Feature: Accoras seeks accord with health identifiers

This article first appeared in the 20 February 2012 edition of Pulse+IT Magazine.

The eHealth team at Accoras is working closely with general practices to sign them up to the new Health Identifiers Service. It has so far signed up 70 practices and is looking to begin recruitment of 25,000 patients, particularly war veterans, people with disabilities and school-aged children.

The Healthcare Identifiers Service (HI Service) is one of the core components of the PCEHR system. Operated by Medicare Australia, it is responsible for allocating Healthcare Provider Identifiers for individuals and organisations (HPI-Is and HPI-Os), and Individual Health Identifiers (IHIs) for every person currently listed on its existing databases.

It is also creating a Healthcare Provider Directory (HPD), which will allow GPs to locate other clinicians and specialists in a timely manner and improve communication when referring patients or making decisions about patient care needs.

Accoras, formerly Brisbane South Division Limited, is concentrating on the primary care aspects of the PCEHR system in its project, and is leveraging the work already done by the Wave 1 sites: Metro North Brisbane Medicare Local (formerly GP Partners) in Brisbane, Hunter Urban Medicare Local (formerly GP Access) in the Hunter Valley, and Inner East Melbourne Medicare Local (formerly Melbourne East GP Network). For Accoras, the focus is on networking with general practices in its catchment area to assist them to sign up to use the HI Service.

The eHealth project manager with Accoras, Nigel Fairhurst, says that subsequent to that phase, the team will be working with practices to take on board the concept of a shared electronic health record that can be used by themselves and other practitioners.

“It's a grounding project for the government's national roll out,” Mr Fairhurst says. “In our case, we have some specific target cohorts that we are working with as part of the project, and those are people with disabilities, war widows and war veterans, and school-aged children, specifically in the starting school, four to six-year-old bracket.”

Mr Fairhurst says the main reason these cohorts were targeted was the prior relationships Accoras had with some of the organisations representing these groups, including the Department of Veterans Affairs (DVA) and several child care centres in the area. It has also recently signed a memorandum of understanding with the Queensland Centre for Intellectual and Developmental Disabilities (QCIDD).

“The government wants the various sites to tackle different target cohorts so they will have a wider view of how best they can approach the national roll out,” he says. “Some of the other projects are running with different cohorts so the government gets that feedback and the understanding that what works in this space might not necessarily work in another.”

The main focus to date has been on assisting practices to apply for and receive their HPI-Os and HPI-Is. Mr Fairhurst says his team has developed its own procedure to streamline the application process with Medicare.

“We go into the practice and provide them with the necessary knowledge and explanation of what it is all about and what they need to do,” he says. “But at the same time, we've been able to get the practices to sign us up as the contact point for Medicare, so if there are any problems then Medicare deals directly with us, not the practice, which makes it a bit easier. Often times we can solve 80 per cent of what Medicare might want to find out, as we already know.”

As part of the process, an officer responsible is chosen at each practice to maintain the data in each organisation. The team is also working with practices to ensure they put their details on the Healthcare Provider Directory, which at the moment is not an automatic process, and is training practice staff in the effective use of the HI Service using Public Key Infrastructure (PKI) certificates.

“We can also make enquiries on behalf of the practice as to how things are progressing,” Mr Fairhurst says. “It also gives us the opportunity that once we know a practice has been registered, we can go back to the practice and say now that you've got your HPI-O or a new PKI certificate is coming through, we can come out and double check the next day.”

Patient and practice recruitment

Accoras currently has over 70 practices involved, and has worked closely with these to ensure the appropriate support has been provided. The next step will be the roll out of health identifier functionality in GP software.

Patient recruitment is the next phase of the project, with Accoras looking to enrol 25,000 patients. The team is reviewing a number of ways to recruit patients, including manual enrolment, where the practice will be provided with a printed consent form and brochures, Mr Fairhurst says.

“We are also looking at doing a bulk mail-out process where we will provide a pre-printed consent form. We will be looking to see what sort of data we get from that because this is all adding to the government's learning about the best approach, remembering that this is an opt-in system.”

Accoras has also signed a memorandum of understanding with Mater Health, another of the Wave 2 sites, to refer expectant mothers to the Mater to sign up for the Mater Shared Electronic Health Record (MSEHR), an electronic alternative to its paper-based pregnancy health record. Accoras is working with Mater in about 14 practices in its catchment, Mr Fairhurst says.

“We also recently signed an agreement with the QCIDD, a not-for-profit group based at the Mater, which is run by the University of Queensland's Professor Nick Lennox,” he says. “They are going to identify from their clients about 10 or 12 families with disabilities, and then go through the consent process and subsequent presentation at practices and interview them to provide us with some specific reports and case studies.

“For them, it is a terrific opportunity to get more information about how well society allows people with disabilities to interact in things like this. For government, it gives them lessons learned on whether this will or won't work with people with disabilities or only certain types of disabilities.

“It will also address concerns about legal issues, carers, guardians and consent issues and privacy issues. That's an example of how we are working with specific organisations to look at getting details about target cohorts. It is a real win-win.”

Posted in Australian eHealth

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