Feature: Sharing records in the North, West and South
If there is one jurisdiction in Australia where the benefits of a shared electronic health record are most obvious, it is the Northern Territory. The NT has been a pioneer in the adoption of eHealth and – with good reason – was chosen last year as one of the Wave 2 sites for the implementation of the PCEHR.
The NT Department of Health introduced a shared electronic health record (SEHR) in 2005, predominantly for indigenous people in rural and remote areas. In the ensuing seven years, the SEHR has gradually added both users and functionality, but only reached critical mass in the last two years, according to NT Health’s CIO, Stephen Moo.
Now, the SEHR – recently rebadged to My eHealth Record (MeHR) – has around 47,000 people registered, a remarkable achievement in a challenging environment. Predominantly clients of clinics administered by the NT Department of Health and the Aboriginal Medical Services Alliance of the Northern Territory (AMSANT), these clients represent almost 90 per cent of the entire remote indigenous population. Some non-indigenous people working in remote areas – on cattle stations, for instance, who attend the same clinics as Aboriginal people – are also registered for the service.
So with this sort of experience in designing and operating an electronic health record, it is no wonder that NT Health was chosen as one of the nine Wave 2 sites for the implementation of the PCEHR. The NT consortium’s five partners — NT Department of Health, AMSANT, General Practice Network NT (GPNNT), Western Australian Country Health Service (WACHS) and Aboriginal Health Council of South Australia (AHCSA) – plan to expand registrations into the Kimberley region of WA and down into SA. AHCSA is already working with the NT in the northern part of South Australia and Central Australia, including the Anangu Pitjantjatjara (APY) Lands.
Along with 47,000 consumers, the MeHR system is used by 105 clinics and five public hospitals in the NT. As part of the Wave 2 project, consortium partner GPNNT is looking to offer MeHR to urban populations as well, predominantly through general practices and specialists in the major towns of Darwin, Alice Springs, Katherine, Tennant Creek and Nhulunbuy.
“With AHCSA, which is based in Adelaide, the target is their member organisations, of which there are about 11 across SA, in regional areas and in Adelaide,” Mr Moo says.
In Western Australia, the target is in the Kimberley, with a plan to connect up the hospitals initially and then expand it into primary care. The consortium is initially targeting six hospitals in the Kimberley region to provide the MeHR service.
“What we are looking to do is have a large footprint across northern Australia and into SA and WA with a service that is already proven and is providing benefits,” Mr Moo says.
“About 4000 healthcare providers are already registered and we are getting significant usage rates. We have around 100,000 new records a month going into a repository, and we are now up around 30,000 views a month, which is an exceedingly high viewing rate and clearly demonstrates the clinical benefits of the service.”
One of the main reasons for the success of the system, according to AMSANT’s Simon Stafford, is that it has become an essential part of remote clinical practice, overcoming the fear of many that EHRs interfere with clinical workflows.
“It is working well because it has become part of clinical practice now,” Mr Stafford says. “For the clinicians and the services out there, they don’t even think about it any more. It is integrated into normal clinical practice.”
In addition to expanding the service into urban areas in the NT and to the Kimberley and South Australia, the consortium plans to upgrade the repository for its EHR to incorporate items that will make up the PCEHR, Mr Moo says.
“We are moving towards what we call a fully atomised repository that will accept the new clinical documents that are being developed as part of the PCEHR,” he says. “As part of our expansion project we are looking to work with the vendors to be able to produce discharge summaries and health summaries and event summaries using the new CDA specification.”
The other major implementation the team is undertaking is the adoption of national healthcare identifiers. Until now, the MeHR has used an internally-built identification system, called the Health Connect ID, which is what Mr Moo calls a jurisdictional-based healthcare identifier. This has been mapped to the NT Health’s Territory-wide client master index and to the Medicare numbers used by the Aboriginal Medical Services.
“We have had our own identifiers for our registered clients and we will be progressively adopting the individual healthcare identifiers (IHIs) and the healthcare provider identifiers,” Mr Moo says.
“All of our registered 47,000 consumers have them and those we register between now and June will be registered with a Health Connect ID, but we will start to allocate the IHIs in parallel – hence the importance of having that in the clinical information systems. And as we start to get the software enabled, we will start to capture the IHIs. In some point in the future the IHI will become our primary identifier but that will be done down the track.”
Critical mass for data
As Mr Moo and Mr Stafford emphasise, the MeHR has been a long-term labour of love for the NT, starting off with very small steps with a view to future benefits. Those benefits are appearing now, as clinics and hospitals throughout the Territory have access to a wide range of health data.
“We have a large number of data sources coming in,” Mr Moo says. “We have a current health profile, which is a health summary; we have individual primary care event summaries so that when you go in for a consultation, whether it is a GP or a primary care clinic, you get an individual event summary for that consultation; we have pathology results coming in from community pathology providers, if the pathology is ordered from the primary care consultation. Separately, the pathology results are stored in the repository.
“From hospitals, we have accident and emergency summaries, we have inpatient discharge summaries, we have specialist letters, and recently we have added radiology reports from hospitals. We also have two external databases we are able to access: the Rheumatic Heart Disease Registry and the Northern Territory Child Immunisation Register. We are able to go through a portal to access records in those registers.
“And soon we will be bringing in hospital pathology and advanced share care plans. They will start to be available later this year. We have very clinically rich data sources now available, and most of the clinical documents that you would require are now accessible.”
The majority of AMSANT and AHCSA members use the Communicare system, while the Health Department uses a primary care information system (PCIS). GPs in the area predominantly use Medical Director, Best Practice and Genie, and all of these vendors are working with Pen Computer Systems for system integration.
“There are a lot of activities going on at the moment but the key activities are with our vendors in terms of doing a lot of work to create the new CDA documents and also to incorporate the identifiers,” Mr Moo says.
Transition to the PCEHR
Progress to date has predominantly been around implementation planning and developing the engagement strategies. The consortium has also done some extensive work on consent forms and privacy impact assessments, and between now and June the focus will be on getting as many consumers and providers registered as possible.
“The other big activity we have been involved with is the transition planning to the PCEHR,” Mr Moo says. “We’ve had some intensive workshops with all of our consortium partners and NEHTA and we spent four days workshopping how we would transition what we have to the national PCEHR service. It is quite a complex process to work through because we have such a mature and well-accepted service. We need to make sure that whenever we go into the transition, we can’t afford to lose any service quality.
“We expect the transition to take up to two years because it is not an overnight thing. There are extensive software development, engagement, change and adoption processes to be done.”
The team is also now ready to kick off a major consumer registration campaign in WA and SA, as well as urban areas in the NT, to register more clients.
Mr Stafford says while the details of the campaign are still being finalised, work has begun through GPNNT to ensure the system is integrated with GPs’ business processes. GPNNT is working with 28 general practices to target urban consumers for registration as they come into the practice.
“When the SEHR started there were a whole lot of mass community activities out bush,” Mr Stafford says. “It started with a basic ‘this is what it is’. That is the kind of stuff that AHCSA will be doing – they have communities that haven’t really been exposed to what that story is yet.”
WA Country Health will be similarly involved, hoping to run forums in remote communities as well as country towns, he says. “The idea is to tie it in with the fabric of those communities – the sports carnivals or the local show.
“For example at AHCSA, they have already started the engagement with the clinicians, and then the next step is engaging with the boards of health services, the CEOs, with administrative staff in clinics, and then once they start doing the community thing, everybody is ready and understands what this is all about.
“In the Territory, what we have done is to re-engage with our membership around the shared record, which is now a seamless thing that is just done, and now it is time to work on things like data quality. Sharing information is only worthwhile when the information is of good quality.
“This was a process that we learned when the shared record first started. You have to make sure the data is of high quality. What is happening now with advanced things like shared care planning, that data quality has to have another step up.
“We will be working with the health boards – the community people, the leaders – talking about ‘that health story thing that’s in the computer’, making sure that people remember that all the kids are registered and to make sure that it almost becomes part of life. And we’d like to see ourselves up around the 98 per cent mark for registrations.”
Posted in Australian eHealth