Information science

To the Editor: Patients presenting to an emergency department (ED) may be unable to communicate with treating clinicians. Immediate access to emergency medical information is essential to providing optimal care and avoiding harm. Smartphone medical alert apps, such as those pre‐installed on the two major operating systems (iOS [Apple], Android [Google]), allow patients to store emergency medical information that is accessible to clinicians when a patient is incapacitated and the smartphone is locked. Similar to medical alert bracelets, these apps are designed to store basic emergency medical information. Via a self‐administered app, patients can record as much emergency medical information as they feel comfortable sharing. This information can be rapidly accessed from the smartphone's locked screen, bypassing default security features. We recently asked a convenience sample of 250 adult ED patients, well enough to complete a survey, to complete a questionnaire assessing their smartphone usage, familiarity, attitudes and barriers towards storing emergency medical information on smartphone apps. Ethics approval was obtained through the St Vincent's Hospital Melbourne Human Research Ethics Committee. Two hundred patients completed the survey. The mean age of respondents was 39 years (95% CI, 37–41 years). Most owned a smartphone and had it with them in the ED. Only 15% (31/200) currently used an emergency medical information app, with most using the default pre‐installed app. The commonest barrier to use was a lack of awareness or familiarity with the app. Once informed, most patients (97%; 194/200) were willing to use such an app in the future (Box). Patients who have privacy and security concerns about the government‐controlled My Health Record may view storing emergency medical information on smartphones as a safer option. The depth of information on a smartphone would be considerably less than that accessible via My Health Record, but in an emergency, some information is better than none. Using smartphones to store emergency medical information may lead to better emergency care for incapacitated patients. There is enthusiasm from patients to embrace this technology. General practitioners and other clinicians are well placed to inform patients and facilitate its adoption. ED clinicians should be encouraged to check the phones of incapacitated patients in the initial assessment and triage phase for the presence of potentially lifesaving information. Box – Number of patients currently storing or prepared to store emergency medical information on a smartphone app, by type of information Currently storing (n = 31) Prepared to store (n = 194) Number 95% CI Number 95% CI Name 27 (87%) 74–97% 171 (88%) 84–93% Date of birth 26 (84%) 71–94% 148 (76%) 70–82% Emergency contact 21 (68%) 48–84% 179 (92%) 88–96% Medical conditions 16 (52%) 36–68% 168 (87%) 81–91% Medications 11 (36%) 19–52% 162 (84%) 78–89% Allergies 9 (29%) 14–48% 177 (91%) 87–95% Organ donor status 11 (36%) 19–52% 173 (89%) 85–94% Blood type 13 (42%) 26–58% 184 (95%) 92–98%

Weiyu Fang · Rachel Zordan · Stuart J Dilley

My Health Record will foster a more connected health system that will help prevent avoidable harm

Meredith AB Makeham · Angela Ryan

New digital health services and technologies are transforming how health care is provided and experienced in Australia

Steven J Hambleton · John Aloizos AM

My Health Record can support emergency department clinicians by providing timely and secure access to patients’ clinical histories

Paul Miles · Andrew Hugman · Angela Ryan · Fiona Landgren · Grace Liong

Sophisticated methodological approaches and measures for scaling up are key elements of effective evaluation

Janice S Biggs · Andrea Willcocks · Mitchell Burger · Meredith AB Makeham

Despite most Australians having most of their health‐related interactions in the primary care sector, primary care‐based research is disproportionately low. Access to quality EMR data, lack of resources to remunerate GPs, and a lack of understanding among some GPs of the value and importance of secondary use of EMR data are barriers to data sharing. Data extraction tools that enable ethical, secure and privacy‐protected access to routinely collected datasets nationally have been developed. The task now is to build trustworthy primary care data repositories for research that will provide researchers with timely access to quality‐assured general practice data. Linkage with other datasets could enable significant scale‐up of primary care‐based research in Australia, contributing new knowledge in public health, health promotion, economics and evidence‐based clinical care. Technologies that allow consumers to have greater control over how their data are used can provide better options to policy makers, hence investment in this area is essential. Educating clinicians and the public about the need for, and existence of, research based on de‐identified patient medical records has the potential to generate greater social licence and acceptance of this emerging area of study. This has the potential to generate significant gains in terms of service delivery, economics and patient health. We can “do the right thing” now, but we must never become complacent.

Rachel Canaway · Douglas IR Boyle · Jo‐Anne E Manski‐Nankervis · Jessica Bell · Jane S Hocking · Ken Clarke · Malcolm Clark · Jane M Gunn · Jon D Emery

The known: Large amounts of clinical data are collected in electronic health records (eHRs). This information is largely untapped by clinicians for purposes of performance review or professional development.

Tim Shaw · Anna Janssen · Roslyn Crampton · Fenton O'Leary · Philip Hoyle · Aaron Jones · Amith Shetty · Naren Gunja · Angus G Ritchie · Heiko Spallek · Annette Solman · Judy Kay · Meredith AB Makeham · Paul Harnett

Gaining value from decision support in electronic medication management systems requires a well evidenced approach

Johanna I Westbrook · Melissa T Baysari

Widespread adoption of digital health tools requires comprehensive evidence of their effectiveness and value

Andre Q Andrade · Elizabeth E Roughead

Improving the care experience with an e‐health tool that addresses patient and family priorities

Cheryl McCullagh · Melanie Keep · Anna Janssen · Hiran Selvadurai · Tim Shaw

Benefiting from genomics in health care depends on data sharing and digital health integration

David P Hansen · Marcel E Dinger · Oliver Hofmann · Natalie Thorne · Tiffany F Boughtwood

Specialist practices may benefit from the implementation framework and resources developed at Melbourne Hand Surgery

Jillian Tomlinson

My Health Record is an easy‐to‐use and effective clinical tool for specialists

Elizabeth Jackson

“A picture says a thousand words … especially when it's the patient's third language”

Marianne St Clair · David P Murtagh · John Kelly · Jeff Cook

Decision support tools driven by artificial intelligence are a new clinical method that clinicians need to embrace

Christopher Pearce · Adam McLeod · Natalie Rinehart · Robin Whyte · Elizabeth Deveny · Marianne Shearer

To the Editor: It was a pleasure reading the 20 August 2018 issue of the Medical Journal of Australia, containing many informative, broad‐ranging articles. However, the absence of the authors’ qualifications, which ultimately establish who the authors actually are — possibly reflecting their credibility — may render an article potentially less valid for the readership. This contrasts with the detailed and impressive qualifications of the MJA staff members, faithfully and appropriately listed in each issue, transparently demonstrating their expertise. No MJA author is awarded such recognition. The perspective by Munk and colleagues1 highlighted the threat posed by predatory journals to researchers and academic literature. The MJA lists only their affiliations; therefore, the readership is unable to establish a frame of reference for their opinions. Cursory investigation reveals lead author, Peter Munk, to be a Canadian radiologist, thereby impressing also as an authority on predatory journals. Rochwerg and colleagues2 discuss clinical decision making with network meta‐analysis. Without their qualifications, the reader is unable to determine whether they are physicians, statisticians, health economists or politicians. In their helpful Editorial, Shorthouse and Stone3 examine the need for additional mental health care training for rural medical practitioners. It turns out that both authors are Australian general practitioners — Molly being a rural generalist, and Louise a professorial medical educator. Interestingly, neither is a specialist psychiatrist. Professor Olver4 discusses B‐cell non‐Hodgkin lymphoma in Queensland. Despite his fame, his Editorial would potentially have been augmented had the readership been presented with his impressive research and clinical credentials. It seems reasonable to raise the notion that the absence of authors’ postgraduate and other qualifications could diminish their contribution to the medical literature. Our group has previously documented the importance of journals publishing authors’ qualifications.5 We published that “if the author qualifications are designated, the reader may be quite sure that the article was not written by the medical records librarian, let alone the hospital trolley boy in a moment of inspiration”.5 This is not to say the hospital trolley boy is not entitled to offer his thoughts on a medical subject. Rather, it provides the readership with perspective concerning authors’ expertise and opinions.

Damien L Ling · Anna M Waldie · Ian C Francis

In reply

Nicholas J Talley AC