Work restarts on pathology and diagnostic imaging for PCEHR

The Department of Health has issued invitations to expert groups to take part in workshops next month to finalise the design and integration of pathology and diagnostic imaging reports into the PCEHR.

It appears likely that pathology and imaging reports will be uploaded as “immutable” or unmodifiable PDFs. Diagnostic images themselves will not be uploaded, but work is continuing on how to add information to the report on where the image can be located.

Pathology reports were originally planned to be included in the PCEHR release five in May this year, but there were serious disagreements over how they would be rendered and who would upload them.

Uncertainty over the continuing operation of the system following the Coalition's victory in the 2013 election and the delayed release of the Royle review commissioned by Health Minister Peter Dutton also impeded progress.

The review panel recommended that work should proceed on integrating pathology and diagnostic imaging despite a submission from the Royal Australian College of General Practitioners (RACGP) calling for work on extra functionality to be immediately suspended until the basic clinical usability of the system was addressed.

However, in a letter inviting nominations for interested parties to attend the workshops, the department's first assistant secretary for the eHealth division, Linda Powell, said the government would make further decisions about future PCEHR operations over the coming year, and in the meantime, “it has been agreed to progress with the final design and planning for the next release of the PCEHR, including the integration of pathology and diagnostic imaging reports.”

Last year's discussions on how best to upload pathology results and reports to the system were fraught, with the Royal College of Pathologists of Australasia (RCPA) and provider association Pathology Australia both arguing that the mooted “cut and paste” method of uploading test results without the full pathologist's report was profoundly unsafe.

Despite the Department of Health rejecting the notion that data could be cut and pasted by a GP or medical specialist, there was no clear decision on how best to get pathology results uploaded, or which provider would be responsible.

It appears that the RCPA's desire that reports be uploaded as immutable PDFs has been agreed to, despite the PCEHR having never been designed to accept the format.

The two day-long workshops – to be held in Melbourne on Tuesday, July 8, for the pathology sector and the next day for diagnostic imaging – will both begin with an overview of the PCEHR review and plans for consultations on the PCEHR program for the next 12 months.

For the pathology workshop, agreed positions from previous consultations will be confirmed. These include:

  • that pathology providers are responsible for the clinical content and management reports available to the PCEHR
  • standing consent to upload a report to the PCHER is in place unless an individual advises otherwise
  • reports should be clinically curated before they are made available to the PCEHR
  • the solution and clinical workflow needs to provide for appropriate communication with patients about their results before the report is added to the PCEHR
  • reports will be provided in an immutable PDF format with key information that supports viewing and sorting of reports.

Undecided is how to handle the withdrawal of consent, how to handle the follow up of reports, and authority to post (ATP) message handling. It is understood that the preferred method is for pathology reports to be sent to the referring GP as usual, and that the GP and patient decide together what is uploaded to the PCEHR.

The GP would then send an ATP through messaging software to the pathology practice, which would then upload the report as a PDF.

This would also require work on how to include individual and provider healthcare identifiers, and further discussion on “mature minors”, or adolescents aged 14 to 18 who could have sensitive sexual or mental health results.

An update on progress in the pathology sector since the previous round of consultation concluded will also be held, including an update on the RACP's standardisation activities and its Pathology Information Terminology and Units Standardisation (PITUS) project.

The diagnostic imaging workshop will also cover previously agreed issues, outstanding issues and possible design solutions.

Diagnostic imaging reports will be provided as a PDF attachment to the PCEHR with key information to support viewing and sorting of of reports. However, images themselves will not be uploaded but the report may include information about the location of an image.

Further workshops are planned for the week beginning August 4 and, if necessary, September 8.

The department also wants to convene two “co-designed” technical working groups for pathology and diagnostic imaging “to consider the detailed clinical and technical workflow implications, design features, clinical usability and functionality and implementation issues”.

These working groups would involve pathology and diagnostic imaging providers, clinicians, local system implementers and other practitioners.

Posted in Australian eHealth

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