Next challenge for eHealth is acute: CSC

CSC’s Healthcare group is currently working on the final conformance tests for the interface to the PCEHR for its practiX general practice management software, and is now turning its focus on getting the acute care sector up to speed.

CSC, which bought the GP and hospital software assets off iSOFT last year, has recently been demonstrating its ability to close the primary-acute care loop by sending eReferrals from practiX to its i.PM acute care patient administration system using secure messaging and the Healthcare Identifiers (HI) Service.

The company was able to show last year that it could integrate the HI Service into i.PM – the PAS used by more than 300 hospitals in Australia and New Zealand – without having to upgrade the core product by leveraging its Health Information Exchange (HIE) Suite software.

Now, the company is eager to get on with bringing the acute care sector into the government's wider eHealth program, CSC's director of market and solutions, Byron Phillips, said.

“It was about four months ago that we actually demonstrated the whole loop from primary care referral, wrapped in the SMD standard, and pushed through to i.PM,” Mr Phillips said. “But it doesn't just sit at the front door – it is consumed into that product which we believe achieves some of the greatest efficiencies and care improvements in the acute sector."

While getting acute care integrated into the PCEHR system is one of the long-term goals of the government's strategy, most of the emphasis for the last two years has been on primary care. CSC believes, however, that integrating acute care will not be as difficult as some would imagine.

And it is the wider use of the HI Service that will enable this, Mr Phillips said. In its experience, confirming the HI Service's accuracy was best done upon presentation rather than through a batch import method. “In the primary and acute care sectors, face to face is essential to get a high hit rate with the HI Service,” he said. “We keep hearing that it's not going to work because they are only getting a 65 per cent hit rate, but based on our experience so far, it seems to be much higher.

“While enabling our products for the PCEHR we have worked on the basis that IHI look-ups are best done at the front desk. This means little impact on clinical workflows and information accuracy.”

This is also the process the company is encouraging general practice clients to follow, according to CSC's out of hospitals solution manager and leader of its PCEHR project team, Perry Pappas.

CSC, which is one of the six companies on NEHTA's GP desktop software vendors panel, demonstrated HI Service integration into practiX in July last year.

“For the customers that have the HI component in and running, they are very happy and have very few if any issues,” Mr Pappas said. “Byron and I went and visited one of our champion practices recently and their comment was they generally do it on admission. They've got the patient in front of them and they can confirm their details as they are standing there, and their hit rate was in excess of 90 per cent.”

Mr Phillips said once the use of common healthcare identifiers was instituted, linking different departments in the acute care sector such as emergency, pathology and laboratories will not be overly difficult on a national scale.

“There are only three entries into acute – in-patient, emergency and in some cases out-patients. We run the majority of those systems in this country. So, an HI is recorded in the patient admin system, we can pass that information on to other systems, including our competitors' systems.

“The argument is you enable ED, in-patients and out-patients and you pretty much have the health identifier flowing. There are some exceptions but in general the PAS system already publishes those demographics and identifiers downstream. I just can't see a hole in this – it seems like an obvious approach to be able to turn on three-quarters of the country in a couple of years.”

There are two stumbling blocks, however: funding for software vendors to begin the work for the public and private hospital sectors and building a business case for private hospitals to come to the party. Mr Phillips said CSC was in serious discussion with its private sector customers on what the next steps are.

“The most fruitful discussions we are having at the moment, believe it or not, are with the privates. They are frustrated because they feel left out, but there are a number of groups that are caught between acknowledging that amongst all of this, communities of care and ecosystems are very important to the private sector, and yet of course they have to be commercial.

“They want to make it happen but they are trying to make a business case. They are being quite grown-up and proactive about it but of course they have commercial realities they have to deal with. Right now we are working with one group trying to define an ecosystem, a combination of primary care, their hospitals, their aged care, their local health networks that actually have an appetite to do something in this area.”

Pre-admissions

In other acute care developments, CSC has recently partnered with Sydney company EpiSoft to market its new pre-admission patient portal and booking system, which allows patients to check their details are correct and list their medications before they present to hospital. Mr Phillips said the private sector is particularly interested in this capability for elective surgeries and admissions.

“We believe that things like identification should happen way back in the process, and possibly in the home,” he said. “You can't do that for emergency obviously but for a lot of elective stuff, we can be educating the patient by saying 'we notice you haven't got a PCEHR record yet, here are the benefits of having one'.”

The company has also launched an enterprise scheduling system that takes a referral and uses clinical protocols to translate the referral into the required appointment or set of appointments. The system schedules bookings for the various services and does so according to rules defined in the particular clinical protocol.

“We believe improving the handling of referrals and appointment scheduling within hospitals has great potential to meaningfully improve healthcare, and connections between primary and acute care,” Mr Philips said.

“Our scheduling product also has a portal component so that eventually patients can manage their own bookings from home. This will be especially useful for patients undergoing complicated treatments with multiple appointments. Patients are in control of their calendars. Specialists know that all bookings will be made according to the pre-defined protocol.

“For example, the protocol might say 'don't turn up for your appointment unless you have fasted for eight hours'. The system uses protocols to ensure all necessary information and preparations are complete before each appointment. But again you need a health identifier to do these things – we see that we can achieve some very significant differences beyond what is planned in the NEHTA program just by virtue of this infrastructure that is on the ground.”

Primary care

CSC believes the ability to close the primary-acute care loop is built on a number of foundations, not just common healthcare identifiers. In addition to integrating the HI Service into practiX last year, CSC was one of the first to integrate secure message delivery into its product.

“We achieved certification in November last year for the secure messaging component,” Mr Pappas said. “It was months in advance of where we needed to be. I think we were the first of all of the vendors – or the only vendor at the time – that met that initial 31 July 2011 deadline for conformance for the Health Identifier.”

HI Service integration and SMD capability were two of NEHTA's “deliverables” under the contracts signed by the software vendors panel, and July 31 this year was another, with a requirement to show the software could unpack and render a CDA document.

Mr Pappas said CSC successfully made this milestone, and is now awaiting its final certificate of conformation for the largest milestone on October 31 – successfully packaging a CDA document and uploading it to the PCEHR.

“That milestone is by far the largest single chunk of the NEHTA contract and includes all of the interactions between the GP vendor software and the PCEHR,” he said. “We have been beavering away at it and the notice of connection (NOC) test cases for that component were executed and passed and we are now waiting for formal advice from NEHTA.

“We have started on a subsequent conformance assessment process and we expect to have this complete before the end of October. Once we have the tick on that, we will be in deployment mode and start installing and testing the new features at our pilot sites.”

CSC has selected a number of pilot or “champion” sites who are trusted partners and are keen to move ahead, he said. “They were the initial ones we picked for the HI. The big bang approach is something that as project director I intentionally avoided. Instead I really value working with these motivated sites as we work together to incrementally develop and evaluate new functionality."

Mr Pappas said CSC will apply to the new ePIP registers as the company ticks off the various components to inform its customers on its progress and capabilities. “The pilot sites are all very keen to move ahead with a plan to have the 31 October deliverables installed by then. Then [we plan on] a roll out to our broader customer base.”

Posted in Australian eHealth

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