NSW HealtheNet nears statewide roll-out

eHealth NSW is close to completing the statewide roll-out of the HealtheNet system, which provides NSW Health clinicians with a single view into various clinical repositories as well as the PCEHR, with plans to add more functionality on the cards.

eHealth NSW chief clinical information officer John Lambert told the Australian Telehealth Conference (ATC15) in Sydney today that all but two local health districts (LHDs) were now sending discharge summaries from every inpatient stay or emergency department presentation to HealtheNet, with all LHDs to be online by the end of June.

In addition, in all but two instances, clinicians are now able to access discharge summaries generated from any other electronic medical record in the state through a simple link in their own EMR. The two exceptions – St Vincent's Hospital network and Justice & Forensic Mental Health, which has recently implemented a new EMR from Orion Health – will have the capability by August.

Dr Lambert said the plan was to extend this in future to include letters and other correspondence, management and care plans, procedure reports and other referral documents.

What this means for clinicians is that if a patient has a procedure at Royal North Shore Hospital and later presents at Orange Hospital, clinicians in Orange can simply look at their current EMR and there will be an alert that there has been a recent presentation at Royal North Shore.

“Click on a link and you'll see the discharge summary and everything that was done during that admission to Royal North Shore,” Dr Lambert said. “That is today. In future, we will have far more information.”

HealtheNet is also used as NSW Health's link to the PCEHR, with all LHDs now able to send discharge summaries to the national system and to view it within their own EMR.

Dr Lambert said NSW Health looked at the PCEHR as not only a way to easily provide information to patients, but to clinicians outside of the acute sector and outside of the state.

“We feel that what the PCEHR represents is a very sound way to cross boundaries,” he said. “For HealtheNet to work, we want the private hospitals involved and the community clinics to buy into this system and that's why we are looking at the PCEHR at the moment as it is the only common point that everybody can access and share information.”

Dr Lambert described HealtheNet as having three core elements. The first is the enterprise patient registry (EPR), which provides an identifier for every patient in the health system by collating all of the commonly used identifiers.

There is also a registry of providers that is currently being built. In the meantime, HealtheNet has a link through the PCEHR to the national provider directory. “Through the EPR, we do have an understanding of providers and patients and that's very important for the next parts of HealtheNet,” he said.

The next element is the clinical data repositories that are linked through one clinical portal or view for all clinicians. This includes the enterprise imaging repository (EIR) that gives clinicians access to radiology images from any other hospital in the state.

“In NSW, we have 11 different EMRs and that's not counting the other hundreds of systems that store clinical data,” he said. “The primary, core EMRs we have 11 of and they are from three different vendors – Orion, Cerner and DeLacy [St Vincent's Hospital's EHS].

“That's challenging to work with so we have created a single repository of information. Connected to that is an enterprise imaging repository, and although it has some gaps that we are trying to fill at the moment, in theory it is a repository of every image performed in every facility in NSW Health, and that is accessible from every other facility in NSW Health through the clinical repository.

“And then we have this incredibly complex piece of technology called the integration system or the enterprise services bus. That basically transfers information from all of the EMRs, all the PACS/RIS systems, to and from the clinical repository and other places it is needed to be.”

This service bus has two views, he said: one is the inward-facing view for the core EMRs as well as the many secondary EMRs used and the new MetaVision intensive care EMR that is being rolled out.

There is also an outward-facing view that links to the PCEHR as well as to GPs through three secure messaging vendors – HealthLink, Argus and Medical-Objects – and which forms part of the overall NSW Health integrated care plan.

“The PCEHR is a great coordinating broker for cross-boundary issues, state issues, and is a great way to communicate with areas outside of NSW Health, but obviously with the opt-in model the uptake isn't great, so we also connect to three of the major vendors in secure messaging,” he said.

“One of the challenges there is that the secure messaging systems have very high uptakes in GP land but not so great an uptake in the allied health professional world, not so great an uptake in the medical specialist world.

“So, we are hoping that opt-out comes into play from the federal government for the PCEHR, because we feel that what the PCEHR represents is in fact a very sound way to cross boundaries and to get information out of NSW Health to any other carer who the patient authorises to have access to their information.”

In the future, eHealth NSW intends to add a host of new functionality to HealtheNet, including information on demographics, allergies and alerts, diagnoses, problem lists, family and social history, immunisations, medications, measurements, observations, pathology orders and results, imaging orders and results, and other clinical images such as clinical photos and ECGs.

“There is no reason at all why we can't use the enterprise imaging repository to store other images,” he said. “We are looking at using it to be able to transfer clinical photos of trauma patients and burns patients across the system in a secure way and try and reduce the use of iPhones to take photos and SMS them to other clinicians.”

Also in the future is the ability to integrate the many apps that are always springing up and use these to provide better access to the healthcare system to patients. Dr Lambert foresees a time in the near future when things like appointments information and waitlist position are provided to patients through a simple app.

“We can have apps that allow them to know when their operation is being scheduled and when it changes. They can get alarms and advisories, their progress in the queue. This sort of information is not currently being built but it is certainly an area that we need to provide as part of a standard bus to allow innovation to occur with our systems.”

Dr Lambert said eHealth NSW's vision for HealtheNet was to use it to ensure all of the relevant health information held about a patient is available and accessible in a useful, secure form by authorised, innovative tools through standard interfaces.

“We create the standard interface and say 'this is how you interact with Health, this is how we provide the information, go for it'. Do something exciting and we'll make sure it is connected to our systems and done in a safe and controlled way.”

Posted in Australian eHealth

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