National CDA specification for obstetric information under development

Queensland's Mater Health Services is continuing the development of its shared electronic pregnancy health record and is currently completing a transitional contract with NEHTA that will help formalise a national Clinical Document Architecture (CDA) specification for obstetric information.

Mater's Shared Electronic Health Record (EHR) for maternity patients is one of the projects funded under the Wave 2 projects for the implementation of the PCEHR. Mater Health has been given funding for a transition project that will in part use the knowledge gained from the Wave 2 project to inform the development of a national specification for CDA documents relating to pregnancy, to be developed and adopted by NEHTA.

Mater's Shared EHR is a repository for obstetric information that is accessible by patients, internal clinicians and external healthcare providers. It uses Mater's existing clinicians' portal along with a newly developed patient portal, which went live on July 1.

Mater's CIO, Mal Thatcher, said the system uses InterSystems' HealthShare informatics platform to extract data from three different CDA documents that are sent in from external clinicians, one generated by Genie Solutions and two different documents generated by PEN Computer Systems software. The documents are all based on a specialisation of the NEHTA-defined event summary, he said.

Most of the consultant obstetricians engaged in the project use Genie software. “Obstetricians can submit a CDA antenatal record which the Mater can store and then extract relevant information to provide a composite view of a woman’s antenatal record, derived from internal Mater clinicians' records and external providers,” Mr Thatcher said.

PEN Computer Systems' PrimaryCareSidebar tool is used to extract information from Medical Director or Best Practice general practice software. The Sidebar includes a widget that flags to the GP that a patient has enrolled in the Mater Shared EHR, so the GP can then choose to send a full antenatal record or a summary of a particular visit. The Sidebar tool packages it up as a CDA document and sends it to the Mater repository.

Once the information from external clinical systems is received in the repository, HealthShare is used to transform the incoming CDA files into a single document type and extracts relevant information to create an obstetric patient record. The original CDA file is attached to the record for future reference.

HealthShare then combines the obstetric patient record with information from a range of other Mater systems, such as patient registration, pharmacy and pathology, to create the Mater Shared EHR. This is available to external clinicians and maternity patients via the provider or patient portal.

Mater's integration specialist, Andy Richards, said HealthShare comes with a series of pre-built and pre-tested building blocks, including support for the CDA specification, secure messaging delivery (SMD) adaptors and transformation engines for clinical data so the organisation didn't have to develop any of them itself.

Mater also used HealthShare to develop an interface to the national Healthcare Identifiers (HI) Service, and has now obtained over 80,000 Individual Healthcare Identifiers, which it has matched and verified against existing patient information and added to the Mater Shared EHR using HealthShare's inbuilt technology for the disambiguation of personal records.

Mr Thatcher said Mater has chosen to search for IHIs for patients based on new activity in the patient’s record. “For example, a change to the patient’s details in the patient master index will prompt the system to seek an IHI match where a current active and verified IHI is not recorded by Mater,” he said. “IHI matching is done for the entire patient cohort on this basis, not just maternity patients.”

The Shared EHR will continue to be developed for Mater's patients, but it will also link up to the national PCEHR, he said. “Mater clinicians are expected to be able to access the national PCEHR from within our internal clinical portal via an integrated B2B solution. Mater is also looking to contribute event summaries to the national repository.”

Mr Thatcher said that since going live on July 1, there are now over 1000 patients registered for the patient portal.

Posted in Australian eHealth

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