Hits and misses with eHealth foundations: PCEHR review

The PCEHR review panel has recommended that the government implement a standardised secure messaging platform for the health sector and expand the secure messaging strategy to include consumers as well.

Secure message delivery (SMD) and the Healthcare Identifiers Service (HI Service) are highlighted in the panel's report as essential foundations for the eHealth system that are immediately valuable platforms.

The report says many submissions to the review were highly critical of the implementation of some of the eHealth foundations – including the National Authentication Service for Health (NASH), which has been plagued by problems, as well as the myGov services website, clinical information systems in general and the PCEHR itself – SMD and the HI Service were singled out for their immense potential value.

The panel is critical, however, of missed opportunities to provide benefit through poor usability, inability to agree on standards or an inability to adopt standards in a timely manner.

On the HI Service, the panel says it is an “excellent foundational system” that is widely recognised for its value in linking information between disparate systems. However, further focus is needed for a widespread roll-out to all healthcare systems.

The HI Service is used in all clinical software that is PCEHR-compliant, especially general practice and aged care software, but is not widely used in hospitals as yet. The mapping of Individual Healthcare Identifiers (IHIs) to hospital medical record numbers (MRNs) and other patient and provider identifiers is still ongoing.

On secure messaging, the report highlights the common opinion in the healthcare industry that it is an important enabler of interoperability between clinicians. While there is an SMD standard, the review found that software providers “have not adopted this strategy in a manner that enables true interoperability”.

The report says this has resulted in multiple proprietary networks and an inefficient outcome for users who must use multiple different products depending on who they need to interact with.

“A new approach is needed to ensure compliance with the standard, either through defined compliance programs that ensure providers meet the intent of the strategy and enable true interoperability linked with ensuring only compliant providers must be used to receive the ePractice Incentive Payment (ePIP), or via centralisation of messaging to operate through a standards compliant messaging gateway,” the report states.

“This work would require evaluation, however immediate action is needed to ensure meaningful progress is made.”

While the report does not go into detail, several submissions to the review made the point that in addition to frequent use between pathology providers and general practitioners, SMD is now being increasingly used between general practice and hospitals for discharge summaries.

The use of secure messaging between GPs and medical specialists or allied health practitioners is very low, however.

In its report, the review panel harks back to the eHealth strategies of last decade, which broached the issue of secure messaging between clinicians and patients, something that has been off the agenda for some years.

The review panel wants this revisited, saying secure messaging is a “closed network that operates between clinicians and it has not been designed to include communication to patients and consumers.

“Action must be taken to expand the scope of secure messaging to a next generation service that ensures interaction between the medical profession and consumers for information that must be passed in a reliably secure manner to facilitate improved workflow and secure communication of private information.

“The intent is to enable a next generation of secure messaging capability that can enable instant and secure communication between the medical industry and consumers for the purpose of enabling workflow and communication of information that is appropriate to exchange electronically and without an in-person discussion. This capability is in line with the government’s policy.”

It also recommends that work be done on using the ECLIPSE billing system used in hospitals to see if this could be harnessed as a method of integration and alignment.

In addition to recommendations 23 and 24, which call for the implementation of a standardised SMD platform and expanding secure communication to consumers, the panel recommends that consumers be notified by SMS when their PCEHR is opened or used.

This would require everyone's mobile number to be recorded on their profile, and the panel does not investigated the cost of such a proposal in the report.

The panel also recommends that the government commission a scoping project to identify the options available to encourage further take up of electronic transmission of data by specialist medical and allied health professional practices and private hospitals.

On the other eHealth foundations, NASH and myGov come in for some criticism due to their complexity and lack of ease of use, and the known problems with the PCEHR itself are highlighted, with recommendations for potential remedies.

Posted in Australian eHealth

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