A way forward: New technologies improve refugee health

A new electronic patient records system is improving the health of recently arrived refugees and facilitating collaboration between general practitioners in regional areas and metropolitan specialists.

Developed by staff at the Peter Doherty Institute for Infection and Immunity at the University of Melbourne and the Victorian Infectious Disease Service at the Royal Melbourne Hospital, the electronic record system is used by general practitioners and specialists to improve immigrant healthcare through collaboration with technology, as part of a Refugee Clinical Hub. 

Victorian Infectious Disease Service physician Professor Beverley-Ann Biggs says refugees that arrive from developing countries can present with non-infectious, chronic conditions such as Hepatitis B and parasite infection that require diagnosis and management.

At present, the Hub is dealing with recently arrived refugees from Afghanistan, and there have been waves of refugees in recent times from Sudan, Afghanistan, Iraq and Burma,” Professor Biggs says.

Language is a key barrier to managing illness among new arrivals, as is ensuring messages are being communicated clearly between refugee patients and their healthcare providers.

“The main problem we were trying to fix in developing the new system was that recently arrived refugees can have multiple medical issues that require treatment from GPs and specialists – and that can take months or years. To get best patient outcomes you need a coordinated system and we didn’t have that.

“This is a tremendous way to build refugee primary care capacity and is a way to promote refugee health care in general practice,” Professor Biggs says. 

The technologies being developed by the research team allow for a more integrated approach to patient care in a system that still relies on paper-based records where, in complex cases, papers can go missing, and test results can be duplicated, making it difficult for specialists to get a full picture of the patient, based on their record. 

Professor Biggs says the electronic records system allows sharing of patient information between GPs and specialists to get a holistic picture of their patient. 

“The clinical hub became a concept of a hospital-based refugee health system and a general practice management system that were integrated, with which we’ve ended up,” she says.

The main aims of the project were to improve medical record systems at a hospital level, and improve the ability to make a comprehensive healthcare plan at the general practice level. Practitioners involved also hope to incorporate tele-health to support specialists in rural and remote areas. 

Professor Biggs says the system offers insight into the future of healthcare we want to see, where there is better integration with the general practice and hospital systems in rural and metropolitan areas.

Dr Thomas Schulz, from the Victorian Infectious Diseases Service, explains the process of telehealth connection: “We have the patient sitting with their GP in rural or regional Victoria, and linked via a videoconference to a specialist sitting at Royal Melbourne.” 

“In a trial setting we have used telehealth to access interpreters via video conference,” which helps to communicate information to refugee patients,” Dr Schulz says. 

Dr Schulz believes the telehealth system has many benefits, by allowing patients to see their doctor rather than just talking on the phone. 

“Patient perception of the video conferences were favourable. We did a formal trial of the patient’s perceptions of telehealth for accessing an interpreter. Compared to a telephone interpreter they much preferred it. As a comparison to the voice without the picture, it is much preferred by patients and doctors,” he says. 

In addition to integrating refugee health care, the system is valuable in that it presents an upskilling opportunity for general practitioners in rural areas to work and train with specialists they may not otherwise have access to. 

The new records system can also be used for any chronic disease translation, explains Professor Biggs.

“The system we’ve built is incredibly flexible and could be similarly configured for any chronic or acute disease where specialists and general practitioners need to interact and share information and work with hospitals.” 

Reflecting on the process, Dr Schulz and Professor Briggs both agree it has been rewarding to work towards trying to improve care for a group of patients with complex needs. 

“It is nice to face a new challenge and to improve care for a particularly vulnerable patient group who have many complex issues, including the financial and social issues of getting to a clinic, which are often as pressing for the patient as our issues of managing their disease state. Helping to address those issues is challenging and satisfying,” Dr Schulz says. 

The project is a collaboration between the Department of State Development Business and Innovation, The Royal Melbourne Hospital, The University of Melbourne, the Royal Children’s Hospital, Monash Health, Barwon Health, Arcitecta, Precedence Health Care, the Windermere Foundation and the Department of Health. 

More information on the Refugee Clinical Hub and partners here.

www.video.visualdomain.com.au/26616/?bcId=3368432208001