Feature: Sydney connects with shared health record

Written by Kate McDonald on .

This article first appeared in the 20 February 2012 edition of Pulse+IT Magazine.
The Eastern Sydney Connect Wave 2 site has already signed up 338 GPs and 1300 consumers to its project, which will test some of the core components of the PCEHR, including discharge summaries, electronic referrals and specialist letters. It is a huge undertaking involving a number of software vendors.

The Eastern Sydney Connect (ESC) project is one of the larger sites in the Wave 2 round, covering a large and disparate demographic and geographic area. The project encompasses St Vincent’s Public Hospital, St Vincent’s Private Hospital and St Vincent’s Clinic private specialists in partnership with three divisions of general practice — East Sydney, South East Sydney and the Murrumbidgee Medicare Local.

The project is demonstrating all of the core components of the PCEHR with the exception of the consumer portal, and is differentiated from the other eHealth sites by its focus on medication management, engagement of private specialists and the technical integration of conformant repositories.

The Eastern Sydney Connect eHealth site has two phases — Phase 1 is about e-enabling the community as a precursor to Phase 2, which will deliver the PCEHR, project manager Steve Saunders says.

“It’s a huge project that’s not only about the PCEHR; it’s also about e-enabling the community,” Mr Saunders says. “There are many benefits for participating providers even before we implement the PCEHR. As an eHealth site, a requirement of participation is that whatever we do has to be sustainable beyond June 30 2012. Everything we are putting in place here – the discharge summaries, specialist letters, referrals – will continue.”

Phase 1 components include electronic referrals, electronic admission and discharge notifications, electronic discharge summaries, nurse-initiated electronic discharge referrals and public and private specialist letters. It is a massive job but progress to date has been swift.

Phase 2 will focus on health providers of consenting patients accessing the PCEHR, which will contain event summaries, referrals, clinic letters, discharge summaries, shared health summaries and event summaries – all accessible with patient consent.

The project is working with a number of industry partners, Mr Saunders says, all working together to get the system up and running, with some components already happening. Electronic referrals, shared health summaries and event summaries will be sent to the St Vincent’s campus from general practice using Best Practice, Zedmed, Genie, practiX and Medtech32 clinical desktop software, while the admission and discharge notifications, the discharge summary from the public hospital and the nurse-initiated discharge from St Vincent’s Private are being sent from Emerging Health Systems’ (EHS) clinical information system, known in-house as deLacy, which has been used on the St Vincent’s campus for many years.

The creation of specialist letters is being handled by practice management systems used by some of the private specialists within St Vincent’s Clinic, while public specialists are being equipped with either an internal or an outsourced specialist letter service. Secure messaging is being delivered by HealthLink and Argus, while iSOFT is enhancing MedChart for the medications component of the project. Pen Computer Systems is providing its Clinical Audit Tool to improve clinical data quality and Precedence Health Care is providing care planning support for chronic disease management. The shared electronic health record repository is provided by Smart Health Solutions.

The HL7 standard is being used in Phase I for exchanging information, but Phase II will require conformance with the National E-Health Transition Authority's (NEHTA) prescribed CDA specifications. “The referral will be CDA and all of the discharge summaries and letters back will be CDA,” Mr Saunders says. “Some of the solutions used by providers that are not on NEHTA’s clinical desktop panel won’t be CDA compliant so these messages will continue to use HL7 and be included as a PDF attachment to a CDA document.”

If it sounds like a major undertaking, it is. “It is a requirement of GP participation that they will electronically refer to this campus – St Vincent’s Public Hospital, St Vincent’s Private Hospital and St Vincent’s Clinic – where the private specialists are based," Mr Saunders says. "It’s important to get critical mass in the community so GPs don’t have to think about whether the recipient can receive electronic referrals or not. For this campus, all inbound referrals are electronic – even if we have to hand-deliver some of them.”

Although not in the original scope, Prince of Wales Hospital has also agreed to accept electronic referrals into its ambulatory clinics to improve the value proposition to local GPs, he says.

“In return for the electronic referral, we’ll be doing several things. For all admissions and discharges from the public and the private hospitals, we’ll send an admission and discharge notification. Often GPs don’t know that their patients have been in hospital, and they really appreciate receiving the notifications, which they have never had before.

“With discharge summaries, St Vincent’s Hospital is now live across all inpatient wards and 100 per cent of all public hospital discharge summaries will be sent to the GPs electronically, where a nominated GP has been provided.

“The next thing will be the specialist letters. St Vincent’s Hospital has replaced the old dictation system with a hosted service by Ozescribe offering a 24-hour turn-around time to the hospital. The specialist letters are then sent electronically to GPs.”

The private specialists who are participating at St Vincent’s Clinic who use Genie will be sending specialist letters through that software, but if they don’t use a conformant system, the project team has devised an internal system so the specialist letters can still be sent electronically, Mr Saunders says.

“GPs will be getting admissions and discharge notifications from the public and private hospitals, specialist letters from public hospital and private specialists, and discharge summaries. Where there is no discharge summary from the private hospital they’ll get a specialist letter back. For nurse-initiated ongoing care, say in an aged care facility, nurse-initiated discharge summaries to those facilities will be going electronically point to point to GPs.”

Then it is on to Phase 2, which is aligned with the work the NEHTA GP desktop panel is currently completing.

“The timing hasn’t been finalised yet but all of the GPs and healthcare providers will start accessing the PCEHR and submitting shared health summaries and event summaries,” he says. “That’s when things start to get really interesting.”

Patient recruitment gearing up

The initial target for GP recruitment was 260 GPs, which the team achieved back in December. The project has now reached a total of 330 GPs, led particularly by the work of the divisions of general practice. The well-known Sydney GP Ray Seidler, medical director of the Eastern Sydney Division of General Practice, is a firm supporter of the project and recently appeared on a Channel 10 news story spruiking its value.

Now, recruitment is being geared up to target community pharmacies, allied health providers, community-based specialists and consumers themselves, with the massive task of enrolling 46,800 people.

Priority consumer targets will be people with chronic diseases, people with addictions, homeless people, older Australians and indigenous Australians in particular. Mothers and newborns will also be part of the recruiting phase but will not be targeted specifically.

Patient recruitment involves sending “dear patient” letters from GPs in participating practices asking patients to participate and to consent to the sharing of their EHR. Recruitment is supported by community advertising as well as direct practice-initiated recruitment of priority patients.

“We have now ramped up recruitment at the St Vincent’s campus,” Mr Saunders says. “All of the patients attending priority outpatient clinics will get a letter with a registration booklet. We are also targeting pre-admission clinics, and patients discharged from St Vincent’s Hospital.

“The letter to patients explains what it is we are doing and how it will benefit them, such as that there will be less of an onus on remembering the specifics of past healthcare interactions. We’ll also explain the opportunity to improve care coordination and continuity of care by better communication between their GP, other providers and the hospital system.”

The team is now merging with the Calvary eHealth site in the implementation in the Murrumbidgee, due to the overlap of referrals between that region and St Vincent’s and Calvary providers, he says.

“We are changing our consent and registration processes and our GP and provider recruitment to the Murrumbidgee in a coordinated joint effort. Although not in our original scope, Griffith and Wagga base hospitals will also participate as the main service providers to the local GPs.”

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