syllabus e health
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e-health GPEP Syllabus
www.rnzcgp.org.nz
e-health
e-health
e-health
e-health is rapidly evolving and expanding into everyday general practice. It has been adopted in primary care from an early stage through electronic patient records, recall systems, prescriptions and patient management systems. Developments are under way in New Zealand through the National IT Health Plan1 in partnership with software providers that will include a virtual health record, a shared care record and a national patient portal through which patients will be able to communicate with their clinicians in a secure environment.
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e-healthwww.rnzcgp.org.nz
Email, internet and smartphone applications (‘apps’) have quickly become part of everyday life and many patients expect health care providers to adopt this technology. ‘Telehealth’, the direct (e.g. video-conferencing) or indirect (e.g. website delivery) delivery of health information or health care is another emerging field of e-health, which may become more widespread, for example providing care in rural areas.
e-health curriculum in the context of general practice
Pauline comes in for a visit about her asthma medication. She has not been seen for a year and was sent a text reminder by the nurse that it was time for her annual check-up. Her asthma is under control and she finds that the new Symbicort that you had started her on just before last winter has been excellent. She had very few problems this year and feels that her health has improved. She is pleased that she had followed up on that advert she saw on TV.
You examine her chest and there are no signs of wheeze or other chest pathology. She looks well. You look through the screening window on the computer and realise that you do not have data on cervical screening or her smoking status. Pauline is a non-smoker and thinks she has had a smear recently through family planning. You ask if it is okay for you to be sent the information electronically from the cervical screening service. She is happy with this.
She would also like you to look at a mole that she has noticed. She has a family history of melanoma with her uncle and grandfather both having one, so is a little concerned. The mole is on her lower leg, measures 4mm diameter and has a darker area on one corner, although is not tri-coloured. She thinks the dark colour has not been there before. You take a photo on the practice camera and ask her permission to send this to the local dermatologist for review. You explain that unfortunately your current system for doing this is not via a secure weblink, but it is the quickest way of getting a response. She feels this is okay but has a long chat with you about the security of information as she works in IT. She would like you to email the response that you get from the dermatologist.
e-health has significant implications for both patients and clinicians. Advances in technology and the development of e-health have many potential benefits for delivering health care. It is important, however, that privacy, security and safety of care are not compromised. General practitioners need to be aware of the risks and potential issues involved in some forms of e-health, for example use of email – the Medical Council of New Zealand provides guidance in this area.2
The learning outcomes and expectations listed here will be undertaken over the three years of training in no particular order but at every opportunity that presents itself.
1 National IT Health Board (2010). The National IT Health Plan. Wellington: National IT Health Board.2 http://www.mcnz.org.nz
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e-health
e-health
Domain 1: Communication
Throughout vocational training a registrar will develop a variety of competencies and be expected to:
• develop communication skills required for non-face-to-face consultations, such as telephone consulting or email
• define the difference in communication skills – things lost or gained – when consultations are not done face to face
• describe ways of reducing misinterpretation of information that is sent electronically
• describe to patients, and their family/wha-nau and carers the confidentiality issues around electronic forms of communication, such as texts being read by others, messages left on answer machines
• reflect on personal communication style by using video.
Domain 2: Clinical Expertise
Throughout vocational training a registrar will develop a variety of competencies and be expected to:
• demonstrate a working knowledge of the practice management system used within the practice
• describe the security measures used when transferring patient information to other health professionals
• extract information from the practice management system to enable audit and primary care objectives to be met
• demonstrate safe and competent use of internet resources for patient care and educational purposes
• describe the pitfalls of receiving and sending electronic information, such as lab results allocated to the wrong person, and how these can be reduced
• describe how consent is obtained for using electronic media for communication, such as email and text, and how this is recorded in the practice
• describe and demonstrate using electronic decision support tools used within the practice
• demonstrate the ability to use all aspects of the practice management system, including billing and booking systems
• demonstrate competent telephone consultation and triage skills and record these accurately
• develop competent typing skills.
Communication Clinical Expertise
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Domain 3: Professionalism
Throughout vocational training a registrar will develop a variety of competencies and be expected to:
• reflect on using social networking as a doctor and how this can impact on the doctor–patient relationship
• ensure confidentiality of all electronic records in the clinical setting, and consider how records can be accessed by a nominated proxy provider as a back-up
• describe the measures taken to ensure security of patient information sent to other health providers or patients
• reflect on the boundary issues in doctor–patient relationships when using personal email addresses or phone numbers
• ensure patient records contain sufficient information to describe and support the management of health care provided
• recognise and respect different attitudes to using electronic information among patients, family/wha-nau and carers
• make sure usernames and passwords are kept securely.
Professionalism
Domain 4: Scholarship
Throughout vocational training a registrar will develop a variety of competencies and be expected to:
• ensure they are skilled in using the various decision support tools and undertake training as required
• demonstrate knowledge of appropriate and reliable websites for patient information
• use search engines, such as Pubmed, Ovid and Cochrane, when undertaking internet-based research
• describe the patient and the reasons for referral in electronic format, not just relying on ‘cutting and pasting’ the patient notes.
Scholarship
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e-health
Domain 5: Context of General Practice
Throughout vocational training a registrar will develop a variety of competencies and be expected to:
• describe the variety of practice management systems available to primary care
• demonstrate knowledge of the various agencies that are accessed electronically through the practice, for example laboratories, radiology, ACC
• ensure information on shared records is accurate, such as palliative care shared records.
Domain 6: Management
Throughout vocational training a registrar will develop a variety of competencies and be expected to:
• ensure the electronic recall system and decision support tools within the practice management system are easy to use by staff and training is readily available
• describe the system for back-up and retrieval to protect electronic patient information
• participate in auditing patient information on electronic databases to enhance care and improve health outcomes, for example high-needs cervical screening rates
• describe the enhancements to clinical practice that e-health provides
• establish protocols for policy around electronic records.
Context of General Practice
Management
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e-healthwww.rnzcgp.org.nz
Learning experiences and assessment
Year 1 Learning experiences Assessment
In practice
Seminar day
Clinical attachments
• Minimum five patients per half day
One on one teaching
• Role-play of cases involving electronic decision support tools
• Discussion of email consultation and other electronic forms of communication with patients
• Video/direct observation – teacher to registrar, registrar to teacher
Community visits
• Pharmacy – faxing of prescriptions, shared records e.g. warfarin monitoring
• Ma-ori providers and aged care: how are electronic forms of communication best used?
In-practice visit from a medical educator
• Direct observation• Record review • Personal reflection
Specialist presentation
Small group learning
• Case-based discussion• Role-play• Video interview• Journal club and discussions• Articles on Ma-ori health inequalities
Registrar presentation of:
• Vignettes on professionalism and electronic communication
• MATCH quizzes• WEBS – research on electronic shared records,
telephone and video consultation
In-practice visits
Video/direct observation
Vignettes
WEBS
MATCH questions
Patient satisfaction survey
Skills log
Online quiz
Learning record
Summative • GPEP written• GPEP clinical• Academic output
Further details about academic output in Year 2
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e-health
Year 2 Learning experiences Assessment
In practice
Learning group
Other learning
As for Year 1, plus:
• Increase in patient numbers seen daily• Attention to PHO performance parameters recording
in the PMS• Practice team meetings and input into these
Audit
Medical educator visits• Video/observation• Case discussion• Record review
Involvement in CORNERSTONE® accreditation if occurs – electronic record information, under ‘clinical effectiveness processes’Significant event review
Case-based discussion
Role-playLiterature review and critical appraisal Specialist or guest speaker
NZRC resuscitation course minimum level 5 and appropriate for practice environment
CME
Professional development plan
Collegial support – case discussion
Academic output • Enhanced audit• Research• University paper
Medical educator visits
NZRC resuscitation course
Audit project
Professional development plan
Mini CEX
Collegial support
eLearning modules
Patient satisfaction survey
Summative • GPEP written• GPEP clinical• Academic output
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e-healthwww.rnzcgp.org.nz
Year 3+ Learning experiences Assessment
Clinical
Educational
As for Year 2, plus:
Training under vocational scopes – if applicable
Management of electronic media in:
• outpatient clinics – referrals review, shared record, discharge summaries
• virtual clinics, e.g. dermatology
Work with allied health professionals ensuring accurate electronic communications and other e-health interactions:
• Rehabilitation specialists• Hospice carers – shared records• Physiotherapists – ACC referrals• Pharmacists – e-prescriptions• Occupational therapists• Social workers – shared notes• Multidisciplinary team meetings, teleconferencing
• One-on-one teaching • Departmental teaching • Journal clubs • Peer groups
Medical educator visits
Audit
Academic output
Mini CEX
Learning log
Supervisor reports
Multi-source feedback
Previous summative assessments if not completed
Fellowship Assessment
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e-health
References/resources
e-health is a developing field and resources will be added with time. The following are a guide:
• Medicine and the Internet www.mcnz.org.nz/assets/ news-and-publications/coles/chapter_15.pdf
• Social media and the medical profession https://ama.com.au/social-media-and-medical-profession
• Manage my health www.managemyhealth.co.nz/home
• IT Health Board www.ithealthboard.health.nz
• Patients First www.patientsfirst.org.nz
• New Zealand TelePaediatric Service www.telepaeds.co.nz
• Australian e-health www.ehealth.gov.au
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© The Royal New Zealand College of General Practitioners, New Zealand, 2012
The Royal New Zealand College of General Practitioners owns the copyright of this work and has exclusive rights in accordance with the Copyright Act 1994.
In particular, prior written permission must be obtained from the Royal New Zealand College of General Practitioners for others (including business entities) to:• copy the work• issue copies of the work, whether by sale or otherwise• show the work in public • make an adaptation of the work as defined in the Copyright Act 1994.
December 2013
978-1-927240-23-6
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