We have now had more than three years of the covid pandemic and national emergency.
Contrary to the hopes of governments and to public perception, the pandemic continues, with the number of deaths in 2022 the highest since the start of the pandemic.
Despite every health authority continuing to emphasise the importance of vaccination, only 72% of eligible Australians have received their third dose, and only 45% of those eligible have received their fourth dose, at this time when a fifth dose is now recommended for some people.
Ninety per cent of Australians make an average of seven visits annually to general practice, with people over 60 making twice as many visits as those under 60. Each of these consultations is an opportunity for the GP or practice nurse to check the patient’s covid vaccination status, and if the patient has not received all of the recommended doses, to advise them to have those doses as soon as possible.
GPs and practice nurses can access the Australian Immunisation Register (AIR) from within their clinical software. The link to the AIR uses the FHIR (Fast Health Interoperability Resources) application programming interface that was developed in Australia and that is being adopted worldwide as the preferred method by which clinical information systems exchange data.
With patients now receiving many vaccinations outside their usual general practice, assembling a complete record of each patient’s vaccinations has become a larger task than previously. The link in clinical software to the AIR lets GPs and practice nurses view the patient’s vaccinations given by any provider and allows them to download any of those vaccination records into their practice’s clinical system.
Notably, as reported in The Medical Republic more than a year ago, this downloading can be done only of one vaccination at a time, and currently is not automated. Unless the GP or practice nurse remembers and has the energy to view the patient’s record in the AIR while also performing the many tasks in most consultations, the GP or practice nurse and often the patient are unaware that the patient is not fully vaccinated against covid or other infections for which vaccination is recommended for them. My experience is that when I have informed patients that they are not fully vaccinated against covid, many have been surprised. However, this is understandable in view of the frequent changes to the recommendations.
The problem of GPs, practice nurses and patients being unaware during consultations that the patient is not fully vaccinated could be addressed by alerting GP and practice nurses prominently about this during the consultation. To achieve this, clinical software will need to automatically download from the AIR at the beginning of each consultation any vaccinations that are not yet in the patient’s clinical record. This requires only a small improvement to the current functions in clinical software. Rather than accessing the AIR only if and when the user remembers to push the button, clinical software should access the AIR automatically when the patient’s record is opened at the start of a consultation. Once the clinical system has downloaded any vaccinations that are not yet in the practice’s record for the patient, it can alert the GP or practice nurse if the patient has not received all of the recommended doses and has not been recorded as refusing or ineligible for covid vaccines.
In addition to the above, patients could be informed automatically by text message immediately before consultations that they are not fully vaccinated and encouraged to discuss with their GP. My university research program is finding that patients welcome and respond to such SMSes.
A new feature in clinical software packages allows GPs to record and to report to the AIR medical reasons why patients should not receive a particular vaccine. However, this “medical exemptions” function allows users to choose from only a small number of fairly generic pre-defined reasons and not to enter any other reason. Users can specify that the selected reason is “permanent” or “temporary”, but there is no explanation of the duration of “temporary” reasons for exemption.
The medical exemptions function does not allow users to record and report that the patient is refusing covid vaccines, or all vaccines. In my experience up to 10% of patients refuse a vaccine, some vaccines or all vaccines. There are four reasons why it is important that we can record and report the patient’s refusal:
- to enable others who are viewing the patient’s record in the AIR to know why the patient is not fully vaccinated
- to suppress alerts and reminders about vaccines that the patient is refusing to have
- to help to maintain good relationships with patients, by not continuing to advise them to have vaccines that they have already refused, which they might see as harassment or poor record keeping on our part
- for our legal protection, should the patient come to harm as a result of not having been vaccinated.
With GPs’ clinical software packages automatically reminding GPs about a range of preventive activities including vaccination, it is disappointing that two years after vaccination against covid became available, no clinical software package provides automated reminders that the patient in a consultation is not fully vaccinated against covid.
I have asked Services Australia, which runs the AIR, the Australian Digital Health Agency, the Medical Software Industry Association and the vendor of my clinical software whether there are any legal or bureaucratic barriers to automated downloading of the patient’s vaccinations from the AIR during consultations. After considerable correspondence back and forth, I still have not received a straight answer, but my understanding is that there are no barriers.
My advocacy with the organisations above and with the RACGP for automated downloading during consultations from the AIR of vaccinations has so far failed to see this implemented in clinical software. If you want this function to be introduced, you can help to make it happen by writing to the vendor of your clinical software. Copy your message to advocacy@racgp.org.au so that the college can support your request.
Dr Oliver Frank is a GP in South Australia and the RACGP’s nominee on Services Australia’s Stakeholder Consultative Group.
