Aged care repeats calls for PCEHR transfer document

The Aged Care Industry Information Technology Council (ACIITC) has repeated its long-held view that a transfer document be established on the PCEHR as a way to improve care coordination for older people moving between aged, primary and acute care.

In its submission to the panel reviewing the PCEHR, the council – a joint venture between provider organisations Leading Age Services Australia (LASA) and Aged & Community Services Australia (ACSA) – has also called for improved governance of the system, a role for aged care in guiding its development, and an end to the culture of pilot programs that only serve limited needs.

It has also called for funding for the sector to implement the PCEHR, and for the development of a coherent policy for the system and its use for older Australians.

The council sees the transfer document as a kind of “reverse” discharge summary that would be uploaded by a registered nurse and would contain a host of information important to the care of the older person when they enter hospital from residential aged care.

It points out that there are approximately 65,000 transfers a year between public hospitals and nursing homes alone. The primary point of contact is the emergency departments of state hospitals, with an average of 60 per cent of activities represented by people over 65.

Long championed by the industry and software companies such as AutumnCare and Leecare, which worked on the Pathfinder project, the transfer document formed an integral part of that project's recommendations.

The Pathfinder project was completed within six months and was submitted to the Department of Health in October 2012, but has not yet been released publicly.

“We have identified discharge from hospitals and transfers from aged services as a key area to complete the integrated health concept in critical information flow,” ACIITC said in its submission.

“As part of Pathfinder, we have even identified the elements of a transfer document uploaded by a registered nurse from aged services, within the existing architecture of an event summary, developed with vendors who serve the sector and proposed this as a low-lying, cost-effective but high-impact way to address the sector's need.

“That input was in October 2012, well before the cut off dates for 2013 and 2014 releases.”

The council says a transfer document is more than just a reverse discharge as it contains extra information that is essential to the quality of care of older people, including their food requirements, the prosthetics they use, their continence and behavioural issues and cognitive capacity, and the medicines they are taking.

“Considerable energy is wasted in both hospitals and nursing homes in the transfer of residents/patients between one sector and the other, usually with minimal or no formal documentation,” the submission states.

“The introduction of a transfer document in both directions would simplify the exchange of information between both settings, thus removing the current highly inefficient transfer mechanism.”

ACIITC says that despite proposing a number of solutions on how to engage with aged care, and providing many briefings and consultations over the years, it is “yet to see an emergence of a coherent and consistent endorsed policy initiative/strategy for older Australians that will realise the objectives of this national investment”.

“This is a revolution for consumers and health care providers, but age services are being left behind as there is no effective voice or aged care industry representation in governance arrangements with respect to PCEHR,” ACSA CEO John Kelly said.

LASA CEO Patrick Reid said that while primary and acute care providers had been funded to implement the PCEHR, there had been no similar funding for aged care services.

“An integrated system is a good example of public policy but it is being set up for failure by excluding millions of Australians and their health care providers,” Mr Reid said.

“[W]e are not involved in setting priorities for the development of software and a culture of pilot programs such as downloading of prescriptions rather than a transfer document for use by registered nurses does not bode well for a sustainable market-driven future for the PCEHR.”

The council would also like to see the PCEHR develop to enable data capture from monitoring of vital signs, but warned that the current developers of the system were pursuing “perfection in software architecture” when a more pragmatic approach was needed.

“Quality will be improved as technology continues to evolve,” it said.

It also pointed out that the former government's Aged Care Gateway plan – the future of which is still uncertain – would be delivered faster and more cost-effectively if the PCEHR was developed alongside it.

“With financial assistance, aged service providers can not only adopt PCEHR interacting with the Aged Care Gateway, but will also have a reason to sustain and incorporate PCEHR as part of their operations.”

In terms of usability, it says it agrees that the system must be usable by clinicians, but this should not just be GP-centric.

To review a table of submissions to the PCEHR review compiled by Pulse+IT, click here. This resource will be updated as more submissions become public.

Posted in Aged Care

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