key benefits include removal of opportunities for cross infection, a reduced
cost associated with travel, higher patient reach due to lack of need to travel, reduced ‘noshows’ and real-time assistance with difficult cases and emergencies, opportunities to work
remotely.
Telehealth example
Aboriginal and Torres Strait Islander people experience dementia at a rate of three-to-five
times higher than the non-indigenous population. The DREAMT project is a telehealth
service for Indigenous peoples living in rural and remote Queensland.
UQ Faculty of Medicine (2018, March 8) DREAMT: Using telehealth to support Indigenous
people with dementia. [Vis deo} You
Tube.https://www.youtube.com/watch?v=SrGaBhoLWEY
Reflection activity:
Reflect upon the above video story demonstrating the use of telehealth to provide a
diagnosis and implement care using specialists. The ability to engage in this form of digital
health technology creates better access to healthcare in the community of the person.
Independent Research Activity:
Conduct independent research to identify how digital health is used in your local health
services to support chronic health care.
Telehealth and the use of digital technology has changed healthcare in many ways. It moves
healthcare from a situation where individuals health is compromised to one of access and
better health outcomes.
peter robey (2014, September 3) CSIRO Telehealth: Saving the eyesight of indigenous
Australians [Video] YouTube
Telehealth does not just benefit individuals who live in rural and remote areas of Australia.
Telehealth can be beneficial for individuals that live locally. Telehealth offers an opportunity
to relieve the symptoms that arise from tedious and intense visits to specialists.
The Women’s (2019, September 12) Noelene’s telehealth experience.[Video] You Tube

The Women’s (2019, September 12) Staff at ‘The women’s’ describe the telehealth
service..[Video] You Tube

Digital health creates opportunities to improve patient outcomes. The area of chronic
disease management is a key health priority of the Australian government and health care
professions. Use of digital health creates opportunities to provide support to individuals
with chronic disease and their carers. The use of telemedicine is not just for chronic disease
management or ongoing care. Telemedicine is having an increased place in the management
of acute situations in which specialist knowledge and expertise is needed. As a registered
nurse it is important to be able to connect the strategic priorities of Australia’s digital health
strategy to the actions taken on a day-to-day basis.
The following recent article discusses the recent rapid development of telehealth in
response to Covid-19 in the USA. Table 1 Classification of Telehealth Encounters has great
practical application as it lists the main uses of telehealth in patient care, and their
advantages and limitations. A comprehensive discussion on the use of telehealth during
three phases: outpatient care during stay at home orders; inpatient care; and post pandemic
recovery suggests practice applications that are likely to be sustained.
Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., Curtis, S., Roman, M., Poon,
E. G., Ferranti, J., Katz, J. N., & Tcheng, J. (2020). Telehealth Transformation: COVID-19 and
the rise of Virtual Care. J Am Med Inform A
ssoc, 27(6), 957-962.
https://doi.org/10.1093/jamia/ocaa067
Finally, the following video offers a similar level of emphasis on telehealth during the
pandemic.
The next video shares how telehealth has changed since 2020 out of necessity
AuDigital Health (2020, November 17).Digital Bytes with Dr Phil Britton- Telehealth.[Video]
You Tube
https://www.youtube.com/watch?v=EgdUnwmxrxA&feature=youtu.be
2. Telehealth
Conclusion

Mobile Health
The popularity of mobile health technology has also climbed over the past ten years, and of
course more recently in relation to the Covid-19 pandemic. Owing to the worldwide uptake
of mobile phones, M-Health has great potential to influence global health:

“The use of mobile and wireless technologies to support the achievement of health objectives (m
potential to transform the face of health service delivery across the globe. A powerful combinati
driving this change. These include rapid advances in mobile technologies and applications, a rise
opportunities for the integration of mobile health into existing eHealth services, and the continu

 

coverage of mobile cellular networks. According to the International Telecommunication Union
over 5 billion wireless subscribers; over 70% of them reside in low- and middle income countri
Association reports commercial wireless signals cover over 85% of the world’s population, exte
reach of the electrical grid. ” (World Health Organization, 2011, p. 1)

What is M Health?
Before you proceed with your study of this topic, be sure you understand the nature and
scope of M Health.
The following YouTube video presents a solid explanation:
NIHOD (Octcober 22 2017) mHealth evidence. [YouTube video]

The application of mobile health to practice is demonstrated in the following presentation.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2018, November
20) Using mobile health tools [Video] You Tube
https://www.youtube.com/watch?v=YPfIxN7XDDY

As emphasised in the opening quotation from the WHO, ‘M health: New horizons for health
through mobile technologies’ M-health has enormous capacity for advancing global health
(Refer back to the preceding module). The following comprehensive reading should be
studied closely. The nature of MHealth, its applications, challenges, benefits and possibilities
are explained in detail in this comprehensive paper. A case study analysis is a valuable
addition to this learning resource.
Latif, S., Rana, R., Qadir, J., Ali, A., Imran, M. A., & Younis, M. S. (2017). Mobile Health in the
Developing World: Review of Literature and Lessons From a Case Study. IEEE access, 5,
11540-11556. https://doi.org/10.1109/ACCESS.2017.2710800
In the following interview, Dr Gary Clifford details a project using mHealth in a developing
context. This is a powerful example of the practical application of this innovation. Note the
actions taken to develop collaborative networks, decision support and culturally acceptable
practice.
Health Informatics (July 11, 2018). mHealth in the third world Gary Clifford interview
[YouTube Video]

Note: if the video does not load then paste the URL into your browser
How can M health be used to support networking in nursing an a culturally acceptable way?
Post to the
Module Discussion Area.
Electronic Prescribing
Digital platforms, including m Health, are creating a movement away from paper or faxed
prescriptions. An electronic prescription is a digital version of a paper prescription. These

are sent to individuals either via SMS or email. This process will allow easier access for
individuals and minimises the risk of the loss of a prescription. Those individuals that have
multiple prescriptions will be able to have their pharmacy set up a list. Then when the
doctor re-issues a prescription this will be added to the list that can be presented to a
pharmacy. A pharmacy can also manage the list, and this allows individuals to phone ahead
to organise dispense of their medications.
The need for safe and secure connections between healthcare providers is essential. Secure
messaging allows interoperability and safe, seamless, secure and confidential sharing of
information across all healthcare providers. Secure messaging allows the sharing of
documents and information between providers of care sent either directly or through more
secure providers.
Secure messaging
Secure messaging allows a referral to be written and sent during a consultation. The
information is then able to be triaged by the recipient and the healthcare consumer is not
trying to secure an appointment while the referral is delayed, adding frustration and delays
in care. Secure messaging is not the same as email it has added security, auditability and
privacy requirements. Secure messaging also has the ability to integrate with other
healthcare systems and create automation of some administrative tasks.
3. M Health
In this Module you have explored three relevant and interesting areas of digital health, that
have direct relevance to nursing practice: Electronic health records and My Health record,
telehealth, and M health. These technologies are developing rapidly. It is essential therefore
that you maintain awareness and continue to learn about new technologies and their
implications for your work.
References
Evans, R. S. (2016). Electronic health records: then, now and in the future. Yearbook
of Medical Informatics, (Suppl 1) S48-S61, doi: 10.15265/IYS-2016-s006
Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., Curtis, S., Roman,
M., Poon, E. G., Ferranti, J., Katz, J. N., & Tcheng, J. (2020). Telehealth Transformation:
COVID-19 and the rise of Virtual Care. J Am Med Inform Assoc, 27(6), 957-
962.https://doi.org/10.1093/jamia/ocaa067