PwC to conduct safety audit on PCEHR discharge summaries

PricewaterhouseCoopers has been selected to conduct a clinical safety audit looking at the accuracy and quality of data included in electronic discharge summaries uploaded to the PCEHR.

A PwC audit team will inspect de-identified records and make site visits to selected hospitals in the jurisdictions sending discharge summaries to the system.

The audit team will also look at actual use of eDischarge summaries by healthcare providers, the presentation of data at all points in the process of developing and submitting a summary, any errors in the system that could lead to the storage of incorrect information, and the potential effect this might have on patient safety.

This is the fourth such audit conducted since the system went live in July 2012 and is part of the remit of the independent PCEHR Clinical Governance Advisory Group (CGAG), which was set up by the Australian Commission on Safety and Quality in Health Care (ACSQHC) and is chaired by Australia's chief medical officer, Chris Baggoley.

PwC also conducted the third clinical safety audit, a draft of which was discussed at a quarterly CGAG meeting last December, although none of those audits have been released publicly.

According to documents seen by Pulse+IT, the third audit involved a survey of pharmacists as well as site visits and analysis of 112 de-identified PCEHR documents, along with interviews with peak organisations.

Of the priority review areas in that audit, one issue was considered critical, four major, five moderate, two minor and four minimum. The audit report subsequently made 15 recommendations to improve the clinical safety and governance of the PCEHR. Commission CEO Debora Picone told the meeting that all issues raised in that audit could be resolved.

The draft fourth audit report is due to be complete for consideration by CGAG at its next quarterly meeting on June 6.

Clinical incidents

According to the documents, the most recent meeting of the CGAG, held on March 25, heard details of an incident reported by a clinician concerning the presentation of medicines information in the PCEHR and the clinical risk arising from the potential for misinterpretation of that information.

The incident was investigated by KPMG associate director Bernadette Eather, who also worked with the commission to investigate an incident concerning this reporter, in which incorrect PBS information was added to my PCEHR.

The issue seems to have arisen due to the clinician's software vendor's interpretation of the technical specifications for the on-screen display of medicines information.

This was given an 'extreme risk' assessment by DoH, but was not escalated to the department for two months. Dr Eather recommended that incident notification processes should include online technical support with a requirement to escalate clinical incident types to the department.

More recent incidents include an intermittent error that was occurring in the PCEHR view in the consumer portal, the provider portal and in the B2B gateway in clinical software. A general error message was appearing in all of the portals indicating that no information was available in certain categories, despite there being actual documents on the record.

The error message appeared on the health record overview, Medicare overview, prescription and dispense view and the health check schedule view, but did not affect the ability to actually open the documents.

NEHTA's clinical safety unit (CSU) was advised of the problem by DoH on January 8, and applied a fix to the system on February 20, as the incident was considered an extreme risk for healthcare providers.

However, a check by DoH a day after the fix had been implemented showed no improvement was noticeable. DoH then applied a temporary measure in which a message was shown to users that the views were temporarily unavailable and to check the individual documents in the list on the left-hand side of the record.

A further fix was applied on March 3 which solved the problem.

Other incidents reported recently include the system failing to automatically convert dates and times to the user's local time zone. This means a clinical document containing one date but displaying another could be viewed, which might change the display order of the documents.

Changes are expected to be applied in clinical software this month so that all dates and times displayed are consistent. Further changes will then be made to the system during the next release which will provide accurate time zone conversion and display wherever the user is located.

The meeting also discussed an incident first reported by Medical Observer in February, in which former NEHTA clinical lead Mukesh Haikerwal complained that documents in his particular clinical information system were not appearing according to the correct date. This issue is being worked on by the software vendor, and NEHTA has added it to its guidelines for its clinical usability program (CUP).

This will involve all CDA documents being sorted in chronological order with the oldest at the top and undated entries placed above others.

A study into evidence of reported clinical incidents in electronic health systems in clinical use around the world has been completed by researchers from the Centre for Health Informatics at the University of NSW, the documents reveal.

Posted in Australian eHealth

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