Digital tools in your practice

Most Australian general practices use electronic clinical information systems (CIS), which are vital tools in the delivery of safe, high-quality healthcare and good practice management.

One of the main purposes of a CIS is to hold healthcare records which contain information about patients to support effective care and clinical decision making. With the increasing use of shared care models and the increased use of My Health Record, the quality of information contained in general practice CIS is more important than ever.

No longer serving only individual GPs or practices, information in a patient’s health record is likely to be shared between, and relied upon by primary, secondary and tertiary healthcare services, and the patient themselves.

Some of the core functions of general practice CIS are to:

• manage patient personal details and demographic information
• record healthcare history, social history, risk factors and allergies
• record, track and support follow-up reminders for preventive medicine and recalls for ongoing care
• manage medications and generate prescriptions
• create electronic referrals and receive electronic reports, including specialist letters and discharge summaries
• create electronic diagnostic orders and receive laboratory and radiology reports
• provide decision support in various forms (e.g. drug–drug interaction checking, drug–disease interaction checking, checking for appropriate care in people with chronic diseases)

To get the most out of your clinical information system, features like structured data entry, clinical decision support tools and data analytics should be actively used.

An artificial intelligence (AI) scribe is a tool that can automate parts of the clinical documentation process for GPs. AI scribes can convert a conversation with a patient into a clinical note, summary, or letter that can be incorporated into the patient’s health record.

An AI scribe cannot completely replace the work a general practitioner (GP) undertakes to prepare clinical documentation. The output of an AI scribe must be carefully checked for accuracy by a GP, as it can produce errors and inconsistencies. GPs are ultimately responsible for ensuring the patient health record is accurate and up to date.

A practice website is an important tool for communicating information and making your practice more accessible to current and future patients.

Traditionally, general practice has used information brochures and printed material to provide information to patients. Some specific patient cohorts who do not use digital technologies may still require this, however, having an online presence via a website adds to the way you can communicate and share information to a larger audience. It is important to plan your website and how it will be used and schedule in ongoing updates and maintenance to ensure information is up to date and relevant.

There are many benefits of having a well-designed website, which include:

• increasing your practice’s online visibility - a website is a great tool for promoting your practice. It is important to ensure your website is up to date as this creates a better first impression.
• enhancing the patient experience - current and potential patients can make an appointment or access health information and resources at any time, making your practice more accessible. You can provide information about clinicians and practice staff specialisation, opening hours, billing and location.
• reaching a broader audience - having a web presence will open your general practice up to new patients from your local area. If you offer specialist services, such as women’s health or diabetes education, you may be able to use your website to attract patients from outside your area.
• creating and establishing your business image - a well-designed website will make your general practice appear professional and accessible.
• gaining patient feedback - feedback is often difficult to gather. A website allows you to enter into a dialogue with your patients though surveys, questionnaires and feedback forms on your website and by directing them to your social media platforms. Most websites will also provide analytics so you can gauge what is working and not working in terms of content with your audience.

When designing your website, have a think about how a patient would feel visiting your webpage for the first time. How easy is it to find the information they are looking for? Does the webpage give the patient a sense that they would be welcome in your practice? Who are the doctors and practice staff and what are their credentials and specialties? What services does the practice offer and how easy is it to book?

There are also some other things to consider for your practice website:

• Privacy and security - one of the primary concerns for general practice when using the internet for communication is maintaining business and patient privacy. Providing a copy of your privacy policy on your website communicates to patients how you meet your privacy obligations.
• Costs and resources - there are a number of tools available that will allow you to design and manage your own website or you can spend money to have your website professionally designed and managed. You also need to pay for a domain name and ongoing website hosting. You might want to consider investing in search engine optimisation or paid advertising to ensure your website can be easily found by potential customers using website search engines such as Google. If you decide to manage your own website, you’ll need to make sure you have the time and resources to keep your website up and running and up to date.
• Content - you will need to consider what sort of information you would like to have available on your website. For example, will your website pose as a directory and include basic information like the phone number, address and team member profiles or will you also provide health information for patients and links to other sources of information?

Having a strong website presence enhances the patient experience by making your practice easily accessible and reducing some of the administrative burden of your front desk.

Online booking systems allow patients to book appointments online through internet-connected devices, such as computers, tablets and smart phones, at a time convenient to them.

Some online booking systems include additional features, such as automatic SMS and/or email appointment confirmations and reminders and online check-in processes when patients arrive for appointments.

There are benefits to both the patient and practice by having online bookings available, including:

• improved patient access - patients can book, reschedule or cancel appointments outside of the normal general practice business hours providing more access and flexibility.
• improved business efficiencies - practice staff spend less time on the phone managing appointments, allowing them to undertake more patient-focused tasks and potentially improving health outcomes. This can result in a reduction in costs, as staff resources can be directed to other tasks. Patient non-attendance can be minimised through reminder systems, reducing lost revenue.

Before introducing an online booking system, you will need to ensure the system you are using has privacy and security policies to protect patient confidentiality and the use of patient information, particularly if you decide to use an external provider.

One of the downsides of online bookings is there is no ability to triage patients when they make an appointment. For this reason, the RACGP recommends the use of online booking systems for routine and non-urgent appointments only. You may also want to consider only making online bookings available to existing patients of the practice and not to new patients.

You will need to consider the system you use – there are some online appointment systems that integrate directly with general practice clinical information systems, or you may look to go with an external provider as these may provide more services such as technical support for patients as well as analytics on booking trends.

You will also need to think about some of the practical things such as managing booking errors, last minute cancellations, unexpected GP availability, what to do if the online system fails, and the privacy and security requirements of managing patient information.

You will also need to ensure that patients who do not have access to an internet-connected device, or lack confidence or ability in using online booking systems, continue to have the option of making appointments by phone.

GPs and practice teams are increasingly using social media for professional and business purposes to engage with patients and the community. While there are benefits, there are also potential risks. Professional and safe conduct online is paramount.

Given that nearly 80% of Australians use some form of social media, and a quarter of Australians follow businesses or brands on social media, the widespread use and low cost of social media makes it a convenient tool for general practices to connect with patients and health professionals, and vice versa. It allows you to engage patients before they even attend the practice or keep them engaged as an ongoing patient.

Social media not only allows you to publicise your practice name, address, contact details and services, it also allows you to build social connections and genuine communications. It allows your general practice to be part of conversations, provide useful information and start to nurture a community. Your social media platforms can be the source of evidence-based health information that your patients use and trust.

There are many benefits to your practice using social media, including:

• patient engagement - social media provides a unique opportunity for staff to engage with patients by answering their questions online. This is often more efficient than answering phone calls and allows other people to read common questions and answers without having to personally approach your practice. This could be things such as alerting patients when your practice has flu vaccines available, for example.
• raising awareness – you can increase your practice profile on social media by encouraging people to click the ‘Like’ button on your Facebook page, follow you on X (Twitter), or connect with you on LinkedIn. Once people are connected, they will receive any updates you post, raising awareness of your practice and services.
• increasing traffic to your website – you can include links to your website on your social media pages, encouraging patients to access more detailed content and other resources.
• professional development - social media can also serve as a tool to facilitate expansion of professional networks (local, regional, national, international), information exchange, collaboration, curriculum development and e-learning, among many other professional activities. It’s an easy way to network, keep up to date, learn, engage and connect directly with decision-makers.

The use of social media naturally raises concerns about privacy and security. Social media sites often require personal information is surrendered to the provider and while there are some levels of privacy available, the reality is that once information is online, it can easily be found. 

The unique nature of general practice and the need for confidentiality and privacy means social media can have its challenges and the line between business and social interactions can become easily blurred. General practices that want to use social media need to have robust policies and procedures in place to ensure patient, GP and staff privacy is maintained.

Before you set up any social media accounts, you should consider whether social media is right for your practice.

• Do you have the staff resources to implement and manage your social media profiles?
• What policies and procedures will you need to create to use social media safely and efficiently?
• Will this be of benefit to your patients?
• Do you have the time to train staff?
• What social media platforms will allow you to collaborate with the most relevant groups or people?
• Who is your target audience? Will you be able to connect with your target audience to increase your business profile?

Patients commonly interact with multiple healthcare providers and organisations across numerous locations. Efficient communication between all parties involved in a patient’s care is critical to ensure the delivery of high quality, effective and safe healthcare.

When exchanging sensitive patient information, it needs to be done in a way that is safe, secure and efficient. The RACGP Standards for General Practices 5th edition (the Standards) (Criterion C6.3) requires practices to transfer relevant patient health information in a timely, authorised, and secure manner. There are no mandatory requirements in the Standards about how this information should be transferred but the RACGP has long advocated for interoperability between different clinical information systems (CIS) to enable secure message delivery because it is the safest, most secure and efficient method of communication available.

Secure messaging enables healthcare providers to send information via their clinical information system to the receiving provider or through one or more secure messaging systems.

In order to send and receive secure messages, your practice will need to have a conformant clinical information system and be registered with one or more secure messaging providers. Once a secure message is created, it is encrypted and sent through the sender’s secure messaging system to the receiver’s secure messaging system, de-crypted and passed on to the receiver’s clinical information system.

More than 90% of general practices utilise secure messaging systems and most other specialists and healthcare organisations have secure messaging capability. There are some simple steps you can take to start using secure messaging, starting with contacting your preferred specialists and contacts to find out which secure messaging systems they use. You may already be using the same secure messaging software, or you can arrange for a free trial of their system/s to securely exchange documents.

Once you have selected the secure messaging product that meets your needs, you would then configure your software address book to quickly look up your contacts, train your staff on how to use secure messaging and notify your key contacts of your secure messaging identifier.

These systems are widely underutilised, especially for outbound communications. Despite the considerable efforts of professional bodies, government agencies and industry, interoperability between CIS has not yet been achieved.

The RACGP is continuing to advocate for secure electronic communications and has provided recommendations to the Healthcare Interoperability Plan and the National Digital Health Strategy to establish clear regulations to drive the necessary changes required for widespread adoption of interoperability across the health sector. Secure communications also need to be supported by high quality, searchable directories containing healthcare provider information which must be maintained and kept up to date.

Secure digital communication is the RACGP’s preferred method of exchanging information to and from general practice. However, in the current state of a non-integrated healthcare system, the RACGP views email as preferable to other less secure methods of exchanging patient information, providing it adheres to RACGP guidance on using email in general practice and every effort is made to secure it as much as possible.

The RACGP views email as the simplest and most effective method of communication where secure messaging is not available.

As with all forms of written communication, there are risks that unsecured or unencrypted emails can be sent to the wrong recipient, forwarded or changed without the knowledge or consent of the original sender, or even intercepted. That’s why it’s important to follow RACGP guidance on using email in general practice, and to obtain informed consent from the patient.

You should also consider the content of the email and how sensitive the information is that you are sending and discuss this with your patient.

When sending an email, every effort should be made to secure it as much as possible, by using password protection, encryption software, or via a secure website with passwords requiring multi-factor authentication. You should also ensure you have up to date antivirus protection and maintain hardware/software firewalls and use a quality email delivery service and internet service provider.

It’s important to educate all staff in the practice on how to use email appropriately and have a documented email policy available to staff and patients.

There are many instances where email is an appropriate method of communication, provided both the sender and the patient are aware of the risks and limitations, and consent is provided by the patient.