PCEHR view customisation capability in CUP release three

The National E-Health Transition Authority (NEHTA) has released version three of its clinical usability program (CUP), providing recommendations to GP desktop software vendors on how to enhance the PCEHR aspects of their software through the use of prompts and reminders, as well as allowing GP users to customise and configure their PCEHR interactions.

NEHTA's CUP manager Heather McDonald told an Australian Association of Practice Management (AAPM) webinar last week that when implemented by vendors, the functionality would allow GPs to be notified that new documents such as discharge summaries or event summaries had been uploaded to their patient's record.

The improvements are expected to be incorporated by vendors over time as they release their own system updates.

“What we've done in release 3 is identified for the GPs how many documents that they didn't add into the PCEHR,” Ms McDonald said. “What will come up on their screen is 'two new clinical documents' … that means that documents that have been added to the system not by the GP.

“If a discharge [summary] was there, it would be coming up as a new clinical document. Most GPs know their patients really well, so they only want to know when they have gone to see somebody else or something else has happened that they haven't known about.”

According to NEHTA's website, CUP release 3 also includes recommendations for a new 'PCEHR page' that can be opened by a drop-down menu when the GP opens the patient's file. For existing patients, the PCEHR page will include a document list displaying any new clinical documents, the most recent shared health summary, and a list of the different PCEHR views such as pathology, prescription and dispense or Medicare services with links to open that particular view.

For new patients, the PCEHR page will include those three items as well as a document list displaying historic shared health summaries.

For existing patients, there will be a filter function that will allow them to see types of clinical document with the list sorted by date in reverse chronological order.

NEHTA has suggested to vendors that they add sorting functionality for document date, service date, document type, and organisation. There is also a recommendation that they include the ability to display a clinical synopsis from an event summary.

A series of prompts and alerts are also suggested, such as a prompt for the GP to upload a new shared health summary if any key clinical information has changed, and the ability to set an alert for front desk staff displaying “Not PCEHR registered” for new patients.

Ms McDonald told the webinar that the system was seeing on average 500 shared health summaries added per week, but little activity with event summaries.

She also said eReferrals and specialist letters were “a little bit slow”, but there were many prescription and dispense records. “We've got over a thousand pharmacists who are registered to send up dispense records, [but] probably not quite so many who are actually sending them up.”

Release five of the PCEHR in January included a section to receive pathology and diagnostic imaging reports, but no reports have yet to be uploaded.

Ms McDonald said she expected this capability to be six to 12 months away, as the pathology sector has to ready itself to connect to the PCEHR system.

“They have their technical requirements and some have started … but it isn't going to happen in the next week or two,” she said.

She also said the ability to upload advance care directives was some time away but it was on the work program.

NEHTA is also working with some consumer groups to get patients registered and encourage them to ask their GPs to upload clinical documents, she said.

Posted in Australian eHealth

Comments   

# Phil 2015-03-10 09:49
There needs to be a major focus on the specialists community. They have valuable data that GP s are interested in but many don't participate in the PCEHR program, let alone contribute to the data in the record.
# Simon James 2015-03-10 12:33
Hi Phil,

I guess the question I have is how would specialists benefit from having access to the PCEHR....for decades they have gotten by pretty well with a couple of (increasingly templated) paragraphs in the form of a GP referral letter, so I'm not sure what drivers there are to get them excited about what the PCEHR has to offer.

There's nothing stopping them from connecting their practice to the PCEHR today, and I'd hate to see a repeat of the failed change and adoption strategies attempted in general practice (over $50M burnt by MLs alone, plus whatever Aspen have extracted in pursuit of meaningless registration numbers) without there being a compelling underlying clinical reason why a specialist might want to connect to the system. Until GPs start to get excited about what is there now (discharge summaries in some areas for example), then I think any attempt to drum up interest amongst specialists is premature and would amount to another failed taxpayer funded eHealth frolic.

In any case, going back the other way, what sort of info are you talking about that GPs would be interested in? Every speciality is different but as far as I'm aware, many patient "medical records" in specialist practices consist of a scanned referral letter from a GP, and a transcribed letter going back the other way. These days there are a lot of specialty-speci fic modules built into the leading specialist clinical software packages, but other than the free-form outbound specialist letters I mentioned above, I'm not sure if there are any standards/speci fications governing how this sort of information could be presented in a PCEHR environment, but I'll check with a few contacts and see what they reckon.

Interested in your thoughts on this in any case.

Cheers,
Simon
# Terry Hannan 2015-03-10 19:04
Quote:
SJ - Until GPs start to get excited about what is there now (discharge summaries in some areas for example), then I think any attempt to drum up interest amongst specialists is premature and would amount to another failed taxpayer funded eHealth frolic.
There are several ways to look at these problems.
When we discuss Discharge Summaries we need to appreciate what is contained within these Summaries and do they constitute an effective decision support communication tool? Up to 2007 MOST systems (paper and “e”) are not providing adequate clinical decision support-see
Kripalani, Sunil MD, MSc; LeFevre, Frank MD; Phillips, Christopher O. MD, MPH; Williams, Mark V. MD; Basaviah, Preetha MD; Baker, David W. MD, MPH. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians Implications for Patient Safety and Continuity of CareJAMA. 2007;297:831-841
There is an abundance of data showing that “current” summaries contain very little information that is “relevant” to the referral because the MAIN function of the referral letter in this country is so reimbursement can be made.
In relationship to Simon’s latter comments relates to how Specialists Summaries are created.

Quote:
In any case, going back the other way, what sort of info are you talking about that GPs would be interested in? Every speciality is different but as far as I'm aware, many patient "medical records" in specialist practices consist of a scanned referral letter from a GP, and a transcribed letter going back the other way. These days there are a lot of specialty-specific modules built into the leading specialist clinical software packages, but other than the free-form outbound specialist letters I mentioned above, ……..
Here is some data from 2012 on this topic [QOC-Quality Of Care]

Physicians who more intensively interact with EHRs through their documentation style may pay greater attention to coded fields and clinical decision support and thus may deliver higher quality care. [CAD/Diabetes]
Dictation 9%
• QOC poorer on 3 measures - a/platelets, tobacco use, eye examination
• No measures better than Structured or Free Text
Structured documentation 29%
• QOC better on 3 measures-BP, BMI, diabetic foot examination
Free Text 62%
• QOC better on 1 measure- influenza vaccination
EHR-assessed quality is necessarily documentation-d ependent, but physicians who dictated their notes appeared to have worse quality of care than physicians who used structured EHR documentation.
Method of electronic health record documentation and quality of primary care. Linder JA, Schnipper JL, Middleton B. Journal of the American Medical Informatics Association : JAMIA. 2012 May 19;

Therefore one of the issues that needs to be addressed in the PCEHR is the structure and content of the Summaries and their flexibility for the defined clinical environments in which they are supposed to be used. I suspect that the “document storage structures” within the PCEHR do not support adequate Clinical Decision Making and lack the data granularity required to measure the QOC.

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