Barwon ML moves into patient PCEHR registration

Barwon Medicare Local in Victoria has begun assisting general practices to sign up patients to the PCEHR system, with the organisation confident it will have close to 100 per cent of practices ePIP-ready by the end of the month.

Barwon ML CEO Jason Trethowan said a number of students had been recruited on a casual basis to encourage consumer registration and to relieve some of the administrative burden on practices. The Barwon area hopes to have up to 10,000 consumer registrations by the end of the year.

It also hopes to have almost all of the general practices prepared for the eHealth Practice Incentive Program by the first deadline of February 1.

“There may be one or two who are not ready but we can say that close to 100 per cent will be ePIP-ready by the end of January,” Mr Trethowan said. “It's one thing to have the practices ePIP-ready but what will come of it is more important. It is the increase of online clinical information coming to them through secure messaging and also the significant delivery in the context of the PCEHR.”

Barwon ML has placed eHealth high on its agenda, having been involved in a number of eHealth projects in its previous incarnation as the GP Association of Geelong. These include working on the cdmNet chronic disease management program since its inception, the move towards widespread use of the ReferralNet secure messaging service throughout the area's primary and acute care sectors, as well as the MedView medications repository project, which was one of the Wave 2 eHealth sites for the implementation of the PCEHR.

Barwon ML, which has 336 GPs and 186 practice nurses in its catchment, was incorporated as a Medicare Local in September 2011. It is now acting as a 'hub' in the Department of Health and Ageing's eHealth cluster program, assisting four other Medicare Locals with their eHealth needs.

It started early on the PCEHR project, Mr Trethowan said. “Our initial role was to take all of the information that is available from NEHTA and the Department of Health and Ageing, from software vendors and from Medicare, and to distil that into the regional level to make it a logical discussion for local healthcare professionals about what the PCEHR is.

“We held two information sessions late last year that had 60 to 70 professionals – specialists, GPs, pharmacists – and from that we started the conversation. Now we are going into each of the practices to support them with signing up to the PCEHR. There is a lot of paperwork and typically general practices and more paperwork aren't natural allies, so we support the practices with the administrative functions and the process, which is really important to get right.”

As part of the MedView project, Barwon ML is working with Fred IT to incorporate the medications functionality into the PCEHR. “MedView has been a really good project to be a part of from a quality and safety point of view,” Mr Trethowan said.

“It is really important for clinicians to understand each patient’s medication profile and this is a big value proposition for the GPs to get interested in the PCEHR.”

The project involving eHealth consumer assistants is a short-term initiative involving seven students to gauge patient interest in signing up for the PCEHR at the practice level, he said.

“Basically the way it goes is that the GP introduces the idea of the PCEHR to the patient and then after the consultation the patient goes out to the eHealth consumer assistant, and on the spot they do a 100-point check to again help out with the administrative work.

“Then they have them registered and the patient has enough information to go back home and set up their own portal. It is a way of trying to get more patients to be registered, and when the software becomes available, it will be a one-off thing.”

Anecdotally, patients seem to be very interested in the project, he said. “They seem to think these things should be done already. We haven't had any negative feedback from patients at all. We have about 500 registered already in the Geelong region but each day now we are building it up.

“I can't see any reason why we can't achieve a target of about 10,000 by the end of the year, by having the general practices on board, patients getting the introduction and equipping the practices with eHealth consumer assistants helping them to sign up.

“We are targeting the cohorts that we think will benefit the most from the PCEHR – those with chronic disease especially – as they are the ones we believe will benefit most if they end up in hospital. Initially it is about getting the registration process going for practices, practitioners and patients.”

Allied health practitioners are also being encouraged to take part in the organisation's eHealth projects, both through cdmNET and ReferralNet as well as their future role in the PCEHR.

“We've been involved in cdmNET through our former division of general practice since the early days, and we are doing sessions more with allied health and pharmacists now. The allied health people love it and the GPs love it because they can see what others are writing about their patient.

“It's gradually evolving with a number of campaigns being generated. For the practices that use it, there is a bit of time needed to get used to it, but particularly where the practice nurses take a lead role, they are using it exceptionally well.”

ReferralNet has been used throughout the Geelong region for several years now, with many practices and Geelong Hospital, now known as Barwon Health, involved. Mr Trethowan said it was well established in primary and acute care and the focus had now turned to allied health.

“Pretty much the GPs and specialists are all on it in the region and gradually we are getting more and more allied health practitioners involved. We will probably have about 12,000 pieces of patient correspondence that goes across it in our region each day. Previously 95 per cent of that would be by fax or mail and it's just a part of how we do things now. Secure messaging is obviously part of the ePIP so we will continue supporting it.”

Barwon ML is also starting some new initiatives, including launching an after-hours pharmacy and GP website at docgeelong.com, which Mr Trethowan said had received over 1000 unique hits in its first couple of weeks over Christmas.

“The main reason for that was to use technology to promote to the community the services that are available and to say it's not just about going to the emergency department, that there are many other options in general practice in the after-hours period,” he said. “A lot of times you might perceive yourself to be worse than you are so the idea is rather than go to the emergency department, here are the GP options.”

The information gathered for docgeelong.com has also been added to the National Health Services Directory, which recently launched a new app to give consumers up to date information on local health services and opening hours.

Barwon Medicare Local is also adopting the Health Pathways initiative from New Zealand, which is scheduled to begin next month.

“Health Pathways is a product built by the Canterbury District Health Board and it is basically clinical pathways that are co-designed by specialists and GPs. It also includes allied health on a needs basis as well.

“Effectively it is a website that can describe the way a patient is cared for, what is required for referrals and what the specialist will do. New Zealand found that it reduced a lot of unnecessary referrals from general practice to specialists and the idea is to empower general practice to do more of what they are trying to do.

“The initial focus will be on paediatric care – setting the pathway between paediatricians and general practice and allied health providers to be fully transparent. It will be designed by local clinicians.”

While some parts of the catchment were unfortunately eliminated from Medicare's telehealth rebate program recently as they are within the metropolitan zone, some of the more rural parts are still eligible. Mr Trethowan said that while it was very disappointing that Geelong was no longer eligible, Barwon ML will continue to support telehealth and was building a regional directory for GPs and specialists.

He said eHealth was a hugely important part of what Barwon ML hoped to achieve. “The reason that we are delivering outcomes is purely because of the relationship that we have developed with local clinicians, and I can't stress that enough,” he said.

“That's the foundation for successful eHealth implementations. If we have the trust and the capability and the runs on the board, then with the next generation of things like the PCEHR, there is a track record of delivery.

“We are now working with four other MLs and their eHealth teams as they establish themselves. Whatever lessons that we've learnt can be translated across to them and we have this shared learning environment, and we also pick up things from them.”

Posted in Australian eHealth

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