Mater Health Services has for a number of years pioneered the use of eHealth to improve patient care in its seven hospitals in south-east Queensland. Its Smart Hospital strategy strategy, launched in 2005 with industry backing from IBM, Cisco, Clintel Systems, Microsoft and software provider InterSystems, has seen the health service become one of the leading lights in eHealth integration in Australia’s acute care sector.
Eighteen months ago, Mater launched an external doctor portal to allow general practitioners and private specialist clinicians to access Mater’s electronic health record, and more recently attention has turned to creating a patient portal to do the same for patients.
So it was opportune that the Federal Government announced the second wave of PCEHR implementation sites in March last year, with Mater Health Services chosen to create a shared electronic health record for one of the priority patient groups: mothers and newborns.
The Mater Shared Electronic Health Record (MSEHR) will initially deliver an electronic alternative to the paper-based Pregnancy Health Record currently used in Mater’s maternity hospitals for publicly funded expectant mothers, and will store key information such as health history, previous pregnancy history, birth preferences, pathology and radiology results, alcohol and drug screening information, medications, allergies and adverse reactions.
Mater is working with Medicare Locals, general practitioners and a number of private obstetric practices on the project, which again ties in nicely with the organisation’s overall strategy, according to Mater’s CIO, Mal Thatcher.
“There are five strategic themes within our Smart Hospital strategy: one is about the patient experience and another is around our clinical partners,” Mr Thatcher says.
“We made a conscious decision to embark down the path of developing portals for both of those cohorts. In around August 2010 we established our external doctor portal … and part of the strategy around the patient experience was to build a patient portal, so what the Commonwealth program has allowed us to do is accelerate our aspirations in that area.”
Mater judiciously chose a particular cohort of patients to work with on this project who are known to engage with online resources and initiatives.
“Mothers are a very engaged group and are interested in anything that has to do with the care of their children, so it is the ideal target group,” Mr Thatcher says.
“We already have in place well-established protocols for the sharing of care for maternity patients between the obstetricians and primary care, so the proposition here was a great opportunity to leverage those existing patients and to leverage our existing infrastructure along with the work we had already done on our doctor portal, and to bring together that cohort online.
“What it will allow those mothers to do is go online and access healthcare information and all of the information on their electronic health record associated with their pregnancy. At the moment they carry a hand-held record when they visit the GP, the GP puts their observations and notes into it and they carry it physically with them when they visit our antenatal clinic or their private obstetrician.
“The obstetricians do the same thing with their observations and notes, and that record goes with the mother. Soon they will be doing it online.”
Integration into the PCEHR
Mater already has its own EHR based on the Verdi system from IP Health, which allows Mater clinicians to access health summaries from close to 100 different clinical information systems. Mr Thatcher hopes that this EHR, and the new Mater Shared EHR, will be integrated into the eventual PCEHR.
“We have a service-oriented architecture (SOA) model, so we are able to reuse web services and therefore don’t have to rebuild them for each application,” he says.
“We are able to separate out the presentation layer or interface from the data services, so even though the Mater external doctor portal uses a different interface and different applications, it is accessing exactly the same data services as our internal system. For the patient portal, when we choose to expose that same data to the patient, it will use the same data services.”
Mater has also worked with integration partner InterSystems since about 2005, using its Ensemble platform. This was chosen to ensure that instead of point-to-point messaging, a hub and spoke model was used.
“This means we publish a message once to the central hub, and then one or more subscribers can access that message,” Mr Thatcher says.
“Ensemble does that really well, and because of that capability we are able to do some great things, like when we get pathology information, we can manipulate that into a form that allows us to expose it to an electronic health record.
“With our patient administration system, which does admissions, discharges and transfers, we built a patient master index, so we had a lot of these foundation elements under way when the PCEHR opportunity came up. I think that is one of the reasons why Mater was chosen as one of the lead sites.”
Mater is also using the project to test some of the most important parts of the PCEHR, especially how its systems will interact with the national infrastructure and standards being devised by the National E-Health Transition Authority (NEHTA).
Mater has worked with InterSystems, using its HealthShare technology, to build an interface with the Medicare Healthcare Identifiers Service to match patients with their Individual Healthcare Identifier (IHI) numbers. In November last year, Mater received its Compliance, Conformance and Accreditation (CCA) certificate for the HI Service, which went live on December 6.
By connecting to the HI Service, Mater has incorporated IHIs with the Mater Shared EHR. As well as storing the clinical information submitted by patients, participating external providers and Mater, the repository will use healthcare identifiers in Mater’s exchange of information with other healthcare repositories.
“At the moment we are doing searches and matches with the Medicare service for IHIs,” Mr Thatcher says.
“We are currently building our databases with those IHIs, but we are not relying on those for the sharing of information with the GP practice management systems at this stage.
“We are currently matching about 500 patients a day and we probably have around 25,000 matches in our patient master index, but that is only a small number in terms of total patients. It’s going well — we are getting around an 85 per cent match rate in terms of requests to Medicare — and we hope that through the vendor panel that NEHTA has set up we will be able to send information through secure messaging and have the IHI embedded in it. Nationally we are not ready for it, but by 30th June we will be close.”
Mater as an organisation has received its HPI-O number and has established the governance protocols around that internally. The Mater Shared EHR team will liaise with internal Mater clinicians to obtain their HPI-Is, guiding them through the steps of obtaining this number from the Australian Health Practitioners Regulation Agency (AHPRA). In addition, internal recruitment processes will ensure that any new clinicians have their HPI-I recorded upon commencement with Mater.
Like most of the other projects at this stage, Mater is using the existing Medicare PKI certificate, which external clinicians use to access the external doctor portal. In the near future, when the National Authentication Service for Health (NASH) being built by IBM is available, Mater and the other projects will transition to that service to allow practitioners access to its systems.
Mater is also working on secure messaging as part of the next stage in the project. InterSystems and Mater have worked together to enhance messaging capability to be compliant with the national Secure Messaging Delivery (SMD)
Although Mater has signed an agreement with Pen Computer Systems to provide a messaging interface, Mater has already completed work with InterSystems to communicate with other healthcare providers regardless of their secure messaging systems. InterSystems and Mater worked together to add the national SMD standards to Mater’s interface.
“We are waiting to see what the government is going to do about messaging services,” Mr Thatcher says.
“The standards will be a little bit like HL7, but while that is an international standard it is not particularly well-adhered to and is interpreted differently, so there will probably be a national secure messaging service that could be administered by NEHTA or Medicare whereby we don’t have to worry about vendor compliance around secure messaging.
“Our target is 30th June but at the moment that is all in development. What we are hoping to achieve is for the GP practice to be able to send antenatal event summaries to us and for our antenatal clinics to send back reports to the GP through that secure messaging service.”June 30 is also the target for enrolment of over 400 expectant mothers that the project is recruiting. Active recruitment of consumers is due to begin at the end of April, but it has already begun its recruitment of general practices and private specialists, working with the Greater Metro South Brisbane Medicare Local and Accoras (formerly part of Brisbane South Division). About 80 GPs in 50 different practices are involved, and Mater is targeting nine consultant obstetricians in South Brisbane with whom it already has strong relationships.
“It is a slightly different model for them (private specialists), and what we are really interested in with the consultant obstetricians is that quite often we don’t have a lot of exposure to those private patients. What we’d really like to do is get an antenatal summary from the private obstetricians’ system so that when the midwife is first dealing with the expectant mother, we already have their antenatal history.”