eHealth – update from AustraliaAndrew HowardHead of the PersonallyControlled Electronic Health Record25 November 2011
Major change in Australia’s age profile are              on the waySource: Productivity Commission Research Report,Economi...
Major increase in Diabetes and       Chronic Disease
Adjusted health care  costs increasing
Health and Hospital Reform ReportJune 2009 • Redesign health services around   people • Creation of a „Health care home‟ •...
NEHTA‟s purpose o Lead the uptake of eHealth systems of   national significance o Coordinate the progression and   acceler...
Foundations for anational eHealth system
eHealth is here
It‟s happening now
It‟s happening now• More than 1,184,000 Individual Healthcare  Identifiers in use across Australia.• More than 730,000 GP ...
The National Product Catalogue : • The National Product Catalogue (NPC) is a way of suppliers   providing standardised and...
NPC – Progress     National Product Catalogue        225,000+ items, 360+ suppliers        All jurisdictions accessing d...
The Personally ControlledElectronic Health Record
Requirements breakdownA total of 337 High Level Requirements are organised in tofunctional areas where each functional are...
• Conformant Portals use• Clinical Model services as Orion             same Solution: Product View                        ...
Sample screen shot                                                          16Copyright © 2011 Accenture All Rights Reserv...
Current Content – July 2012 •   Health Summary •   Event Summary •   Discharge Summary •   Medicare Data (MBS, PBS, ACIR, ...
Shared Health Summary Information: Who / What?Medical PractitionerRegistered NurseAboriginal Health Worker• Continuing coo...
Shared Health SummaryInformation: Content• Individual [patient]• Source of Shared Health  Summary• Allergies and Adverse R...
Event Summary Information•   Individual [patient]•   Event Details•   Event Summary Author•   Allergies and Adverse Reacti...
Actions under the delivery documents can be filtered through many lenses  ~2,400 actions have been identified to enact the...
Awareness of PCEHR is low, but the concept is popular once explained   Percent of respondents                             ...
Desire for use of computers in health care is high, and already prevalent inother areas                                   ...
Significantly lowerThe identified attitudinal clusters cut across                                                         ...
The majority of groups with potentially high requirements for the eHealthrecords system fall into the top three clusters  ...
75% of GPs are not familiar with PCEHR however around 40% agree orstrongly agree with the concept and would encourage pati...
PRELIMINARYChronic care patients are seen by 87% of GPs as a top group forPCEHR, followed by aged care, which was a top gr...
PRELIMINARY73% of GPs estimate it will take over 5 minutes to explain PCEHR topatients, and 52% estimate will take over 15...
77% of practice managers believe they will be responsible for keepinghealthcare professionals up to date in the establishm...
Where to from here?• Significant opportunities for healthcare  organisations to improve efficiency and  effectiveness thro...
Keeping up with the PCEHRprogram news  PCEHR  www.yourhealth.gov.au  The latest in eHealth  www.ehealthinfo.gov.au  Nation...
Thank you andquestions…
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Australia’s Personally Controlled Electronic Health Record (PCEHR) Initiative

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Andrew Howard
Chief Architect, Australian National e-Health Transition Agency (NEHTA)
(Friday, 11.50, Keynote)

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  • Good morning, it’s a pleasure to be here today.Our focus is on enabling disparate health systems across Australia to connect with each other, use a common language and securely exchange information, to create a more effective health system and better health outcomes for the Australians as they travel between different parts of it.
  • This slide outlines the current NEHTA work that forms the foundations of a national, connected eHealth system.A national eHealth system needs all parties involved in healthcare being accurately identified – the patient, the healthcare provider, and the healthcare organisation – and an authentication process to prove organisations and people are who they say they are. You need a common language or terminology across the multitude of healthcare systems and a secure way for information and messages to be transmitted between them. And on that journey, people’s information needs to move between organisations so there need to be templates and standards.The foundations we have built are now in place and many of these systems are in action or ready to go soon. Here are just a few examples:We can now correctly identify individuals in the system and make sure the right information is attached to their health records through the use of Healthcare Identifiers which are a unique identifier for all Australians. Since July 2010, around 23 million have been allocated. These enable the right information to be attached to the right person as they travel through different parts of the health system. They are being put into action in a number of lead eHealth sites around Australia. Around 1 million have been downloaded in Brisbane, Melbourne and Newcastle to support more accurate patient administration, they are being used in Tasmania and will be by other jurisdictions shortly.As at the end of June 2011 the Service had issued:24,019,128 Individual Healthcare Identifiers.381,997 Healthcare Provider Identifiers (Individual).170 Healthcare Provider Identifiers (Organisation).We are now conformance testing new types of medical software systems that use Healthcare Identifiers, paving the way for a new generation of software to support healthcare professionals in their day to day practice. We now have a standard clinical language for Australian health professionals and it’s being put into action. SNOMED CT-AU (a clinical terminology adapted for Australia) is updated every six months and the Australian Medicines Terminology, a standard national approach to identify and name medicines is now released monthly as new medicines are released. Australian Medicines Terminology is now used in several clinical environments, after starting last year with Box Hill Hospital, part of one of Melbourne’s largest metropolitan health service. This will enable, over time, improved ability to search patient data for common terms. We now have standards that enable health professionals to securely communicate with each other: NEHTA’s conformance test specification and automated open-source test tools help software developers implement new Australian standards for secure message delivery. We can ensure the right communication gets to the right person: Health professionals who use eHealth systems need to be confident in what they send electronically. The National Authentication Service for Health does this and will support strong access control mechanisms for the personally controlled electronic health record. All of the above solutions for health professionals and healthcare provider organisations support improvements in information exchange across all workflows both within the organisation as well as better healthcare organisations eg between health workers, specialists, pathology, hospitals etc.eHealth solutions• eDischarge: Having a timely, consistent record of a patient’s hospital discharge information is critical to ensuring continuity of patient care as they move between different parts of the health system. The eDischarge Summary Release 1.1 in October 2010 brings to life the first stage of a national approach for how patient information is exchanged between hospitals and primary care providers. • eReferrals: In a paper based system, the first time a specialist may see a referral could be at the time they first see the patient. eReferrals enable specialists to receive this information earlier, which means they can identify patient needs in advance. The eReferrals Package 1.1 released in February 2011 supports secure referrals between health practitioners. In March 2011, NEHTA sought feedback from national stakeholder organisations on draft clinical business requirements and what standard fields of content should be included in the specialist letter message.NEHTA continues to work with medical software vendors, GPs and healthcare organisations to understand existing technologies and processes and how to move towards national standards for eDischarge and eReferrals.• ePathology: We are aiming for a nationally-endorsed, consistent and secure exchange of pathology information across the healthcare sector. To achieve this, we worked through the year with the Australian Association of Pathology Practices, the National Coalition of Public Pathology and the Royal College of Pathologists of Australasia on the implementation of eHealth specifications.• ePrescriptions: Electronic Transfers of Prescriptions enable accurate information about prescriptions to be sent securely between different parts of the health system eg from general practice to community pharmacy. In December 2010, NEHTA published the Electronic Transfer of Prescription 1.1 National Specifications, based on a review and consultation around draft specifications. They apply anywhere formal prescriptions are used, including between organisations such as GP and pharmacy. NEHTA continues to consult stakeholders on how the specfications will be implemented as well as compliance, conformance and governance. Standards Australia has started considering the Electronic Transfer of Prescription package as a basis for the development of Australian Technical Specifications for electronic prescriptions - a key milestone to achieving a national approach.Unlike paper systems, or systems where information is moved manually between different parts of the health system, this work creates data integrity, with information entered once into a record being available, without the need for rewriting or reinterpretation, to different health professionals around the system.All of them support an effective national system and enable the Personally Controlled Health Record, which is being launched nationally next year, to support a consistent patient journey through the health system.
  • Many of you would be aware that last month, Minister for Health and Ageing Nicola Roxon released the Concept of Operations for the Personally Controlled Electronic Health Record System. From 1 July 2012, Australians will be able to register for an eHealth Record. For the first time all Australians will be able to choose to have password controlled access to summary information about their medical history - including some of their medications, test results and allergies - allowing them to make better informed health decisions and have more informed conversations with their healthcare providers. They will choose who sees it, by setting access controls. This work can happen because many of the foundations we have been working on over the last 5 or so years are now being realised. eHealth is no longer about what will happen in the future: it is very much about what we are implementing on the ground today.Why are we doing this?This work supports National Health Reform by increasing the efficiency, effectiveness and improving health outcomes. It particularly supports the needs of priority communities identified in the reform agenda, including Aboriginal and Torres Strait Islander peoples, the ageing population, mothers with young children and the increasing number of Australians with chronic diseasesAmong other things:Clinicians currently spend around a quarter of their time collecting information rather than treating patientsElectronic systems have been demonstrated to reduce the time spent by health professionals on adminstrationThe systems we are building will reduce medical errors – for example, around 30% of unplanned hospital admissions in those over 75 are associated with prescribing errors. More than 140000 Australians are hospitalised annually due to medication errors.It has been estimated that eHealth applied comprehensively across Australia could help avoid an estimated 5000 deaths, two million primary care and outpatient visits, 500,000 emergency department visits and 310,000 hospital admissions a year. (Booz and Company Report: Optimising eHealth Value)
  • 12 lead eHealth sites across Australia (the orange)The sites demonstrate different elements of eHealth in actionThey use consultation and communications strategies (including engaging vendor panels and clinical leads) to drive change and adoptionLearning from local experience before rolling out nationallyThese sites are leading the transition to national PCEHR
  • The grey – foundation workThere is a commonality and coordination by NEHTA of all these activities through NEHTA, helping “connect the rail gauges” across all parts of our nation’s health system
  • Building on these foundations, from 1 July 2012, Australians will be able to register online for a Personally Controlled Electronic Health Record (PCEHR). This is a major focus of our attention over the next year, while we also continue to develop and launch improvements to our eHealth foundations and eHealth solutions for health professionals.With the Personally Controlled Electronic Health Record:For the first time Australians will be able to choose to have password controlled access to summary information about their medical history - including some of their medications, test results and allergies - allowing them to make better informed health decisions and have more informed conversations with their healthcare providers. They will choose who sees it, by setting access controls.For one in seven Australians suffering from a chronic illness, it gives them the ability to manage their illness more effectively, regardless of age or physical location. They will experience the freedom of enhanced shared care, improved decision support, and be more involved in the management of their own health. For mothers with young children, keeping track of immunisations, treatment and drug allergies will be much easier. Their data will be private, they will choose who accesses it and they will be able see who has viewed it.The frustration of repeating a full medical history, from memory, to several different doctors will be replaced by the doctor first double checking information held on the summary record. For doctors and nurses, there will be less trawling through lengthy paper records and quicker access to key and current issues. It will not replace the information held in health organisation’s own patient management systems, but will provide a standardised summary and access to some types of reports, to assist providers as the patient moves through different parts of the health system. Australians are used to the ease and efficiency that technology brings to banking travel and other services and they will soon realise similar benefits in managing their health. The PCEHR and other platforms we are building are the start of the story. They will be the base on which, in coming years, developers will create new and innovative health applications, which you can expect to experience the benefits of in your organisation. NETHA is the Managing AgentNEHTA is developing the architecture and system designThe Concept of Operations was released on Monday 12 September and from this the final product will be developedNEHTA will deliver it by June 2012 so that on 1 July 2012 all Australians will be able to register for oneIn the meantime, 12 eHealth lead sites are live examples of some of the elements in action and what we learn from these will be applied nationally.
  • It goes without saying, you are critically important to eHealth – as you told us in a recent survey!In June 2011 AAPM, in conjunction with NEHTA, commissioned focus groups and an online survey to Practice Managers to assess the level of eHealth literacy in the community. The market research included Practice Managers from General Practices, Allied Health and Specialist clinics and from metropolitan, regional and rural areas across Australia. The market research delved into the Healthcare Identifier Service (HI Service) and the proposed personally controlled electronic health record (PCEHR). More about the survey results later in the presentation.
  • Australia’s Personally Controlled Electronic Health Record (PCEHR) Initiative

    1. 1. eHealth – update from AustraliaAndrew HowardHead of the PersonallyControlled Electronic Health Record25 November 2011
    2. 2. Major change in Australia’s age profile are on the waySource: Productivity Commission Research Report,Economic Implications of an Ageing Australia, 2005
    3. 3. Major increase in Diabetes and Chronic Disease
    4. 4. Adjusted health care costs increasing
    5. 5. Health and Hospital Reform ReportJune 2009 • Redesign health services around people • Creation of a „Health care home‟ • Comprehensive Primary Health Care Centres and Services • Creation of a PCEHR
    6. 6. NEHTA‟s purpose o Lead the uptake of eHealth systems of national significance o Coordinate the progression and accelerate the adoption of eHealth by delivering urgently needed integration infrastructure and standards for health information
    7. 7. Foundations for anational eHealth system
    8. 8. eHealth is here
    9. 9. It‟s happening now
    10. 10. It‟s happening now• More than 1,184,000 Individual Healthcare Identifiers in use across Australia.• More than 730,000 GP patient records have been matched in 370 GP practices in Brisbane North, the Hunter and Melbourne East.• WA, NSW,SA, VIC, QLD and ACT are using the National Product Catalogue• VIC has started using Australian Medicines Terminology• NT, SA and ACT are using Secure Messaging Delivery
    11. 11. The National Product Catalogue : • The National Product Catalogue (NPC) is a way of suppliers providing standardised and accurate product and price data electronically to the Australian health departments and private hospital providers. • The NPC provides suppliers with a single mechanism to communicate structured catalogue data to many health customers – and the health customers a single way to access this data from multiple suppliers. • The NPC enables synchronisation of product and pricing data for accuracy in electronic procurement.11 National E-Health Transition Authority www.nehta.gov.au
    12. 12. NPC – Progress National Product Catalogue  225,000+ items, 360+ suppliers  All jurisdictions accessing data  Clean, standardised data in all systems Private Sector Clinical Outcomes Focus  Private Hospitals  Clinical Terminologies – Australian  Community Pharmacies / Medicines Terminology (AMT) pharmacy software providers  Product tracking and recall  Accurate reference of  Bedside scanning (incl. batch, exp., Prosthesis Rebate Code for serialisation, etc) => patient record billing benefits  TGA approval of pharmaceuticals12 National E-Health Transition Authority www.nehta.gov.au
    13. 13. The Personally ControlledElectronic Health Record
    14. 14. Requirements breakdownA total of 337 High Level Requirements are organised in tofunctional areas where each functional area is broken downtwo further levels. The top functional areas are:• Participation Requirements Break Down• Managing PCEHR Information• Privacy and Security 79• PCEHR System 107 Participation components Managing PCEHR Information Privacy and Security PCEHR system 93 components 58 14
    15. 15. • Conformant Portals use• Clinical Model services as Orion same Solution: Product View • Implementing Repository Health Portals thin slice of Individuals and Health Org 1 Health Org 2 Health Org 3 Health Org 4 Oracle’s• Technical Representatives capability • Clinical portal Interaction Local System Local System Local System • Proven Health Templates Products • Future Browser Regional, State and Territory SEHRs Conformant System Conformant Gateway • Proven functionality Browser and Secondary Use performance• Visualisation • Proven Templates Middleware Call Centre Siebel On Orion Health Accenture Health B2B Orion Health • Patient Portal – user Oracle Business Patient Clinical Demand Portal Gateway Portal centred design Intelligence • Pre-integrated•• Oracle Siebel Functionality Oracle Service Bus Oracle Enterprise Gateway for Design Time in asset On Demand • Patient and Clinical and Run Time • Supportsshare common Portal Conformant activities Oracle Identity and Access Management Oracle HIM RLS Oracle HIM PM Oracle HTB, HIM & SOA Suite Oracle OBIEE and ODI • Scalability the Repositories out of &• Quick to Deploy architectural reliability – box framework => efficient underlying• Scalable delivery Oracle • Standards based architecture• Can be Oracle Health Conformant Conformant Conformant Conformant Conformant • All access channels use integration. Leverage XDS Conformant Transaction Base Repository Repository Repository Repository Repository Repository deployed to Accenture HEARTS to a Common Privacy aid adoption. multiple Model Key organisations 15Accenture Oracle Orion Health Third Party 15
    16. 16. Sample screen shot 16Copyright © 2011 Accenture All Rights Reserved. 16
    17. 17. Current Content – July 2012 • Health Summary • Event Summary • Discharge Summary • Medicare Data (MBS, PBS, ACIR, ODR) • Consumer Entered Data • Advanced Care Directives (Custodian) • Support for Diagnostic Reports • Specialist Letters
    18. 18. Shared Health Summary Information: Who / What?Medical PractitionerRegistered NurseAboriginal Health Worker• Continuing coordinated care• Agree to create SHS• Review and agree with patient before upload
    19. 19. Shared Health SummaryInformation: Content• Individual [patient]• Source of Shared Health Summary• Allergies and Adverse Reactions• Medicines• Medical History• Immunisations• Document Control
    20. 20. Event Summary Information• Individual [patient]• Event Details• Event Summary Author• Allergies and Adverse Reactions• Medicines• Diagnoses• Interventions• Immunisations• Diagnostic Investigations• Observations• Document Control
    21. 21. Actions under the delivery documents can be filtered through many lenses ~2,400 actions have been identified to enact the C&A Strategy. Examples of lenses used to structure them include: Which uses will we target initially? • Foundations • Easier-to-adopt • Single Stakeholder • Multi-Stakeholder Which stakeholders will we target initially? E.g., • Consumers • GPs • Pharmacy • Pathology What is the delivery channel for these actions? • National • Local • Health Communities 21
    22. 22. Awareness of PCEHR is low, but the concept is popular once explained Percent of respondents PRELIMINARY ? Have you heard about the PCEHR? No Yes 81 19 ? To what extent do you agree with the statement “I support the concept of a PCEHR” Strongly disagree Mildly disagree Mildly agree Strongly agree 13 11 36 41 ? Would you sign up for a PCEHR? Definitely not Probably not Probably Definitely 10 19 47 25 ? How useful do you think the PCEHR could be to you? (1=least, 4=most) Least useful Most useful 14 20 35 31SOURCE: eHealth readiness survey 22
    23. 23. Desire for use of computers in health care is high, and already prevalent inother areas PRELIMINARY ? For which of the following activities do you use a computerised system? Percent of respondents Don‟t use and don‟t need Don‟t use but would like Use a computerised system Use of computers… For paying my medical and/or health bills 40 34 27 For accessing general health information 25 35 40 For viewing my own health information 34 50 15 For tracking my aspects of my own health (i.e. blood glucose 39 47 13 results) For managing my medications 53 38 9 For communicating with my health professional/s 45 44 11 For submitting my Medicare or health insurance claims 39 40 21 For booking appointments with my GP or other medical specialist 43 47 10 For requesting refills for my prescriptions 45 46 9 For participating in social networking sites, for example Facebook, 39 5 56 Twitter, LinkedIn, etc For making bookings: (i.e. holidays, flights, restaurants, movies) 22 10 68 For making purchases online 25 7 68 For doing my general banking (i.e. checking account balances, 24 5 71 paying bills)SOURCE: eHealth readiness survey 23
    24. 24. Significantly lowerThe identified attitudinal clusters cut across Significantly higherdemographic groupsPercent of cluster Socio-demographic Excited Uncertain Young & characteristics & Ready Traditionalists Healthy Tech Wary Able Sceptics Gender (female, %) 46 53 51 51 53 Percent over 60 21 26 17 39 27 Percent over 45 to 59 28 30 21 19 28 Percent over 30 to 44 29 27 29 23 25 Percent over 18 to 29 22 17 33 20 20 Percent total chronic illness 36 49 21 36 38 33% 21% 20% 14% 12% ▪ Strongest ▪ Need to see ▪ Don‟t consider ▪ Don‟t feel they ▪ Strongest interest in and how eHealth themselves to have the opponents of use of the records will have enough knowledge to eHealth eHealth complement health use eHealth records records existing health problems to records ▪ Concerned ▪ Respond system benefit from about potential strongly to all eHealth breaches of drivers records privacy 24SOURCE: eHealth readiness survey
    25. 25. The majority of groups with potentially high requirements for the eHealthrecords system fall into the top three clusters Aged over 60 Chronic Illness New Mothers1 Mental Health2 Rural areas3 Excited 28 and ready 33 35 34 40 Uncertain Tradition- 23 alists 29 27 20 32 Young and 13 Healthy 11 16 24 8 Tech 23 Wary 14 12 15 7 Able 13 12 14 Skeptics 9 9 n=377 n=647 n=168 n=181 n=197 +/-5.0% +/-3.9% +/-7.6% +/-7.3% +/-7.0%1 Women younger than 45 with decision making responsibility for children under the age of 2 used as proxy for New Mothers2 People with depression used as a proxy for people with mental illness3 People living in outer regional, remokte and very remote areas as per ABS classifications grouped as “rural” 25
    26. 26. 75% of GPs are not familiar with PCEHR however around 40% agree orstrongly agree with the concept and would encourage patients to registerPercent of respondents PRELIMINARY ? Are you familiar with the PCEHR? Familiar with Have heard of but not sure what it is Have not heard of it 24 51 25 ? To what extent do you agree with the statement “I support the concept of a PCEHR” Strongly disagree Disagree Somewhat disagree Somewhat agree Agree Strongly agree 7 9 10 31 30 13 ? To what extent do you agree with the statement “I will encourage my patients to register for a PCEHR” Strongly disagree Disagree Somewhat disagree Somewhat agree Agree Strongly agree 7 10 13 32 27 11SOURCE: eHealth readiness survey 26
    27. 27. PRELIMINARYChronic care patients are seen by 87% of GPs as a top group forPCEHR, followed by aged care, which was a top group for 64% of GPsPercent of respondents stating group is first or second in terms of GP willingness to sign the group up ? Which patients/groups would you be willing to sign up to a PCEHR? Chronic care 87 Aged care 64 Mothers and babies 22 Children and adolescents 11 Aboriginal and Torres 8 Strait Islander peoples Immigrants 4 Other 4SOURCE: eHealth readiness survey 27
    28. 28. PRELIMINARY73% of GPs estimate it will take over 5 minutes to explain PCEHR topatients, and 52% estimate will take over 15 minutes to create a SHS1Percent of respondents ? How much effort will it take to explain PCEHR to a patient before registering them? < 5 minutes 6 to 10 minutes 11 to 15 minutes > 15 minutes 27 33 17 23 How much effort will it take to complete a shared health summary for an existing patient based on ? existing records? < 5 minutes 6 to 10 minutes 11 to 15 minutes > 15 minutes 16 17 16 52 ? How much effort will it take to update the shared health summary after a consultation? < 5 minutes 6 to 10 minutes 11 to 15 minutes > 15 minutes 49 28 11 131 Shared health summarySOURCE: eHealth readiness survey 28
    29. 29. 77% of practice managers believe they will be responsible for keepinghealthcare professionals up to date in the establishment of the PCEHR I won’t do much of it: 2% Unsure: 5% I will do some of it: 16% I will do most of it: 77%
    30. 30. Where to from here?• Significant opportunities for healthcare organisations to improve efficiency and effectiveness through eHealth• Immediate need to get eHealth ready, especially around the personally controlled health record
    31. 31. Keeping up with the PCEHRprogram news PCEHR www.yourhealth.gov.au The latest in eHealth www.ehealthinfo.gov.au National E-Health Strategy www.health.gov.au NEHTA specific information www.nehta.gov.au
    32. 32. Thank you andquestions…

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