Getting ready for ehealth records

Transcription

1 Getting ready for ehealth records Medicare Local Support May 2012 Version 2

2 Contents Introduction 3 The ehealth record system 5 What is an ehealth record? 6 Why do we need an ehealth record system? 7 What does the new system mean for healthcare professionals? 8 When does the ehealth system start? 9 How will people adopt the system? 10 What can Medicare Locals do? 12 Further information and materials Building awareness 13 Available support for raising awareness 14 Printed and digital material 15 Sample brochures 16 Learning Centre modules 17 Events Supporting practice readiness 19 Getting practices ready 20 Healthcare Provider Identifiers 21 Clinical system data quality 24 Digital Credentials 26 Clinical data software 27 ecollaboratives 28 Acronyms 29 2 of 30

3 Introduction The Department of Health and Ageing (DoHA) is pleased to provide Medicare Locals (MLs) with this support pack that provides information to help prepare for the Personally Controlled Electronic Health Record system (ehealth record system). The pack includes: An overview of the ehealth record system Details of all available communication materials, learning modules and events, and copies of relevant communication material Tips for getting primary healthcare practices ready Lessons learned from current change initiatives (such as ehealth sites and ecollaboratives, see in the orange box below) This resource forms part of a wider program to raise the awareness and readiness of MLs to support the ehealth record system, aiming to: For MLs Raise Medicare Local awareness and understanding of the ehealth record system For primary healthcare practices Clarify what MLs can do to support adoption of the ehealth record system (and to assess their readiness to do so) Provide MLs with the information they need to communicate the benefits and implications of the ehealth record system to those in primary healthcare settings Guide MLs on how they may support primary care providers get ready for the ehealth record system (e.g. health identifiers, software, workflow implications) This pack is the first instalment of such a resource for MLs. It focuses on some of the basic awareness and understanding elements that are important for MLs and their stakeholders. Next Instalment Instalment Two will provide more depth about the ehealth record system itself. It will include more detail on: ehealth record functionality Registration processes for consumers and healthcare professionals, and Tools to assess the readiness of MLs and primary care providers to adopt the ehealth record system. This second pack builds on the first pack you received in May We would value your feedback on this resource so please let us know by contacting the Australian Medicare Local Alliance on It follows the same themes of awareness, readiness and adoption for you to add to your folder under the appropriate tabs 3 of 30

4 Lessons Learned Twelve ehealth sites and ecollaborative initiatives have been implementing the ehealth record system. Lessons are being systematically collected from these sites as they successfully implement ehealth changes, and are being used to inform and improve the broader program. Throughout this resource you will find examples of these lessons and the benefits they offer. They summarise the perceptions and experiences of the ehealth Sites and those practices involved with the ecollaboratives program as they plan for and take on their ehealth change journey. 4 of 30

5 The ehealth record system

6 Using the ehealth record system will change the way in which healthcare is provided in Australia, and will deliver substantial benefits for consumers and for our healthcare system. As more healthcare professionals and consumers join the ehealth record system will grow to progressively connect Australia s healthcare delivery systems. For it to be successful, healthcare professionals and consumers must first, with support, become aware of the ehealth system, get ehealth ready and then adopt and use the system. What is an ehealth record? An ehealth record is a secure electronic summary of a patient s health records. A national system has the potential to deliver better care for patients, save money and make the health system more efficient. ehealth records will not replace existing medical records. Healthcare professionals will continue to take and review clinical notes. More detailed patient information will be available on local clinical information systems, as per current practice. The ehealth record system provides an active online record that over time will follow patients as they move through Australia s health system, including important clinical and treatment information at different points in time. All those seeking care in Australia will be eligible for an ehealth record. Registration for an ehealth record is voluntary and will not be required in order to receive health care. July 2012 is just the starting point for the ehealth record system. Over time, a comprehensive national system can enable better access to a patient s current health summary, updated medications, tests, results and treatment plans. 13% of health provider consultations were found to have missing information Source: PCEHR Baseline Monitoring Report For more information about the ehealth record system please review the key messages and Q&A documents that will be provided to you. 6 of 30

7 Why do we need an ehealth record system? Pressure on Australia s health system and healthcare professionals is increasing due to factors that include: A growing and ageing population More patients with complex and chronic care needs, and Increasing patient expectations and demands. To respond to this pressure and sustain the quality of our health system, innovative approaches are continually needed, including those that harness improved technology and communications. Every year Australians have an average of 22 interactions with the health system, including four visits to a GP, 12 prescriptions and three visits to a specialist 1. Most of the information from these visits is currently held in paper-based records in separate locations. Most of these records are not shared electronically. ehealth records will enable easier, more accurate sharing of information within all parts of the health system, including between GPs, specialists, pharmacists and hospitals. For example, ehealth records will help minimise unnecessary repeat tests, manage medication better and improve continuity of care. Healthcare organisations that choose to participate can, over time, access important health information more effectively, helping to provide safer, more efficient, and more effective care. Better access Safe care Improve access to providers according to clinical and personal need Increase choice Increase responsiveness Reduce errors Promote population health By revealing important clinical information about a patient such as allergies and adverse drug reactions, current medicines, and medical and immunisation histories. Effective care Efficient care Improve assessment Improve clinical efficiency Improve treatment Improve use of funds Increase consumer participation Improve use of infrastructure Improve preventative care By accessing information to allow more opportunity for prevention, early intervention and treatment of chronic and complex diseases, as well as for improved diagnosis and emergency treatment. By providing secure and quick access to patient s key health information, reducing the unnecessary repetition of tests, histories or consultations. 1 SOURCE: ABS 2010a; 2010b, AIHW 2011, AIHW 2011; 2010a; 2010b, PHIAC 2011, MBS of 30

8 What does the new system mean for healthcare professionals? While all healthcare professionals will experience changes in the way healthcare is provided, the ehealth system will affect different professionals in different ways. For more information about articulating the benefits of the ehealth record system review the key messages and Q&A s that will be provided to you. General practices Pharmacists Better continuity of care for patients Better access to medication history Reduced pressure in coordinating patient care Pharmacists will no longer have to rely on the patient s memory Hospitals Specialists/Allied health Better emergency access to patient information and history Better information sharing with GPs, nurses, allied health professionals, and hospitals A sample taken at ehealth sites in March 2012 has shown 72% of calls to medical records were requesting a copy of discharge or operation related reports Source: February BEP status report 8 of 30

9 When does the ehealth system start? July 2012 is the starting point for the ehealth record system. That is when the initial basic features will be available. Australian consumers and healthcare organisations will be able to register to use the system and view a limited amount of information. When Australians register for an ehealth record they will able to: Add their own personal health notes, emergency contact details and location of their advance care directive Set privacy controls Register their children for an ehealth record Should consumers decide that the ehealth record is not for them they can deactivate the record. Further features of the system will become available later in As the system evolves, and more individuals and healthcare professionals register to use it, it will increasingly complement local practice records. Timeline July 2012 Functionality Consumers will be able to register for a ehealth record, set their access controls and create their own consumer health summary record Next Steps As providers become ready the ehealth record system will include the sharing of: Shared health summaries Health overview Event summaries Discharge summaries Specialist letters ereferrals Medicare data, including child immunisation data, organ donor register data, DHS data and PBS and RPBS data Healthcare professionals can, with patient consent, access the above information through: Conformant clinical information systems The provider portal, pending verification 9 of 30

10 How will people adopt the system? Adopting new technologies, including ehealth innovations, is never as straight-forward as it seems. For the ehealth record system, consumers and healthcare professionals are being asked not only to adapt existing processes of healthcare, but also to adopt and use technology to perform an entirely new activity (namely, the creation and use of an ehealth record). They need to be convinced of the benefits of this new activity, and to be provided with all necessary assistance to use the new technology. A national approach has therefore been developed to foster adoption of the ehealth record system. This summary provides Medicare Locals with this context for discussing the ehealth record system with colleagues and fellow care providers. The following diagram shows the phases that consumers and healthcare professionals may go through before using the ehealth record system in a meaningful way to support their healthcare interactions. Change Use Awareness What s happening? Readiness Why are we doing this? How will it affect me? Register What do I need to do? What will really change? How will I be supported? Are others changing? Is it working? Is it making a difference? Time Aware Work is underway to provide consumers and healthcare professionals with all the information, training and education tools they need to know about the ehealth record system. The initial focus will be on those who have the most to gain from an ehealth record such as new mothers, older Australians, those with chronic conditions, Aboriginal and Torres Strait Islander people, and their healthcare professionals. Ready Next, people need to become ready to register for or adopt the ehealth record system. They need to be ready in three ways: to believe that the benefits of using the system outweigh any costs or Over 81% of consumers agree ehealth records have the potential to save their life by having important medical information immediately accessible Source: PCEHR Baseline Monitoring Report inconveniences, to have the IT and organisational support to use the system, and to have the skills or available training to start using it. Materials and learning opportunities are being made available to support these three forms of readiness. For example, DoHA has gauged the readiness of Australia s allied healthcare practitioners and medical specialists in an extensive study, details of which can be found at: Register (Adoption) In this stage, people are adopting the ehealth record program by taking the steps needed to register for it. To do so, they may need further information on specific ehealth record uses, data storage and privacy, and healthcare processes and workflow implications. 10 of 30

11 Use As more clinical software connects with the ehealth record system, more clinical information will be added by healthcare professionals. This will enable the system to assist with coordinating the patient journey, supporting clinicians and service providers, supporting new primary healthcare initiatives and improving process efficiencies. All of these benefits are directly linked to Medicare Local s own project objectives. 11 of 30

12 What can Medicare Locals do? As Medicare Locals are a critical link for the local primary health care sector, they are uniquely placed to support ehealth. Medicare Locals can therefore play a critical role in the introduction of the ehealth record system. The rest of this document provides information to assist Medicare Locals with the first phases of this critical role. These two phases are: 1. Building general awareness of the coming ehealth record system (from April 2012) Building an initial understanding of what ehealth records are all about, including assessing the current awareness of consumers and healthcare professionals in your catchment area. 2. Supporting practices to get ehealth ready (from mid to late 2012) Start to work with healthcare professionals and organisations (especially GPs and community pharmacies) to build their foundations for the ehealth record system. This may include assessing the readiness of healthcare professionals and consumers to adopt ehealth records. More information and guidance around what types of activities may be suitable in your catchment and how to assess the ehealth readiness of your local area will be provided in future releases of this resource. Beyond these initial phases, Medicare Locals can also: Facilitate ehealth record adoption Once the foundations are in place you can contribute to facilitating provider and consumer registration and initial use. Encourage meaningful use Over time, Medicare Locals will lead the way in utilising the ehealth record system to promote better, more integrated models of service delivery and meet local population health needs. Further information and materials The Department of Health and Ageing will continue to provide Medicare Locals with information and guidance through If you have any queries or would like hard copies of the materials mentioned in this document, please contact: From 1 July 2012 ehealth.gov.au or the Australian Medicare Local Alliance on of 30

13 1. Building awareness

14 Available support for raising awareness The initial role of Medicare Locals is to help both consumers and healthcare professionals in their catchment areas understand what ehealth records are all about. Towards this, Medicare Locals might assess the current awareness of consumers and practitioners in their catchment area. Many of the information, training and education tools and materials for consumers and healthcare professionals are already available, with more becoming available every week. Medicare Locals can use these tools and materials as and when they would like to, to raise awareness of all healthcare professionals and consumers in their catchment areas. The initial focus of these materials and other national awareness efforts is on those who have the most to gain from an ehealth record, such as new mothers, older Australians, those with chronic conditions, Aboriginal and Torres Strait Islander people, and the healthcare professionals that provide care for these groups. There are three main resources for you to draw on, and which are introduced in the pages that follow: 1. Printed brochures and materials This communication collateral is developed for each stakeholder group, and contains key information, FAQs and case studies for the introduction and use of the ehealth record system. They also provide information for those advocates of the system to support their efforts in advocating for the system and assisting others in adopting it. 2. Web-based learning resources A dedicated web-based ehealth record learning centre is being launched with over 30 targeted e- learning modules and associated content for stakeholders to use for their local communities. 3. Healthcare industry events The ehealth record program will have a strong presence at 48 national and regional healthcare industry events before July 2012, and a continuing presence afterwards. About 50% of these events are for health professional groups aligned to the priority health community groups mentioned above. In addition, there will be a national ehealth roadshow and a mobile Model Healthcare Community resource that will visit many Medical Local areas. The work in the ehealth sites confirms that providing communication toolkits to practices is an effective way to raise ehealth awareness. Source: ehealth Site February 2012 Lessons Learned. 14 of 30

15 Printed and digital material A range of materials are available to Medicare Locals in both printed format or by internet download, including: Brochures for general consumers and specific cohorts, and for healthcare professionals in general and for GPs, specialists and community pharmacists. FAQ documents and Case studies for both consumers and health care professionals, to use both on their own or to include in existing Medicare Local communications. Presentation packs for use by Medicare Locals at forums, GP engagements and the like. On the Record, a monthly enewsletter that you can use for your communities. Local clinician champions have proved to be a very successful way of promoting ehealth to the healthcare professional community. Source: ehealth Site February2012 Lessons Learned. Copies of this material can be obtained from ehealth.gov.au or by contacting the Australian Medicare Local Alliance on Available material The following material is available now or soon. Information updates will be provided to all Medicare Locals in the monthly enewsletter On the Record. Communications Collateral Customisable Letter - General Consumers, Mothers, older Australians and people with chronic conditions Basic Brochures - General Consumers and Healthcare Professionals Target Groups Targeted Health Community Groups Consumers and HCPs Case Studies - Consumers and Healthcare Professionals Newsletter Copy - Consumer and Healthcare Professionals Key Messages and Q&As - General Consumers, Mothers, older Australians, people with chronic conditions, Healthcare Professionals, Specialists, GPs and Pharmacists Presentation Pack for Stakeholder Groups - General Consumers, Mothers, older Australians, people with chronic conditions, Healthcare Professionals, Specialists, GPs and Pharmacists 150 and 500 word summaries - General Consumers, Mothers, older Australians, people with chronic conditions, Healthcare Professionals, Specialists, GPs and Pharmacists Customised Brochure - Mothers, older Australians, people with chronic conditions, Specialists, GPs and Pharmacists Customised 'How to Get Ready for the EHEALTH RECORD System' Brochure: Consumer and Healthcare Professionals Clinical Information Advocates - Supporting Materials Consumers and HCPs Consumers and HCPs Targeted Health Community Groups Targeted Health Community Groups Targeted Health Community Groups Targeted Health Community Groups Consumers and HCPs HCPs 15 of 30

16 Sample brochures Consumers Healthcare Professionals 16 of 30

17 Learning Centre Modules The Learning Centre is an online portal containing training modules and other information on the ehealth record system. It will be regularly updated over the coming months with new information and learning modules. You can access the site at: The Learning Centre contains learning modules that take healthcare professionals and consumers through accessible and structured information about the ehealth record system. The modules align with the stages of change that people may go through on their ehealth journey: awareness and readiness, to commit and act (adoption). While the modules are designed for individuals to work through online, they also form the basis of learning materials for facilitators to run face-to-face learning sessions with their organisations or stakeholders. Support packs include a facilitator s guide and a PowerPoint presentation with key animations. All of these materials will be available for Medicare Locals to use. Awareness modules The table below outlines the awareness modules are available now or shortly thereafter. Learning Module Description Target Groups Introduction to ehealth record Patient journeys ehealth record evolution Clinical scenarios Understanding privacy and security What the ehealth record does, how it works and its major benefits broad operating principles and benefits, not detailed functionality. A view of the future where the ehealth record system assists better outcomes for patients facing particular health needs. The timing and steps for the introduction of the ehealth record system Illustrate how HCPs will use the ehealth record system in these scenarios Explains the privacy and security protections including access controls, the identification process for health care professionals and consumers, audit trails, technology protections, and legislation protection. 1. Consumers 2. HCPs 1. Consumers 2. HCPs 1. Consumers 2. HCPs HCPs Consumer and HCPs How an EMR works Explains in non-technical terms how an EMR system and the Specialist and GP 17 of 30

18 Learning Module Description Target Groups with ehealth record system ehealth record system will share data, and the roles of each. Stresses that the ehealth record does not replace the local EMR system. Overview of potential ehealth record system uses Different uses of the ehealth record and their benefits to the health practice: the shared health summary, additional PBS or MBS data, event summaries and emergency access. For staff needing an overview, but not implementing those changes. HCPs Events Medical Locals will have many opportunities to attend, or encourage healthcare professionals to attend, events at which the nature and workings of the ehealth record system will be discussed. There are three sets of events being arranged for this purpose: 1. The AAPM National ehealth Roadshow is targeted at practice managers understanding the foundations for a number of ehealth initiatives, including the ehealth record system. 2. The NEHTA Model Health Community is a further interactive display of the ehealth foundations. 3. NEHTA will be showcasing the ehealth record system at many events in the healthcare industry calendar. Their presence may be in the form of presentations, booths and sponsorships. Look out for information on these three sets of events to be provided to you as a separate paper accompanying this document. 18 of 30

19 2. Supporting practice readiness

20 Getting practices ready This section details many of the things that a practice may need to do to be ehealth ready. Medicare Locals can help with many of them. Actions b. to d. are explained further on the pages that follow. a. A plan for the ehealth record system Healthcare organisations and professionals can prepare for the change by talking with their team on the implications of the ehealth record system, and how changes can be managed in a way with which the team is comfortable with. The communications materials detailed in the building awareness section will assist with this process. An interactive Learning Centre module is available to take healthcare professionals through the steps needed to prepare for the ehealth record system. For further information for Medicare Locals assisting in this process, please contact the sources noted in the first section of this document. This action is not discussed further below. b. Healthcare Provider Identifiers Each healthcare professional needs a Healthcare Provider Identifier - Individual (HPI-I) if they wish to author information for the system or access records via the provider portal. If you are registered with the Australian Health Practitioner Regulation Agency (AHPRA) you will have been assigned one of these. Otherwise you can apply for one through DHS Medicare. In addition, each healthcare organisation needs to register for a Healthcare Provider Identifier - Organisation (HPI-O) from DHS Medicare. c. Clinical system data quality Maintaining a practice s data quality forms part of its obligations under the Privacy Act Each practice should review its data quality on a regular basis to ensure patient information is up-to-date and accurate. This will help the practice search for and match information held by the HI Service. d. Accessing the provider portal with a digital credential Data cleansing concepts have proved useful to ehealth sites and ecollaboratives. It was reported that a number of practice managers and reception staff were generally receptive to data cleansing concepts and as such were the ones who relayed information regarding the ehealth record system to the GPs Source: ehealth Site February 2012 Lessons Learned. To log into the ehealth record system using the web-based provider portal, healthcare professionals will need to verify their identity using a digital credential (for example a USB key or smart card) which will identify them as an authorised healthcare provider. e. Clinical systems IT and software compatibility Providers will need to upgrade their desktop systems to ensure that their clinical software is ehealth record compatible. More compatible desktop products will become available over time. These products will allow you to view and update ehealth records, according with the access rights set by patients. 20 of 30

21 b. Healthcare Provider Identifiers Australia s governments have together developed a Healthcare Identifiers Service (HI Service) to uniquely identify individuals who seek healthcare in Australia, as well as the healthcare professionals and organisations that provide that care. The HI Service will be essential for accessing the ehealth record system. It is operated by DHS Medicare (the service operator) on behalf of the National E-Health Transition Authority (NEHTA, the governance authority). The HI Service uses a unique 16-digit identification number to identify people and organisations. These identifiers give both individuals and healthcare professionals confidence that the right health information is associated with the right individual at the point of care. There are three types of healthcare identifiers (HIs): Healthcare Provider Identifier Individual (HPI-I) allocated to healthcare professionals involved in providing patient care Healthcare Provider Identifier Organisation (HPI-O) allocated to organisations (such as a hospital or medical clinic) where healthcare is provided, and Healthcare Identifier (IHI) allocated to all individuals enrolled in the Medicare program or those who are issued with a Department of Veterans' Affairs (DVA) treatment card, and others who seek healthcare in Australia. Applying for an HPI-I and HPI-O Each healthcare professional needs a Healthcare Provider Identifier - Individual (HPI-I) if they wish to author information for the system or access records via the provider portal. In addition, each healthcare organisation needs to register for a Healthcare Provider Identifier - Organisation (HPI-O) from DHS Medicare. Registering for an HPI-I A range of healthcare professionals, including those in primary care and allied health, may be issued with an HPI-I. They will be eligible for an HPI-I if they are either registered under state, territory or national law, or are members of a professional association that meets certain criteria. Practitioners already registered with Australian Health Practitioner Regulation Agency (AHPRA) have been automatically assigned an HPI-I and will need to log in to the AHPRA website to obtain their HPI-I. There are a number of resources available to help healthcare professionals apply for an HPI-I and HPI-O. These include a podcast ad handbook available at Practitioners whose field of practice is not covered by AHPRA may apply to the HI Service for a HPI-I if they are eligible under the Healthcare Identifiers Act They would use the Application to register a Healthcare Provider form (available at: Registering for a HPI-I as a known customer A known customer is a healthcare professional with an existing Public Key Infrastructure (PKI) issued by DHS. To secure their HPI-I, the healthcare professional will need to provide the HI Service information to identify themselves and show their professional membership. Registering for an HPI-O To be eligible to apply for an HPI-O, the healthcare organisation must be an entity (as defined in the Healthcare Identifiers Act 2010) that provides or controls the delivery of healthcare services within Australia, and have an employee who is an identified healthcare professional and provides healthcare as part of his or her duties. The organisation must then have a responsible officer as its authorised representative (e.g. its CEO or board member). 21 of 30

22 A healthcare organisation will receive a HPI-O when they register to participate in the HI Service, using the forms housed on the Department of Human Services website. A healthcare organisation may also be responsible for other related entities in an organisational hierarchy. If so, it is a seed HPI-O that is responsible for those network HPI-Os. There is no limit to the number of Network HPI-Os that may exist under a Seed HPI-O. An organisation maintenance officer within the Seed HPI-O is responsible for maintaining information about all of its Network HPI-Os. Searching for IHIs Healthcare organisations and professionals will need to identify their patients by searching for their Individual Healthcare Identifiers (IHIs) using the HI Service. Searches will only be available on four criteria, to ensure the matching of the correct IHI to an individual and avoid the risk of misidentification. They are: 1. Medicare card search with Medicare card number, IRN, family name, given name, date of birth, and sex 2. Medicare card search with Medicare card number, family name, given name, date of birth, and sex 3. DVA file number search with DVA file number, family name, given name, date of birth, and sex; and 4. Detailed IHI search with family name, given name, date of birth, sex and address. More than one search may be performed on each search criteria. If the healthcare practice s software automatically applies one search after another, it will stop searching once a matching IHI has been found. The search types may be performed using historical data (e.g. using a person s maiden name for the family name), but only if the IHI searches using current data fail to find a matching IHI. If a match still cannot be found the healthcare professional can contact the HI Service team. This search criteria has been determined and approved following extensive testing for clinical safety purposes. Health software searching for an IHI in the HI Service using the business-to-business (B2B) channel cannot use other IHI search types. Software must undergo conformance assessment, incorporating the requirements for searching, before they can access the HI Service. (Note that this requirement does not apply to searches containing an IHI as a search parameter (i.e. searches to validate an IHI). To watch a podcast on applying for a HPI-O, go to: http/ecollaborative.com.au/podc ast/ 22 of 30

23 HI Service practice checklist Review current practices to identify anything that will need to be addressed before the integration of the healthcare identifiers. (e.g. rejected IHI s, consent). Implement processes to ensure that all patient data is accurate and up-to-date. A simple way to do this is confirm patient details when they next visit your practice. Speak with software providers to ensure that practice management software complies with HI Service requirements. Providing assistance to practices to improve their overall ehealth capability is usually well-received when engaging with practices to introduce healthcare identifiers. It s often easier to approach general practices with the small picture initially, such as. how can we assist you to get registered? Source: ehealth Site February 2012 Lessons Learned. If practitioners in a practice are not registered with AHPRA, register with the Department of Human Services to obtain HPI-Is. Register the practice for an HPI-O Determine who will be the RO and who will act as the OMO (if not the same person.) Gather supporting identification documentation for RO, OMO and organisation. Download and fill in form 2978 (Seed organisation) If required, download and fill in form 2849 (Network organisation) Check all forms and supporting documents are signed by a referee. Fax or post application to DHS. With consent from the organisation and practitioner, contribute information to the Healthcare Provider Directory Request through DHS to have permissions on PKI certificates updated to include access to the HI Service. Take advantage of any education and training opportunities available to practice managers in the future relating to the HI Service. For more information about the HI service visit: healthcareidentifiers@medicareaustralia.gov.au Call: of 30

24 c. Clinical system data quality Practices should review their data regularly to ensure patient information is up- to- date and accurate. A high level of clinical data quality contributes significantly to improved health care delivery, efficiencies and patient health outcomes. Maintaining data quality within a general practice also forms part of an organisation s obligations under the Privacy Act The RACGP guidelines and general practice accreditation also outline a number of data quality obligations for a general practice. As use of the ehealth record system increases, data contained in a practice s clinical information system will be used not just by the practice itself, but also by other healthcare professionals to support treatment of shared patients. Health professionals and patients will only be willing to share information if they have confidence in the quality of the data they are sharing. Accurate patient demographic data will also be needed for a practice system to interrogate the Healthcare Identifier (HI) Service, and match and retrieve Individual Healthcare Identifiers (IHI). This can be difficult if the practice records have an invalid or missing Medicare card number, address or DVA number. Supporting improved clinical data quality Several sources are available to assist practices improve their clinical data: The Clinical Data Self-Assessment tool developed for the national ehealth program: see below. Divisions of General Practice, and by extension Medicare Locals, have a strong history of supporting data quality improvement across general practice. A number of successful data quality improvement methodologies and interventions have been applied and are available to Medicare Locals. Source: ehealth Site February 2012 Lessons The Australian Primary Care Collaboratives has been Learned. proven a highly successful method for driving quality improvement within general practices. The ecollaborative has been established to focus specifically on ehealth readiness and adoption: see page 28 below and the APCC website at Clinical Data Self Assessment Tool (CDSA) NEHTA has engaged Pen Computing Systems and Canning Division of General Practice to develop a tool for general practices to help assess, analyse and improve the quality of data contained within their clinical information systems. This Clinical Data Self-Assessment (CDSA) tool combines the functionality and capabilities of the Pen Clinical Audit Tool (CAT) and the Canning Data Extraction Tool to allow general practices to interrogate their clinical desktop software and provide a report on the completeness and quality of their data. The CDSA tool can: Report on the completeness of patient demographic and health summary data Report on duplicate patient records Provide a dashboard or traffic light report on data quality and improvements Provide guidance on addressing identified gaps and improving overall clinical data quality The CDSA is compatible with the following clinical software systems: Demographic data quality was found to not be related to the size of a practice, but to data quality procedures, patient profile and the work habits of the Practice Manager and Receptionist. This means each and every practice will be different, and the approach to addressing matching issues must be flexible. 24 of 30

25 Pen CAT tool Medical Director 3 Medical Director 2 Best Practice Genie Solutions Zedmed Canning Data Extraction tool Medical Director 2 Medical Director 3 Medical Spectrum Classic MedTech32 Best Practice PractiX Zedmed Existing PEN or Canning users will see the functionality appear when they upgrade to the latest version. For those without a licence: Canning has made their entire tool available free of charge so you can download it here: PEN has made a CDSA-functionality only version of their CAT tool which is available here: (username: cdsa, Password: cdsa1234) 25 of 30

26 d. Digital Credentials A digital credential offers a standardised way for practitioners and healthcare organisations across Australia to strongly assert their identity and electronically sign and encrypt documents so that all digital transactions remain secure and private. Using a digital credential ensures that: The person seeking information is who they claim to be Information received from the person is actually from them Information sent electronically arrives at its destination without being intercepted or altered Information is appropriately authorised (signed) where required Healthcare providers and administrators will rely on digital credentials. For example: Doctors: Doctors will obtain a smart card or usb with their digital credential contained within, providing unique identifying information for the doctor. Practice administrators: Administrators will be able to order and manage credentials on behalf of their organisations. Organisational credentials contain unique identifying information for an organisation and are installed on computers. Patient consultations: When consulting with a patient, the doctor can use the credentials in their smartcard to access clinical systems, sign and encrypt ereferrals and eprescriptions, and decrypt reports received from other areas such as pathology and emergency. 26 of 30

27 d. Clinical data software To participate in the ehealth record system, healthcare professionals and organisations will need to ensure their software is conformant for at least three purposes: Secure messaging with other healthcare professionals Using the HI Service, and Communicating with the national ehealth record system. Secure messaging A secure messaging system (SMD) that will allow healthcare professionals to connect directly to other healthcare professionals is currently available and is already being used by some pathology and radiology companies. It can be accessed as soon as a practice s clinical software provider implements the Standards Australia specifications for SMD. Software providers will notify practices when the necessary upgrades will be ready. Healthcare Identifier software Software systems designed to use national Healthcare Identifiers (HIs) are required to undergo a two-stage assessment process to demonstrate they comply with national specifications for quality, safety and interoperability. Practice managers are encouraged to speak with the practice software providers to ensure that the practice management software complies with these requirements. Separate Notice of Connection (NOC) tests, required by DHS and independent Compliance, Conformance and Accreditation (CCA) tests have been streamlined into a single business process. The NOC process checks that HI software clients do not pose any risk to DHS s operating environment, while the CCA requirements assess the behaviour of software applications or the manner in which they acquire, use and manage HI information. Even if the software does not directly access the HI Service, compliant software is essential to clinical safety. ehealth record software Healthcare professionals will need a computer that can be used for viewing ehealth records, and software that will conform to the national specifications. These specifications will enable computer systems to connect to the ehealth record system, allowing healthcare professionals that have been given permission to access a patient s ehealth record. Practices should ensure their clinical software can communicate with the national ehealth record system. Software providers will tell practices when upgrades will be ready. 27 of 30

28 ecollaboratives In conjunction with the Improvement Foundation, the National E-Health Transition Authority (NEHTA) has delivered a new Collaborative wave program for primary care practices focused on improving chronic disease care and self management using innovative new technology. The ecollaborative aims to support general practices and health services to be ready for the ehealth record system when it becomes operational. This includes both putting in place the pre-requisite systems such as HI Services, and establishing clinical and business processes within the practice to support ehealth adoption. The ecollaborative leverages the breakthrough collaborative methodology, which has been proven internationally and successfully implemented through the Australian Primary Care Collaboratives (APCC) Program since Through the ecollaborative, participating practices are engaging in the following activities: 5. Engage the Health Service Practice Team Establish processes to engage all members of the practice team in ecollaborative activities and ehealth record preparedness. 6. Undertake foundational work for the ehealth record Ensure foundation services such as HPI-Is and HPI- Os are in place. 7. Develop systems to improve and maintain data quality across the clinical system in preparation for creating Shared Health Summaries. 8. Engage with patients in maintaining the accuracy and currency of their health information, including helping patients understand the purpose of the ehealth record and their role in it. 9. Develop systems and processes to upload and maintain a Shared Health Summary. 10. Develop systems to improve the integration of care, and the patient s co-ordinated care health outcomes, by the sharing of a patient s electronic health record across their care team (family, carers, health providers). 11. Develop systems and process to improve patients self management skills and ability to leverage the ehealth record in order to be in greater control of their own health. ecollaborative practices are learning lessons on how the above activities can be done successfully. These lessons are informing national change and adoption activities, and will be available to Medicare Locals to support their ehealth support activities. A website has been established for participants that will host resources and information as they are being developed. For example, a podcast has been created covering the establishment of HPI-Os with experts from Australian Association of Practice Managers and NEHTA presenting. These resources can be accessed at 28 of 30

29 Acronyms CDSA DoHA DHS HPI-O HPI-I IHI ML NCAP NEHTA Clinical Data Self Assessment Department of Health and Ageing Department of Human Services Health Provider Identifier Organisation Health Provider Identifier Individual Individual Health Identifier Medicare Local National Change and Adoption Partner National E-Health Transition Authority 29 of 30

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