National E-Health Transition Authoritywww.nehta.gov.au
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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
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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
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The Challenge…
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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
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• Bill passed on 24/6/10
• Live on 1/7/10
• Run by DHS Medicare
The HI Legislation
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• Bill passed on 21/6/12
• Live on 1/7/12
• DoHA is the Operator
The PCEHR Legislation
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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
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What it is not
• A replacement of local
clinical records
• A replacement of
current standard
point-to-point
communications
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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
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Registration Channels
• Assisted registration
• Online: www.ehealth.gov.au
• Call centre: 1800 PCEHR1 (1800 723471)
• Medicare shopfront
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• 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
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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
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Consumer Registration
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The Consumer Portal
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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.
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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?
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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
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Provider access
Conformant local GP desktop
software
Provider portal(web access)
National electronic
health record
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Provider Portal View
This Health Record Overview does not represent a complete record of the individual’s health information.
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Hospital Software View
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GP desktop software View
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The Clinical Documents
• Shared Health Summary
• Event Summary
• Discharge Summaries
• Referrals
• Specialist Letters
• e-Prescriptions
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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
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What’s in a shared health summary?
1. Allergies and adverse reactions
2. Current and past medical history
3. Medications
4. Immunisations
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Shared health summaries
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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
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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
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Discharge summary
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Medications - Electronic Transfer of Prescriptions
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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
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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).
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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
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Clinical Engagement
• Clinical Governance
• Clinical Safety
• Clinical Leadership
• Clinical Design Assurance
• Clinical Usability
• Clinical Advice
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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
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• 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
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Clinical governance
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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’
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Culture eats strategy for lunch
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Clinical Safety
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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
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Clinical Usability & CUP
Clinical Usability
CUP
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Next steps - The road to Adoption
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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
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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
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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
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Thank you
Questions