Getting ready for the new ePIP

The Australian Medical Association has drawn up a checklist to help general practices through the steps they will need to take to remain eligible for the eHealth Practice Incentives Program (ePIP).

The first four requirements are due to come in on February 1, while the fifth – the ability to access the PCEHR and upload shared health summaries – is due by May 1. Pulse+IT also published a guide to the five different requirements in our November issue (see below).

AMA president Steve Hambleton said that compiling all the information into a single package should have been done by the government and its agencies.

“Our checklist shows clearly that there is a lot of work to be done for medical practices to meet the new PIP e-health requirements,” Dr Hambleton said in a statement.

“The AMA supports the PCEHR, but we also support fair and orderly processes to allow general practices to properly prepare for its full implementation.”

Under the new ePIP, practice software must be able to access the Healthcare Identifiers (HI) Service to look up patients’ Individual Healthcare Identifiers (IHIs) and to securely store the practice’s Healthcare Provider Identifier – Organisation (HPI-O) and each practitioners’ Healthcare Provider Identifier – Individual (HPI-I).

Practices will also be required to install and use systems that allow for secure message delivery (SMD) and electronic transfer of prescriptions (ETP). They must also show that they are using an approved clinical coding system for diagnoses.

These four requirements – HI Service integration, SMD, ETP and clinical coding – must be deployed in their practice by February 2013 in order to qualify for payments. The capacity to interface with the PCEHR must be integrated by May.

Most of the market-leading general practice clinical software vendors have informed Pulse+IT that they will fulfil all five requirements well before the prescribed deadlines, but practices need not wait until their software has been updated, released and installed before addressing some of the administrative requirements, such as the registration processes associated with the HI Service.

NEHTA has established an online eHealth PIP Product Register so practices can check that their software meets the various requirements. The register went live in early October and has been updated regularly since then.

There is a register for each ePIP requirement except the third – clinical coding. Practices are encouraged to talk to their software vendors to discuss when conformant software and any training, if required, will be available.

Requirement 1 – HI Service

The first requirement to qualify for the ePIP is the ability to integrate Individual Healthcare Identifiers (IHIs) into electronic practice records. This will mean that practices can directly access Medicare Australia’s Healthcare Identifiers (HI) Service to retrieve a patient’s IHI and to import it into the patient’s record.

The HI Service is a national system used for uniquely identifying healthcare professionals, organisations and individual consumers of healthcare services, and according to Medicare, will help ensure individuals and healthcare professionals have confidence that the right information is associated with the right individual at the point of care. All Australians have been assigned a 16-digit IHI, which is different from a Medicare number.

In addition to the patient’s IHI, each organisation that delivers healthcare will ultimately have a Healthcare Provider Identifier – Organisation (HPI-O). This is further divided into a Seed HPI-O, defined as any entity that delivers healthcare services, including medical practices, community healthcare organisations and hospitals; and a Network HPI-O, which is a sub-entity of a Seed HPI-O, such as branch practices or individual hospital departments.

Practices must apply to the Department of Human Services (DHS) to be allocated an HPI-O and more information is available from the Medicare Australia website.

Each individual practitioner has also been assigned a Healthcare Provider Identifier – Individual (HPI-I). Practitioners can find out their HPI-I by contacting the Australian Healthcare Providers Regulation Agency (AHPRA) or logging in to the AHPRA website.

Practices must ensure that HPI-Os and HPI-Is are stored in a compliant practice management and clinical software system. The members of the GP desktop software vendors panel, which was established to test this new functionality in the field, began integrating the HI Service as the first part of their scope of work.

In addition to correctly identifying patients throughout the healthcare system, the intent of this ePIP requirement is to make healthcare identifiers available for secure message delivery and for use in the PCEHR system.

Requirement 2 – secure messaging

The second requirement of the ePIP is to have secure messaging capability to electronically transmit confidential patient information. According to NEHTA, to qualify for ePIP payments, practices must have a standards-compliant secure messaging service that allows them to electronically transmit and receive clinical messages to and from other healthcare providers. Practices are encouraged to check the ePIP register to see if their software is compliant.

Under the ePIP requirements, practices must also use secure messaging ‘where feasible’, which softens the requirement somewhat in reflection of the fact that the major secure messaging vendors have not yet achieved interoperability. However, in June this year, three of the leading secure electronic messaging providers announced that they were working together to open up secure messaging channels to each other’s customers. Currently, service users can only communicate with practitioners using the same product.

In what is called the Secure Message eXchange (SMX) collaboration, DCA, HealthLink and Global Health – which market the Argus, HealthLink and ReferralNet products respectively – have agreed to work together to use the Secure Message Delivery specification (ATS 5822-2010) to allow each other’s customers to communicate with each other.

More recently, NEHTA announced that it would provide financial assistance to the secure messaging providers to work on interoperability. The other market leader, Medical-Objects, will take part in the project.

HealthLink’s head of operations for Australia and New Zealand, Geoffrey Sayer, said messaging service providers would not have to do integration work with each separate clinical software vendor, and current users of the electronic messaging services will not need to do anything different through their clinical software. “Nothing is different,” Dr Sayer said. “That is part of the benefit.”

Requirement two also states that practices must have a written policy to encourage the use of secure messaging, stating that it prefers to send messages electronically rather than by fax or letter.

Requirement 3 – clinical coding

This requirement will not necessitate changes to software and there is no individual ePIP product registry for it, but it does require that practices show they are using a clinical coding system for problem diagnoses.

According to NEHTA, “practices must ensure that where clinically relevant, they are working towards recording the majority of diagnoses for active patients electronically using a medical vocabulary that can be mapped against a nationally recognised disease classification or terminology system. Practices must provide a written policy to this effect to all GPs within the practice.”

These recognised vocabularies include the bespoke models used by Medical Director and Best Practice, called DOCLE and PYEFINCH respectively. The vast majority of other vendors use ICPC-2 PLUS, which has been used in many research projects, including the Bettering the Evaluation And Care of Health (BEACH) program, so is often referred to as the BEACH coding system.

ICPC-2 PLUS has been classified to the International Classification of Primary Care, Version 2 (ICPC-2) and allows health professionals to record symptoms, diagnoses, past health problems and processes such as procedures, counselling and referral at the point of care. It currently contains approximately 8000 terms that are commonly used in Australian general practice.

The requirement states that the vocabulary used must be able to be mapped against a nationally recognised disease classification or terminology system, with NEHTA having selected SNOMED CT as the preferred terminology. However, mapping most local codes to SNOMED is not expected to begin until next year.

The Family Medicine Research Centre (FMRC) at the University of Sydney, which maintains ICPC-2 PLUS, recently undertook a project to map 100 commonly used general practice terms to SNOMED CT and is hoping to continue the work next year. PYEFINCH, the terminology used in Best Practice, is currently 85 per cent mapped to SNOMED CT.

Requirement 4 – electronic transfer of prescriptions

To qualify for this requirement, practices must have an agreement with one of the two recognised prescription exchange services – eRx Script Exchange or MediSecure Script Vault. Many clinical software vendors have already integrated with one or both services, as currently the two prescription services do not communicate with each other.

However, the Department of Health and Ageing recently announced that an agreement had been struck between the two exchanges to work towards interoperability by December 24. Pulse+IT understands that while the technical hurdles are not difficult, it will require the exchanges to add an adaptor to each system in every client pharmacy.

ETP specifications developed by NEHTA are currently being considered by Standards Australia, so until full ETP capability is implemented, which will also include the ability to use electronic signatures, prescribers will still have to give patients a signed paper prescription. This must be generated by the clinical software and contain a barcode to enable the retrieval of scripts from the prescription exchange for dispensing.

Part of the agreement between the prescription exchanges includes work on the standardisation of the format and positioning of the barcodes on the original prescriptions and a mechanism for facilitating an inter-exchange transaction fee, to be paid by the government under the Fifth Community Pharmacy Agreement.

Requirement 5 – PCEHR

Requirement five – full interface, uploading and downloading capability to the PCEHR – is not due until May 2013. While the majority of software vendors are near to or have completed the conformance tests for this requirement, it is, in the words of one vendor, “the most complex piece of the puzzle”, and will require further testing in the field over the next few months.

Two general practice software vendors – Zedmed and Genie – have already achieved uploads to individual PCEHRs, and acute care software specialist Emerging Systems has also achieved the same feat in a hospital setting, but the correct use of the system and its integration into general practice workflow is expected to take quite a deal of training.

Requirement five states that practices must use compliant software for accessing the PCEHR and to create and post shared health summaries. A shared health summary is defined as a clinical document sourced from the individual’s nominated provider – usually but not always the family doctor – which provides a clinically reviewed summary of an individual’s healthcare status and provides information about allergies and adverse reactions, medicines, medical history and immunisations.

It is a ‘point in time’ clinical document, so it will be complemented by other documents that will be attached to the PCEHR to provide what is called a ‘consolidated view’. Other documents include event summaries, discharge summaries, specialist letters, referrals, prescribing and dispensing information, and pathology result reports. However, work on standardising event summaries, specialist letters and referrals is still being undertaken, and the ability to upload prescribing and dispensing information and test results is still believed to be some years away.

In addition to having PCEHR-compliant software, to qualify for the ePIP, practices must also apply to participate in the PCEHR system upon obtaining an HPI-O and sign a participation agreement. They must also develop policies and procedures on the correct use of the PCEHR, patient confidentiality under the Privacy Act and training for all staff.

Posted in Australian eHealth

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