Australia’s eHealth Journey: Where are we and what’s next? · Dr Nathan Pinskier Deputy Head, Clinical Leadership & Stakeholder Management, NEHTA Chair RACCP NSC ehealth 2 National

National E-Health Transition Authoritywww.nehta.gov.au

1

Australia’s eHealth Journey:Where are we and what’s next?

The Alfred Medical Research and Education Precinct

28 June 2013

Dr Nathan Pinskier

Deputy Head, Clinical Leadership & Stakeholder Management, NEHTAChair RACCP NSC ehealth

2 National E-Health Transition Authoritywww.nehta.gov.au

Why do we need a national eHealth record system?

• Australians have an average of 22 interactions with the

health system p.a., including:

• 6 visits to a GP

• 3 visits to a specialist

• Allied Health

• Tertiary

• Prescriptions

• Diagnostics

• Most of the information from these visits is currently

held in paper-based records.

• Most of these records are not shared.

Approximately 13% of

healthcare provider

consultations have missing

information


The Challenge…



The Journey

Paper records

• fragmented information

Local computer records

• fragmented information

• limited electronic transfer

Shared records

• sharing of electronic records

• improved access to information

The NEHTA Foundations

1. Healthcare Identifiers (HI)2. Secure Messaging (SMD)3. Authentication (NASH PKI)4. Security & Access Framework (NeSAF)

5. Clinical Terminologies (CTI)1. Snomed

2. AMT



• Bill passed on 24/6/10

• Live on 1/7/10

• Run by DHS Medicare

The HI Legislation


• Bill passed on 21/6/12

• Live on 1/7/12

• DoHA is the Operator

The PCEHR Legislation


The PCEHR - What it is?

• A document store

• A new way for patients

to share:

o key pieces of their

health information

o with providers of

their choice


What it is not

• A replacement of local

clinical records

• A replacement of

current standard

point-to-point

communications


The national eHealth record system…

is: is not:• a digital record of your patient’s key

health information

• a replacement for existing practice

clinical records

• opt-in • compulsory

• a potential enhancement of medical

information

• a requirement for medical treatment

• a source of information to assist

information sharing and decision

making

a replacement for current standard

information sharing and clinical

decision making

• multiple sources of health

information accessed through a

central point

• a single government store of personal

information

• personally controlled • provider controlled

• evolving • going to look the same in 5 years time


Registration Channels

• Assisted registration

• Online: www.ehealth.gov.au

• Call centre: 1800 PCEHR1 (1800 723471)

• Medicare shopfront

• Mail


• Establish a my.gov.au account

• Create eHealth record for themselves & others (where authorised)

• Nominate Representatives

• Manage Access Rights

• Setup Notifications

• View the Audit Log

• View Medicare Data (MBS, PBS, ACIR, ODR)

• View Clinical Documents

Consumer Functionality


Types of information available

• Personal health summary• Personal health notes (not available to providers)• Advance care directive custodian• Emergency contact• Child eHealth record new

• Medicare services (MBS & DVA)• Prescription information (PBS & RPBS)• Immunisations (ACIR)• Donor details (AODR)• Medication record new• Test results future• Advance care directive future

• Shared health summary• Event summary• Discharge summary• Specialist letter• Referral

Healthcare professional or organisation

Other data sources(e.g. Medicare)

Patient


Consumer Registration


The Consumer Portal


Patients can decide…

Whether or not they have a national electronic health record – it’s opt-in

Who can access it (record control and organisationalcontrol)

What information is displayed (document control)

Patients can also view an audit trail showing who has accessed their record and when.


However…

If the idea of patients controlling what information

they share with you worries you

Patients cannot modify clinical documents

Less than 1% of patients restrict access

Emergency access overrides any access controls

Think about:

How is this different from the situation now?


Provider Participation

Conformant Clinical Information System software

• Your organisation will need a HPI-O and to be registered with the eHealth

Record System

• Organisation permission

• Read, Write (upload & download) access

Provider Portal

• You will need a HPI-I and an individual authentication token (NASH)

• Authorised by your organisation (HPIO)

• Read Access only


Provider access

Conformant local GP desktop

software

Provider portal(web access)

National electronic

health record


Provider Portal View

This Health Record Overview does not represent a complete record of the individual’s health information.


Hospital Software View


GP desktop software View


The Clinical Documents

• Shared Health Summary

• Event Summary

• Discharge Summaries

• Referrals

• Specialist Letters

• e-Prescriptions


Shared health summaries

• Are expected to be uploaded most commonly by the patient’s usual GP

• Can be uploaded by:o any medication practitioner

o a registered nurse

o a registered Aboriginal Health Worker

• Can be uploaded when you update the patient’s local record (and other times as appropriate)

• Are summaries and not complete records


What’s in a shared health summary?

1. Allergies and adverse reactions

2. Current and past medical history

3. Medications

4. Immunisations


Shared health summaries


Event summaries

• Can be created by any participating healthcare provider (with the right software)

• Are for ‘clinically significant’ events• Are independent documents• Are not progress notes• Don’t replace normal clinical communications• Content is flexible• Can be used in a number of ways


Event summary

Event Summary 8 Mar 2013

JONES, Francis (Mrs) DoB 4-Sep-1963 (50y) SEX Female IHI 8002 6521 1962 7758

START OF DOCUMENT

South Coast Physio

Author Bill Irish (Physiotherapist)

Phone (03) 8669 9123

Encounter 8 Mar 2013 08:20+1000 to 8 Mar 2013 12:44+1000

Period

Event Details

Clinical Synopsis Description

Mrs Jones presented with mechanical neck pain and treated her with a stretching program. Given her a home exercise program and will review

her progress as needed.

Adverse Reactions

Adverse Reactions

Substance/Agent Manifestation

Nil Known

Medications

Reviewed Medications

Medication Directions Indication Change Type Change or

recommendation

Reason for change


Discharge summary


Medications - Electronic Transfer of Prescriptions


Medicolegal matters

• Consent is implicit

• There is no obligation for

healthcare providers to use the

eHealth record system (it is

opt-in)

Medical defence

organisations have

ongoing input into

the eHealth record

system


What about privacy & security?

Security and privacy of the national eHealth record system is protected by:

o Only allowing authorised participating organisations to access patient information

o Secure technology (similar to banking)

o New and existing legislation.

Security and privacy of your local data is protected by:

o Your normal practice policies to keep patients’ health information confidential and secure

o Your compliance with NeSAF

o RACGP Computer and information security standards (second edition).


Potential benefits

• Less time finding information

• More efficient consultations

• Potentially less duplication

• Better informed clinical decisions

Provide efficient access to healthinformation that

you didn’t already have


Clinical Engagement

• Clinical Governance

• Clinical Safety

• Clinical Leadership

• Clinical Design Assurance

• Clinical Usability

• Clinical Advice


Points of engagement in product/project life cycle

• Initiation � start clinical SME engagement

• Design � Initiation & Design Phase - CDA Gate 1

• Build / Develop � Build Review Phase - CDA Gate 2

• Implement � Final Review & Launch Phase - CDA Gate 3

• Run / Maintain (BAU)

CDA = Clinical Design Assurance = Clinical functionality + Usability


• A shared responsibility for improving health IT safety

• Health IT safety is contingent on how the technology

is designed, implemented, used, and fits into clinical

workflow, requiring the cooperation of both vendors

and users

• Safety considerations need to be embedded

throughout the product development life cycle

Clinical Governance & Safety


Clinical governance


Clinical Governance & Safety

• Core function of clinical governance – focus of IT to

ensure product is safe.

“Overall aim of better, safer care”

• Safe implementation includes:• Appropriate use – intended purpose

• Mitigation of risks – safety functions are retained

• Reporting of adverse events – lessons [not just a help desk]

• Effectiveness – does what was intended

• Patient focused

• Clinician ‘friendly’


Culture eats strategy for lunch


Clinical Safety


The CUP

CUP Projects• GP Desktop Software review• Clinical Impact Assessment (Practice Workflow Assessment)• Clinian User Guide

Projects contributing to improved Usability• Testing & Training environment• Customer Support Services• eReferrals (end to end workflow)• Point-to-point Secure Message Delivery


Clinical Usability & CUP

Clinical Usability

CUP


Next steps - The road to Adoption


Challenges to date

The focus has been on registration. Meaningful use begins now

• Registration processes are complex for providers and consumers

• New compliance requirements include addition of a number of new policies for provider

organisations

• Delays experienced in receiving HPI-O, NASH & PCEHR

• Limited availability of conformant software outside General Practice

• Low awareness of the eHealth record system across provider and consumer communities

• Misinformation leading to misplaced concern

• Medicare Local transition – capacity to support primary care varies


Clinical usability – The CUP

CUP Projects

• GP Desktop Software review

• Clinical Impact Assessment (Workflow Assessment)

• Clinician desktop User Guide

Projects contributing to improved Usability

• Testing & Training environment

• Customer Support Services

• eCommunications (end to end workflow)

• Point-to-point Secure Message Delivery


The Numbers

• 370,000 registered consumers

• 4,200 healthcare organisations (HPI-Os) registered

• 4,724 providers (HPI-Is) with authorisation links

• 26 conformant software vendors


Thank you

Questions