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COVID a ‘stimulus’ for increased uptake of secure messaging
But is the Australian healthcare system ready?
Universal secure messaging is technically possible, but a number of barriers are preventing its widespread use.
A new report produced by the Australian Commission on Safety and Quality in Health Care (ACSQHC) on the benefits of secure messaging has found widespread recognition of its potential to improve the Australian health system.
However, low uptake as a result of barriers and perceived risks to patient safety and quality is likely to stymie uptake and broader adoption.
‘The increased rate of digital adoption through the COVID-19 pandemic provides one of the major opportunities for acceleration in digital health transformation initiatives worldwide,’ the report states.
‘These opportunities enable the realisation of secure messaging benefits … and incorporate specific use cases where secure messaging or other digital solutions have demonstrated reasonable success.’
Dr Rob Hosking, Chair of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), told newsGP he broadly supports the sentiments contained in the report. But he does not believe secure messaging will become widespread until interoperability issues are resolved.
‘Secure messaging has been bubbling along for a long time, and I think we’re a bit frustrated with the lack of progress with the interoperability and the uniformity of the widespread use of secure messaging,’ he said.
‘Even though we’ve had agreement for a number of years and people have been trying to work together, they still haven’t really sorted it out to the point where it’s easily usable by everyone in the health system.
‘Technically there’s interoperability. But practically, it’s not happening.’
Dr Hosking said the lack of progress is in part due to a lack of incentives, as well as commercial competition between software providers.
And while the coronavirus pandemic has highlighted the potential benefits of secure messaging to a wider population, he does not think it will be enough to overcome the current obstacles.
‘COVID has been the stimulus for, obviously, the rapid adoption and uptake of telehealth and that has directly had an impact on the increased uptake and use of secure messaging – but it’s still not ubiquitous yet,’ he said.
‘There’s been increased uptake as a result of COVID. But there’s also been increased uptake and use of plain email.
‘The lack of uniformity and availability of secure messaging has made us think that if secure messaging is not available, and the patient consents, then we may need to revert to other methods like standard email, or faxing, and even paper-based mail systems.’
Another issue, according to Dr Hosking, is that there is some confusion over where the main benefits of secure messaging lie.
‘Secure messaging is mostly about point-to-point communication between clinicians, not doctors and patients, because that’s a much harder thing to implement,’ he said.
‘The idea of secure messaging between clinicians is to try to protect the privacy and security of the patient’s information, because the widespread thinking is that plain email is not secure enough unless there are other systems utilised, such as encryption.
‘I think there are lots of GPs who are using secure messaging with pathology results and imaging results who don’t even realise. And now, more and more hospitals and specialists are sending information to us using secure messaging systems.
‘Unfortunately, they don’t interoperate so you have to have a number of different systems loaded on the server in your practice to be able to receive all the different forms that come in.’
Dr Rob Hosking does not believe secure messaging will become widespread until interoperability issues are resolved.
The ACSQHC lists several criteria required for the widespread adoption of secure messaging in the Australian healthcare system, including:
- a whole-of-sector approach
- promoting interoperability
- sound governance mechanisms
- adherence to standards
- data accuracy and consolidation
- ensuring privacy and security
- putting users at the centre
- pragmatic incentives.
Once it does eventually become widespread, Dr Hosking says there are numerous other benefits aside from security that GPs and other clinicians can take advantage of, in particular what he refers to as ‘structured data’.
‘If the message is sent via just a standard email with a Word document or an image attached or something, you can’t do anything with it when it gets to your information system such as Best Practice, or Medical Director or whatever you’re using,’ he said.
‘But if it comes in a structured format, and the information systems that we’re using can read that structured format, then there’s potential to import medications or medication lists directly from the document into our system.
‘So when there’s a change in medication and a patient’s come out of hospital and we receive a discharge summary, we can import that information directly into our medication list in our system.
‘Likewise, with pathology reports, if they come in in a structured way, then our systems can start to do interrogation of those multiple pathology reports and display trends over time of blood counts, and kidney function tests [etcetera] … so they become more useful if the data that we’re receiving is in a structured form that our systems also recognise.
‘It has a lot of potential to be really helpful, but interoperability isn’t there at this stage.’
Structured data also requires some coding, which can be challenging to undertake given the time constraints already placed on GPs.
‘That’s another area we find problematic – getting doctors to code the data that they’re entering into the documents … when they’re entered into the software system in the first place, such as diagnoses, and medications,’ he said.
‘If you use freehand text, you might be able to read it, and the person on the other end might be able to read it, but then it doesn’t have all those other functionalities that we get, like interaction checking with medications and conditions, and so forth.
‘I don’t think the average user understands that fully until they start to try to get the benefits out of their systems and they understand that the data elements really make it easier for them.’
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