The Healthcare Identifier Service: an introduction for practices

This article first appeared in the May 2012 edition of Pulse+IT Magazine.
The Healthcare Identifiers (HI) Service is a key foundation technology for not only the personally controlled electronic health record (PCEHR), but many other eHealth-related services that stand to benefit from more accurate identification of patients, providers, and the organisations for which they work.

After years of planning and development, the Healthcare Identifiers Service was switched on in July 2010. The system was built by Medicare Australia (now Department of Human Services) having been contracted by the National E-Health Transition Authority (NEHTA) to develop a system to assign a “unique national healthcare identifier for each patient, practitioner and healthcare organisation”.

In Medicare Australia’s own words: “The HI Service is a system that provides a consistent set of identifiers for healthcare individuals and healthcare providers (organisations and individuals). The HI Service enables providers to associate health information about a healthcare individual in a secure, consistent and accurate manner.”

While much of the discussion around eHealth remains focused on the PCEHR, it is important to note that while the HI Service plays an important role with the PCEHR, healthcare identifiers have a much broader application, according to NEHTA. “In the near future, identifiers will be used within electronic communications such as discharge summaries, prescriptions, and referrals to correctly identify the patient, referrer, referring organisation, referee, and referee organisation.”

Unfortunately the tangible benefits of healthcare identifiers will not be immediately apparent to many healthcare organisations, as the usefulness of the service will scale in proportion to the number of healthcare organisations using them. In much the same way as the owner of the very first telephone had little reason to celebrate, early adopters of healthcare identifiers are unlikely to extract much benefit until other organisations with whom they communicate also adopt the system.

That said, the health sector is certainly not positioned for a standing start and there has already been a considerable amount of money expended by government, both on the HI Service itself and on incentivising software vendors to develop HI Service functionality in their solutions.

In the first year of operations, the HI Service operator assigned 24,051,919 healthcare identifiers to individuals and over 500,000 to healthcare providers. However, despite these impressively large numbers, awareness of these identifiers amongst both consumer and healthcare provider cohorts remains modest.

In the case of consumers, this is not necessarily a problem as it is not a piece of information that they need to know to access healthcare services. However, if they so wish, they can retrieve their healthcare identifier from Medicare Australia, either by the telephone or online if registered for Medicare's Online Services. Once logged into this portal, consumers are able to see their identifier’s access history, including the date it was created, and any subsequent access thereafter.

For the vast majority of the first 12 months of operations, the HI Service sat relatively dormant as software developers were not able to interface with the service until the very last days of June 2011. However, since funding for the Wave 1 and Wave 2 pilot projects and the GP vendor panel emerged, increasing numbers of healthcare organisations are connecting to the service as part of their day to day operations, a trend that is likely to continue as more emphasis is placed on the broader rollout of HI Service-compatible software.

The identifiers

While all the new healthcare identifiers are 16-digits in length, there are four different types that organisations should be aware of. As defined by NEHTA in its practice-centric literature:

IHI: The Individual Healthcare Identifier (IHI) has been allocated to all consumers enrolled in the Medicare program or those who are issued with a Departments of Veterans' Affairs treatment card, and others who seek healthcare in Australia.

HPI-I: Healthcare Provider Identifier – Individual (HPI-I) numbers are allocated to healthcare providers involved in providing patient care. All healthcare providers registered with the Australian Health Practitioner Regulation Agency (AHPRA) have been allocated an HPI-I, which they can retrieve from AHPRA’s website after logging in.

HPI-O: Healthcare Provider Identifier – Organisation (HPI-O) numbers are allocated to organisations, such as medical practices and hospitals. As discussed later, there are two types of HPI-O, however most organisations are likely to only need to obtain one.

CSP: while a detailed discussion of CSP identifiers is outside the scope of this article, a fourth identifier designed for ‘Contracted Service Providers’ is also defined by the system. In practical terms, a CSP is most likely to be a software vendor that acts on behalf of a healthcare provider organisation with the organisation’s explicit authority to do so.

The people

Before continuing with the deluge of acronyms, it’s worth noting at this juncture that healthcare organisations need to assign people to be the HI Service’s main points of contact. A full explanation of their roles and responsibilities is available on the Healthcare Identifiers Service application form and has therefore been excluded from this article, but from a high level, the two classes of people authorised to act on behalf of the organisation as far as the HI Service operator is concerned are:

Responsible Officer: The Responsible Officer (RO) is the officer of a healthcare organisation who has accepted responsibility for participation of the organisation in the HI Service. The RO is primarily responsible for ensuring their organisation complies with the rules and regulations that govern the HI Service, and appointing at least one organisational maintenance officer.

Organisation Maintenance Officer: an Organisation Maintenance Officer (OMO) is an officer of a healthcare organisation who is responsible for maintaining information about their organisation within the HI Service. They act as an authorised representative of the healthcare organisation and maintain the accuracy and completeness of the HPI-O record, add new OMOs, maintain the links between the organisation identifier and the provider identifiers, and manage the organisation hierarchy as explained later in this article.

Marina Fulcher, a past president of the Australian Association of Practice Managers (AAPM) and member of NEHTA’s clinical leads team, suggests that medical practices need to ensure ROs and OMOs are accounted for in practice staff policies and procedures to ensure continuity. Ms Fulcher also provided an example of how typical practices might assign people to these roles.

“It’s a discussion that needs to happen in your practice to work out what suits you, however we would recommend that you have at least two OMOs in case something happens to one of them,” Ms Fulcher said. “It’s probably best that one of the business owners is set up as the RO, but if they agree that it should be the practice manager for example, that’s fine, it just needs to be noted in the practice staff register as something that needs to be managed when the practice manager finishes up with the practice.”

The organisations

As the HI Service is designed to cater for healthcare organisations of all shapes and sizes, two types of HPI-O classifications have been defined:

Seed HPI-O: a Seed HPI-O is to be obtained by any legal entity that delivers healthcare services, including for example medical practices, community healthcare organisations, and hospitals.

Network HPI-O: a Network HPI-O is a sub-entity of a Seed HPI-O that provides healthcare services, including for example branch practices or individual hospital departments. Network HPI-Os cannot exist in isolation and require a linkage to a Seed HPI-O.

It should be noted that the HI Service operator takes an IT-centric view of the healthcare system, and in some cases a practice with multiple locations may in fact not need to obtain Network HPI-Os. For example, the more simplified HPI-O arrangement may be applicable if the healthcare organisation uses a single database that is accessed remotely by branch practices.

The Healthcare Provider Directory

As part of the HI Service registration process, healthcare organisations are able to elect to have their organisation listed on the Healthcare Provider Directory. While there are certainly other provider directories and health services directories in operation around the country, this particular service is specifically designed to allow healthcare providers to look up details of healthcare organisations and providers participating in the HI Service.

Ms Fulcher stressed that organisations should make themselves aware of the Healthcare Provider Directory and encouraged them to add their details into the directory, taking care when completing the HI Service registration form.

“It’s a service that people don’t currently know a lot about,” Ms Fulcher said. “It has the potential to be extremely useful but it needs people to register. Because people don’t understand what it is, they aren’t registering. If you look at the form, there are a few lines about the Healthcare Provider Directory on the front page, but when you’re filling out the form and you get to the section on ‘HPD details’, and the first option is ‘no’, I gather it’s somewhat confusing for practices.”

Further information

There are several resources practices may like to refer to with a view to extending their understanding of, and ultimately registering for, the HI Service.

Comprehensive information about the Healthcare Identifiers Service including registration forms is available from Medicare Australia.

The Australian Association of Practice Managers is currently conducting a National eHealth Roadshow, with the HI Service being a dominant theme of the presentations. Many Divisions of General Practice and Medicare Locals are also distributing resources via their websites, with some assisting practices with HI Service registrations.

Posted in Australian eHealth

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