National Initiatives: PCEHR and other NEHTA packages Health Design Authority, Office of the Chief Information Officer Tony Abbenante : Manager Design Authority and Integration
OCIO Heath Design Authority The Health Design Authority provides: information and communication technology (ICT) advice, guidance, best practice principles, methodologies and standards to/across the Victorian Public Health Sector (VPHS) The OCIO HDA, improves: health outcomes for all Victorians through enhanced interoperability of health applications and the sharing of quality clinical information across Victoria HDA reports the CIO of the Department of Health (Andrew Howard)
Health Design Authority ehealth initiatives supported by the Health Design Authority include: Providing principles for the introduction/expansion of Electronic Medical Record systems and Adoption models Guides and standards, and integration toolset solutions, including guides for use of Health Language 7 (HL7) Guidance and advice on solutions and interoperability a range of core health ICT applications including clinical, patient administration, finance, pathology, radiology and orders applications Support and guidance for Victorian Department of Health ICT initiatives, including alignment with National direction, e.g. NEHTA initiatives.
Health Design Authority ehealth initiatives and Involvement with NEHTA: Full participation and guidance in all NEHTA packages Key initiative: IHI Design for Australia Wave 1 support project/poc (Discharge Summary to GP, Referrals) IHI, HPI-I/O, Discharge Summary content (Standards), Provider registration, HSD Minimum Standards and Maturity Level Rapid Integration Project/POC (Discharge Summary to PCEHR) IHI, HPI-I/O, Discharge Summary content (Standards), Consent Management, Patient Self Registration, Provider Registration, NHSD Minimum Standards and Maturity Level PCEHR Viewing Capability
Health Design Authority Design Authority Web Page http://www.health.vic.gov.au/designauthority Interoperability Standards for Victoria (HL7/Codesets/Terminology) HL7 / CDA and Messaging Standards Terminology Principles NEHTA IHI Design Minimum Standards for Health Systems (EMR), plus..
Key NEHTA initiatives Foundation Elements: Individual Health Identifier (IHI) Health Provider Index Individual/Organisation (HPI-I/O) National Authentication Service for Health (NASH) National Health Services Directory (NHSD) Terminologies (SNOMED-CT, AMT) Conformance and Compliance Assessment (CCA) Packages: Discharge Summary Health Provider Index Individual/Organisation (HPI-I/O) Shared Health Summaries (SHS) Electronic Transfer of Prescriptions (ETP), NPDR Personally Controlled Electronic Health Record (PCEHR)
Health Design Authority NEHTA Pilots NEHTA Wave 1 Pilot Collaboration with IEMML, DH, NEHTA and Eastern Health Standards based reusable Scope (2011-12) ereferrals from General Practitioner to Eastern Health (NEHTA Format) Provider Registration Change Management Shared Health Summaries GP to PCEHR (Compliant Repository) Discharge Summary from Eastern Health to General Practitioners IHI, HPI-I/O, HSD Conformance and Compliance
Health Design Authority NEHTA Pilots Health Service Systems OCIO Production Gateway OCIO Wave 1 & PCEHR Gateway Eastern Health Production Gateway Clinicals Cerner Millenium ESB Oracle JCAPS ESB Oracle JCAPS ESB Oracle JCAPS AMT /, SNOMED Certificate Store Discharge Summary Ref^I12 Production Discharge Summary Flow EH Ref^I12 DS Redirection Ref^I12 Check PCEHR Consent Obtain IHI (HI Service I/F) Not applicable for GP DS transmission EH Prod Disch Summary Flow EH MDM Routing Patient Consent AH Ref^I12 DS Redirection Obtain HPIs (HSD I/F) MDM^T02 IHI Extraction and Storage PH Ref^I12 DS Redirection Generate CDA Disch Summ y Encapsulate DS Generate MDM Transmit MDM Check PCEHR Exists Validate & Upload CDA DS Legend Wave 1 Functionality Web Services request / response Web Services XDS.b Web Services request / response MDM^T02 New Quick Wins Functionality External Services Internal network Via Internet ehealth Foundation Services HI Service PCEHR B2B Gateway Record Access Document Exchange Provider Directory Services Human Services Directory Messaging Services HealthLink
Health Design Authority NEHTA Pilots NEHTA Wave 1 Pilot - Findings Victorian Health Systems must adhere to standards to adopt NEHTA packages 80% Matches for IHI General Practitioner systems not ready to receive, until current Not yet ready for production implementation NEHTA endpoint location services (ELS) directory not present General Practitioner systems not ready (currently being released) General Practitioner registrations low-medium Mandatory field requirements, discharge summary content, discharge disposition, etc
Health Design Authority NEHTA Pilots Current HL7 DS
Health Design Authority NEHTA Pilots
Health Design Authority NEHTA Pilots
Health Design Authority NEHTA Pilots
Health Design Authority NEHTA Pilots NEHTA Wave Rapid Integration Project Collaboration with DH, NEHTA, Eastern Health, Barwon Health Standards based - Reusable Scope (2013) Discharge Summary from Eastern Health (NEHTA Format) to PCEHR PCEHR Viewer options / Portals Consent Management (Eastern Health and EMR) Conformance and Compliance IHI, HPI-I/O, NHSD Consumer Registration to the PCEHR
NEHTA Packages Maturity Implementation Maturity Funding for enhancements is required. IHI - high maturity level: Can only be used as a secondary identifier Currently cannot be allocated to newborns and deceased 80% match rate, health systems require accurate address, and patient details Vendor products need enhancement in community and health services, enhancement are complex not just storing the number HPI-I/O - low maturity level: Governance process not well defined Provider registrations require take up Organisation details complex to manage, full design not complete NASH, SMD, ELS medium/low maturity level: Discharge Summary medium to high maturity level: NHSD, not fully established, ELS not established Cannot currently guarantee delivery, require roadmap for transition from current production messaging PCEHR medium maturity level: Consumer registration not high Consent processes for each document not established in vendor applications Viewing capabilities, not fully established Quality of information
NEHTA Packages Maturity Implementation Maturity NPDR low/medium maturity level: Consent processes for each document not established in vendor applications Vendor applications in health services require costly updates Viewing capabilities, not fully established Quality of information NHSD medium/high maturity level: (previous HSD) Victorian providers well established, content from other jurisdictions being added Establishment of ELS limited Addition of HPI-I/O limited SHS medium: Currently being established for GP systems Limited availability from health service and community systems ereferral low: Standards not complete Low adoption by vendors
NEHTA Packages Maturity Implementation Maturity Terminology (SNOMED/AMT/NPC): Clinical decision support content and rules not complete Adoption of terms clinical terms is complex and takes time AMT requires clinical terms to be defined AMT and NPC, require GTIN mapping and alignment
NEHTA Packages Maturity Implementation - Roadmap New product implementation/new Initiatives: Review Health Design Authority minimum standards Discuss feasibility of adoption with Design Authority Questions??