AAPM The Practice Manager Issue 4 2018

2018 – Issue 4 | aapm.org.au

IN THIS ISSUE 15

Families, Children and My Health Record – Changes in Technology

18

Cultural Competence and Your Organisation

22

Moments of Magic – AAPM National Conference In Canberra

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Contents Your Association – AAPM Board

1

A Message from the President

2

From the CEO’s Desk

2

New AAPM Board Members and Bios

3

Driven by data?

4

The Top 10 Tips to Become a Networking Whizz

6

Will NBN Finally “Axe the Fax”?

9

Patient-Centric Practice Organisations

11

Managing Access to Online Services to Support Digital Health

12

Families, Children and My Health Record – Some Issues to Consider

15

Cultural Competence and Your Organisation

18

2018 AAPM National Conference – a Review in Pictures

22

Australian Dental Care Report

26

Fellowship Case Study – Awa: The People of the Jungle

22

Impact of the New EU Global Data Protection Regulation

30

International Review puts Australia ahead in Personal Control of Electronic Health Records

32

Your Association AAPM Board President

Secretary

Cathy Baynie

Fiona Wong

Vice-President

Treasurer

David Osman

Jackie Beer

Non-Executive Directors James Downing Jon Erwin Richard Evans Danny Haydon David Oberklaid

CONTACTS NATIONAL OFFICE Level 1, 60 Lothian Street, North Melbourne, VIC 3051 P 1800 196 000 F (03) 9329 2524 E nationaloffice@aapm.org.au VISIT THE AAPM WEBSITE www.aapm.org.au facebook.com/AAPMAustralia @AAPM_National linkedin.com/company/aapm

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@aapm1979 No part of this publication may be reproduced, copied or duplicated without the written consent of AAPM.

The content of articles and advertisements contained in the Practice Manager Journal solely reflect the personal opinions of the authors or contributors and does not necessarily represent the official position of AAPM.

Thank you to our National Partners

www.aapm.org.au | 1

FOREWORD

A message from the President Conference Week

Cathy Baynie National President

For those lucky enough to join us in Canberra for the AAPM National conference week it was, as usual, jam packed with learnings, take home strategies and new friendships.

The opportunity to hear from subject matter experts is rivalled only by the chance to network with our peers, to learn of their journeys and to better understand our own daily challenges. This serves to increase our own depth of understanding and knowledge of the Primary Health industry.

For me, this year, one particular highlight was the inaugural Special Interest Group Breakfasts. Over 80 of us gathered before the conference was even officially opened to share our stories, experiences and skills and to meet with other Practice Managers from our own craft groups. The room was buzzing with conversation and laughter – an amazing start.

While this is how the conference began for me, it ended on another high note. The Gala Dinner is where we get the opportunity to formally recognise and congratulate

FOREWORD

Nicholas Voudouris CEO

Many thanks to the National Conference Committee, CEO Nicholas Voudouris and National Office Staff for all the hard work that makes the conference such a success.

Thanks also to Fiona Kolokas and the NSW/ACT committee for hosting us so warmly in Canberra.

There will be many opportunities offered by AAPM for education and networking in the next twelve months until we gather again in Brisbane in 2019.

Cathy Baynie National President

From the CEO’s desk The excitement of this year’s conference has barely subsided and the AAPM staff team is already working flat out reviewing, revising and creating as we advance our program of reform and renewal. Three new staff members have recently joined our team; Neil Street (Marketing and Communications), Miranda Grace (Partnerships and Engagement) and Andrea HarrisPoddi (Executive Support) and they are already contributing new ideas and skills to our work. More about the changes ahead will follow in future AAPM communications, so stay tuned.

AAPM is in demand, receiving requests for engagement and consultation from government, PHNs and a range of other organisations, and is ramping up its external engagement and advocacy on a number of fronts.

These include the Workforce Incentive Program, Digital Heath Strategy and Medicare. To meet the increasing demand for engagement, we rely on our ambassadors.

We will soon be calling for expressions of interest from members who would like to contribute to AAPM’s

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the awesome practice managers who proudly represent each state as 2018 Practice Manager of the Year. Whilst all are extremely deserving, only one recipient can bear this title. Congratulations to Darcy Inglis from QLD who was this year’s recipient.

work by becoming an AAPM ambassador – please keep an eye out for the call and consider submitting an expression of interest.

Significant reform continues across the health sector, and through our member communication channels we aim to keep members informed of changes as they emerge. We are currently reviewing our approach to member communications and would like to hear from you regarding which digital platforms you prefer.

Next year is AAPM’s 40th anniversary and we are seeking photographs, videos and written material from AAPM’s early years, especially the 1980s, to draw on when putting together celebrations for our 2019 National Conference in Brisbane. If you can assist us by contributing materials to the archive, please get in touch.

Nicholas Voudouris CEO

New AAPM board members Dr David Oberklaid MBBS, Grad Dip Health Ed. David Oberklaid has worked for over 35 years in general practice, and has also been heavily involved in a broad range of clinical, administrative and educational roles.

David Oberklaid MBBS, Grad Dip Health Ed. Non-Executive Director

Currently working as a Medical Adviser to Link Community Health General Practice. David teaches general practice to 4th year medical students and is an AGPAL surveyor. As an AGPAL surveyor, he has conducted over 750 survey visits throughout Australia and has visited a range of very diverse practices from solo general to very large corporate practices.

David has worked in a variety of general practice settings. He first set up his own practice in 1979 and subsequently worked as Head of Staff Health Service at Royal Melbourne Hospital. He worked as a GP and was part owner of a large multi-disciplinary practice in inner Melbourne from 2000 until 2017.

David was a past Chair of the Preventive and Community Medicine Committee, Royal Australian College of General Practitioners (RACGP) (Victoria Faculty). He recently became a Life Member of the RACGP. As a Member of the Board of the Melbourne Division of General Practice from 1993 to 2004 he also assumed responsibility as Deputy Chair of the Division from 2000-2004. David has previously been on the Medical Advisory Committee and the Board of Foundation 49 - a not-for-profit Men’s Health Promotion Initiative, which was established by Cabrini Hospital and is now run through the Baker Heart and Diabetes Institute.

David’s interests include quality issues in general practice and how the organisation of health care impacts on the delivery of health services, and he understands the critical role practice managers play in general practice.

Jon Erwin B. Bus, MBA Jon Erwin is currently the Business Manager at Prospect Medical Centre in Launceston, Tasmania having joined the practice in early 2014.

Jon holds a Masters of Business and Bachelor of Business from Charles Sturt University and has worked in a range of private and public sector organisations.

Jon Erwin B. Bus, MBA Non-Executive director

Originally from Sydney, Jon moved to Tasmania in 1995.

He has experience in a diverse range of industries which include service, entertainment, construction and agricultural before joining the health industry in his current role.

he has worked with. He has also undertaken on small business advisory roles to assist businesses in regional Tasmania under the auspices of the Federal Government’s Small Business Answers program.

This has also provided a good insight into a range of challenges that impact businesses and the diverse solutions owners employ to meet these challenges.

Jon has a strong community involvement through his association with the Launceston PCYC (Police & Community Youth Club) where he is President.

Through his tertiary studies and industry experience, Jon has been successful in bringing an approach of systems management and innovation to organisations

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Driven by data?

T

he mention of the word “data� in the hearing of Practice Managers seems to generate two very different responses. Some Practice Managers quickly embrace despair at the thought of incentive payments in general practice being linked to benchmarked data. Their emotions having been stirred they then recount the challenges they have with the usefulness of PHN information, their frustration at doctors who each enter information in different ways and their lack of time to run reports or analyse data. They then proceed to talk of fears of being sucked into roles where the mainstay of their existence is ticking boxes and reporting on data. The potential to forget the real needs and experiences of patients is uppermost in their minds.

The second reception is entirely different but no less informed by the realities of working in practices. In this scenario, Practice Managers talk about the shortfalls of practice systems and cultures to generate meaningful data. They then talk in animated fashion about the range of spreadsheets they have to generate data and the personalities most in love with using data in their practice. This quickly leads into how data does not always pave the way for easy decisions. It opens debate and even power struggles around who can access data, what the data says, risks and how the practice should respond.

Healthcare is big business. It should be underpinned by science and data is part of a scientific approach. It is increasingly monitored by huge funders scared at the rate of growth in expenditure. It is amazing that the role of data in practice management has not reached maturity in Australia. That is why travel to other parts of the world to monitor what they are doing with data is always so interesting‌and a good way to mitigate risks in our changing health landscape.

In August and September I travelled to the UK. It was three years since my last visit. This time I returned to a couple of practices as well as visited some new sites. What was remarkable was that in just three years the use of data in the UK has undergone significant extension. This was despite a number of very public challenges in the data space.

In 2015 the NHS fumbled and backtracked on allowing pharmaceutical companies access to big data. Austerity measures have triggered criticism

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of pay for performance which is often equated to pay for reported delivery.

Earlier in 2018, a number of hospitals were hacked. Of course in 2018 simply getting access to a GP remains a challenge in the UK. Therefore, reporting is heavily focussed on achievements in removing the access block evident across the country. Australian cities and larger centres do not have this same challenge, not surprising given the 20 percent growth in registered doctors over the last five years.

So what can we learn from the NHS experience?

Clinical Commissioning Groups (CCGs) are localised PHN equivalents in the NHS landscape. They typically oversee activity across 30-50 practices providing for rich analysis on needs at a local level. Based on increasing local knowledge, GP Federations are a parallel development and becoming ascendant. These coalitions of GP practices are becoming involved in bidding for NHS contracts. They are successfully bringing care out of hospitals and into the community. Participation is entirely voluntary.

Their creation was an organic response to drives by the NHS to fund integrated care. Picking up delivery under the recent PACs and Vanguard initiatives gave GPs a real seat at the table in many regions. The creation of GP Federations has enabled wider participation in negotiations, hiring of shared resources which are deployed across multiple practices and a mechanism for distributing shared savings.

On the ground many Federations have become actively engaged in localised benchmarking. CCGs play a role in providing data to demonstrate change in clinical outcomes, patient experience and provider satisfaction. Sometimes, they act as a fund holder; distributing incentives for improved achievement to sub-clusters within the CCG or GP Federation.

Such efforts have led to rapid expansion of the work of groups like the Clinical Effectiveness Group (CEG) at Barts and the London hospital.

CEG is led by GP academics and produces an array of benchmark data across many CCGs and thousands of practices. This data is presented at individual practice and clinician level, providing for fine tuning of models of care, clinical protocols and prioritisation of ongoing quality improvement efforts. Occasional papers produced by the CEG provide topical guidance to GPs on evidence based medicine and best practice care.

Hospitals have long appreciated the role of health informaticians. Accurate coding of data to funders results in more appropriate payments. In the NHS data on hospital performance is publically available by hospital, providing further incentive to manage ongoing quality improvement efforts.

GP Federations and CCGs have embraced data experts so that they can bid for contracts, influence where NHS funding is spent, negotiate incentives and share resources where need is greatest. Some GP practices have taken the idea of federating and data management to the next level. Modality, a GP practice group originating in Birmingham, now has over 400,000 patients in care across numerous regions of England. 130 partners (nearly entirely GPs) have merged their practices and participate in Divisional Boards with area and clinical specific mandates. These Boards in turn report to a national Board of eight rotating members.

Their expansion and ability to use data to inform their care means they are now advocating to become an Accountable Care Organisation. Theirs would be the first in the UK. They propose to hold funds and manage risks and rewards for the total care of all their patient population. Their GPs with special interests run outpatient replacement activity across dermatology, pain, gynaecology, ophthalmology and cardiology with more areas of specialisation soon to come on board. Their growth was spurred in the Vanguard era when the NHS funded GP and hospital partnerships in some pilot regions. Their success with that model has fuelled increasing confidence and ability to use data to drive change and negotiate deals.

The Productivity Commission Report of late 2017 recommended that three percent of all hospital funding be allocated to new pools of funds for integrated care. If implemented, that would mean primary care and new specialist models could arise. Where integrated care has been piloted in Australia data sharing, common records or at least access to patient records across primary and secondary care have been central. That means the quality of our data and ability to use it to identify needs and manage innovation becomes paramount.

So whilst changes to practice incentives will arrive early next year and we need to prepare for that, my advice is focus on an even bigger picture.

Your practice data will become an increasingly valuable resource and

constant source of reference in years to come. PHNs are already equipped to support practices interrogate data. Some PHNs like WentWest are charging ahead with production of linked datasets which identify patients presenting to hospital back to their home GP practice. Such initiatives will become mainstream within years. Those practices most able to use data to improve health outcomes for their patients stand to gain the most. If you see anything outside of financial data as someone else’s remit, my time in England should be seen as a clarion call. Practice Managers need to anticipate change in our healthcare environment to a data driven system where practices making use of data stand to win.

Clearly, this will necessitate changes to the systems available to support practices. Bolt-ons which sit outside of usual workflows, which to not reconcile back to source data or integrate across clinical and management systems are yesterday’s approach. Wait for the emergence of new solutions which make benchmarking within and between practices a real possibility.

They will provide insights into financial performance, rostering adequacy, diary management, clinical processes and even be capable of tracking segments of the patient population. We have been deploying such systems internally over the last five years and keep learning new ways to work with data. So in summary, the change has already arrived in the UK, the benefits have just not been equally distributed yet. Australia we are next.

Tracey Johnson, Chief Executive Officer Inala Primary Care – Excellence in General Practice

www.aapm.org.au | 5

The Top 10 Tips to Become a Networking Whizz

G

rowing a strong practice management network has many benefits – including some hidden gains for you.

In today’s busy professional life, it can be a push to attend networking events, especially when they are after hours or in a location that’s out of the way. But without a strong network – a strong support system – practice managers can struggle to remain compliant. And that’s at the most basic level. So, consider networking as an essential part of your career as a practice manager. And to help you become a networking whizz, read our top 10 tips.

1. Be prepared That’s not just for the scouts! It’s for you, before you attend a networking event. To get the most out of your time there, think about your aims.

Perhaps you’d like to find a mentor, or a new job. Or if you just have questions, make sure you write them down. In fact, take a list of five questions with you that you can use to spark conversation.

2. Be professional but approachable At any practice management networking events, always be professional, but approachable. People will warm to you if you’re friendly and open. You’ll be in the company of practice managers with a wide range of experience, so you want people to enjoy your company and feel comfortable about talking with you. You could use one of your five questions to get the conversation rolling.

3. Share ideas Other people have different points of view. They can offer you a unique perspective on the industry. When a group of practice managers get together, their depth of knowledge and experience can be remarkable.

Make the most of the time you have. Ask questions, Give feedback. Share experiences, and best practices. And make sure you have your notebook at the ready so you don’t miss any gems of wisdom.

4. Raise your profile When your peers see you at events, they’ll know that you’re serious about your profession – maybe even a good choice for them if you’re considering your career prospects. There could also be the possibility of joint ventures or even partnerships. Whatever the outcome, your profile will be in front of a powerful network.

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5. Promote Using your professional network to promote a new product/service or move your career forward is a smart way to go. Word of mouth has always been considered the best form of advertising, and your network may have many contacts you can use for promotion, make sure you are sensitive to any conflicts of interest when promoting.

6. Increase your credibility As you attend more professional networking events, so your support, credibility and reputation grow. You may become sought after for your unique perspective and knowledge. Make sure you share these with those in your network who could benefit. Giving helpful advice to a colleague can go a long way to increase your profile. So, it’s a win for you, a win for your colleague and a win for your network.

7. Improve self esteem Making new friends and developing relationships is important for us as human beings and it increases our confidence and raises our self-esteem.

Networking is a great way to grow personally, because we’re challenged by new people, new ideas, and experiences that take us outside our comfort zone. The more confident you are, the more people are drawn to you.

Networking is great for personal development. So, network, network and network some more.

8. Speak out Often networking events feature speakers who have something of value that you can use. Speaking to your networking group is a great way to share your unique knowledge. It might just be for a few minutes. We’re not talking keynote speaking here – unless that’s your thing. It will also earn you the respect of others in the group. And it may encourage others to do the same. It’s all part of personal development. When someone else is speaking, listen to every word. Don’t interrupt them with questions. If you want to know something, write it down and ask them later.

9. Join online groups Join and participate in some online networking groups that have been set up by professional organisations in the practice management field. You’ll get to meet new friends and introduce yourself – it’s convenient and costeffective! And if you’re looking at your next healthcare career move, use Linked In, or start some conversations on Facebook or Twitter. And who knows? You might meet some of your contacts at your next professional networking event.

10. Observe etiquette - and more When you attend networking events, how you behave, and present yourself, is all part of networking etiquette. Buckle up and read on…

• It’s not all about you. An event is for everyone. Don’t just be a taker. Think about what you can offer to others.

• Remember details about the people you meet. Collect their business cards and note something interesting about them on the back of the card. These notes can be great conversation openers when you meet next time.

• If you’re in a social media networking group, be very mindful of what you post.

• Ask questions. Then listen. Don’t talk over the top of someone or be thinking of what you want to say. Listening is an art. Give the person your undivided attention.

• Don’t monopolise someone. Move around. Circulation gives you the chance to meet a range of people and for them to engage with you. If you want more time with someone, arrange to follow up after the event.

• Build relationships with consultants and allied health professionals. This way you’ll have access to perspectives that could help to improve the care you deliver. And it could also be invaluable from a career perspective.

• Having a mentor can help newbies tremendously. If you have a mentor, soak up all their help and knowledge they share like a sponge. What they offer is invaluable so be appreciative. One day, you could be a mentor to someone.

• Always have your business cards at the ready. They are the perfect way to provide your contact information quickly.

• Remember that you only have one chance to make a first impression. So, make that first impression unforgettable. Smile, shake hands, and let the person know you’re delighted to meet them.

• Have your ‘elevator pitch’ down pat. Make it short, sharp, sweet and memorable – and no more than 30 seconds. No one wants to hear War and Peace. Practice it until you have it word perfect. Then when someone asks, “What do you do?” you won’t be struggling to answer.

• And lastly, try to attend a networking event at least once a month.

Practice makes a big improvement.

So now that you have all the lowdown on how to become a networking whizz, it’s time to enjoy some events.

Sheyda Kazemi, Networking, AAPM

www.aapm.org.au | 7

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Will NBN

finally “axe the fax”?

T

he ubiquitous fax machine in Australian healthcare practices may finally be pushed to the palliative End-of Life (EOL) stage with the increasing disconnection of copper public switched telephone network (PSTN) lines and migration to the NBN IP network.

Fax is an old copper based analogue technology while NBN is fibre based digital technology, and the old and the new do not co-exist. A fax machine cannot plug into the NBN IP line without the use of a ‘translation’ gateway device which uses the T.38 protocol, an International Telecommunications Union (ITU) standard for fax relay over modern IP networks. These “translation” gateway devices are called either an Analogue Telephone Adapter (ATA), or an Integrated Access Device (IAD). ATAs can be tricky to setup especially over a multi-site Wide Area Network (WAN).

While ATA/IADs are inexpensive and do work generally, in the experience of many healthcare practices faxing over NBN via ATA is problematic.

A number of practice managers have told me that the consistency and reliability of fax transmissions using an ATA/IAD over NBN is only approx. 70-80%, with random incoming and outgoing fax transmissions going missing into “outer space”. Clearly not good enough for medical communications.

the migration of any impacted business services or devices, including EFTPOS, fax machines and health claim terminals. It’s important you talk with your phone and internet service provider and any device providers to discuss moving these devices onto your new plan on the nbn™ access network.”

Though most healthcare providers in Australia still rely on fax, calls to “axe the fax” and move to secure messaging are not new. Some GPs are refusing to use faxes for patient information. At the recent AAPM 2018 Conference, former RACGP eHealth chair Dr Nathan Pinskier said that “faxes are well past their use by date”. A recent report in Pulse IT news posed the question, “Do we need to take a local axe to the fax?” citing a RACGP position paper released in October 2017 calling for the moving away from paper based communications, and that, “The adoption of secure electronic communications should be a priority for the entire healthcare sector to ensure improved efficiencies and provision of safe quality care.”

A recent RACGP newsGP article highlighted the urgent need to replace faxes with interoperable secure messaging systems for healthcare, citing a Victorian Coroner’s report into the “death of Mettaloka Halwala, a cancer patient whose crucial medical test results were faxed to the wrong number.”

An alternative to an ATA gateway based workaround is to port the fax number to an online faxing service, (google ‘online faxing Australia’). Be warned however, shop around, the online faxing services charge on a per page basis. A busy GP practice owner was charged more than $600.00 for one month of online faxing recently upon being forced to use an online faxing provider when the major Australian telco disconnected the fax line without warning five weeks before the scheduled date (this practice owner first tried the ATA gateway but was not happy with the reliability).

Coroner Rosemary Carlin comments regarding the continuing use of faxes in healthcare are clear and unequivocal;

NBN Co’s Talia Spink recommends that, “…businesses yet to switch [to NBN] to contact their preferred phone and internet service provider well in advance of the switch-off date to ensure you allow plenty of time to manage

It’s time to “axe the fax” in your practice and go with two-way secure messaging.

“…faxes are still very commonly used in the medical profession. It is difficult to understand why such an antiquated and unreliable means of communication persists at all in the medical profession. Without presuming to anticipate every scenario, it seems to me that it should be phased out as a means of communicating test results as a matter of priority.”

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AAPM NATIONAL CONFERENCE

WAVES OF CHANGE

01 - 04 OCTOBER 2019 Brisbane Convention and Exhibition Centre Queensland Join us as we celebrate AAPM’s 40th Anniversary at the 2019 AAPM National Conference, Join us as we celebrate AAPM’s 40th Anniversary at the 2019 AAPM Early Bird Registrations will be opening early 2019 and this year a Full with our theme “Waves of Change”.

National Conference, with our theme “Waves of Change”.

Conference Registration includes: • All Plenary Sessions Held in Brisbane, exciting will• be of our 2019 calendar Held in Brisbane, this exciting this conference will be theconference highlight of our Your the Choicehighlight of Concurrent Sessions 2019 calendar providing a range of guest speakers, workshop based • Welcome Drinks providing a range of guest speakers, workshop based education and great networking education and great networking events. Make sure you diarise the • Happy Hour Drinks events. dates today! Make sure you diarise the dates today!

• Your ticket to the Gala Dinner! Plus more...

Early Bird Registrations will be opening early 2019 and this year a Full Conference Registration includes:

To keep up to date on the latest conference information go to www.aapmconference.com.au and follow us on #aapmnational @aapm1979

◊ ◊ ◊ ◊ ◊

All Plenary Sessions Your choice of concurrent sessions Welcome Drinks Happy Hour Drinks Your ticket to the Gala Dinner! plus more . .

AAPM welcomes our members to The Practice Space

By now, our members and e-newsletter subscribers have seen the To keep up to date on the latest conference information go to design and format changes to our regular e-newsletter – The Practice www.aapmconference.com.au and follow us on #aapmnational Space (formerly AAPM News).

The AAPM National office is committed to sharing with you the latest in relevant and current industry news and information to help you stay on top of an ever-changing health sector.

The Practice Space will include key articles along with regular updates including: • Upcoming webinar information • Networking events • Partner news • New members welcome • Career opportunities.

@aapm1979 Are you missing out on Government incentives?

Your practice can earn up to $4000 per employee through the Australian Apprenticeship Incentives Programme* Ask us how

Have an enjoyable and safe holiday season – see you next year!

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Patient-Centric Practice Organisations -

The Need For Patient Centricity And The Price Of Failure

D

espite their best intentions, many healthcare practices who are often medical ‘outcome-specific’ have been unable to successfully transform themselves into a truly patient-centric enterprise. Research on successful and unsuccessful organizations highlight what is among the greatest challenges facing attempts to become client centric – sometimes called “inherent conflict.”

On one side, they attempt to retain their patient outcome centricity and practice growth mindset. On the other, they think they are simultaneously trying to transform themselves into a patient-centric organization. The two strategies highlight the inherent conflict between them. A ‘one-off’ patient outcome is all about providing the same thing to all patients. Customer (or, in our case, patient) centricity is about providing more of customized value to the experience we strive to deliver.

The failure to adopt patient centric business models comes with a steep cost. In a world where patients demand individualized treatment and empowerment, practices that continue operating under an outcomespecific centric business model and treating patients through a one-sizefits-all prism will suffer a number of adverse consequences: 1. Wasted resources – Treating patients through a one-size-fits-all model leads practices to unnecessarily waste valuable resources. Even a wellestablished and successful practice will frequently fall into the trap of treating both short and long-term patients identically and do not allocate or prioritize limited resources according to customer value. As a result, the best talent and most expensive channels are sometimes allocated to patients who are often short-term, while junior/less experienced talent is unintentionally allocated to or extensively used by long-term (loyal, engaged) patients. This scenario, so common among many organizations, has a debilitating affect on the loyalty of engaged patients and the ultimate return-rate of “lower-end” patients.

2. Resources Misalignment – Under an outcome-specific centric practice model, practice personnel pursue instructions and respond to patient requests in a disjointed fashion. Closely related to the aforementioned “wasting resources” example, healthcare practices will often fulfil countless requests for alignment meetings and escalations to satisfy their patients, irrespective of ultimate patient value. Instead of pursuing additional business and concentrating on dedicated, long-term patients, they sometimes treat all patients similarly and consequently, fail to retain the current volume of business and generate new business from new and existing patients. Aside from the effect on patient loyalty, this may well lead to reduced employee productivity and morale.

3. Disappointed patients – As patients increasingly seek personalized experiences, they will ultimately reject a one-size-fits-all value proposition, even though this may well be in line with traditional medical practice. This disappointment will not be relegated to patient satisfaction metrics in surveys but will manifest itself through decreases in the size and frequency of practice visits, higher attrition, and increased negative word of mouth.

4. Unproductive working environment – The lack of coordination between patient-facing and non-patient facing business functions often results in practices constantly operating in “crisis mode” characterized by chaotic, frenzied and jaded environments adversely affecting patients and practice employees alike. This chaos not only wastes limited resources but demoralizes employees who are trying to perform their jobs effectively and help patients. Moreover, chaotic work environments impede an organizations’ ability to innovate the patient experience and provide value to patients during each interaction.

5. Decreased loyalty – One-size-fits-all treatment (again, being well aware of medical standards) of patients ultimately fulfils the needs of only a small portion of patients. Many practices fail to recognize that there is no such thing as an “average” patient. Each client is different and has unique needs that need to be addressed or else they will seek a competitive alternative that better fulfils their needs. However, rather than focusing on the impact to client loyalty, ALL practice associates are often encouraged to focus on cost reduction initiatives and process redesign programs – issues rarely of concern to the patient group When these associates finally recognize that they are not delivering the right value to patents/clients, they discover that improperly designed cost reduction initiatives and one-size-fits-all processes come at a steep price – patient return rates and loyalty.

Neil Street Marketing & Communications AAPM

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Managing access to online services to support digital health I

n any practice, access to Department of Human Services (DHS) online services is really useful for healthcare providers and practice managers.

Whether it is to manage provider numbers, PBS Authority prescriptions or practice incentive payments, the ability to undertake tasks in a secure online environment will help to save time and increase efficiency.

In this article we will look at some recent changes that will impact the way your practice interacts with digital services such as certificate management, Healthcare Identifiers and My Health Record.

Access to services provided by agencies such as DHS, Medicare, the Healthcare Identifiers Service and My Health Record is managed through the Provider Digital Access (PRODA) portal which requires users to go through a registration process to verify their identity.

Why verification of identity is important Generally speaking, in healthcare we take the identity patients present to us at face value. We may ask to see a Medicare card, yet it is rare that any photographic or other proof of identity is requested from our patients. We trust they are who they say they are.

Identity verification in other aspects of our lives is becoming more and more critical to reduce the risk of fraud and it requires us to go through a process to prove we are who we are. If we think back, 100 points identity checks have been in place for many years for services such as banking and applying for a passport.

The need to ensure we carefully establish the identity of the people we are working with, and ensure they are qualified to work in the role they are fulfilling within the practice, is not new. Apart from anything else, we routinely check registration and qualifications, then continue to ensure registrations are kept up-to-date.

So it should come as no surprise that in healthcare we are more frequently being asked to prove our identity to access services.

In these times of increasing use of online services, both at work and in our personal lives, opportunities to improve access and ensure the identity of the person requiring access to services, needs to be regularly reviewed and updated. Part of this process is to ensure appropriate levels of identity verification – that is making certain the person accessing a service is who they say they are – whether that be accessing internet banking or managing the linking of healthcare providers to your organisation for the Healthcare Identifiers (HI) Service.

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In the world of My Health Record and HI, that means ensuring a person is authenticated to perform the tasks necessary to carry out their role. So whether you are a healthcare provider wishing to view your patient’s My Health Record or a practice manager needing to link a new doctor to your practice, verification of identity ensures you are who you say you are and are authorised to perform a particular task.

Provider Digital Access (PRODA) and Health Professional Online Services (HPOS) PRODA is an online authentication system that all healthcare providers and practice managers may use to securely access a range of government online services. Using a two-step verification process, you only need a username, password and access to a personal mobile phone or email account.

Depending upon your role, services that you may be able to access through PRODA include: Health Professional Online Services (HPOS) National Disability Insurance Scheme (NDIS) Disability Medical Assessment online service My Health Record National Provider Portal Child Care Provider Entry Point (PEP) PRODA is replacing individual Medicare Public Key Infrastructure (PKI) certificates as the way to authenticate the identity of an individual, so you no longer need to use a token such as a smart card or USB. PRODA offers increased flexibility of access because healthcare providers are able to log on using a smart phone or tablet and no additional software needs to be installed as access is via a web portal.

Renewed individual certificates now need to be downloaded using PRODA. That means when your individual PKI expires, you will need a PRODA account to be able to download your new individual certificate.

Delegates can then access a range of useful information and services.

In HPOS, Healthcare providers nominate someone, such as a practice manager, to undertake tasks on their behalf. The delegate must have their own PRODA account.

Delegates can then access a range of useful information and services.

Health professionals changing from a PKI token to PRODA will need to reset their delegations and favourites in HPOS. Using PRODA, authorised healthcare providers are able to access My Health Record for their patients. This means that patient information is available to them, via the National Provider Portal, even when they are unable to access their practice’s clinical information system, for example when they are away from the practice.

More information about PRODA and registering for a PRODA account is available on the Department of Human Services (DHS) website in services for health professionals. Visit:https://www.humanservices.gov.au/ organisations/health-professionals/services/medicare/proda HPOS provides secure and convenient access to online services and payments that will help to streamline your interactions with DHS. Australian Immunisation Register (AIR) Child Dental Benefits Schedule My Health Record System Health Care Homes (HCH) National Bowel Cancer Screening Program (NBSCR) PBS Authorities Practice Nurse Incentive Program (PNIP) Rural Incentive Program

Centrelink Forms Department of Veterans’ Affairs Healthcare Identifiers Service Pathology Registration Midwife Professional Indemnity Scheme (MPIS) Practice Incentives Program (PIP) Prescription Shopping Information Program TGA recall and hazard alerts

Healthcare Identifiers (HI) Service via HPOS • Organisation details • View network map • OMO Details • Search HI provider directory service for organisations • Search HI provider directory service for individual • Search HI for organisation • Search HI for provider individual

National Authentication Service for Health (NASH) certificates for healthcare organisations A NASH certificate is required by organisations seeking to interact with the My Health Record system using conformant software. It can also be used for secure messaging.

New HPOS functionality allows organisations’ NASH certificates to be downloaded securely via HPOS by the Organisation Maintenance Officers (OMO). The certificate is available for download for a period of 30 days from when it is issued.

This means that, for existing NASH Organisation PKI certificates, your practice will be sent a letter approximately 60 days before the date of your current NASH certificate’s expiry date, notifying you when your NASH Certificate is due to expire and directing you to use HPOS to download a new certificate. This will allow time for practices to register for HPOS if they are not currently using this service.

For certificates issued using this functionality, the change also allows practices to submit requests to revoke certificates via HPOS, rather than completing a paper form.

The process for Supporting Organisations (e.g. Contracted Service Providers) to request and receive NASH certificates on CD will remain unchanged.

Some useful learning modules are available on the DHS web site both form PRODA and HPOS. Visit: https://www.humanservices.gov.au/ organisations/health-professionals/subjects/health-professional-onlineservices-hpos-education-resources HPOS and PRODA offer access to useful service practices that interact with DHS Medicare. If your practice is not already registered, perhaps now is the time. You may be surprised at what you find.

You also don’t need to wait for NASH certificates to expire to register for a PRODA account, you can do that at any time.

Online health services will continue to increase and evolve. Practices need to stay abreast of this evolution to maximise benefits to patients and practice staff.

• Healthcare Identifiers (HI) Service via HPOS

Marina Fulcher Life Member FAAPM CPM Senior Clinical Reference Lead Australian Digital Health Agency

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Families, children and My Health Record – some issues to consider Kate Gillman, Head of Medico Legal Advisory Service and Georgie Haysom, Head of Research, Education and Advocacy, Avant Mutual Group Chris comes to the practice with a friend. He is 17 and explains that he has been in a same-sex relationship for about a year. Based on his description of his symptoms the GP considers that he needs an STI screen. Chris is very distressed because he has not told his parents about his sexual activity and is fearful of their reaction. He insists that his parents are not to know anything about his visit.

The issues raised by this scenario – about Chris’s capacity and privacy – are not new. Changes in technology, including electronic communication and the rollout of My Health Record, necessitate some additional considerations.

Do you need authority from Chris’s parents to treat him?

Y

ou do not need authority from Chris’s parents to treat him if he has capacity to consent to the proposed STI screen, even though he is under 18.

Once a young person turns 18 or the child is a ‘mature minor’, their parents have no right to information without the young person’s consent.

Importantly, the question of capacity relates to the specific decision in the specific circumstances – so Chris may have capacity in relation to some decisions but not others.

Having considered Chris’s age, insight into the nature of the treatment and its possible side effects, as well as his intelligence and general attitude, personality and health, Chris’s GP needs to be satisfied that Chris has the capacity to consent to the tests without involving his parents.

In all states and territories, except South Australia, at 18 years or over a person can make decisions about their medical treatment as validly as an adult. In South Australia the relevant age is 16. However children under 18 are considered by law to have capacity to make decisions if they have achieved a sufficient level of understanding and maturity to enable them to understand fully what is proposed. This is known as ‘Gillick competent’ or the ‘mature minor’ doctrine.

Privacy

Having decision-making capacity means that a patient can: • understand the facts involved • understand the main choices • weigh up the consequences of the choices • understand how the consequences affect them • communicate their decision. For more information see the Capacity resources listed below.

Ensuring Chris’ privacy requires a discussion with him about the best means of communicating with him. Additionally it means checking whether he has a My Health Record (MHR) and what information might be uploaded to his record.

Even if Chris is competent to make decisions, it is still important to ensure that he is supported in this scenario. It is advisable to discuss with the child or young person the benefits of involving a parent or trusted adult for support. However, having determined that he is a ‘mature minor’ his treating doctor cannot discuss the treatment with his parents or anyone else unless he consents.

Contacting Chris can raise practical issues if he is living at home, so you need to be careful not to inadvertently breach his privacy when you communicate

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with him. Make sure you ask about the best way to contact him and whether you can leave a message or send correspondence to him at home.

You can contact Chris via email if that is his preference. Privacy legislation does not prescribe how a healthcare organisation should communicate health information to patients or third parties. Any method of communication may be used as long as the organisation takes reasonable steps to protect the information transmitted and the privacy of the patient.

There are a number of steps that practices can take to manage email communication.

Practices should consider the type of information to be sent, the sensitivity of the information and the patient’s circumstances. Policies and procedures should cover issues such as ensuring staff know what they can and cannot send by email, advising patients about the risks associated with unencrypted email and obtaining and documenting their consent, using password protected attachments where appropriate, checking email addresses, retaining copies of emails in patients’ clinical files. For more detail see the privacy resources listed below.

My Health Record and young people As the My Health Record program rolls out, it is also important to check whether Chris has a My Health Record, and who has access to the information in that record.

If Chris has a MHR, he had the option of taking control of his record when he turned 14. If Chris has a MHR, he had the option of taking control of his record when he turned 14. From December 2018, when a child turns 14, their parents will be automatically removed as their “authorised representative”.

If Chris has taken control of his MHR and given his parents access as his nominated representative, his parents will be able to see documents in the MHR, depending on what access he has given them.

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If Chris is unsure who may have access to his record, and given his specific request that the GP not inform his parents, we recommend that his GP: • Does not upload a new shared health summary.

• Ensures that the ‘Do not upload to My Health Record’ box is checked on any requests for pathology tests or prescriptions.

The GP may also wish to inform any specialist to whom Chris is referred about Chris’s privacy concerns and that he does not wish documentation to be included in his MHR. There is currently no obligation for a healthcare provider to access MHR or to upload information. Further, a clinical document must not be uploaded where an individual has specifically requested that a document not be uploaded. Practices must however take reasonable steps to ensure their staff exercise due care and skill so that any record uploaded to the My Health Record system is at the time it is uploaded, accurate, up-to-date, not misleading and not defamatory. https://www.avant.org.au/Resources/Public/My-Health-Record-FAQ/ ‘Mature minors and My Health Record’ Once Chris turned 14 he was automatically allowed to take control of his MHR. However children under 14 may apply to take control of their MHR as a ‘mature minor’. They will need a letter from a healthcare professional supporting their application.

As noted above, the issue of capacity is decision-specific. If a child requests such a letter from their doctor, the doctor is being asked to provide an assessment of their capacity to make decisions in relation to their health records. The doctor needs to be satisfied that the child understands what it means to have control of their health record.

Bearing in mind that they will have access to the reports and results that are uploaded to MHR, a doctor should consider whether they have the capacity and maturity to manage that information without parental support.

Age of child / young person

Who controls MHR?

Who has access to MHR

What information is visible?

Under 14 years

Parent or guardian can take control as authorised representative.

Parent or guardian can access if authorised representative.

Parent or guardian can view and manage all information in MHR.

Child may apply to manage MHR as a ‘mature minor’ – with letter from healthcare professional or court.

‘Mature minor’ can take control.

If child takes control they can choose level of access to allow – as per from age 14.

When young person turns 14, access of all authorised representatives is automatically cancelled.

Parent or guardian no longer has access unless young person appoints them as nominated representative or they are authorised representative for young person without capacity

Parent or guardian can register child for MHR, opt child out of MHR. Child may apply to manage MHR as a ‘mature minor’ (see below).

Under 14 years – ‘mature minor’

From 14 years

Young person can take control.

If child takes control as ‘mature minor’, parent or guardian does not have access unless child appoints them as nominated representative.

If young person does not have capacity, parent or guardian can apply to continue as authorised representative.

My Health Record and family violence Another aspect of the MHR that has attracted some attention is the question of parental access in the context of family violence. Specifically concerns have been expressed that having left a violent situation, the family’s location may be exposed, for example where a former partner has access to their child’s MHR. From December 2018, a parent cannot be an authorised representative of a child if there is a court order where they do not have unsupervised access to their child, or who pose a risk to the life, health and safety of the child or another person. The aim of this change is to strengthen protections for victims of domestic and family violence. If patients have any concerns in this regard, they can contact the My Health Record helpline and set up protections to ensure the family’s safety.

In this context doctors can also avoid uploading a shared health summary and ensure that the ‘Do not upload to My Health Record’ box is checked on any requests for pathology tests or prescriptions.

Young person (with capacity) can choose level of access to allow: • General access – view all docs except restricted documents • Restricted access – view all docs including restricted documents • Full access – view all docs, make additions and set access controls and notifications

More information Capacity Attorney General’s Department of NSW. Capacity Toolkit http://www.justice.nsw.gov.au/diversityservices/Documents/ capacity_toolkit0609.pdf.

O’Neil N, Peisah C. Capacity and the Law. www8.austlii.edu.au/cgibin/viewtoc/au/journals/SydUPLawBk/2011/.

Privacy Office of the Australian Information Commissioner. Guide to Securing Personal Information. https://www.oaic.gov.au/agencies-andorganisations/guides/guide-to-securing-personal-information Royal Australian College of General Practitioners. Using email in General Practice. https://www.racgp.org.au/your-practice/ehealth/ protecting-information/email/ Haysom G, Kelly, M, You’ve got mail: should you reply. Australian Doctor [Internet]. 2018 Jul [cited 2018 Jul 30]. Available from www. medicalobserver.com.au/workwise/youve-got-mail-should-you-reply My Health Record - generally My Health Record – Frequently Asked Questions: https://www.avant. org.au/Resources/Public/My-Health-Record-resources/

Kate Gillman, BA, LLB Head of Avant’s Medico-legal Advisory Service

Young people and My Health Record https://www.myhealthrecord.gov.au/for-you-your-family/howtos/ allow-others-view-my-record https://www.myhealthrecord.gov.au/for-you-your-family/howtos/ take-control-your-record-age-14 Family and Domestic Violence

Georgie Haysom,

https://www.myhealthrecord.gov.au/for-you-your-family/howtos/ family-and-domestic-violence

Head of Research, Education and Advocacy Avant Mutual Group

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Cultural competence and your organisation A

ccording to 2016 Census data, Australia has a population of approximately 23.4 million people who come from over 195 countries across the globe. This combination of nationalities, combined with our diverse yet unique Aboriginal and Torres Strait Islander populations, makes Australia one of the most culturally and linguistically varied populations in the world.1 The evolving collaboration and injection of old and new cultures is playing a significant role in driving change across Australia’s health and community service settings as more organisations aim to become culturally competent.

Officer from Victoria’s Centre for Culture, Ethnicity and Health, says it is learned and is something that is shared.

To ensure Australian health and community service providers are keeping up with this change, it is vital that these organisations start strengthening the level of cultural competency across their workforce, governance structure, systems and processes, day-to-day operations and service delivery.

With increased migration and globalisation in Australia, and a significantly strong Aboriginal and Torres Strait Islander history and culture, Australian health and community service providers need to understand and place greater emphasis on addressing the cultural and linguistic needs of diverse populations.

This diversity requires service suppliers to be aware of their consumers’ cultural needs and to be able to provide them with culturally congruent services.3 Further necessitating these organisations to provide services in a way that recognises and is compatible with the consumer’s cultural values, beliefs and needs, including the consumer’s race, culture, language or ethnic background, religious or spiritual beliefs or principles, gender, age and sexuality.

Cultural competence can be defined as ‘a set of organisational systems and processes, and worker attitudes, skills and knowledge that enable both to work effectively in cross-cultural situations’ (Burford, 2018 based on Cross et al 1989). It is not just about individuals improving their own skills, actions and values; it’s also about organisations ensuring that they have systems in place that can support the needs of clients and staff of all cultural backgrounds; and that an organisation has made a commitment that is reflected in policy, governance and resources.2 Culture refers to the actions, beliefs and symbols that different groups of people use to articulate or express their identity, often in relation to specific traditions of ethnicity, race, language, religion, occupation or social relations.

While it is easy to think of culture as something we are born with, Siri Gunawardana, Project

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“Culture is dynamic, it changes over place and time and others must understand it,” Siri said. “Our own culture influences how we react to people from other cultures so health and community service providers need to be in check with both their staff’s individual, and the organisation’s bias’, and to consider what impact that may have on their patients, consumers or clients.”

The combination of a culturally competent organisation with a consumer-centred care model can be hugely beneficial for both consumers and the organisation itself.

Consumers will feel more comfortable with staff who demonstrate an understanding of their culture, without making assumptions, and who make an effort to understand their individual beliefs rather than resorting to stereotypes.

This will result in better response rates, health and support outcomes for consumers and

the organisation which, in turn, will increase consumer satisfaction and trust, and may open up new promotional opportunities for the organisation.

However, an organisation’s level of cultural competency is heavily influenced by the cultural attitudes, beliefs, expectations and perceptions of individual staff members. Each individual needs to explore their own beliefs and perceptions, and consider how these could influence their delivery of care and/or services to various cultural groups and consumers. This could be through examination of how they may react in certain situations and taking the time to understand and appreciate the cultures of those around them. Culturally competent individuals accept and respect differences; continually selfassess and expand their cultural knowledge, and use these skills to better meet the needs of all members of their community.4 Of course, even the most culturally competent individual may be constrained by an organisation that has strict policies and processes with little room for flexibility. Often, the needs of culturally diverse consumers don’t fit into these strict policies and processes which means community and health service organisations need to find flexible ways to integrate these groups into their existing services. Where language is a barrier, either due to limited education or a differently spoken first language, for example, a consumer may have trouble filling in forms, fully describing their issue or understanding exactly what is being asked of them. This may be resolved through simply allowing longer appointment times to accommodate these consumers, having access to trusted and reputable translating services or employing staff with knowledge, skills, understanding and appreciation for specific cultural groups within your local population. Alternatively, staff may need to find

different ways of communicating such as with posters, pictures and multi-language flyers.

Culture can affect health beliefs which influence how consumers perceive their illness and treatment and, as such, staff need to be able to identify and incorporate these beliefs in their treatment. At times, this will be relatively easy, such as a female staff member seeing a female patient; however, there will be other times when it can prove challenging as there may be a conflict between the consumers beliefs and the required treatment. For example, an insulin dependent diabetic who wishes to fast during Ramadan may require an adjustment in their dosage, or an obese consumer who needs to lose weight but has a strong cultural connection to a certain food, may require additional support and awareness from service providers to succeed.

In celebration of the differences across cultures, there is no ‘one-size-fits all’ approach in terms of effective cultural competence. To support organisations to get started, Siri shared eight organisational domains where teams and individual staff can start improving their cultural competency to create better access and equity across the health and community services sectors: • Communication • Governance • Partnerships • Organisational infrastructure • Organisational values • Planning, monitoring and evaluation • Staff development, and • Services and interventions.2

As the first peoples and traditional owners of the land, Aboriginal and Torres Strait Islander culture is a vital component of cultural competency for all health and community service providers across Australia.

As stated by the Centre for Cultural Competence Australia (www.ccca.com.au), the knowledge gap that still remains between Aboriginal and Torres Strait Islander cultures and nonIndigenous cultures exists due to lack of education, knowledge and understanding.

To support improved cultural competence for non-Indigenous Australian’s, it is important that these skills are developed to become culturally competent at both a personal and professional level and that learning, knowledge, understanding and awareness continues to evolve.

Organisations looking to support staff in developing their own cultural competence could begin by undertaking an audit across the eight areas Siri identified above. Cultural competence training for all staff can also ease the general discomfort that some staff may have with discussing cultural aspects, or interacting with someone who is culturally different, for fear of appearing prejudiced or discriminatory.

all-of-organisation approach which will support positive improvements now and in to the future.

There are a number of training programs, resources and learning offerings available to support your organisation with enhancing your culture competency.

Visit the Centre for Cultural Competence Australia’s website: www.ccca.com.au for further details and to start your cultural competence change journey today.

Developing your organisation’s cultural competence can formulate part of your continuous quality improvement process and accreditation requirements.

Speak to our AGPAL or QIP team to learn more about our accreditation offerings and Standards requirements: AGPAL QIP P: 1300 362 111 P: 1300 888 329 E: info@agpal.com.au E: info@qip.com.au

Cultural competence is an ongoing process, not an endpoint, meaning that cultural competency and capability can be continuously enhanced over time.3 Taking time to develop organisational policies and processes to increase the inclusion of cultural competence will demonstrate an

Peter Frendin AGPAL & QIP General Manager Health and Human Services National Development Team

1. RacismNoWay.com.au (2017) Australia’s cultural diversity. http://www.racismnoway.com.au/about-racism/australias-cultural-diversity/ Accessed 30 August, 2018.

2. Gunawardana, S. (19 May, 2018) Building organisational cultural competence workshop presented at the AGPAL & QIP 2018 Conference, Melbourne, VIC 3. Alizadeh, S. & Chavan, M. (2 September, 2015) Cultural competence dimensions and outcomes: a systematic review of the literature https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.12293 Accessed 30 August, 2018 4. Cornish, N. & White, M. (2016) Cultural Proficiency: Supporting the Development of Cultural Competence in Mentoring Relationships http://web.b.ebscohost.com/ehost/pdfviewer/ pdfviewer?vid=0&sid=174b6b63-7455-45cd-a547-db1993009417%40sessionmgr104 Accessed 30 August, 2018

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To find out more, contact our team on: 1800 143 733 vop@insyncsurveys.com.au www.insyncsurveys.com.au/vop

2018 AAPM National Conference – a review in pictures…

A

APM National office was pleased to support our members and other visitors during the recent 2018 National Conference at the Canberra National Convention Centre. Along with NSW/ACT State President Fiona Kolokas and the Conference Committee hosts, we trust you all enjoyed your conference and expo experience, and were able to come back from the conference with new friends, knowledge, and ideas to help you innovate with enthusiasm for the future.

Our post-conference member/visitor feedback shows that we met our objective of providing a varied, yet balanced combination of Interest Group forums, State Breakfasts, Plenary sessions, Workshops and interactive Q & A sessions. Conference participants had the opportunity to engage with Healthcare sector leaders via a choice of sessions most important to them. We trust that the information and knowledge gained during the conference will add

further value to your own practice and experience of your patients.

The AAPM conference also brought together over 70 Healthcare exhibitors, providing unique networking opportunities for the duration of this event.

Following the opening Welcome Reception, informal social gettogethers at the end of each day and Dinners (First Time attendees and Fellow Members) gave our guests the opportunity to not only relax, but continue to build new (and re-ignite) old friendships. The closing ‘Black & White’ Gala evening showcased all of our State Finalists and National Practice Manager of the Year winners – congratulations to Darcy Inglis on this well-deserved individual award.

We look forward to seeing you in October, 2019 for the AAPM 40th Anniversary National Conference in Brisbane!

AAPM Board delegation to Parliament House. L-R David Osman, Jackie Beer, Cathy Baynie, Fiona Wong, Richard Evans, James Downing

Cathy Baynie, AAPM National President

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Fiona Kolokas, AAPM State President - NSW/ACT

Nicholas Voudouris, AAPM CEO

AAPM Conference Opening - Royal Theatre, National Convention Centre – Canberra

Dike Drummond, MD - Physician Coach and Keynote Speaker

AAPM Conference Exhibition

AAPM Conference Exhibition

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Anne Davis, AAPM Fellow

Colleen Sullivan, AAPM Life Member

AAPM National President Cathy Baynie presents delegate prize winners

AAPM Practice Manager of the Year Finalists - Presented

by Dr Stephen Clark - AGPAL (second from left)

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AAPM Black & White Gala Dinner - Ballroom, National Convention Centre

AAPM Practice Manager Conference delegates sharing their Gala Dinner moments

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Australian Dental Care Report R

esearch by the Australian Institute of Health and Welfare’s “Health expenditure Australia Report found in 2016-17 that: • Australia spent nearly $181 billion on health (10% of our nation’s overall economic activity) • the Federal government spent $124.2 billion on health (or 68.7% total health expenditure) with the health funds share of expenditure at only 8.8% • the estimated per person expenditure on health averaged $7,411 (NT has nation’s highest per person spend at $9,827, with NSW lowest at $6,678) • Our nation’s health spending growing by 4.7% (adjusted for inflation) • On average individuals spent º $394 on all [other] medications º $240 on dental services º $156 on medical services (referred and unreferred) º $133 on hospitals º $118 on aids and appliances º $95 on other health practitioners, and º $58 on benefit-paid pharmaceuticals The report also provides granularity with regards to the types of primary health care services – separating it into streams including: • Public Health • Other health practitioners • Unreferred medical services & • Dental services …with dental services as being defined as: ‘services that registered dental practitioners provide as funded by health funds, state and territory governments and also individuals’ out-of-pocket payments”.

The question can therefore be raised…

Why are dental services separated from “Other Health Practitioners” within the report…?

It seems this separation is perpetuated within our healthcare industry.

For example Allied Health Professionals Australia define allied health professionals as “…health professionals that are not part of the medical, dental or nursing professions…” clearly annexing dental off to one side.

This separation appears to pervade government support/funding –

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whereby despite a limited number of PHN recognising, embracing and supporting aspects of oral health services, (as being encompassed within the allied health space) it unfortunately seems the field isn’t on the radar for the vast majority of PHN’s?

So, why might this be the case?

What is it about dentistry that results in it being isolated and separated from the rest of healthcare?

Dental decay is the second most costly diet-related disease in Australia, with an economic impact comparable with heart disease and diabetes The World Oral Health Report (2003) states clearly that the relationship between oral health and general health is proven by evidence, with more recent evidence further strengthening this case.

Oral health and general health are related in four major ways: 1. Poor oral health is significantly associated with major chronic diseases 2. Poor oral health causes disability 3. Oral health issues and major diseases share common risk factors 4. General health problems may cause or worsen oral health conditions Poor Oral Health & Coronary Disease Many peer-reviewed studies have found a link between Poor Oral Health & Coronary Disease and a person with fewer than 10 of their own teeth remaining being seven times more likely to die of coronary disease than someone with more than 25 of their own teeth.

Oral Health & Diabetes A 2011 study of 232 physicians and 278 dentists concluded that dental and medical practitioners need to know more about the important association between periodontal diseases and diabetes - to effectively prevent, manage, and control diabetes and periodontal diseases18. This is especially significant when considering that dental problems consume substantial Medicare resources due to patients accessing subsidized consultations from non-dentally trained health care professionals.

Oral Health & Respiratory Disease There is good evidence that improved oral hygiene and frequent professional oral health care reduces the progression or occurrence of respiratory diseases among high-risk elderly adults living in nursing homes and especially those in intensive care units (ICUs).

Oral Health & Strokes

with 2 chair clinics requiring a significant level of investment – for a quality fitout you won’t get much change from $750,000.

I have recently taken to meeting/speaking to organisations including the Primary Health Networks about why there is such separation – in my plight for clarity. To date, I have not yet found an answer…

Joshipura et al (2003) reported a significant association between stroke and periodontal disease and between stroke and number (n = 16) of remaining teeth.

I was embraced by the AAPM ‘family’ since attending my first National conference in 2016, and have been significantly involved with this memberbased organisation ever since then.

The science now becomes more clear: Oral health issues and major diseases share common risk factors General health problems may cause or worsen oral health conditions There are multiple links between dentistry and allied healthcare – consider sleep apnoea, stress (and teeth grinding) & TMJ.

It is for this reason I’m proud of my association with AAPM – and wear as a badge of pride my CPM, SA/NT President and as Australian Practice Manager of the Year for 2017, and actively engage as an Ambassador and Mentor. My aim is to complete my Fellowship application early next year.

What about the practitioners and the practice you ask – surely that’s completely different?

Dental practitioners diagnose and treat oral health issues; with a significant number of general dentists routinely performing complex dental treatment [surgery] such as wisdom teeth removal, surgical extractions and the placing of medical devices (eg. dental implants).

As with GPs and Allied Health care practitioners, dental practices are regulated by bodies such as AHPRA, and are required to meet national standards spanning the quality and safety care of healthcare provision (NSQHSS) and infection control (eg. AS 4815) needing to be built in appropriately medically-zoned buildings (per a local planning authority requirements).

Dental (and specialist practices) are not excluded or precluded from AAPM – rather, it is embraced as being integral to the overall health care industry.

We currently have more than 75 members of AAPM from dental practices, whereby our membership has every opportunity to continue to grow given the many benefits that AAPM offers that others done.

My association with AAPM and role as founding Board Member of the Australian Dental Outreach Foundation drive me to continue to advocate for integration of dental services as an integral and synergistic allied health service that is better embraced and supported by PHN; if nothing else but to try to improve quality of life and health care outcomes for our local community.

A dental practice’s team looks similar in many ways to those in allied healthcare, and typically comprise a mix of reception staff, [dental] nurses to assist the practitioner, and other admin staff including a Practice Manager. Yes, there are often out-of-pocket costs but this is the case with many allied health care services and specialist services for that matter.

The nature of a dental clinic is a mixture of waiting space (or reception lounge if your practice is a bit fancy), front desk, sterilisation area/CSSD, surgeries and the odd office. The average dental clinic setup does cost a little bit more than that of a GP, physiotherapist or allied healthcare provider

Brett Miller AAPM SA/NT State President

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Photography: Troy Guilfoyle

Fellowship Case Study:

The setting up of Clinics in villages in the remote rural area of Ecuador, South America Awa: The People of the Jungle A

highlight over the past eight years in both my career and personally has been that I have been given the opportunity to travel as a volunteer with Dr Gordillo to South America to set up clinics in rural and remote villages in the jungle on the Ecuador-Colombia border. He is a native of Ecuador and of course that helps with the language. My background in both Nursing and Practice Management has been invaluable in this endeavor.

but just as an example, consider their first trials to raise guinea pigs. Some Awa families were given a few guinea pigs to raise but the pigs were taken to the jungle, let loose and then, after a ceremony they were hunted and speared for what food the Awa needed for the next few days as they found that the only acceptable way to kill an animal! Slowly the Awa are being educated that letting the guinea pigs breed will give them more food in the long term.

In the Awapit language Awa means the people of the jungle, that’s what they call themselves and that’s an accurate description. The Awa see themselves as part of the jungle where they have always lived. The jungle provides them with everything and the jungle is all they need. The problem is that the jungle is disappearing and the Awa are struggling to survive let alone to maintain their cultural integrity.

The mortality rate is extremely high as after childbirth the men still cut the cord with a machete causing infections in the newborn. The communities would benefit from birthing kits.

Education is also a problem as health workers are scarce and doctors visit rarely and this is only to the more easily accessible villages. The more remote jungle areas are accessed only by canoes, and these trips can take up to 3 days!

There are some 35,000 Awa people living in a contiguous area located in the south of Colombia (317,000ha) and the north of Ecuador (116,569ha) in one of the hotspots of biodiversity in South America that is under threat. In Colombia some 60 Awa have died in the last three years defending their territory. In Ecuador the Constitution provides legal recognition to the territorial integrity of the Awa people.

The Awa understand illness as nature’s punishment when an individual shows lack of respect or consideration to others, to his/ her people or to him/herself. But nature itself provides what in necessary to restore the balance needed for good health. Their knowledge of snake poisoning treatment is legendary in the region. Unfortunately, with the shrinking of their habitat, their plants and the knowledge of their use are also shrinking however the morbidity and mortality rate are increasing.

Logging is the main problem; it is aggressively sought by external loggers with the added irony that it offers the only source of cash in a traditional economy organised around subsistence.

I became aware of the reality of the Awa people through Pablo, one of Dr Gordillo’s friends from his youth who was working for an organisation called “Land for Everyone” that had started a project to provide the Awa with the means and knowledge to survive in their fast-changing land.

The Awa are learning to plant new crops and to raise domesticated animals: pigs, chickens and guinea pigs to supplement their traditional and ever harder to find nutritional sources. This may not seem too difficult to learn and implement

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It was under these circumstances that my first attempt to help set up a Primary Care Clinic in the Awa community started. We decided to make it easy and try the most accessible of the Awa communities first, one called “Middle Green River” (as opposed to High or Low Green River).

We left the city of Ibarra (80 Km north of Quito, the capital of Ecuador) early in the morning and two hours later reached the small town of Lita, close to the border with Colombia. From there two more hours 4WD driving to the Green River, that is actually green. The river has been overfished with dynamite, electricity and several

poisonous plants with the expected decimation of fish stocks. And of course, the added danger of loss of some digits and even limbs for the Awa when using these methods.

We were met by the Awa at the side of the road, they made us feel extremely welcome but more importantly, they had horses ready for us. They told us they would not think any less of us if we decided to walk, that sounded strange but when the horses started to slip and almost fall few times at the edge of the cliffs we understood what they meant!

Almost two hours later we arrived at the community of Middle Green River, a collection of houses organised around a soccer field with a hall in the center. The total population reaches almost 400, with 60% being under 16.

The oldest person we saw was aged 56. As previously explained the Awa in Middle Green River die young.

We set camp in the main hall that also served as school during weekdays. Some adults with infants were sitting around in the hall while the adolescents only stopped playing soccer to check on us from time to time. We placed a desk with a laptop to keep records and two chairs on one corner of the hall, and placed chairs in another corner, this would be the waiting room.

We were now ready to start the clinic.

As I looked around I realised that I had to let go of the way I am used to working. I needed to prioritise. We had to make do with the bare minimum and I had to let go of the concern about such things as infection control. Simple things such as hand washing were not so easy! This was delivering health care at a grass roots level and I quickly realised that the most important aspect was to help each and every Awa as best we could with the limited resources we had. It was clear that I was the one that needed to adapt.

One of the other challenges was to make up patient files. Each person is given a National

ID number which we decided to use as their Medical Record number. As the communities are small and most people are related more often than not they had not only the same surname but the same first names! Often the date of birth was incorrect as well.

Further investigation explained why. This ID number is given at the time of registering the birth. A person from the village will travel to do this, but that person is not always the parent.

This can cause confusion with the date of birth.

I was very amused to hear that if the person registering the name did not like the chosen name they would change it to one they preferred which was usually their own name!

That did explain the number of people with the same names.

The people were at first very shy. Because I am so fair in complexion and hair colour the children were hiding outside the hall and would occasionally peep in at me. Initially only a couple of women with their young children came to see us to test the waters. As the day progressed they returned with their extended family consisting of older children, sisters, cousins and even their husbands! We had won their trust!

was so fulfilling, we were making a difference to their lives by just providing very basic care.

A simple dose of an Antibiotic delivered on the day greatly improved health outcomes. A vastly different practice management experience and definitely no complaints from the patients about waiting times!

As a sign of gratitude, at the end of the days we were fed chicken soup while some of the boys played marimba and guitar for us.

We slept on hammocks strung up in the hall which were covered in mosquito nets to protect us against mosquito borne diseases such as Malaria.

It rained for the days we were there, which made it too dangerous for the horses to climb down, so we had to walk. This trip took approximately three hours on the dirt (now mud) road. We then met our lift back to Lita then further on to Ibarra.

On our way down, while we were trying not to trip and fall, the school teacher, a young woman in her early twenties who is based in Lita ran past us at full speed. She had no time to chat to us, not to anyone, she did the round trip running every day. She was not given the luxury of a horse ride! I have never again complained about traffic on the way to work.

The problems were as expected, mostly respiratory, wound and eye infections, parasites, asthma, anaemia, cases of? Tb and children with retarded growth; and of course, the men had the usual machete injuries. I dressed quite a few wounds over the next few days. The other problem was the lack of medications as we had collected only what we could on our way up but unfortunately that wasn’t enough. We would need to arrange for more to be delivered to the community on our return to Ibarra.

On the way back from Lita we were stopped by the Military Border Force at gunpoint. We were told to get out of the truck which was searched and asked to surrender our passports. Petrol is very cheap in Ecuador and smuggled to Colombia via the border which is very close to Lita. Once we were cleared we were on our way however, I did reflect that there were many more obstacles to navigate than I been prepared for.

For the locals this is an everyday occurrence.

We saw 44 people that first day. Word travelled fast and the next days were busy as well. This

On our return to Ibarra, we organised the rest of the medications to go to the community.

The cost of Amoxicillin 500mg x 20 is actually USD $2.50 so we could afford medication for all including vitamins and iron supplements. We now understood the supplies necessary to take with us in the future.

Our second trip was two years later. This time we spent a week there which gave us time to catch up with the local news: mainly who had became romantically involved with whom, how many new babies have been born and of course, how was the domestication of animals developing. It was great to see how the children had grown. We also travelled to another Awa community called Palmira; which is further into the jungle from Middle Green River.

We hope to return later this year. I really enjoy the experience and it certainly puts things into perspective as a Practice Manager. What I am most touched by is the humility and gratitude of the Awa people and their gentle way. A simple smile from one of the children makes it so worthwhile.

The Ecuadorian government has increased its expenditure in the public health system and some communities have started to benefit however the Awa are way down in the list of anyone’s priorities and the race to save them and their traditional way of life seems doomed unless, somehow, more help and effort come to their aid.

For me it is such an honor and privilege to help them in the small way I can.

Di Mouncey Practice Manager (CPMAAPM) Diploma of Management, Cert IV in Business, Member, APNA, SCCA

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Impact of the New EU Global Data Protection Regulation on Australian Medical Practices

I

n the medical and health space, where discretion and privacy is paramount and a data hack can cripple a business, the old adage, “better be despised for too anxious apprehensions, than ruined by too confident security” provides sound advice.

The European Union General Data Protection Regulation (GDPR) came into effect on 25 May 2018. The objective of this regime is to harmonise data protection laws across the European Union. Australian businesses (which include medical and healthcare practices) with European connections, may be subject to the GDPR. The fundamental question for our purposes is whether, and in what circumstances, Australian businesses and specifically, medical and healthcare practices, are required to comply with the GDPR. Who does the GDPR apply to?

The GDPR applies “to the processing of personal data of data subjects who are in the Union by a controller or processor not established in the Union, where the processing activities are related to: a. the offering of goods or services, irrespective of whether a payment of the data subject is required, to such data subjects in the Union; or b. the monitoring of their behaviour as far as their behaviour takes place within the Union.”1 The terms controller and processor are unique to the GDPR and there are no equivalents in Australia’s privacy laws. However, in reality, a typical Australian business such as a medical practice would be the equivalent of a controller2 under the GDPR to the extent that it is responsible for the collection and use of personal information of patients in the normal course of its business. It is unlikely that an Australian medical practice would be a processor3 unless it has outsourced the handling of patient data to a European based company.

GDPR: Medical and Healthcare Practices?

We can assume that the vast majority of Australian medical and allied healthcare practices do not have an establishment in the European Union.

Therefore, such practices will only be subject to the GDPR if they are offering goods or services to, or monitoring the behaviour of individuals in the European Union.

In present day Australia, medical and healthcare practices and services are generally state or nationally based and generally do not provide goods and services internationally. Therefore, it is unlikely that the GDPR will apply to the operation of, say, a general practice in today’s climate. However, for specialist medical and healthcare practices, for example, it may very well be that those practices are servicing or otherwise targeting patients or other medical practices as customers (i.e. to purchase a medical or healthcare device or method) all around the world. In these circumstances, such specialist practices would be caught by the GDPR. A practice may also be required to comply with the GDPR if they offer professional development courses or medical analysis to a European country.

What’s the difference? My practice complies with Australia’s Privacy Act Australia’s existing data and privacy laws are largely consistent with the requirements of the GDPR and, simply, if an Australian business is compliant with Australia’s privacy laws, many of the obligations of the GDPR would be satisfied. However, this should not be assumed for medical and health practices and should instead be reviewed on a case by case basis, particularly in light of the sensitive data held by a practice.

When do I need to think about compliance with the GDPR? If a practice offers professional development services or supplies medical equipment, medical analysis or other goods or services to practitioners, clinics or hospitals established in the European Union, the GDPR may apply. It is recommended that all medical practices consider their current offerings and plans for future expansion in the GDPR context.

FURTHER INFORMATION

Recital 23 of the GDPR provides guidance on what constitutes the offering of goods or services by companies not established in the European Union and suggests that if: a. an Australian business whose website targets EU customers, for example by enabling them to order goods or services in a European language (other than English), or enabling payment in Euros; or b. an Australian business whose website mentions customers or users in the EU,4 it will be required to comply with the GDPR.

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Please contact Meghan Warren or Daniel Mainzer of Burke & Associates Lawyers on mwarren@burkes-law.com or danielmainzer@burkes-law.com for further advice or assistance.

1. 1. GDPR Article 3(2) 2. 2. See definition of controller in GDPR Article 4(7) 3. 3. See definition of processor in GDPR Article 4(8) 4. 4. https://www.oaic.gov.au/resources/agencies-and-organisations/business-resources/privacybusiness-resource-21-australian-businesses-and-the-eu-general-data-protection-regulation.pdf

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International review puts Australia ahead in personal control of electronic health records A

n international comparison review of digital health record systems shows My Health Record consumers in Australia have more ability to personally control their digital health information than in similar countries worldwide.

University of Melbourne Professor of Primary Care Research and General Practitioner Jane Gunn says she supports the development and ongoing review of clinical evidence, as it will drive improvements in the digital health system.

The Digital Health Evidence Review, released by the Australian Digital Health Agency, brings together studies comparing My Health Record with similar systems across the world, including those in France, the UK, the USA and New Zealand.

“Sharing evidence about the way My Health Record and similar international personal health records are used will support clinicians in understanding the benefits of shared health data.

“We know through the important national conversation that is currently occurring that Australians expect and deserve strong safeguards, choice and control when it comes to their personal information,” says Agency Chief Medical Adviser, Professor Meredith Makeham.

“As the Agency responsible for My Health Record, we need to continue to improve the system in consultation with the Australian community and their healthcare providers.”

With the Australian My Health Record system, people have among the most choice in how their medical information, such as their tests and scans, are stored and accessed from an international perspective.

“Although many countries have laws that allow users to view their health information, only Australia and a handful of other countries have laws that allow citizens to control who sees their information and request corrections to their own health data,” says Makeham.

My Health Record is an online summary of a person’s key health information. It allows Australians to share their health information with doctors, hospitals and other healthcare providers from anywhere, at any time. They can control access to their My Health Record including what information gets uploaded and which family members, carers or healthcare providers have access.

Out of the 50 countries surveyed, the Digital Health Evidence Review found: Only Australia and France allow individuals to edit or author parts of their record. Only 32 per cent of surveyed countries have legislation in place that allow individuals to request corrections to their data. Only 28 per cent of surveyed countries have legislation that allows individuals to specify which healthcare providers can access their data.

“This review demonstrates the My Health Record empowers consumers to personally control their information, including what’s in it and who can see it,” says Professor Makeham.

Research Australia CEO Nadia Levin has welcomed the review.

“There is great value in sharing information about the My Health Record system and similar digital platforms around the world. This information can support researchers, policy makers and the community in understanding the way personal health records can support better health outcomes and health system improvements, while considering the necessary controls required to build trust in such a system” Ms Levin says.

“As a practicing GP I can see how My Health Record has the potential to inform better care coordination for my patients, and save valuable time searching for information we need to make safe clinical decisions,” says Professor Gunn.

Professor Meredith Makeham says the Review deepens our understanding of the way shared health records are being developed and implemented in Australia and internationally.

“We need to understand the strength of the current evidence supporting the use of personal health records, and where we see gaps in the evidence base.

“This is important to guide future efforts, working with the research community and others to build our knowledge and inform future digital health service development and investment,” Professor Makeham said.

The Review drew on a variety of research sources, including academic peer-reviewed literature, government reports and white papers, World Health Organization (WHO) data, and other information sourced from international governments and agencies responsible for the delivery of digital health services.

More than six million Australians already have a My Health Record and 13,956 healthcare professional organisations are connected. This includes general practices, hospitals, pharmacies, diagnostic imaging and pathology practices.

FURTHER INFORMATION More information on My Health Record can be found at www. myhealthrecord.gov.au. People who do not want a My Health Record can opt out by visiting the My Health Record website or calling 1800 723 471 for phone-based assistance. Additional support is available to Aboriginal and Torres Strait Islanders, people from non‐English speaking backgrounds, people with limited digital literacy and those living in rural or remote regions.

The Digital Health Evidence Review can be accessed at www. digitalhealth.gov.au/evidence-review.

Media contact Australian Digital Health Agency Media Team Mobile: 0428 772 421 Email: media@digitalhealth.gov.au

About the Australian Digital Health Agency. The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems, and implementing Australia’s National Digital Health Strategy – Safe, Seamless, and Secure: evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency is the System Operator of My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system.

These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information. Further information: www.digitalhealth.gov.au.

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