Feature: Calvary building a shared care repository

Written by Kate McDonald on .

This article first appeared in the 20 February 2012 edition of Pulse+IT Magazine.
As two of the nine Wave 2 sites, Calvary Health Care ACT and St Vincent's & Mater Health Sydney are collaborating on some of the core components of the PCEHR, including discharge summaries, eReferrals and specialist letters. Calvary eHealth is targeting aged care, palliative care and patients living with chronic disease.

Together with the Eastern Sydney Connect team at St Vincent's & Mater Health, Calvary eHealth is working closely with acute and primary healthcare groups as well as GP and hospital software vendors to produce an electronic system for secure communication between providers.

Work has been under way for some time on delivering electronic discharge summaries, specialist letters and eReferrals to and from general practice and acute care providers. In Calvary eHealth's case, aged and community care providers are also taking part.

Both projects are using the same technology partners, including Smart Health Solutions and Precedence Health Care, to build components of a shared health record and repository, while HealthLink is providing the secure messaging service. Smart Health provides an online information management system for sharing patient summaries using secure web technologies and public key infrastructure, while Precedence Health Care has developed the cdmNet system, an online service for developing care plans and documentation for chronic disease management.

According to the project manager for Calvary eHealth, Declan Morgan, both Smart Health and Precedence were keen to have each other on board because, together, they can provide both a hospital clinical system and a care plan from the GP side. But while Calvary eHealth and St Vincent's are trialling the same components, the two are focusing on different patient cohorts.

“We are focusing on aged care, palliative care and chronic disease, because they are the specialisations of our parent company, The Little Company of Mary Health Care, in Australia,” Mr Morgan says. “We have done that for a long time and we do it well. Although we have strong links to those groups, any person of any age may enrol, as we provide health services across all demographics.”

Calvary eHealth has signed a range of healthcare providers as project partners including Calvary's public and private hospitals in Canberra, and its palliative care facility Clare Holland House. It is also working with aged care facility Calvary Retirement Community; Calvary Riverina, a private hospital in Wagga Wagga; and ACT Health. NSW Health is also participating through the Southern NSW and Murrumbidgee Local Health Districts.

GP partners include ACT Medicare Local, Murrumbidgee Medicare Local and the Southern General Practice Network, a division of general practice based in Moruya and covering the south-east corner of NSW.

“GPs are core to Calvary eHealth and we are looking at eDischarge summaries going to the GPs as point-to-point communication,” Mr Morgan says. “The ACT Health Directorate is already doing this electronically but we still send them by fax and some other places still rely on the post. Our hospital specialists receive referrals either by fax or mail.

“We want to be able to give GPs an acknowledgement that we have received those referrals and, eventually, confirmation of their patient's appointment date and time. Following the patient's treatment with us we want to be able to respond to the GP with an electronic specialist letter, confirming what occurred, the outcome and include any further instructions.”

Mr Morgan says GPs have long wanted to receive electronic discharge summaries direct to the desktop to avoid the quite common situation of a patient presenting to them post-discharge but the GP not having any prior knowledge of hospitalisation.

“Often a patient will be admitted to hospital and on discharge be instructed to see their GP,” he says. “But when a discharge summary takes three to four days to arrive, in many instances after the patient has already been to the GP, it becomes a major point of frustration.

“So with the patient sitting with them in consultation the GP then has to ring the hospital, track down and talk to the specialist and ask what to do with the patient. They wait on the phone forever and of course are dragging specialists away from their own consultations.

“A secure electronic solution will streamline patient care and quite simply mean healthcare professionals can spend more time with their patients, and less time stuck in a whirlpool of paperwork.”

Staged roll out

Mr Morgan says his team divided its strategy for the project into two parts. With the National E-Health Transition Authority (NEHTA) working on specifications for clinical document architecture (CDA), Calvary eHealth decided that while that functionality would be the end goal, before that happened it would like to deliver something using standard HL7 messaging and systems that are already in place.

“That is our stage one solution and we are ready to have our electronic discharge summaries go out to GPs and into the repository,” Mr Morgan says. “We already have patients signed up and consenting to share that information.”

The long-term goal is to enrol 150,000 patients from across the ACT and southern NSW.

“We've got a marketing plan with an advertising campaign, and that will roll out in the next two months. It's integrated with the strong brand work we have put in place and will reflect our printed collateral that is targeted to our cohort group.”

In late January, more than 70 healthcare professionals from across the ACT and southern NSW met at Calvary Hospital in Canberra for a dinner event, within the Model Healthcare Community exhibition run by NEHTA. Well-known Sydney GP and eHealth early adopter Dr Raymond Seidler gave the keynote address, outlining the positive changes eHealth had already made to his practice and his patients.

Already, 43 GPs have signed and nine practices enrolled in Calvary eHealth as a direct result of the dinner.

Aged and palliative care

With the close connections to the Calvary Retirement Community at Bruce in the ACT, Calvary eHealth has recruited a number of elderly residents, and is including marketing material in pre-admission packs for the hospitals. “We also have two consumer liaison officers who are talking to patients on the wards,” Mr Morgan says.

For palliative care patients, Calvary eHealth has installed a clinical system at Clare Holland House that will lead into the shared repository. It is also working with patients that are cared for in the home.

“The electronic health record will help them because they often are seen late at night by community nurses through the ACT Health Directorate's Link program,” Mr Morgan says. “At the moment, a full record of that patient has to be left in the home so the Link nurses can see the record and add to it. Then when staff from Clare Holland House visit they have access to this information.

“Obviously, with the electronic health record, that will be a lot more secure than a paper file which anyone can pick up and read. It will make the work of nurses a lot easier too, because they will be able to read the information remotely before the home visit.”

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