PCEHR may accept existing advance care directives

The Department of Health is looking at the possibility of loading existing advance care directives to the PCEHR as PDFs, a method it is also considering to begin loading pathology reports to the national system.

While the newly elected federal government has yet to make clear its plans, DoH's first assistant secretary for PCEHR system development and operation, Fionna Granger, told a forum for healthcare IT vendors immediately prior to the election that the department was working on two new releases of the PCEHR, one scheduled for November and a major upgrade next April.

The November release will entail minor enhancements for consumers, providers and for administrative staff working on the system. Ms Granger told the forum that DoH was looking at some usability enhancements for the consumer portal based on feedback it had received, along with feedback on views and layouts for the National Prescription and Dispense Repository (NPDR).

The major changes are scheduled for the April release, which will involve loading advance care documents and pathology and diagnostic imaging reports.

An invitation-only stakeholder workshop on pathology and the PCEHR was held in Melbourne on September 24, to which the media was not invited. However, Pulse+IT understands that discussions have moved in favour of the preferred direction of the pathology industry, which has argued that pathology reports need to be loaded as complete documents in advance of a standardised way to display results that pathologists believe is safe.

Ms Granger told the vendor forum, held on August 23, that the department was looking at allowing “immutable” PDFs – documents which cannot be modified – to be loaded to the PCEHR with a CDA wrapper, for both pathology and diagnostic imaging reports, and for advance care directives.

“There are two key things we are trying to achieve [with advance care planning] and they have slightly different approaches,” Ms Granger said.

“We are trying to incorporate these type of documents into the PCEHR. We are also trying to make the process for advance care planning more available to patients so they can express their wishes, and there are two slightly different solutions to those.”

She said existing advance care directives and plans differed by state and territory, with some created as simple documents written and signed by the patient to more complex plans developed with healthcare practitioners, and those that have been developed and witnessed by legal practitioners.

“There are also a number of very well-developed forms for advance care already in the community,” she said. “What we are wanting to do with the PCEHR is leverage what has already been done rather than start afresh.”

She said the department was looking at the possibility of loading PDF-type documents with a wrapper that explains what the document is and who loaded it, whether that be a healthcare provider or the consumer themselves.

“We can for example take the well-developed documents in the states and territories and use those,” she said. “We are also planning to make an online tool potentially available to help people on their advance care planning journey, but would load it the way they would any other document. We are getting a reasonably positive response to that approach at the moment.”

The Northern Territory is currently working on migrating its My eHealth Record (MeHR) to the national PCEHR in time for the April 2013 release. The NT Department of Health is hoping the federal system adopts its model for loading pathology results.

Loading diagnostic images is not yet on the horizon, but Ms Granger said the department was not looking at replicating the existing image repositories. It is understood that a link to the location of the images embedded within the imaging report is the preferred option.

Asked why the department would allow encapsulated PDFs to be loaded when that had been rejected for documents such as shared health summaries, Ms Granger said pathology results in particular were not as atomic as they could be and CDA-wrapped PDFs were a short-term solution.

“[W]e'd like to work towards atomic, but we are at the very early stages of figuring out the practicalities,” she said.

“Some of the views we showed [at the forum] aren't as atomic as we'd like, which is one of the reasons why we think CDA wrappers are important and developing views is important. The other thing is that we'd like to move there over time but we have to make sure that everybody is ready to come with us. We think it's a practical starting point.”

Posted in Aged Care

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