About Healthcare Identifiers QUESTIONS AND ANSWERS HEALTHCARE IDENTIFIERS BILL 2010 Q1. What is the Healthcare Identifiers Service? The Healthcare Identifiers (HI) Service will implement and maintain a national system for uniquely identifying healthcare providers and individuals. The HI Service will operate in conjunction with a standardised authentication infrastructure and comply with international best practice for information security. The HI Service will assign three types of healthcare identifiers: Individual Healthcare Identifier (IHI) for individuals receiving healthcare services. Healthcare Provider Identifier Individual (HPI-I) for healthcare professionals and other health personnel involved in providing patient care. Healthcare Provider Identifier Organisation (HPI-O) for organisations (such as the hospital or health clinic) where healthcare is provided. Q2. Why introduce Healthcare Identifiers? Communication of health information is a vital part of effective healthcare. The accurate identification of individuals is critical in all health communication. Mismatching of patients with their records and results is a documented problem for the health system and a clear link has been established between avoidable harm to patients and poor medical records management. Using an IHI provides a way for healthcare providers to more accurately match the right records to the person they are treating and improve accuracy when communicating information with other healthcare providers. This will help to avoid medical mix-ups or one person s information being recorded on another patient s file. Q3. Why implement a national HI service? Adopting a national approach to healthcare identifiers recognises that identifiers are part of the core infrastructure needed to support secure electronic communication across Australia s healthcare system. Failing to establish this infrastructure is likely to result in further duplication or fragmentation of investment, limited uptake and adoption of e-health initiatives, and limited interoperability of available solutions creating a rail gauge problem that will become difficult or expensive to rectify. Q4. What is an Individual Healthcare Identifier (IHI)? An IHI is a unique 16 digit number that will be allocated to each Australian resident and others seeking healthcare in Australia. 1
The Council of Australian Governments decided that IHIs should be allocated on a universal basis to every Australian resident and person seeking healthcare in Australia. While healthcare identifiers will be allocated on a universal basis, an individual s participation in a future national individual electronic health record will be voluntary. Q5. What can Healthcare Identifiers be used for? Healthcare providers and related entities may use and disclose healthcare identifiers, namely for communicating and managing health information as part of the: provision of healthcare to an individual; or management, funding, monitoring or evaluation of healthcare; or provision of medical indemnity cover for a healthcare provider; or conducting research that has been approved by a Human Research Ethics Committee. Healthcare identifiers can also be used to lessen or prevent a serious threat to an individual s life, health or safety or to public health or public safety. Where information is disclosed for these purposes the receiving healthcare provider or entity is authorised to collect the healthcare identifier and use it for the purpose for which it was disclosed. Healthcare identifiers can not be used for other purposes including for insurance and employment purposes, unless the use is for the purpose of healthcare delivery to an individual. For example, it is expected that some private health insurance companies will use identifiers to provide services to their customers, such as chronic disease management programs. Handling of healthcare identifiers does not authorise the sharing of associated personal or health information which would still need to be undertaken in accordance with existing privacy and health information laws in each jurisdiction Q6. Is this a health record? Healthcare identifiers are not a health record. The information held by the HI Service Operator will be limited to demographic information such as name and date or birth needed to uniquely identify individuals and providers. Identifiers will provide a much more reliable way of referencing patient information, particularly in healthcare providers electronic information management systems. The healthcare identifiers are an important building block to enable a national Individual Electronic Health Record (IEHR) system. The national IEHR system will be separate from the Healthcare Identifiers (HI) Service. The IEHR will use identifiers to facilitate the identification of a consumer and healthcare provider. This will provide consumers and their healthcare providers with greater certainty that the individual s information is being correctly attributed to their electronic record. 2
Consistent with the National E-Health Strategy, endorsed by all Health Ministers, participation in an IEHR will be voluntary. In this regard, an individual s healthcare identifier will only be used for their IEHR with their permission. Privacy impact assessments would be conducted at appropriate points in the development of an IEHR system along with regular consultation with the Privacy Commissioner. Q7. Who will be responsible for assigning healthcare identifiers? Medicare Australia will be the initial operator of the HI Service. As a trusted government authority, Medicare has the national infrastructure, as well as the industry and community relationships needed to securely deliver and maintain the healthcare identifiers. The HI Service will be a separate and new Medicare Australia function, not linked to its funding or claims for payment functions. Medicare Australia is a statutory agency and is governed by national legislation that sets out the scope of the functions it can perform and the privacy and security it must maintain for the personal information it holds. Q8. What is Medicare Australia s role? Medicare Australia will be the initial operator of the Healthcare Identifiers Service as a trusted and secure provider of health related services. This new role will be separate to its funding and claims functions. The HI Service will be reviewed 2 years after commencement and will take into account any further e-health developments. Q9. Why not use current Medicare numbers for individuals? A Medicare number is not unique. Some people have more than one Medicare number because they are members of more than one family and may be on multiple cards. Also, not everyone who needs healthcare will have a Medicare number. Q10. Why not use the existing Medicare provider numbers for healthcare providers? Medicare provider numbers are allocated to individual providers and organisations to support payments and claims through government schemes such as Medicare Benefits and Pharmaceutical Benefits Schemes. Healthcare providers who are not eligible to bill Medicare may not have a Medicare provider number. Q11. Will Medicare Australia use healthcare identifiers for claims? No. The HI Service will be a separate and new function for Medicare Australia, and will not be linked to its funding or claims for payment functions. Q12. What key information will be held by the HI Service? 3
The IHI will be associated with a limited amount of identifying information such as, name, date of birth, and sex. In some circumstances, further data may be required to ensure unique assignment or to assist with the use of IHIs such as: address, birth plurality and birth order, and aliases. Q13. How will it work? Healthcare providers will be able to obtain IHIs from Medicare Australia through an online process to update their active patient records in batches. Medicare Australia will only return an IHI where there is an exact match and will not disclose information, other than the number itself, that has not been provided by the healthcare organisation. Or the provider may obtain a patient identifier through an online service or by phone when the patient next visits the doctor or goes to a hospital or clinic for treatment. The IHI will be added to healthcare records along with their name and other identifying information. Existing consumer Medicare cards or DVA treatment cards will be able to be used to help ensure the right IHI is obtained for each patient. Q14. Do patients need an IHI to receive healthcare? If a health provider is unable to obtain a person s IHI from the HI Service, or the IHI is not available for any reason, patients will not be refused treatment. An IHI will also not be required for claiming healthcare benefits. Q15. When will IHIs be available? It is planned to have the IHIs available from mid 2010. The numbers cannot be allocated and used until necessary supporting legislation is in place. Q16. What do people need to do to get an IHI? If a person is enrolled with Medicare or holds a DVA treatment card, they will automatically be allocated an IHI. If not, a temporary IHI number will be provided when that person next seeks healthcare. Q17. Does this mean people need to get a new card or remember a number? People will not need to remember their IHI nor obtain a new card. Healthcare professionals will be able to retrieve a patient s IHI using their current Medicare card or DVA treatment card or via a demographic search. Q18. Can a person have more than one IHI? It is intended that each person will only have one IHI, and that there will be no need to change or renew this number at any stage. 4
There are circumstances where you may have more than one IHI. This could include, for example, in an emergency situation where a provider may not be able to determine who a patient is. In this case, a temporary IHI may be issued and would later be matched to the patient s existing IHI once that person is able to provide information about who they are. Q19. How will the IHI improve healthcare communication? The IHI will improve safety, security and efficiency by making sure patient information is linked to the correct record. There are four key areas where the use of IHIs to support the electronic exchange of information will deliver immediate benefits for patients: Discharge summaries; Pathology Tests; Prescriptions; and Referrals. For example: E-prescription implementations in Sweden, Boston and Denmark reduce provider costs and save time to improve productivity per prescription by over 50%; E- referrals in Denmark reduced the average time spent on referrals by 97% by providing more effective access to patient information for both clinicians and test ordering and results management systems reduce time spent by physicians chasing up test results by over 70% in implementation in America and France. Q20. Will people be able to access healthcare anonymously? An IHI will not alter the way in which anonymous healthcare services are currently provided. Where it is lawful and practical, individuals can seek treatment and services on an anonymous basis. In these instances, an IHI would not be used by the healthcare service. Q21. Can people use a pseudonym in connection with their IHI? Pseudonyms may sometimes be used in special circumstances. The HI Service Operator will have arrangements to support this option in line with existing Medicare Australia practices. Q22. Can people access the information that the HI Service holds about them? Yes. Individuals and their authorised representatives will be able to access demographic information held by Medicare Australia as part of the HI Service and an audit log of which organisations have obtained their identifier. Q23. What processes will be in place for people who need to access information that the service holds on another s behalf? The HI Service will have processes in place that are flexible enough to support the types of arrangements regularly encountered in the healthcare sector, such as a carer or advocate acting for a person with impaired decision-making abilities. 5
The HI Service will set out arrangements to provide for situations where a person may need to access the Service on another s behalf. Q24. Will there be a cost to patients? No, there will not be any cost to patients. Q25. How will an individual s information be protected? The HI Service will protect individual privacy through both legislation and technical means, such as agreed security and access controls. Information security has been a primary consideration in the design and development of the HI service. Healthcare providers who are identified with an individual HPI-I, or an authorised employee, can access the HI Service to obtain the IHI of a patient being treated. The system design does not allow browsing of records a request by an authorised healthcare provider for a patient s identifier will only reveal an IHI when there is an exact match with patient information provided by the healthcare provider. Each time a record held by Medicare Australia is accessed, the details of who and when will be recorded in an audit log. Electronic communications involving healthcare identifiers will be made secure through the use of standardised Public Key Infrastructure (PKI) and secure messaging services. Legislation will clearly set out the permitted uses of healthcare identifiers. Penalties for the intentional misuse of healthcare identifiers, such as inappropriate disclosure of information by the Medicare Australia, or users of the Service, will be set out in legislation. In addition, current privacy laws will continue to apply. The federal Privacy Commissioner will monitor the operation of the HI service by Medicare Australia and handle complaints against the Commonwealth public sector and private sector organisations. Q26. Will introduction of IHI change the way my health information is shared? The inclusion of healthcare identifiers on a health records system or a patient s file will not change how and when healthcare providers share information about individuals. A healthcare identifier is simply a much more reliable way of referencing information, particularly in electronic information management systems. What will Healthcare Identifiers mean for Providers? Q27. What is a Healthcare Provider Identifier (HPI)? 6
Healthcare providers and organisations will be identified with a unique number. These identifiers are referred to as: Healthcare Provider Identifiers Individual (HPI-I) for healthcare professionals and other health personnel involved in patient care, and Healthcare Provider Identifiers Organisation (HPI-O) that will identify the organisation (such as the hospital or health clinic) where care is provided. Q28. Who will issue HPI-Is and when? A national Healthcare Identifiers Service (HI Service) is being established to assign and maintain healthcare identifiers. Individual (HPI-Is) can be issued either via health professional registration bodies (as part of registration process) or directly by the HI Service. It is planned to have healthcare identifiers allocated from mid 2010 through a phased approach. Q29. Who will be eligible for a HPI-I? All healthcare providers who require an identifier to support the delivery of healthcare may be issued with a HPI-I. To be eligible for a HPI-I, a healthcare provider must provide a health service which is defined in the legislation. There are two options available to healthcare providers to be issued with a HPI-I. A healthcare provider will need to provide either: evidence of professional registration or accreditation to the Australian Healthcare Practitioner Registration Authority (AHPRA) or evidence of professional registration, accreditation, qualifications or membership of a professional association direct to the HI Service for health professions not currently covered by AHPRA. Q30. Why do Providers need an identifier (HPI-I)? Will it always be the same number? A HPI-I provides a unique way of identifying the provider on patient records that the provider creates or updates. When information is sent to other providers to support a patient s ongoing healthcare, the HPI-I, in combination with secure authentication mechanisms, will provide greater clarity about who the information is from. A provider s HPI-I will be unique to that professional and healthcare providers will only need one HPI-I regardless of the number of professions for which they are qualified or the number of healthcare organisations which they work for. Q31. Which organisations will get a HPI-O? All organisations that provide healthcare services will be able to apply for a HPI-O. 7
As part of establishing their eligibility an organisation will need to provide evidence to the HI Service that it is a legal entity and that it employs or contract one or more individual healthcare providers or sole traders who are employed for the purpose of providing a health service. Q32. How will introduction of healthcare identifiers affect current IT systems? The HPI-I is designed to work in conjunction with other national e-health initiatives, such as standard clinical terminologies and the development of secure messaging systems, to provide an accurate and secure foundation for sending and receiving messages and information from other providers electronically. In order to participate in the HI Service, a healthcare provider business will require IT systems that incorporate minimum standards and security features necessary to access the HI Service. Given that the HI Service will draw on the same IT infrastructure as Medicare Online, it is anticipated a number of providers will already have this in place. Q33. What is the benefit for providers? A national healthcare identifiers system is an important foundation for accurate communication and management of patient information via electronic means. The benefits of the HI Service will arise in the short term from the use of healthcare identifiers to improve existing methods of communication between healthcare providers as well as future e-health applications for which healthcare identifiers are a foundation element. The costs of adverse events and medical errors are significant. It has been estimated that 10% of hospital admissions are due to adverse drug events and that up to 18% of medical errors are due to the inadequate availability of patient information. An immediate benefit of the HI Service will be the availability of a Provider Directory Service. The provider directory will allow for GPs to locate other providers (such as specialists) in a timely manner, and facilitate communication with other providers when referring patients or making decisions about the patient s care needs. The identifiers are designed as a foundation element for future e-health initiatives in Australia. Providers who update systems to accommodate healthcare identifiers are therefore taking steps to prepare for future e-health developments. 8
Q34. What will be the cost to business? There will be some setup costs for healthcare providers such as, the impact on staff time in terms of considering information supplied to the healthcare provider about how healthcare identifiers should be implemented and because consumers are likely to seek advice from their healthcare provider on the new healthcare identifiers and how they can and cannot be used. Healthcare providers will be provided with supporting materials and appropriate sources to refer consumers to for more information. A public awareness program on the HI Service will provide information to consumers via a range of methods. Safeguards Q35. Q41. How will privacy be protected? The combination of technology controls, specific controls set out in healthcare identifiers legislation and existing privacy laws will provide strong privacy protections. There will be clearly established limits on the adoption, use and disclosure of healthcare identifiers. Healthcare identifiers can only be used for health information management and communication as part of the: provision of healthcare to an individual; management, funding, monitoring or evaluation of healthcare; provision of indemnity cover for a healthcare provider; conducting research that has been approved by a Human Research Ethics Committee; or lessening a or preventing a serious threat to an individual s life, health or safety or to public health or public safety. Q36. Why is legislation required? Specific legislation is required to set out permitted uses and disclosures of healthcare identifiers, allocate the role of Service Operator to Medicare Australia, set out the functions of the Service Operator and how personal information should be managed. Q37. Which regulators will have a role? The Federal Privacy Commissioner will oversight the operation and handle complaints against Commonwealth Government agencies and private sector healthcare providers. Each state and territory is expected to nominate a local regulator to oversight the handling of identifiers by its state or territory bodies and to put these arrangements in place through legislation. The Commonwealth legislation will apply until a state or territory puts consistent safeguards in place for their public sectors. Q38. Are there penalties in place for misuse of identifiers? 9
Yes. Penalties for the intentional misuse of healthcare identifiers, such as inappropriate disclosure of information by the HI Service, authorised healthcare providers or any other person, will be set out in Commonwealth, state and territory legislation. Q39. Will an audit log be maintained? Yes all access to the HI Service will be logged, creating a record of when healthcare providers access an individual s IHI on the HI Service. An individual will be able to view the audit log and see who has requested and obtained their IHI. HI System / Service Issues Q40. Who will be responsible for data quality and reporting? The HI Service Operator will be required to carry out regular maintenance activities including audits, data quality checks, reporting to Health Ministers and reviews of internal policies and procedures. Q41. What are the access channels? How will individuals and providers be able to access the HI Service? Healthcare individuals and providers (both individuals and organisations) will access the HI Service through a number of channels that will be established through existing Medicare Australia service outlets, including via a web portal, telephone and in person. Q42. What are the next steps? NEHTA and all jurisdictions are jointly developing a comprehensive communications strategy for healthcare identifiers. The strategy will include processes for raising awareness about the purpose and benefits of introducing healthcare identifiers and providing more detail about the privacy and legislative protections that will be put in place. Consultation Q43. What has been the consultation process to date? On 13 July 2009, a discussion paper was released seeking comments on legislative proposals to support the establishment and implementation of unique identifiers for healthcare purposes and the privacy of health information. As part of this consultation, two stakeholder forums were held to allow detailed discussion of the proposals. Consultation closed on 14 August 2009, and over 90 submissions were received from stakeholders. Key messages from the consultation include that use of the identifiers should be supported by a national privacy framework and specific limits to ensure identifiers are used only for healthcare and health related purposes such as managing health services and research. Further consultation, including the release of exposure draft legislation has been undertaken from 20 November 2009 to 7 January 2010. Over 50 submissions have been 10
received. There is general support for the legislative proposals with some particular suggestions on extending the use of identifiers for insurance and research purposes and in relation to how the identifiers might work in practice. These have been taken into account in finalising the legislation. Q44. Who has been involved in the design and development of healthcare identifiers? In developing the foundations for e-health, Australian governments, in conjunction with the National E-Health Transition Authority (NEHTA) are collaborating with representative groups drawn from the healthcare sector, as well as health leaders, consumer groups, software vendors, information managers and standards experts. These range from including general practitioners to specialist medical and non-medical groups including the allied health, pharmaceutical and nursing sectors. Q45. What has been the involvement of the Office of the Privacy Commissioner? NEHTA and the Department have provided regular updates to the Privacy Commissioner on the progress of the Healthcare Identifier System. The office of the Privacy Commissioner has actively participated in both consultation processes and provided detailed written comments on the proposals and draft legislation. The office of the Privacy Commissioner attended both public forums held in Sydney and Melbourne, and a number of discussions have been held on the legislative proposals and on the proposed oversight role of the Privacy Commissioner. Q.46 What Privacy Impact Assessments have been undertaken on the Healthcare Identifiers Service? NEHTA s work on development of the HI Service has involved ongoing consideration of privacy issues. A number of independent Privacy Impact Assessments (PIAs) were commissioned by NEHTA to inform the design of the HI Service. The most recent PIA report was completed in late August 2009. NEHTA publicly released three PIAs on 16 November 2009 to demonstrate its commitment to systematically addressing privacy issues and to inform the development of appropriate legislative and technical controls to support implementation of healthcare identifiers. 11