Pathology sector decides against authority to post for PCEHR

Industry groups involved in devising a method to upload pathology reports to the PCEHR have decided against the authority to post (ATP) method, instead agreeing on a seven-day waiting period before reports are directly uploaded by the pathology provider.

Both the pathology and the diagnostic imaging sectors have been debating the best method to include reports on the PCEHR, which the Department of Health (DoH) wants to commence in December.

The favoured method appeared to be ATP, in which the referring doctor would send an authorisation message to the diagnostic provider to upload the report once it has been reviewed.

However, at a second pathology consultation workshop held in Melbourne on August 8, participants agreed that there should be a seven-day period in which the referring doctor can view the results – sent by normal secure messaging – before the actual report is made available to the patient on the PCEHR.

The workshop agreed that this design would support the appropriate communication of results to the patient by their GP. It would also mean that the majority of results can be authorised to be uploaded automatically at the time of referral.

Metadata from the report will be available immediately to the patient but not the report itself. The report will be uploaded as a PDF.

In a summary of the solution design presented at the pathology meeting and issued by the DoH, a series of principles were agreed to, including that the design should be evidence based and result in no increased clinical risk to patients.

It was agreed that the pathology provider will upload the reports, not the GP, and that the design would include a process for making inaccurate reports inaccessible to the users of the system.

Updated versions of the report will be able to be uploaded, and the PCEHR will maintain a history of pathology reports. “There is clinical benefit in preliminary, final and corrected reports being available to the PCEHR,” the summary says.

It also says that wherever possible, the model for incorporating pathology and diagnostic imaging reports into the PCEHR should be consistent. This may reflect the views of the diagnostic imaging sector, which in a meeting last month concluded that an automatic upload from the radiology practice was preferable to ATP.

In terms of technical design, the meeting agreed that the design should use existing infrastructure wherever possible and avoid redefining existing HL7 v2 messages.

The reports will be uploaded as PDFs until standardised terminology is finalised and agreed to, meaning atomic data will then be available through the PCEHR.

Individual and healthcare provider identifiers (IHI, HPI-I and HPI-O) will be used, meaning IHIs will need to be included on both electronic and written requests. Pathology providers will all need to be registered to use the HI Service, with the potential that middleware be used to interact with the service.

More work will also need to be done to map the metadata provided with the PDF to the existing HL7 v2 (AS 4700) standard to support the implementation of the design in software systems. The metadata is necessary to support the searching, viewing, provenance, updating and auditing of the reports.

Another meeting is scheduled for this Friday, August 22.

At the Health Informatics Conference (HIC) in Melbourne last week, PCEHR review panel chairman Richard Royle said the panel had agreed in its report that the PCEHR could not move to an opt-out model until one of three essential clinical modules was up and running – pathology, radiology or medications.

Posted in Australian eHealth

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