Vendor community support for NZ Health IT Plan

This article first appeared in the October 2014 issue of Pulse+IT Magazine.

Considerable progress has been made in achieving the overall objectives of New Zealand’s 2010 health IT plan, with an update released late last year. The health IT vendor community is supporting the updated plan’s priorities, which include electronic medication management, national clinical solutions, regional information platforms and community-based integrated care initiatives.

New Zealand’s health sector has experienced considerable levels of change and progress over the past five years, with IT being viewed positively as an enabler in supporting quality-based health outcomes. A key driver for this has been the leadership provided by the National Health IT Board (NHITB) with the development and implementation of the National Health IT Plan (IT Plan).

The original version of this plan was released in September 2010 and was based on the sector implementing a limited number of regional and national platforms as well as a focus on developing shared care to support an integrated model of care. This has also been supported by the vendor community taking up the challenge to develop the systems required as well as accepting their part in leading the much-needed sector changes.

The IT Plan was then reviewed with an update released in 2013 that took the original plan further. There were four priorities identified for IT investment in 2014 and beyond: electronic medication management, national clinical solutions, regional information platforms and community-based integrated care initiatives. Considerable progress has been made in achieving the overall objectives of the original plan as well as the priorities established in the updated plan.

Whilst strong and purposeful leadership from right across the sector has been a cornerstone to achieving so much in a relatively short period of time, there still remain challenges that will need to be addressed in order for progress to continue. In the IT Plan these revolve around governance, funding and capability whilst standards, common platforms, surety of investment and reduction of inefficient practices are factors that the vendor community would also view as important.

To read the full story, click here for the October 2014 issue of Pulse+IT Magazine.

Exactly the same but entirely different

This article first appeared in the October 2014 issue of Pulse+IT Magazine.

We may share a common language, historical ties and healthcare systems based on a similar model, but the way Australia and New Zealand has gone about automating those health systems over the last two decades is very different. While Australia continues to struggle to get the PCEHR to work, New Zealand has an enviable system of electronic exchange of information between the different tiers of healthcare provision.

Their flags are almost indistinguishable and, to someone from the US or Europe, so are their accents. New Zealand and Australia are two fiercely independent modern nation states separated by a thousand miles of sea. Though viewing themselves as entirely different from their Australian cousins, most New Zealanders are unaware of the fact that until 1901 their country was in fact part of the state of NSW, Australia’s most populous state.

A difficult stretch of sea and an entrenched unwillingness of the peoples of Western Australia and New Zealand to agree on racial laws and policies meant that when push came to shove, New Zealand did not become part of the Australian Federation and became its own sovereign nation.

Camaraderie and fierce rivalry both characterise our relationship. Little known is ‘The Battle of the Wazzir’, four days in 1915 when the two countries’ armies were involved in a pitched fight with one another. The battle was in fact a four-day brawl that involved 2500 Australian and New Zealand troops en route to the bloody battlefields of Europe. It took place in the brothel district of Cairo. Four days on, four soldiers were found to have been injured and no winner was declared. The two armies sailed on to Europe where they fought together bravely and sustained enormously tragic losses. The famed ANZAC spirit was born. Today, the two countries’ rivalry is mostly played out on sports fields with the fiercely contested Bledisloe Cup rugby games an annual highlight. Many New Zealanders live in Australia, which has a population five times larger than New Zealand’s, and there are also a growing number of Australians now residing in New Zealand.

In terms of health systems, there are significant differences between the two countries as well as similarities. Both have health systems based on the British healthcare model, with general practices prominent and with governments playing a key role in funding and administering healthcare.

To read the full story, click here for the October 2014 issue of Pulse+IT Magazine.

Pathology on the PCEHR: seven-day delay v authority to post

Debate over the best method to upload pathology and diagnostic imaging reports to the PCEHR is continuing just a month away from the Department of Health’s preferred deadline for the functionality to go live.

Pulse+IT understands that the next release of the PCEHR is set for November 30 or December 1 and will feature a number of fixes to existing problems with the system as well as the availability of the long-awaited pathology and imaging reports.

However, it is highly unlikely that diagnostic reports will actually be uploaded any time soon, as few private pathology or radiology practices are registered with the Healthcare Identifiers (HI) Service, a necessary prerequisite to use the system.

Pulse+IT understands the December release will contain a repository that can receive the reports, but that there will be no capability to send them. The department confirmed late on Friday that the functionality will be available in the next release, but that changes will be required to pathology and diagnostic imaging software to be able to post reports.

The uploads will contain the diagnostic provider’s complete report as an immutable PDF, rather than simple results as atomic data. This has been agreed to since last year to overcome the pathology sector’s concerns over safety and to allow cumulative results to be uploaded.

In the meantime, debate has been reignited by concerns raised by the new president of the Royal Australian College of General Practitioners (RACGP), Frank R Jones, in a communication to GPs last week.

Dr Jones wrote in the RACGP’s In Practice newsletter that the college had significant concerns about plans to enable the automatic upload of pathology reports after seven days, which it says may result in patients learning about clinical results before visiting their GP.

As reported in August, a series of consultation workshops had concluded that an automatic upload after seven days – allowing time for a GP to contact the patient if there were abnormal results – was a faster method than the alternatives and would prove less of a burden on GP workload.

However, Dr Jones told Pulse+IT this week that the issue was not necessarily that patients potentially had access to their information before the GP saw it, but about who ultimately had responsibility for interpreting the results.

“I believe that the original referring doctor has the clinical responsibility for interpreting the results,” Dr Jones said. “If something is missed then it is ultimately the GP who will be blamed. What we need to do is develop a tried and tested process.”

Dr Jones said the college’s national standing committee for health information systems had worked on the understanding that pathology reports would be sent to the GP in the normal manner and they would decide to upload it or not in consultation with the patient.

This refers to the authority to post (ATP) method, which had been developed by the National E-Health Transition Authority’s (NEHTA) diagnostic services reference group over several years. This group, which involved representatives from the RACGP, the Royal College of Pathologists of Australasia (RCPA) and the Royal Australian and New Zealand College of Radiologists (RANZCR), amongst others, had planned to use ATP as the safest method to upload results.

It would involve the pathology or DI report being sent by secure messaging direct to the requesting GP’s clinical information system, as is the current practice. The GP would then review the results and send a message back to the pathology practice to give them authority to post the reports directly.

This would then allow the pathology or DI practice to capture the necessary healthcare identifiers – the Individual Healthcare Identifier (IHI) for the patient, the Healthcare Provider Identifier Individual (HPI-I) and the Healthcare Provider Identifier Organisation (HPI-O) – which are not yet sent with many referrals, either electronic or paper.

The chair of the RCPA’s informatics committee, Michael Legg, said it appeared that the department had accepted the college’s argument that whatever method is used to post the results, there had to be a way not to post a report.

“There has to be the opportunity for the patient and requester to decide whether it is appropriate to post it or not at the time of request, even accounting for the current policy of having a time delay before the report could be viewed by the patient,” Dr Legg said.

“In my view it would depend on the nature and policy of the requester’s practice what the default would be but in any event there has to be a way of signalling that this report should not be posted to the PCEHR. That means that you have to have a way of being able to post a report at a later time, which may be after review of the results and/or discussion with the patient depending on the agreement they have.

“My understanding is that those views have now been broadly accepted, and there’s work going on to try and work out the detail of how to do this. The point is that the clinical colleges wouldn’t accept as being safe to do otherwise.

“This policy position reflects what is being done in other countries such as Denmark where they have had experience with making reports available to patients and clinicians through electronic health records for some time.”

Patient benefits

One drawback of the authority to post method besides the time burden on GPs is the delay in providing the information to the patient. The majority of pathology results are normal and do not require the doctor to recall the patient.

The Australasian College of Health Informatics (ACHI) has endorsed the direct upload method, arguing that patients should not have to wait indefinitely for their pathology results to be viewed and uploaded by a clinician before accessing them on the PCEHR.

ACHI has prepared an article for the November issue of Pulse+IT as part of its program evaluation committee’s biannual evidence review (BER). The article outlines ACHI’s targeted literature review of research and articles published locally and internationally about the ability for patients to access their pathology results through technologies such as a patient portal.

ACHI president Chris Pearce said the review found that there was no evidence demonstrating harm from access to pathology and diagnostic imaging results.

“The college acknowledges however the clinical cultural issues, and endorses the suggested seven-day delay,” Associate Professor Pearce said. “The current proposal has results being posted after a seven-day delay, allowing clinicians time to review and contact patients before they get direct access.”

A/Prof Pearce said the review acknowledged the concerns about the effects direct access might have on GPs’ traditional role as gatekeepers and the anxiety that could be experienced by patients reading results before their GPs have been able to curate them. However, for clinicians with modern health informatics systems, this should not represent a barrier to access.

“The alternative, that all results should be clinically curated, represents an unacceptable workload on busy GPs,” he said.

“Our review shows patients value access, but are lacking on information as to why and what patient outcomes might be. Accordingly, ACHI support the proposed model, with appropriate safeguards. Allowing consumers direct access to pathology results is new technology and must be framed in the context of improving the quality and safety of care.

“This means working with consumers to understand access and health literacy issues as well as targeting those with chronic diseases, where regular pathology is part of the care plan.”

Informed consent

In his communication to members, the RACGP’s Dr Jones said the college was also concerned that there was a lack of informed consent and transparency for health consumers registering for the PCEHR, the majority of which are established via assisted registration.

DoH figures show that the vast majority of patients leave the access controls in their PCEHR at the default setting, meaning any authorised healthcare provider can view all of the clinical documents it holds.

The RACGP is concerned that documents containing sensitive information such as a diagnosis of a genetic disorder or sexually transmitted disease could be viewed by any healthcare provider, not just those intimately involved in their care, if the patient does not restrict access.

Dr Jones said the college was concerned that many patients registered with the system lacked an understanding of the controls they can enact over who is able to access certain documents.

(Many doctors have cited the opposite as the reason they won’t use the system, arguing that if the patient is able to hide a particular document, then the PCEHR does not contain a full clinical record and it cannot be relied upon.)

Dr Jones said he personally had no problem with consumers being able to restrict access. “I accept that this is the patient’s record, it is personally controlled, but I am a practical person and I think we should be working to find a way that this system can work, that it is right for each user.”

He called on the developers of the system to find a practical way that it can work for both patients and clinicians.

“In my own practice, I check all of my incoming pathology results at lunch time and at the end of the day, so I check twice a day. Today I rang two patients personally because I felt that was necessary, but otherwise the results are sent to the patient’s record in my system with the press of a button.

“There is no reason why this could not also be done with the PCEHR. In fact, you should be able to use the same button.”

The RACGP would also like to see one method agreed to for both pathology and diagnostic imaging rather than separate methods.

Fixes are in for PCEHR data breaches

The Department of Health (DoH) has reported two data breaches of the PCEHR, one in which healthcare providers were technically able to view a consumer’s personal health notes and another in which individuals were able to inadvertently link a family member’s PCEHR to their own myGov account.

Revealed in the Office of the Australian Information Commissioner’s (OAIC) annual report of its activities in relation to eHealth, tabled on Tuesday, the department says a technical fix has been put in place for the first breach and containment strategies put in place for the second.

The report shows that in May this year, the department notified the OAIC that consumers who had logged into their myGov account and used their identify verification code (IVC) to link up their PCEHR were also able to set up access to another consumer’s PCEHR.

The IVC is emailed or SMSed to the consumer after they are registered for the PCEHR through assisted registration, a streamlined way of registering through a healthcare provider’s software. The consumer can then set up or log in to myGov at home and use the IVC to access their PCEHR.

A spokesperson for the Department of Health said a small number of people used their own myGov account to access both their own and their spouse’s or another family member’s existing eHealth record.

“This occurred where a family member made their access code (IVC) available to the other person opening their eHealth record,” the spokesperson said.

According to the OAIC, this resulted in the landing page of the first consumer’s PCEHR showing two ‘Open your eHealth record’ buttons, which provided links to open both consumers’ PCEHRs.

“The system operator [the DoH secretary] removed all links between these records and the small number of affected parties were contacted to explain what had occurred and offered assistance to re-establish the appropriate online access,” the DoH spokesperson said.

“The system resolution to this incident has prevented this situation from occurring again.”

The OAIC noted that the cause of the breach was not related to MyGov, an online portal to government services such as Medicare, the PCEHR, Centrelink, the DVA, the National Disability Insurance Scheme and most recently the Australian Taxation Office.

MyGov is operated by the Department of Human Services. In September, Human Services Minister Marise Payne reported that the system now had five million active users.

In May, it was revealed that MyGov was vulnerable to common cross-site scripting flaw.

DHS rejected these concerns,, saying myGov met all of the government’s security requirements for the protection of personal information.

The other potential breach was notified to the OAIC in December last year. The OAIC reports that this data breach involved a technical change made to the system that meant that healthcare providers could view consumers’ personal health notes.

The personal section of the PCEHR is where consumers can add their own notes or a personal health diary and is not supposed to be accessible to clinicians.

“Investigations by the system operator identified the cause and a technical fix was put in place to prevent further access,” the OAIC said. “The OAIC reviewed the information provided by the system operator in relation to the breach and determined that the response was appropriate and that no further action was required.”

The department confirmed that personal health notes of a small number of registered consumers were accessible by their authorised healthcare providers, but there is no evidence that it occurred.

“The problem was corrected through a technical fix within a few hours of being identified,” the DoH spokesperson said.

“The fact that these notes potentially became accessible to healthcare providers is taken as being viewed, regardless of whether these were actually viewed.

“The small number of affected consumers were contacted and advised of the breach, and were satisfied with the measures taken by the system operator.”

The OAIC said it had also liaised with the department about other incidents relating to the PCEHR system which did not meet the criteria for mandatory data breach notifications under the act.

This includes an incident in September last year in which an email containing a consumer’s IVC and other personal information was sent to the incorrect email address.

“The email recipient, however, did not have the other information required to access the consumer’s record,” the OAIC report says. “The OAIC provided recommendations to the system operator about how it could reduce the impact of any future incidents of this type. The system operator advised that it had implemented the OAIC’s recommendations.”

The OAIC’s annual report also says it received no complaints about the PCEHR system in 2013-14.

During the period, it undertook two audits of the system operator, one involving the department’s policies and procedures for the collection of personal information through the PCEHR consumer registration process.

The other was to examine the storage and security of personal information held in the National Repositories Service, the database that contains all of the clinical documents held on the system, which is located in a data centre in Sydney.

It also audited the assisted registration policies of 10 healthcare provider organisations to assess whether those organisation’s policies addressed the new Australian Privacy Principles, along with the assisted registration practices of the Western Sydney Medicare Local (WSML) and the privacy collection notice of Calvary Health Care ACT in relation to the PCEHR and the Healthcare Identifiers (HI Service).

The OAIC reports that as of June 30, it was awaiting final comments from the system operator on these audits.

The Australian Medical Association (AMA) recently reported that the OAIC would shortly begin conducting assessments of a small sample of general practices that use the PCEHR to see if the practices have appropriate information handling processes to protect the security of personal information.

“The OAIC will make suggestions if it considers improvements can be made to those practices,” the AMA said. “The aim of the assessments is to determine if there is a need for the OAIC to undertake education in this area.

“The OAIC has indicated it is likely that the practices assessed will be based in NSW or ACT. The determination of which organisations to assess will be dependent on their use of the PCEHR system.”

The OAIC also reported that it had received and finalised two complaints from the same person about the use of the Individual Healthcare Identifier (IHI).

The federal government announced in the May budget that it was disbanding the OAIC on January 1, 2015. The functions of the office, which includes the Information Commissioner, the Privacy Commissioner and the Freedom of Information Commissioner, will revert to the structure in place before it was established in 2010.

The Privacy Commissioner will continue as an independent agent but the FOI Commissioner and the Information Commissioner will no longer exist. The FOI Act will be jointly administered by the federal Attorney-General’s Department, the Administrative Appeals Tribunal and the Commonwealth Ombudsman.

It is unclear what agency will have oversight of the privacy aspects of the PCEHR in future. The OAIC has been providing advice and oversight on the PCEHR through a memorandum of understanding with DoH, along with an independent regulatory role for the HI Service.

The OAIC reports that it received $509,898 for oversight of the HI Service and $1,294,818 for oversight of the PCEHR system in 2013-14.

State-wide registry for Victorian cardiac care benchmarking

Information on every patient undergoing percutaneous coronary intervention (PCI), better known as coronary angioplasty, in Victorian public and most private hospitals is being collected and analysed to benchmark performance and improve care through the Victorian Cardiac Outcomes Registry (VCOR).

While the VCOR project has been underway for several years, it was officially launched today with the release of its inaugural annual report.

Coordinated by Monash University and the Victorian Cardiac Clinical Network, the new registry collects information on every patient undergoing an angioplasty procedure, which averages over 8000 Victorians each year.

Head of the School of Public Health and Preventive Medicine at Monash, John McNeil, said the centralised, state-wide registry would help ensure that cardiac patients receive the highest quality of care.

“As the database develops over time, it will provide a crucial opportunity for healthcare providers to benchmark their performance against services both nationally and internationally,” Professor McNeil said.

“Ultimately, we expect this to result in more consistent, best practice cardiac care across the Victorian health sector.”

Since its inception in January 2013, VCOR has recruited 23 of the 29 Victorian public and private hospitals to the project. The registry includes a record of the number of procedures performed, clinical profiles of patients, any complications that develop and the outcomes of these procedures.

Funded by Medibank Private and the Victorian Department of Health, VCOR is also running a pilot project for monitoring the management of early ST-elevation myocardial infarction in regional Victoria.

It is also planning to develop databases for heart failure, implantable devices and arrhythmias and is currently setting up a heart failure minimum data set.

VCOR involves a web-based registry that provides real-time summary reports and raw data downloads for hospital staff. Clinicians can view read-only data for patients they have treated across multiple sites.

Information is taken directly from hospital medical records and entered into the secure VCOR web-based database by hospital staff. It has also implemented a secure file transfer protocol (SFTP) capability for electronic transfer of data.

Patients may opt out of the registry if they wish.

Trust the digital transformation of general practice

This story first appeared in the August 2014 issue of Pulse+IT Magazine.

Many general practitioners are still reluctant to fully embrace digital technologies in their day-to-day work, often as a result of a lack of trust in the effectiveness of IT in improving patient care. However, the RACGP is working to improve uptake of these technologies by highlighting the benefits of IT in patient care delivery.

New technologies are pivotal to the continuation of improved healthcare for all Australians. Under the current Australian healthcare system, most general practices operate as private businesses. GPs who choose to establish their own private practice recognise they often do not possess the appropriate business and technology skills to successfully manage a small business, with little education on business development and information technology provided at medical school.

In the age of a rapidly emerging digital economy, it is vital that practice principals and GPs have the right tools and resources to embrace new technologies within their practice.

The digital revolution is transforming workplaces within the healthcare sector. In general practice, the use of practice management and clinical desktop systems, the internet, eHealth and mHealth technologies have consequently increased the use of PCs, laptops, remote access devices such as smartphones and tablet devices and increased the demand for wireless (Wi-Fi) connections, resulting in widespread uptake of broadband internet and secure external data transfer.

Patient privacy, information security and clinical safety are overriding imperatives with the introduction of many new eHealth initiatives and the implementation of the national eHealth record system.

Core to digital technologies is the security, storage and retrievability of business and clinical information. Patient privacy and information security must be considered during the delivery of evidence-based care by informed and educated clinicians and the sharing of critical business and clinical information.

General practices often lack the specialist knowledge to deal with both internal and online risks.

To read the full story, click here for the August 2014 issue of Pulse+IT Magazine.

Top-down and bottom-up approaches to interoperability

A panel discussion on the steps needed to achieve optimal governance for eHealth interoperability is one of the highlights of the second eHealth Interoperability Conference, being held in Sydney next month.

The panel discussion will look at how to balance top-down and bottom-up approaches to interoperability, as well as the need for an open dialogue and a shared vision on the use of data.

Chris Pearce, president of the Australasian College of Health Informatics (ACHI) and director of research at the Inner East Melbourne Medicare Local (IEMML), will provide the keynote speech on governing for efficiency, usability and safety, emphasising the importance of appropriate governance structures in large-scale eHealth programs.

The international interoperability experience will be illustrated by Poul Mossin, head nurse and head of emergency at Koege Hospital in Copenhagen, who will explain how the many electronic health systems work together in Denmark, considered by many to be of the leading nations in eHealth implementations.

Frank Cunningham, international policy officer with the European Commission in Belgium, will discuss innovative transatlantic collaboration in transformation of healthcare systems as well as eHealth and health IT workforce development.

Closer to home, standards expert Grahame Grieve will discuss architectural approaches for exchanging information, while Michael Legg will use a case study of the Royal College of Pathologists of Australasia’s PITUS project to illustrate what is needed to achieve interoperability.

Some notable interoperable eHealth implementations will also be highlighted, including Jason Whakaari from Western Health on its acute to primary care messaging service, its mobility device layer and its new intelligent Patient Journey System (iPJS), which has been designed by Alcidion and rolled out throughout the three Western Health hospitals.

Kate Richardson, a pharmacist from St Vincent’s Health Australia, will discuss the interoperable challenges of eMedicines and eAllergies. She will use a MasterChef analogy to illustrate medicines data from primary care to acute care and back again: “filleting components on admission, blending elements for administration, then trussing at discharge”.

NSW Health’s program director for electronic medications management, Robin Mann, will expand on interoperability models for EMM as NSW sets out on a 10-year journey to implement EMM throughout the state.

The University of Western Sydney’s George Margelis will discuss whether “personal connected health” is the answer to interoperability, while NICTA’s Leif Hanlen will look at open clinical data and barriers to sharing.

Andrew Burton-Jones, a professor of business information systems at the University of Queensland, will tackle the hot topic of using integrated EHR/EMR systems meaningfully, asking whether we can simply adopt concepts from the United States “meaningful use” regulation.

A new concept called World Café @eHealth Interoperability will be introduced this year, involving an informal, cafe-style meeting to discuss topics.

The eHealth Interoperability Conference is being held at the Parkroyal Darling Harbour in Sydney on October 28 and 29. Registrations are now open.

Griffith launches apps for chronic fatigue and headache research

Griffith University has launched a new app to help patients with chronic fatigue syndrome better manage their illness, along with a headache app designed to be used in a research study to record daily ratings of head pain.

The chronic fatigue app, called CliniHelp, is also suitable for patients with multiple sclerosis and rheumatoid arthritis and allows them to record symptoms, track them on a weekly basis and monitor changes in their condition.

Griffith, which has officially opened a specialist chronic fatigue clinic based at its National Centre for Neuroimmunology and Emerging Diseases (NCNED) on the Gold Coast that will receive patients in October, will also use the app for research purposes, with anonymised data entered by patients sent to its researchers.

Users’ records can be stored on their mobile phones as PDFs and shared with their healthcare practitioners.

NCNED head Sonya Marshall-Gradisnik said a major advantage of CliniHelp was that it will allow physicians to be more informed of their patients’ symptoms, as cognition can be a major impediment for patients with chronic fatigue syndrome.

An iOS version of the app is available now, with an Android version due in August.

Griffith has also launched an app that can be used by participants in research projects such as its ENHANCE project, which is studying the effectiveness of managing headaches using a combination of cognitive behavioural therapy (CBT) and a new approach called learning to cope with triggers (LCT).

The Griffith research team, led by Paul Martin of the Behavioural Basis of Health program, aims to help headache sufferers to become desensitised to triggers such as food, noise and stress or to build up a tolerance to them.

Professor Martin’s team has developed an electronic headache diary that can be used by participants in the study in order to record daily ratings of head pain.

“Information recorded via the app can be directly downloaded into data files, saving time and eliminating transcription errors,” Professor Martin said in a statement. “The technology will enable the team to know when the ratings of head pain are made, rather than relying on the self reports of the participants.

“This app will benefit the ENHANCE project but will also be a very useful tool for other headache researchers around the world.”

Feros Care will go gung-ho for an opt-out PCEHR

Despite facing huge challenges in implementing the PCEHR for its aged and community care clients, aged care provider Feros Care will be “gung-ho” in supporting clients to use it to monitor and self-manage their health if it becomes an opt-out system, the organisation says.

Feros Care’s manager for health and wellness, Kate Swanton, told the Information Technology in Aged Care (ITAC) conference in Hobart last week that the company, which has residential facilities in Byron Bay, Bangalow and Wommin Bay as well as a large number of in-home and community care packages, had put its hand up as an early adopter of the system for the aged care sector and remained committed to rolling it out to all clients, despite numerous challenges it has faced.

Associate Professor Swanton said Feros Care had registered about 600 clients for the PCEHR, and had found that most were keen to take part, with only two who were not. Some clients were actively engaged in their records, including several with diabetes who are uploading their measurements to the personal section of their PCEHR.

Other clients were not interested in viewing their records but felt much safer knowing that healthcare providers will have access to their information, she said.

PCEHR registration is offered to all clients participating in Feros Care’s My Health Clinic at Home NBN trial – made all the easier in that this has been funded – and the organisation is pushing for a link to be added to the tablet PCs used in the trial to make it easier for them to access their record and avoid the myGov website, which is still a very challenging interface, she said.

In addition to unanimous support for a name change from the PCEHR – affectionately known as the pecker – to something like the My Health Record suggested in the Royle review, A/Prof Swanton said the organisation was very supportive of a change to an opt-out system.

“Our lives would be so much easier if the recommendation about the opt-out system is accepted,” she said. “For us registration is a real challenge. We’re really committed to it but it is very challenging. If everyone automatically had a record it would be so much easier.

“We do a lot of vital signs monitoring with our community clients at home via tablets so this is a great opportunity to upload those vital signs. They’ll be useful for GPs and health providers but also useful for our clients to see their progress over time.

“If we get that opt-out recommendation accepted we will be gung-ho in supporting our clients to make use of the record to enable them to much more effectively monitor and manage their own health.”

Feros Care plans to have 100 event summaries uploaded by June next year, and is on the way to its target of registering 70 per cent of its clients by that time.

Never-ending pecker journey

For Feros Care, the PCEHR fits in well with the organisation’s service philosophy, in which technology is used as an enabler to help maintain independence for clients, there is a focus on positive ageing, clients remain connected with family and friends and there are better connections with providers.

Five years ago the organisation was a basically a small aged care provider in Byron Bay with two residential facilities and a few community care packages. A/Prof Swanton said Feros Care had grown very rapidly since then – “but we are still very Byron, still a little bit odd,” she said – and that expansion has been enabled by a concentration on technology.

“We now have clients down the east coast of Australia, our staff are connected virtually, we have an electronic record, we communicate electronically,” she said. “We’ve adopted the use of telehealth and tele-care to provide services for our staff, and an eHealth record was really attractive to us in terms of supporting our clients and better managing their health.”

Feros Care was interested in being an early adopter of the PCEHR as it saw it as a critical alignment with its service philosophy, and it wanted to showcase the functionality of the record for the aged care sector, she said.

“We wanted to allow our providers to access the system and to encourage staff and other providers to contribute to it. We also thought this was such an opportunity to access critical information that would enable us to communicate more effectively with our clients and collectively define our care packages.”

The process, however, was long and arduous, she said. “It won our service desk record. All IT requests go through our service desk, are monitored and usually closed off very effectively and efficiently and we have benchmarks that we need to meet.

“This one was the never-ending pecker journey. It was very complicated, this project. We needed to register as an organisation and can I say I have never seen so many forms before … so many secret numbers, so many mystery secret numbers that we had to enter into systems.

“And there were new roles: we’ve all got new glamorous titles. I’m an OMO – I used to think OMO was a washing detergent but I am now an OMO in our organisation.”

There were problems registering clients from the start, including finding each healthcare provider’s Healthcare Provider Identifier – Individual (HPI-I) and sorting out what a seed and a network organisation were. Some care managers, while having tertiary qualifications, are not registered healthcare providers and therefore are not given an HPI-I by AHPRA. And yet, these are the people who would benefit most from having access to health information on their clients, she said.

The early registration process was near-impossible to navigate, with Feros Care’s CEO Jennene Buckley and CIO Glenn Payne – both very IT-savvy – unable to register online for their own PCEHR. Medicare offices were not helpful and the telephone helpdesk was the same, with instructions given too quickly for older people to understand and none of the helpdesk staff questioned by A/Prof Swanton admitting to having signed up for a PCEHR for themselves.

The eventual release of an assisted registration tool (ART) was a step forward, but even so, she said, community care staff have to remember and enter a 16-digit code every time they try to register a client in the field through the organisation’s care software package, TCM.

“We weren’t funded to register clients and it takes a lot of time for our staff to explain the benefits of the record and go through the essential information that we needed to provide for clients, including verifying ID,” she said.

“For our community clients we had to provide 100-point ID and aged care clients … [mostly] don’t have an available passport or driver’s license or have the documentation that would equal 100 points.

“What we did do to help facilitate the registration process was to establish a number of strategic partnerships. We had an MOU with the North Coast Medicare Local and they agreed to go out with us and engage our clients and they registered on the spot using the ART tool.”

Aged care profile

A/Prof Swanton praised NEHTA for the assistance it gave the organisation, saying NEHTA was able to rewrite certain processes based on feedback on what would and wouldn’t work in the aged care sector.

Now, shared health summaries are even starting to appear. “We don’t always see the shared health summary because that is reliant on the GPs to provide that information,” she said.

“Having worked closely with GPs and knowing how busy they are, if they have to duplicate the process [of writing progress notes] that is going to take part of the consultation time and it won’t happen, but we are starting to see more GPs entering information.

“We are starting to enter information as well so we are starting to get a profile for aged care. Event summaries of significant events, medication prescription and dispense records and hospital discharge summaries are invaluable for a residential establishment.”

With the NBN trial also involving registering clients for and using the PCEHR, Feros Care is now embedding the system in its initial assessment process. A link to the PCEHR is also embedded with the TCM software, although the organisation would like to see an eHealth link added to the client’s tablet as well, allowing them to bypass the notorious myGov access route.

Now, the organisation is awaiting the outcomes of the consultation process on the PCEHR review, which A/Prof Swanton said she was completely supportive of.

“They are very sensible recommendations and hopefully they will be endorsed,” she said. “We’ve had the name change to a much easier name, because trying to sell a personally controlled eHealth record to aged care clients is a bit of a mouthful, and our lives would be so much easier if the recommendation about the opt-out system is accepted.

“We really see this as an invaluable tool to effectively improve our communication with GPs, hospitals and allied healthcare providers. It is about raising the profile of aged care, to show what services we are providing our clients. We want to register and train all our providers to actively access and use the record.”

Authority to post a sticking point for PCEHR pathology reports

The Department of Health has released two consultation papers on proposed models for uploading pathology and diagnostic imaging reports to the PCEHR and is looking for feedback to refine the models further.

The papers detail in full where discussions on uploading pathology and imaging data got up to before the PCEHR review was announced last December, as well as proposed design principles and sample pathology report and diagnostic imaging report views.

One area of interest is the technical requirements behind the proposed authority to post (ATP), a message that would be sent to the pathology provider from the referring healthcare practitioner that a result can be posted as an immutable PDF to the consenting patient’s PCEHR.

Pathology providers will also be responsible to removing older or superseded pathology reports from the system.

The paper states that it is recognised that more work needs to be done with clinicians and software vendors to ensure that design of the ATP workflow in clinical systems integrates well with existing practices. Medico-legal issues are also a major concern.

Pathology providers have in the past raised the issue that their current secure messaging systems only support one-way, outbound messaging, meaning a cost-effective solution will need to be provided for both referring doctors and pathologists to set ATP up.

Pathology software vendors have also advised that they might need technical support with CDA documents, with which they are reasonably unfamiliar.

The plan for diagnostic imaging is that only the reports will be uploaded to the PCEHR, not the images themselves. The consultation paper states that no consensus had been reached in discussions with the sector last year, before consultation was paused when the review was announced.

“There are still outstanding issues around the clinical workflow and the technical changes that would be required to support the proposed ATP model,” the diagnostic imaging consultation paper states.

Similar issues face radiology practices as those facing pathology providers in terms of technical capabilities around ATP, and the suitability of the proposed ATP model was not agreed to in the last round of consultation.

Two-way messaging is a barrier, but there is also the problem that software vendors for diagnostic imaging are predominantly based overseas and therefore not focused on Australian-specific requirements.

“As a consequence any changes required to get diagnostic imaging reports into the PCEHR may take some time,” the paper states.

“While broad consensus was not reached on the suitability of the ATP model there was agreement from a technical perspective that any new messaging capability required for ATP should be based on the existing HL7 messaging framework.

“It was also agreed that a new national technical specification to support the electronic transfer of ATP messages between healthcare providers and diagnostic imaging providers would be required. It is proposed that NEHTA will draft a new National ATP messaging specification based on input received during consultation.”

An alternative model for diagnostic imaging was put forward, in which information about the imaging event was also uploaded to the PCEHR. This information would include the date, location, type of procedure and details of the imaging facility. As this is not necessarily sensitive information, it might negate the need for an ATP.

Samples of both pathology report and diagnostic imaging report views are available as appendices in the consultation papers.

The department is requesting feedback to the consultation papers by email by July 18. Workshops are also being held in Melbourne on July 8 and 9.