Feature: GWS closing the primary-acute care loop

Written by Kate McDonald on .

This article first appeared in the 20 February 2012 edition of Pulse+IT Magazine.
Good communication about a patient's clinical management is a major component to providing continuity of care across acute and primary healthcare settings. The lead site for the PCEHR in Greater Western Sydney aims to share clinical documents between these settings, and is developing an electronic Blue Book for mothers and newborns.

The Greater Western Sydney region is both culturally and geographically diverse with a mix of urban, regional and rural areas. It includes almost two million people and is still growing rapidly, and will soon accommodate 60 per cent of Sydney's growth and 25 per cent of all national population growth. Therefore, a key objective of this Wave 2 site is to introduce a range of clinical solutions where eHealth benefits can be proven on a significant scale.

The Greater Western Sydney program is being delivered via a collaborative consortium consisting of NSW Health, Nepean Blue Mountains Local Health District, Western Sydney Local Health District, the Sydney Children's Hospitals Network, the WentWest and Nepean Blue Mountains Divisions of General Practice, and a range of industry partners.

According to Greg Wells, NSW Health's chief information officer and program sponsor, the ultimate goal of the program is to close the loop between primary, community and acute care.

“Our patients assume the sharing of key clinical documents is already occurring, and our clinicians have made it clear this will improve care, so the program intends to deliver this for the region, to progressively extend these solutions across the state and ultimately integrate with the PCEHR,” Mr Wells says.

The program has an initial focus on high priority consumer groups such as aged Australians, those with complex and chronic disease, mothers and their children under the age of 16, as well as indigenous and culturally and linguistically diverse (CALD) populations.

The program is targeting 140 general practices, 10 hospitals and 95 community health centres in the region, providing the capability to share clinical documents.

Statistics show that 78 per cent of Australian GPs are not directly informed that their patient has been admitted to hospital, and 73 per cent do not directly receive discharge summaries. As part of the first round of the GWS project, 12 GPs in Katoomba in the Blue Mountains are currently receiving electronic discharge summaries direct to their desktops.

“The trial at Blue Mountains District Anzac Memorial Hospital will evaluate the end-to-end delivery of discharge summaries before the solution is extended to a significant number of clinical specialties across western Sydney hospitals,” Mr Wells says.

“We have now achieved a reasonable level of electronic medical record (EMR) maturity within our hospitals, with electronic orders, results, theatre and emergency department documentation rolled out to more than 80 per cent of beds across the state. The opportunity through the lead site program is to make this information available to all providers associated with a patient's care.”

In order to link discharge summaries within GP software, discharge summaries will include the consumer's Individual Healthcare Identifier (IHI) , which will be maintained in a new NSW State Patient Registry Service.

Mr Wells says NSW Health is now an accredited participant in the national Health Identifiers Service following a successful completion of the National eHealth Transition Authority's Compliance, Conformance and Accreditation (CCA) process in December 2011. The NSW Patient Registry Service incorporates patient information including patient IHIs from across the Greater Western Sydney region for up to two million patient records.

The patient registry is part of a broader service-based approach that allows health ICT infrastructure to be better utilised in the management and sharing of clinical information with target audiences, including those that participate in NEHTA programs such as the national PCEHR.

Conformant repositories

According to Mr Wells, the move to a national PCEHR solution is a significant journey. “Over time, some local or regional solutions may be supported within the national solution; however at this stage, lead sites are critical,” he says.

“Clinical engagement, building relationships with general practice, and consumer enrolment best occurs on the ground in targeted patient cohorts where all providers can participate. In healthcare, starting from specific geographies and expanding out has a greater chance of success than a broad big bang approach.”

At the core of enabling this in Greater Western Sydney is a range of clinical repositories for GP-generated shared health summaries, medical images and public health event and discharge summaries.

“In time, these repositories will allow information to be viewed directly in a doctor's main clinical system to minimise workflow impacts,” he says. “For example, an ED clinician will be able to view a shared health summary in the EMR; however all information will also be available to view through a clinical portal to be established as part of the program.”

An electronic version of the My First Health Record (or electronic Blue Book) is also being trialled, providing parents with an electronic version of the paper Blue Book currently given to every newborn child in NSW.

Babies born in a maternity ward in one of the area's public hospitals – such as the Blue Mountains, Blacktown, Mt Druitt, Westmead or Auburn hospitals or the Children's Hospital at Westmead – may be registered for the trial, with the parent or guardian's consent, which will involve the creation of an electronic version of the My First Health Record for storing and updating information.

Parents will be able to access their baby's Blue Book through a parents' portal, where they will be able to put in their own notes, key milestones or specific events.

A portal will also be established for healthcare providers to input healthcare information, such as growth and weight details and immunisation records, and the program is currently developing a mobile application for consumer access.

“The mobile application, in particular, is an exciting component of the program,” Mr Wells says. “Consumers want a simple, highly mobile way of accessing their child's health information – we think the electronic Blue Book is the right way to deliver this and would like to make it a national solution.”

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