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Mobile health records connect outback communities

The Kimberly Aboriginal Medical Services Council has introduced an electronic health record to provide continuity of care for indigenous populations scattered over a vast geographical area.

The Challenge: To maintain continuity of care for a highly mobile population scattered over a wide geographical area.

The Approach: Create an electronic medical record accessible by clinicians, specialists and nursing staff.

The Outcomes: Information is easily shared between clinicians, making it easier to deliver high quality, continuous care.

The Lessons Learned: Without an electronic record, a clinician visiting a remote community is flying blind without a patient’s history. The record turns the lights on.

The Upside for:

Clinicians: Better access to a patient’s complete medical record.

Patients: Being highly mobile, patients can receive the best quality care regardless of where their location.

The Organisation: Is able to deliver continuous medical services to the indigenous population, leading to better clinical outcomes.

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The KAMSC story

It’s hard for city folks to get their heads around the distances involved in delivering medical services in rural and remote Australia. The Kimberley, in Western Australia, has a population of around 50,000. Half of those people are scattered in remote communities across an area the size of South Australia.

“One of our communities is 1000km away from Broome,” said Dr Trevor Lord, senior medical officer with the Kimberley Aboriginal Medical Services Council (KAMSC). “You have to fly to get there.”

Adding to the challenge is the fact many communities are cut off by road during the wet season. Combined with the fact it’s hard to keep clinicians and nurses for any length of time within these highly mobile communities and it all adds up to a serious, almost intractable, problem when it comes to delivering health services to indigenous people.

Part of the reason it’s hard to keep clinical staff is because the communities are so small, making it hard to justify full time medical staff. The other issue is cultural: clinicians, who are predominantly white, find it hard to fit culturally and socially into remote indigenous communities.

According to Dr Lord, attacking the problem requires a multi-faceted approach. Providing medical services will always rely on the Royal Flying Doctor Service for emergency evacuations, and on clinicians flying into the community for regular visits. Training indigenous people to become health workers within their communities has also proven effective.

The other strategy was the creation, in conjunction with the University of Western Australia, of an online medical record. Dr Lord said this record has transformed the delivery of medical services in the Kimberley.

When a clinician, nurse or indigenous health worker treats a patient a record is created. This record contains details of the treatment, medicines prescribed, and observations from the clinician. The record is stored in a central database, and clinicians can access it from wherever there’s an internet connection.

Dr Lord said the record has made such a big difference in how health services are delivered, he now gets nervous if he can’t access it.

“There’s a big difference in risk between treating someone, and not knowing their medical history, and treating them with their full record in front of you,” he explained.

He also noted it makes collaborating with specialists, who rarely, if ever, visit remote communities. When Dr Lord, or another clinician in treating a patient with particular needs, they can get on the phone, ask the specialist to review the record, and receive advice on the spot.

In future, Dr Lord envisages giving patients read-only access to their records, as well as building out the antenatal and mental health aspects of the record.

“In the end, what it provides is communication between healthcare teams,” said Dr Lord. “Because of the record, this communication is first class – probably even better than what people get living in the city.”

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