Digital health literacy: helping older Australians use myGov, Medicare and video consults

Digital health literacy is often sold as a training problem. Download the app. Watch the video. Try again. That story flatters the people who built the portals. It is less useful in a waiting room where the actual barriers are a locked myGov account, a shared family phone, and a text message that looks like Medicare.

Older Australians are not one cohort. Some ran small businesses on cloud bookkeeping. Some have never had an email address in their own name. Many sit in the middle: competent on a familiar iPad, stranded the moment a login loops or a new camera permission appears. The useful question is not "can older people use technology". It is which pieces of the Australian health stack keep failing them, and how a practice can help without taking over the account.

This is journalism about those failure points. It is not a set of clinical instructions, and it is not a claim that every barrier is age.

The lockout is the event, not the password

myGov is the front door to Medicare online accounts, parts of the My Health Record journey, and a pile of other government services. It is also a system that will lock a person out after failed attempts, a lost second-factor device, or a recovered mobile number that now belongs to someone else.

The lockout is where digital health stops being theoretical. A person who cannot get into myGov cannot update a bank account for Medicare claims, cannot always retrieve a digital statement, and may not be able to complete a task a hospital clerk described as "just log in". They can still see a GP. They cannot complete the homework the system now assumes.

Recovery is deliberately hard because the account is valuable. That is rational security design. It is brutal when the recovery path requires a working email, a current mobile, and a memory of which authenticator app was installed three phones ago. Services Australia has in-person and phone options. They are slower than the "forgot password" link, and they are the ones that actually work when the link does not.

A practice cannot reset myGov. A well-run practice can keep a one-page sheet that says so, with the official website address written out, the phone number current as of the last staff meeting, and a warning not to follow links in texts. That sheet is dull. It prevents a receptionist from becoming an unpaid identity broker.

Digital statements and the missing letter

Medicare has been pushing people toward digital correspondence. That saves postage. It also means a missed email filter can look like the government went silent. Older patients who still expect a letter will assume nothing is happening. Older patients who share an email with a spouse may never see the message.

If a practice is going to tell someone to "check their Medicare online account", the sentence needs a second clause: and if you cannot get in, here is the non-digital path. Otherwise the instruction is just another lockout.

Shared family phones are a privacy design, not a quirk

Plenty of households have one smartphone that works. The adult child set it up. The grandparent uses it to take calls. Medicare, the bank, and a group chat live on the same handset. This is not a failure of education. It is a rational response to cost, confidence, and the fact that Australian services still treat a mobile number as a person.

It creates three practical problems.

First, one-time codes arrive on a device other people pick up. A myGov or bank code sitting on the lock screen is an access token.

Second, video consults inherit whoever is signed into the App Store. A clinic sending a link to "the mobile on file" may be sending it to a daughter at work.

Third, electronic prescribing tokens and Active Script List access can land in a family inbox. That can be exactly what the patient wants. It can also disclose a medicine the patient did not plan to discuss at Sunday lunch.

The fix is not to scold families for sharing. The fix is to ask, out loud, which device will ring, who else sees that screen, and whether the patient wants a paper token or a token sent to a number they alone hold. Those are ordinary consent questions. They belong in the same tone as asking who is in the room during an examination.

A shared phone is not a shared body. If more than one person can open the inbox, treat the inbox as a household noticeboard, not a consulting room.

Practices that quietly add the adult child's mobile "so someone answers" should record that choice and revisit it. Convenience decays into a standing disclosure.

Scam texts that look like Medicare

Scams that impersonate Medicare, Services Australia, myGov or a pathology lab are now part of ordinary digital-health literacy. They are not a side topic for the cyber page.

The pattern is stable even when the wording changes. A text or email claims a rebate is waiting, a payment failed, or a record will close. There is a link. The link asks for myGov credentials, Medicare numbers, or a credit card. Sometimes the sender name is close enough that a tired person would not bet against it.

Official services do send messages. That is what makes the copies work. The literacy task is not "never click". It is "do not click through to a login". Open the official app or type the known address yourself. If a payment is real, it will still be there.

Clinics get caught in the same weather. Patients forward the text and ask if it is genuine. Reception should not diagnose the URL on the fly unless the practice has a current fraud-advice process. A safer reply is: we did not send that; do not log in through it; if you already typed a password, change it through the official site and tell your bank if you entered card details.

This is also a privacy and safety issue for the practice itself. Staff who are used to clicking appointment reminders can be phished with a fake "update your PRODA" note. The older patient in the waiting room is not the only target.

Video consults fail on setup, not on age

The clinical case for video is familiar after the pandemic years. Seeing a person's breathing, gait, or home environment can matter. The Medicare telehealth settings have shifted, but video remains the format many items and many clinicians prefer.

The call itself is rarely the hard part. The hard part is the half-hour before.

A working camera permission. A browser that is not five versions behind. A link that opens in the right app rather than a download page. Enough charge. A chair that is not backlit by a window. A second device if the first one holds the only copy of the appointment SMS.

Practices can reduce that friction without becoming a home-IT service.

• Send the link in a channel the patient already uses, and say which app it should open.
• Offer a two-minute test call with a non-clinical staff member, booked the day before, not in the last five minutes.
• Keep a phone-consult fallback and say so in the reminder. A failed video call that becomes a chaotic phone call is still better than a failed video call that becomes no care.
• Ask whether anyone else will be in the room, and whether the patient wants them there.
• Do not require an app install if a browser link will do. Extra installs are extra abandonment.

None of that is "teaching older people to Zoom". It is making the clinic's chosen channel survivable.

If the patient cannot manage video and the clinical problem can wait for a room, book the room. Digital health literacy includes the right to decline the experiment.

How practices can help without taking over

The temptation, especially in a long-standing family practice, is to just do it. Take the phone. Reset the password. Tick the boxes. It feels kind. It also creates a file the practice does not own, a consent the patient did not really give, and a dependency that collapses when that particular nurse is on leave.

A better pattern looks more like supported decision-making than tech support.

Sit beside, not opposite, if the patient wants a demonstration. Let them hold the device. Narrate the official URL. Stop at the password field. If a family helper is present, ask the patient what the helper is allowed to see. Write that down if the practice is going to communicate with the helper later.

Do not store patient myGov passwords in the clinical record. Do not photograph a patient's authenticator screen. Do not use a staff identity document to "help" a patient through a government proof-of-identity step. Those lines are there because the account is a tax and Medicare identity, not a patient portal.

Where the practice does control the channel — its own booking app, SMS reminders, results portal — it should design for the same people it claims to help. Large type. A phone number that reaches a human. Messages that do not look like scams. A way to opt back into letters. Literacy is not only the patient's job.

What "help" looks like on a busy day

Time is the constraint. A ten-minute appointment cannot absorb a myGov recovery. That is an argument for a different appointment type, or for a local library or neighbourhood centre that already runs digital-skills sessions, not for skipping the problem.

Some Primary Health Networks and councils fund walk-in help. Some community health services already sit with people and work through forms. Point to those. Do not invent a clinic side-hustle unless the practice has actually staffed it.

Pharmacies are often the other front line, especially when a token SMS does not arrive. A short, current explanation of how tokens and the Active Script List work — the same ground covered in our electronic prescribing reporting — saves a second trip more reliably than a new app.

Literacy is a systems word

It is easy to turn digital health literacy into a deficit label. The more accurate reading is that Australia built health administration that assumes a private smartphone, a stable mobile number, a private inbox, and a tolerance for lockouts.

Older people wear those assumptions first, because they are more likely to share devices, to lose a number when they change plan, and to be the targets of official-looking fraud. People with disability, people who speak languages other than English at home, and people in temporary housing hit the same walls.

The work, then, is not a pamphlet titled "how to be better at apps". It is fewer mandatory portals, clearer official messages, recovery paths that do not require the device you just lost, and clinics that will still pick up the phone.

If a video consult is the right tool, set it up so a person can succeed on the first try. If myGov is required for a task, say what happens when it fails. If a family helper is the reason care happens at all, name that arrangement instead of hiding it in a shared password.

That is digital health literacy as an adult conversation. It treats older Australians as participants in a brittle system, not as a problem the system has to drag online.