Telehealth: what’s information management got to do with it?
In 2013, the Health Information Management Association of Australia (HIMAA) committed to telehealth as a strategic priority, realising that it was a growing mode of healthcare delivery and would require clear governance from an information management perspective.
As a result, HIMAA has aligned itself with the Australasian Telehealth Society (ATHS) and accepted an invitation from the Health Informatics Society of Australia (HISA) to join the consortium organising the Australian Telehealth Conference.
As a profession, health information managers are beginning to develop a sense of where information management fits into the world of telehealth and what value we can bring to the discussion around structured and sustainable telehealth services.
In fact, without the application of sound health information management principles and practices, telehealth runs the risk of perpetuating the fragmentation of care rather than contributing to models of integrated care.
In the ATHS white paper, Towards a National Strategy for Telehealth in Australia 2013-18, HIMAA applauds the focus on:
- the value telehealth brings to patient-centred, multi-disciplinary care
- the need for fit-for purpose, interoperable systems and technology, and
- evidence-based approaches to telehealth adoption and adaption, leveraging existing health system structures for delivery.
While the strategy is clear about the value of telehealth to multidisciplinary and multi-site care, HIMAA would like to see the inclusion of a reference to the importance of systematic management of the information involved in these activities. Governance around data ownership, structure and quality of information and classification is critical to the success of a telehealth strategy.
The Australian College of Rural and Remote Medicine (ACRRM) acknowledges in its core telehealth principles that “…patient health records and the integrity of information in the health care information system are essential.”
It’s also interesting to note that in a presentation at HIC 2008 (pdf), professor of health informatics at the University of Western Sydney, Anthony Maeder, identified the need for formal standards to support telehealth and talked about the issues around “health data handling”.
HIMAA is keen to drive the development of information management standards in collaboration with the ATHS, HISA and other key stakeholders to ensure we maximise the benefits of the data being captured through telehealth services, while meeting legal and clinical documentation requirements.
Without clarity on ownership of information generated in the telehealth consultation, there is no clarity on accountability and, therefore, governance. Information gathered via telehealth activity, in particular home monitoring, may be generated by more than one service provider, including primary care providers such as district nursing services and GPs as well as hospital-based services.
Data may be stored on remote monitoring devices and paper-based or electronic information systems used to interpret clinical readings and document patient conditions and care. This can blur the understanding about who owns the information and how it should be managed from a legal perspective.
Some consideration of documentation has been made by various organisations, with ACRRM recommending that both healthcare providers in a telehealth consultation maintain their own notes. This is sound advice, but becomes more complex with home monitoring where the volume and type of information is quite different to a telehealth consultation. AHPRA also flags the need for appropriate documentation during telehealth consultations.
Each jurisdiction has legal responsibilities in terms of retention, storage, privacy, destruction and release of clinical information. Service providers must ensure appropriate governance structures and processes are in place for all information they own, so establishing ownership is critical prior to the commencement of information collection for a new telehealth service, including home monitoring.
Once ownership of information is known, it becomes possible to establish systems to meet obligations in relation to retention periods, security and access requirements and freedom of information requests. HIMAA supports a collaborative approach to addressing issues around information ownership and the associated governance structures and is keen to work with key stakeholders to establish agreed principles and practices to support telehealth practitioners.
Information structure and quality
One of the strengths telehealth brings to healthcare is its capacity to cross sectorial divides, not only between health disciplines but also between health jurisdictions. One of the desired outcomes of the current health reform agenda, regional planning to achieve funding and quality of care improvements, is eminently achievable through well-documented telehealth services.
But without the management of documentary quality and structure, telehealth just perpetuates the existing risks to information flow between health providers and jurisdictions.
For example, remote monitoring generates a significant volume of data that can be used for managing and monitoring health conditions as well as supporting research. The data collected must be structured and stored in a way that provides meaningful information for patients, clinicians and researchers.
Also, while recordings of telehealth consultations are not generally encouraged, it is important that there are clear policies in relation to obtaining and retaining written consent as well as retention, access and destruction of the recording. Policies must reflect the legal obligations of each jurisdiction.
Clinical classification is critical in enabling analysis of data for measuring the benefits of telehealth to flow into improved healthcare delivery across the healthcare sector. As we increase the uptake of electronic health records, classification is the key to the management of information to support clinical care and service planning and funding as well as retrieval and storage of information.
Currently, the primary care and hospital sectors do not use the same classification system and are unlikely to do so in the future, so it’s important to consider how coded data can be analysed effectively across multiple service areas.
Without management of a classifications interface (e.g. through clinical coding) between the private and public sectors, primary care and hospital-based services and across jurisdictions, there is no systematic flow of information and funding between the various providers in telehealth care. Health information professionals are perfectly placed to assist with this aspect of telehealth data.
HIMAA believes that health information management has a vital role to play in the development of a telehealth strategy to ensure information is collected and governed in a way that supports telehealth into the future.
HIMAA doesn’t presume to have all the answers around these complex issues, but is well positioned to lead the development of relevant standards and policies around information management in telehealth service delivery.
HIMAA looks forward to contributing to this year’s Australian Telehealth Conference, being held on April 23 and 24 in Sydney, by raising these information management questions with telehealth clinicians and technicians.
We’re also enthusiastic about working with telehealth experts to ensure we achieve well-structured and governed health information and systematic alignment to a national telehealth strategy.
Janine Carter is a board member and Richard Lawrance is the CEO of the Health Information Management Association of Australia.
Posted in Australian eHealth