The Australian Privacy Principles, and the recently passed (by the Australian Parliament) Mandatory Breach Notification bills provide various guidelines, which should be adhered to by anyone who handles any electronic medical data. Basically, the principles stipulate that all medical practices must ensure that all necessary measures are in place while saving, accessing and sharing any electronic medical data to keep patient data secure. Lack of compliance to the security standards could lead to large fines for both companies and individuals. Several steps can be followed by medical practices to ensure compliance to privacy standards. These steps include:
Run a complete risk assessment of the practice
Many medical practices adopted electronic health recording systems before there were clear guidelines on what these systems should contain. This means that a practice could be using electronic systems which are not compliant with current standards. To ensure compliance, a risk assessment should be done on the current systems to highlight areas in which compliance is not enforced, and to expose areas in which changes are needed. Ensure the latest version is being used, including any security patches from the vendor.
Prepare for disaster before it occurs
All data handled by a medical practice should be safe both from loss and corruption. One of the main ways of ensuring that data is not lost in case of any mishaps is backing up of medical data daily. Data should be backed up in an offsite location to ensure that in case of incidents such as natural, or man-made, disasters the data backup is not destroyed, as well. Antivirus programs should also be installed on all computers to ensure that data is not corrupted or destroyed by computer viruses, or held to ransom by cyber criminals.
Implement an ongoing employee training programme
Any system is only as strong as its weakest link, and in some cases poorly trained employees, or temporary staff, are the entry point for hackers into medical practices. It is also these staff who are more likely to have an “oops” moment and accidentally release confidential information. A medical practice could have excellent processes and systems, but if the employees don’t use their passwords to securely access records and files the system security is rendered useless, and anyone can gain access to these records. Medical practices should continually train their staff on how to follow the right security protocols, to ensure data integrity and security.
Purchase medical products with security compliance, and compatibility in mind
New equipment bought for a medical practice should be compatible with existing systems and should offer enough security features. With the advent of connected devices, the Internet of Things, it is critical that devices are secure, and kept up to date. Before making any major purchases enough review of the product should be done to ensure both security and compatibility.
Collaborate with affected parties
Changes which need to be made to bring about cyber security and privacy compliance affect many people in the practice. Affected groups should be offered training and management must ensure that staff understand the importance of compliance to everyone involved in the practice. Also, ensure that key staff are trained on what to do in the event of a breach. A comprehensive disaster plan is essential, and must be practiced regularly.
During the course of a day, I’ll often find myself find myself glued to my phone, staring off into space, or just flat-out falling asleep in the middle of something I probably shouldn’t be falling asleep during.
I like to associate this with a lack of sleep and being on-the-go a whole lot, which in all honesty, probably has a lot to do with it. I average around 5 1/2-6 hours of sleep a night, which isn’t very good at all. But lately I’ve been thinking more and more about this for some reason, and I realize I can’t just place all of the blame on not getting enough sleep.
That’s where the word “apathy” comes into play. A lot of people may not know what that word means. I didn’t, at least not until I heard a song by OneRepublic (one of my favorite bands for those who didn’t…
The humble Pap Smear is over ninety years old so just to jog your memory, the Papanicolaou test (abbreviated as Pap test, known earlier as Pap smear, cervical smear, or smear test) is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix (opening of the uterus or womb).
However, as of December 1st 2017, things are changing with Cervical Cancer Screening in Australia.
December brings about a change in Australia’s approach to screening for cervical cancer. Here’s what you need to know about an exciting revolution in health for people with cervixes!!
Pap smears involve sampling cells from a specific part of the female anatomy: your cervix. This is the gateway between the vagina and the uterus, and its function is to hold a baby inside your uterus for 9 months: then stretch to let it out!
In order to sample cervical cells, the medical practitioner uses a speculum to view your cervix; but many people consider this examination physically invasive and unpleasant. A pathologist then examines these cells under a microscope for signs of pre-cancerous and cancerous change – what we refer to as cervical cancer. Identifying these changes means you can treat early, preventing more serious disease.
Australia introduced the National Cervical Screening Program in 1991. Since then most cervix-bearing people are prompted by their GP to undergo a pap smear every two years after becoming sexually active. Since its introduction, this program has halved the incidence of cervical cancer in the general population.
The thing is: science is rapidly progressing. Our knowledge of cervical cancer has grown substantially, which has prompted a review of how we screen for abnormal changes. We now know:
You need to have contracted a high-risk Human Papilloma Virus (HPV) to get Cervical Cancer.
HPV is a viral sexually transmitted infection, like the flu, but downstairs.
Infection with HPV is really common! Most people are infected during their lifetime but clear it (like the flu!), with 12% of cervix-owners infected at any given time.
Most cervixes infected with high-risk HPV will not develop cervical cancer. The chance of a HPV infection developing into cancer is low.
There are 40 recognised types of HPV, but only 15 are currently considered high-risk.
Luckily, most HPV infections will cause no symptoms and often are cleared by your immune system.
Cervical Cancer develops very slowly and over a number of years.
If you have recently left school, you would recall receiving the HPV vaccination, also known as Gardasil or Cervarix. The National HPV Vaccination Program was introduced in 2007 giving three doses of a vaccination that can protect against two high-risk HPV strains, namely 16 and 18. 71.2% of women in Australia have been vaccinated by the age of 15. Of course, this only works if you haven’t already been exposed to HPV.
Given all this new knowledge, pap smears actually aren’t the most accurate way to measure abnormalities in your cervix! A single test will accurately detect abnormalities in only 40-60% of samples, as it depends on which cells are picked up. This can be improved on with repeated testing (for example, every two years!), but HPV DNA testing is more accurate.
HPV DNA testing involves taking a swab of your cervix, and using genetic assays to look for known DNA that is HPV. It specifically tests for high-risk HPV infections, looking for evidence of the virus from their DNA. This test is better at detecting HPV infection which is the cause of cervical cancer. Using this we can have high confidence that you will not have a HPV infection causing cervical cancer.
Thus, the National Cervical Screening Program is changing to high-risk HPV DNA testing as an alternative to pap smears from the December 2017. This change benefits us because:
High-risk HPV DNA testing is more accurate.
Less of the people screened will have to undergo further diagnostic or treatment procedures. These are often invasive and potentially damaging to the cervix.
You won’t need to be screened as often! Only every five years, and only from 25 years old, until 70 to 74 years old. Of course, if your test is positive you will be required to undergo further investigation, and potentially more regular testing.
There is the potential for people to self-collect the specimen, allow those who are uncomfortable with formal collection by a doctor to still participate in the screening program.
That all sounds good, hey? However you may have some other concerns. I’ve tried to address them in the questions below…
If the pap smear is gone, does that mean the procedure is much nicer and less intimate?
No, unfortunately the procedure is almost identical from your perspective, and you will likely notice no difference. All that has changed is its frequency: every five years instead of two. This is one way of reducing how often you have to have a test! The only change to the procedure is exactly how the doctor or nurse collects a sample and its examination by the pathologists.
Wait, if I’m not getting screened before 25 could I have cervical cancer that no one knows about?
As I mentioned, cervical cancer is incredibly rare before the age of 25 and takes a long time to develop. Most women with cervical cancer experience symptoms.
The main symptom is vaginal bleeding in between periods, and/or during or after sex.
Other symptoms include unusual vaginal discharge, discomfort or pain during sex and lower back pain.
If you or someone you know is experiencing these symptoms you should make an appointment with your GP for investigation. Just because we don’t screen everyone below the age of 25, does not mean we will not test you if you have symptoms.
Why do I know women under the age of 25 who have had cancerous or pre-cancerous cells requiring further treatment?
By screening from the age of 25 a number of women will no longer undergo procedures that are unneeded because some abnormal pap smear results may return to normal over time. In fact, 90% of people with HPV clear the infection in two years, and the abnormalities return to normal! Also, evidence shows that screening below the age of 25 don’t reduce the cancer outcomes, as it is so slow to develop.
If they do have persistent infection linked with abnormal changes, they will be detected when screened at the age of 25, which is soon enough – as cervical cancer is incredibly slow in developing. Screening less often will also reduce stress, time, cost and discomfort and risk of complications from treatment of harmless abnormalities.
In addition, given the success of the HPV Vaccination Program, it is anticipated that infection with two major high-risk groups of HPV will decrease, therefore reducing the number of women who would have had abnormal cells in a pap smear.
There a few cases where screening might be considered earlier, in the case of immunocompromised patients or instances of genital contact childhood sexual abuse, which need to be managed on an individual basis.
How do I know if I was vaccinated for HPV?
All teenagers are currently vaccinated from the age of 13. Males began to be vaccinated in 2013, so if you’re past year seven you will not have been vaccinated. For females, if you finished or left school in 2006 you will not have received a HPV vaccination, but beyond that, unless you or your parents declined you’ll have received it. There was a catch up program run, but it ceased a few years ago. If you have not been vaccinated you can pay to have this done as an adult at your local GP.
You can also contact the National HPV Vaccination Program Register if you are unsure. But remember, being vaccinated only prevents against the most common high-risk strains, not all HPV, so cervical screening is still really important!
I’m in a relationship where there are no male sexual organs involved! Does that mean I won’t get HPV?
No! You are at the same risk of HPV in a relationship where sexual contact involves two people with cervixes, as one with a male sexual organ and one with a female. Don’t neglect getting screened!
Isn’t the government just trying to save money reducing how often we are screened?
There are definitely financial benefits for our government in reducing the frequency of screening tests. However, that’s not the main reason for this change. Cervical screening for HPV DNA will be put in place because evidence shows that your cancer will be detected at five-year intervals, and reduce the cost to you in time, money and discomfort of undergoing the examination.
Do you have some published scientific data to back up what you’ve said?
Of course I do! If you’re interested in the government’s process that researched and recommended these changes, head to this website. The documents on this page cite numerous resources made in reviewing our screening program, as well as published research from across the globe. This was developed by the Medical Services Advisory Committee, which is an independent non-statutory committee under the Department of Health. You can learn more about it here.
If you would like further access to specific evidence, please feel free to get in touch!
Time. Timing. Such a critical aspect of Medicine. When a patient is in VF (Ventricular Fibrillation) the medical team has seconds, tens of seconds to act before the probability of successful resuscitation decreases exponentially. Act too fast (not yelling ‘CLEAR’) whilst activating the defibrillator and they risk hurting a team member and losing further precious seconds whilst the machine recharges. Act too slow and the patient is lost forever.
The same principles apply for non-emergency musculoskeletal workplace injuries. More often than not, I encounter patients, employers and insurers who request for MRIs at early stages of injury when there is no medical indication. The fact of the matter is, there is very little correlation between most MRI findings and the patient’s current injury or problem. Kind of like seeing all the imperfections on footy player’s faces on a 4K TV during a game. Additionally there are quite a large number of studies that show that early spinal MRIs that are not medically indicated often result in poorer outcomes and disability. I once saw a worker who was in such severe pain due to his belief that his ‘discs are squashed, bulged and spinal cord and nerves crushed’. When viewed I his MRI scans and told him that there is mild bulging of his lower 2 lumbar discs , his immediate response was “That’s where my pain is !! Between my shoulder blades……..”
Another example is that of shoulder impingement syndrome. A subacromial injection early on the injury is not going to be of benefit if the patient is not aware of how to perform rotator cuff exercises. An injection too late will also have less chance of success.
It is all about timing. Right, Roger Federer?
I previously wrote about Specialised Early Intervention and Second Opinion Medicine. With both services, we have been able to successfully rehabilitate a good proportion of complex worker injuries to normal work, alternative work, new employment or community restoration. Unfortunately some patients do not do so well. Being a sub-specialist practice, all our patients are referred from GPs. Despite extensive communication to the GP community, employers, insurers and rehabilitation providers emphasising the importance of early referrals, our earliest referral over the past few years has been 7 weeks post injury. This was an outlier, with the average referral being 6 to 9 months old. Well…….it beats my record a few years back when I saw a 50 year old man (with a six-pack) who had been on benefits since 19 and could not remember which leg his sciatica was on………..
Successful Early Intervention requires implementation at 2 to 3 weeks post injury. Some people refer to it as ‘The Golden Month’. For complex worker injuries, there is now good evidence that screening and intervention at day 1 of injury result in a significant reduction in disability and cost.
We are now in the process of implementing this with the introduction of services to GPs. The aim is to provide patients, workers and employers with a personally tailored comprehensive suite of medical and allied health care, as well as quick but well-timed access to medical sub-specialists.
I feel like I have been playing the game of RISK over the past few years. Disability is the enemy. I hope this strategy contains it.
Thanks Kar – it’s inspiring to see the passion you have for returning injured workers to work! Getting you better is what we’re about at PartridgeGP and so we’ll be working together with NGOM whenever we see injured workers.
Here to Help
Our Doctors at PartridgeGP are Here to Help Injured Workers – you can meet them here.
It’s the Sunday after the RACGP AKT and KFP exams for some and before a busy Monday for others. You may be a little flat and the world may seem a bit chaotic at the moment so I thought I’d take a minute to remind us all of how good we have it in Australian General Practice. What are some of the little things your patients have done for you? These are three that come to mind for me: