Uptake of eHealth in Australia

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Dr Karen Gibson
NEHTA

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  • Extent and utilisation of computerisation in Australian General Practice, MJA Volume 185, No 2 July 2006
  • The average clinician spends 25% of his / her time trying to find or collect information. I’m sure you have all been inside a Medical Records department. Records are often not completed and the reliance of clinicians on this information is causing unnecessary waste with respect to duplication of effort and risk, where medical errors are made due to incomplete medical records. Lets look at a real world example.
  • Here is a snapshot of key activity around the States and Territories of Australia.
  • So what is required? Policy issues: Leadership and high level sponsorship Privacy framework Strong governance/ data management framework - includes consideration of data storage options ie. centralised, federated, distributed - and data management/ alteration options – ie. person-controlled, provider controlled editing/ addition Business issues: Leadership and clinical sponsorship – just as important as ‘political’ buy-in Change Management – understanding what is required to implement an EHR – the benefits/ trade-offs and necessary incentives Agreement on Business requirements – both process and information no longer just recording “what I need to know” – now recording “what anyone reading this record needs to know Content Issues: We need agreement on: key data to be collected what needs to be codified, and how structuring of data Technical Issues: Architecture to support all the above requirements and technologies to support: secure access to and exchange of information secure storage and retrieval of information
  • The need for change. Chronic diseases are a strong driver for the delivery of healthcare. Over 2 million Australians, or nearly one in seven, suffer from chronic disease. These seven national health priorities cost the health sector a huge amount to manage, and all can benefit from better health information integration using e-health. And it’s often preventable, but our health system is much better equipped to respond to the acute health crises than preventing it in the first place. To quote the Prime Minister, “Put simply, we are better at providing a hospital bed when you have had your heart attack than providing the advice and lifestyle supports to prevent it occurring in the first place.” AND Not only is the ageing population driving demand in the health sector, but there are real workforce challenges finding numbers of skilled workers to satisfy current (and future) demand. Figures from AIHW http://www.aihw.gov.au/mediacentre/2006/mr20061116.cfm 2006
  • The Intergenerational report, 2007 noted the changing demographics of Australian society. http://www.treasury.gov.au/igr/at_a_glance/IGR_2007_at_a_glance.htm According to recent research commissioned by NEHTA, 82% of consumers in Australia support the establishment of an electronic health record
  • The National Health and Hospitals Reform Commission Report summary was released Feb 16 2009. This report has made 116 recommendations to improve Australia's healthcare system. A common thread throughout the summary is empowerment of the individual to maintain their own wellness – prevention rather than cure. Reform Commission's chairwoman, Dr Christine Bennett stated that the supplementary paper spells out the Commission’s position that an electronic health record is arguably the single most important enabler of truly person-centred care. She also commented that “The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care,” and that “A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.”
  • In December 08, the national e-health strategy summary was released by the Australian Health Ministers. This provides a vision for e-health and NEHTA is aligned with this and had considerable input into the strategy. The summary outlines the national compliance function that will drive development of national ehealth solutions that comply with ehealth standards and can be integrated and scaled across the Australian health sector. Ie: progressive targets over three years. There also needs to be consistently targeted investment in ICT over the next 10 years in the primary healthcare sector as well as public hospitals, pathology, radiology service providers and community and hospital pharmacies. We want to discourage unilateral e-health investment strategies that run counter to the objective of national e-health reform by inhibiting information sharing Available at www.nehta.gov.au
  • In terms of over-arching strategies for e-health. Our work is aligned to the national e-health strategy which was commissioned by Australian Health Ministers and carried out by Deloitte. And we have worked with Deloitte over the last year or so during intensive consultation as the strategy was developed. We are already well in step with the fundamentals and the business decisions we take now are all intended to enable us to progress the strategy. The road map highlights the phases of development to which NEHTA’s work program aligns. Foundations E-health solutions Change and adoption Governance As you can see from these timeframes, of three, six and ten years there is a staged, steady approach to implementation.
  • So what is NEHTA’s approach? Three years ago the governments of Australia gave NEHTA a mandate to find the best technology and national infrastructure for e-health. We received funding from COAG first in 2006 ($96m) and recently in November 2008 ($218m) to develop electronic health communications starting with the national infrastructure components: Individual health identifiers Terminology services Authentication, and Secure messaging to provide a quick overview of how our business functions and goals are aligned with the national e-health strategy. These form the building blocks to enable the innovation of specific e-health solutions: E-Diagnostics (incorporating both Pathology and Diagnostic Imaging) E-Continuity of Care (incorporating both Discharge Summary and Referrals) E-Medications management Ultimately it will enable the introduction of an individual electronic health record for Australians.
  • Identifiers: New Zealand already has unique identifiers in place Australia is building its health identifier service – operational by mid 2010 Consultation on underpinning legislation currently underway Underpins most ehealth communication Authentication: Services based on PKI Delivered in same time frame Terminology and Information Models: Common data groups agreed SNOMED CT and Australian Medicines Terminology Secure Messaging: HL7 CDA preferred way forward Web services PIP incentives
  • Supporting this comprehensive work program is a large commitment to privacy protection. As you know, Australia’s current privacy framework is a confusing patchwork of privacy legislation, non supportive of national e-health reform. I am sure you can appreciate the complexity – This is the privacy compliance framework shown Public and Private Pathology Sectors. NEHTA strongly supports the development of a nationally uniform approach to privacy protection. The original approach taken by the National Health Information Regulatory Framework Working Group was to commence work with a set of draft health privacy principles developed in 2004, and to develop separate health privacy legislation based on these principles. However, this work has since been overtaken by the Australian Law Reform Commission review of privacy legislation in Australia. The Australian Law Reform Commission recommended uniform national privacy legislation across all sectors, including health. The Department of Prime Minister & Cabinet is progressing the Australian Government’s response to the Australian Law Reform Commission’s review, indicating that the first tranche of privacy reform legislation will include health privacy, recognising its importance to e-health initiatives and investment.
  • There are four key areas for early e-health, . eDiagnostics means transmitting pathology and radiology results electronically from the lab with the ability to disaggregate the information for more informed use.; Discharge summaries will be able to be sent directly from the hospital to the doctor or other healthcare provider; Referrals can be sent electronically by the provider, all tagged with unique health ID; and Through electronic medication management, prescriptions can be accurately and securely transmitted from the doctor’s desktop to the pharmacy.
  • To deliver the integrated services required for the national e-health agenda, solid foundations must be laid to support them. NEHTA’s program is building a number of foundation services for ehealth in 2009, and the successful delivery of those services will be critical in the establishment of the initial pilot implementations. When delivered, these services will almost all be ‘beneath the waterline’. It is vital that they are there as ‘the engine room for e-health’, but will be working unseen and integrated with the services delivered. Subsequent layers will build on these foundations, allowing the collaborative applications which everyone is seeking, to be developed.
  • The individual electronic health record – revolutionary health care. The individual electronic health record (IEHR) also promises a new future in healthcare delivery. In many ways, the IEHR is the ultimate goal of e-health, reliant on all the foundational work such as identification, authentication, security and terminologies. An Individual Electronic Health Record (IEHR) will give Australians the opportunity to look at their personal health information using a computer . The IEHR will bring key information from a number of different systems together and present it in one view. This includes a health profile of medications, allergies and treatments, radiology, pathology results, discharge summaries and referrals. This will be able to be accessed by individuals and their authorised health care providers. It will help providers to make better decisions about health and treatment advice for their patients. Over time, individuals will be able to contribute their own information to complement that recorded by their health providers. The IEHR will not hold all the information contained in doctors and other health providers’ records. In the future, as the IEHR becomes more widely available, Australians will be able to access their own health information, anytime they need it from anywhere in the country.
  • Accelerating Adoption of standards Role of Provider records vs Personal Health Records Risks if foundations not in place: “ WASHINGTON - When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.  Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention."   Read more here   http://www.boston.com/news/health/articles/2009/04/13/electronic_health_records_raise_doubt/?page=1 Compliance, Conformance and Accreditation
  • Uptake of eHealth in Australia

    1. 1. <ul><li>HINZ Seminar – CARING AND SHARING Auckland 24 th July 2009 </li></ul><ul><li>The quest to develop a strategy for the sharing of electronic patient records – an Australian Perspective </li></ul><ul><li>Karen Gibson, General Manager, NEHTA </li></ul>
    2. 2. <ul><li>Uptake of eHealth in Australia </li></ul><ul><li>In the late nineties: </li></ul><ul><ul><li>HINA report envisioned “ A health information network for Australia ” </li></ul></ul><ul><ul><li>31% of GP practices had computers </li></ul></ul><ul><li>A decade later: </li></ul><ul><ul><li>– 94% of GP practices are computerised. 84% use for prescribing and 71% for medical records 1 </li></ul></ul><ul><ul><li>- Most exchange of pathology results now occurring electronically </li></ul></ul><ul><ul><li>- Lower connectivity for document exchange with hospitals (discharge/referral) and pharmacies (prescription) </li></ul></ul>The quest for electronic health records 1 Australian General Practice, MJA Volume 185, No 2 July 2006
    3. 3. The quest for electronic health records But we still have islands of electronic health information….
    4. 4. <ul><li>The average clinician spends 25% of their time trying to find or collect information </li></ul><ul><li>The reliance on incomplete paper records results in unnecessary waste and risk: </li></ul><ul><ul><li>18% of medical errors are due to the inadequate availability of patient information </li></ul></ul><ul><ul><li>14% of pathology tests are repeated unnecessarily </li></ul></ul>And hospitals which are largely paper based… The quest for electronic health records
    5. 5. <ul><li>Some success-stories in Electronic Health Records: </li></ul><ul><ul><li>60,000 people are participating in Health-e-link in NSW </li></ul></ul><ul><ul><li>25,000 people are participating in the NT shared electronic Health records service around Katherine </li></ul></ul><ul><ul><li>Chronic care Health Record Exchange through GPpartners in Queensland </li></ul></ul><ul><li>Through these pilots and trials the health sector in Australia now has a far greater understanding about what is required to successfully deliver sharing of electronic health records </li></ul>The quest for electronic health records
    6. 6. <ul><ul><li>Leadership and clinical sponsorship </li></ul></ul><ul><ul><li>Change Management </li></ul></ul><ul><ul><li>Agreement on Business requirements </li></ul></ul><ul><ul><ul><li>- both process and information requirements </li></ul></ul></ul>Business <ul><ul><li>Agreement on: </li></ul></ul><ul><ul><li>key data to be collected </li></ul></ul><ul><ul><li>what needs to be codified, and how </li></ul></ul><ul><ul><li>structuring of data </li></ul></ul>Content <ul><ul><li>Architecture to support all the above requirements and technologies to support: </li></ul></ul><ul><ul><li>secure access to and exchange of information </li></ul></ul><ul><ul><li>secure storage and retrieval of information </li></ul></ul>Technical <ul><ul><li>Leadership and high level sponsorship </li></ul></ul><ul><ul><li>Privacy framework </li></ul></ul><ul><ul><li>Strong governance/ data management framework </li></ul></ul>Policy What is required?
    7. 7. Arthritis Asthma Diabetes Three quarters of Australians have at least one chronic disease Treating these accounts for 70% of health expenditure Cancer Cardiovascular Injury Mental Health Source: AIHW But our health system is better equipped to respond to acute care The need to change is clear…
    8. 8. Australians are getting older and their expectations are increasing 82% support the establishment of an electronic health record 24% 13% And the call is growing stronger
    9. 9. “ an electronic health record is arguably the single most important enabler of truly person centered care” The call is growing stronger www.nhhrc.org.au “ The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care” “ A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions” National Health and Hospitals Reform Commission www.nhhrc.org
    10. 10. <ul><li>Available at www.nehta.gov.au </li></ul><ul><li>Targeted investments in eHealth foundations and solutions </li></ul>And so the quest continues…
    11. 11. National eHealth Strategy
    12. 12. <ul><li>First 3 years – Connect and Communicate: </li></ul><ul><ul><li>Focus on establishing connectivity and completing foundation services </li></ul></ul><ul><ul><li>Implement high priority solutions – information sources and information sharing solutions </li></ul></ul><ul><ul><li>Establish compliance function </li></ul></ul><ul><li>Next 3 years – Collaborate </li></ul><ul><ul><li>Smarter service delivery tools </li></ul></ul><ul><ul><li>Shared records and care plans </li></ul></ul><ul><ul><li>Certification of systems </li></ul></ul>National eHealth Strategy
    13. 13. NEHTA’s Approach ePathology Identifiers Shared Health Profile Event Summaries Self-Managed Care Complex Care Management Clinician Information Individual Information Shared Information (Others) Individual Electronic Health Record E-Health Services E-Health Building Blocks National Infrastructure Components eDischarge eReferral eMedications Terminology Secure Messaging Authentication
    14. 14. Step 1 - Establish the Foundations <ul><li>National Infrastructure Components: </li></ul><ul><li>Consistent identification of people, places and products </li></ul><ul><li>Consistent authentication </li></ul><ul><li>Consistent terminology and standards for recording information </li></ul><ul><li>Consistent standards for information exchange </li></ul>Terminology Secure Messaging Identifiers Authentication
    15. 15. <ul><li>Identifiers: </li></ul><ul><li>operational by mid 2010 </li></ul><ul><li>Consultation on underpinning legislation currently underway: http:// www.health.gov.au /ehealth/consultation </li></ul><ul><li>Authentication: </li></ul><ul><li>Services based on PKI </li></ul><ul><li>Jurisdictions working with NEHTA on implementation, including single sign-on </li></ul><ul><li>Terminology and Information Models: </li></ul><ul><li>Common data groups agreed </li></ul><ul><li>SNOMED CT and Australian Medicines Terminology (AMT) nationally available </li></ul><ul><li>Working with major vendors to implement AMT and Emergency term set </li></ul><ul><li>Secure Messaging: </li></ul><ul><li>HL7 CDA and Web services preferred way forward </li></ul><ul><li>Working with community - PIP incentives </li></ul><ul><li>Two jurisdictions moving to implement Statewide solutions </li></ul>Step 1 - Establish the Foundations Identifiers Authentication Terminology Secure Messaging
    16. 16. <ul><li>Privacy ‘patchwork’ across States and Territories </li></ul><ul><li>Health Ministers support the inclusion of health privacy requirements in the proposed uniform national privacy legislation </li></ul>Step 1 - Establish the Foundations
    17. 17. eDiagnostics eDischarge eReferral eMedications <ul><li>E-Health Building Blocks: </li></ul><ul><li>Starting with the four most commonly used healthcare communications </li></ul><ul><li>Paving the way for more e-health solutions in future </li></ul>Step 2 - Connect and Communicate
    18. 18. <ul><li>States and Territories are in the midst or planning major upgrades to acute hospital clinical systems </li></ul><ul><li>Discharge summary – Activity to Align to Core Data Standard: </li></ul><ul><ul><li>Qld, ACT, NSW, WA , Tas, NT, Mater Private, Healthscope </li></ul></ul><ul><li>eReferrals – Activity to Align to Core Data Standard: </li></ul><ul><ul><li>DHS Victoria, ACT Health, Queensland Health </li></ul></ul><ul><li>E-prescribing and medications management: </li></ul><ul><ul><li>Electronic transfer of prescription implementation studies underway in Victoria (Barwon) and NT </li></ul></ul><ul><ul><li>NT exploring better medications management in Aged Care </li></ul></ul>ePathology eDischarge eReferral eMedications Step 2 - Connect and Communicate
    19. 19. Next Steps - Collaborate ePathology Identifiers Shared Health Profile Event Summaries Self-Managed Care Complex Care Management Clinician Information Individual Information Shared Information (Others) Individual Electronic Health Record E-Health Services E-Health Building Blocks National Infrastructure Components   eDischarge eReferral eMedications Terminology Secure Messaging Authentication
    20. 20. <ul><li>NEHTA’s goal is an individual electronic health record for every Australian </li></ul>The quest for electronic health records
    21. 22. Connectivity Information Models Identifiers and Security Information Assets Integration EHR
    22. 23. Privacy and the EHR <ul><li>Privacy blueprint for the EHR </li></ul><ul><li>http://www.nehta.gov.au/connecting-australia/privacy </li></ul><ul><li>Feedback: </li></ul><ul><ul><li>Strong governance in management of EHR </li></ul></ul><ul><ul><li>Support for “sensitivity labels” </li></ul></ul><ul><ul><li>Individual control and voluntary participation important </li></ul></ul><ul><ul><li>Authorised and nominated representatives required </li></ul></ul><ul><ul><li>Consumer confidence requires strong audit capability </li></ul></ul><ul><ul><li>Secondary uses limited to public good </li></ul></ul><ul><ul><li>Other issues : data integrity, provider participation, education </li></ul></ul>
    23. 24. Emerging issues <ul><li>Accelerating Adoption of standards </li></ul><ul><li>Role of Provider records vs Personal Health Records </li></ul><ul><li>Risks if foundations not in place: </li></ul><ul><li>  http://www.boston.com/news/health/articles/2009/04/13/electronic_health_records_raise_doubt/?page=1 </li></ul><ul><li>Compliance, Conformance and Accreditation </li></ul>
    24. 25. <ul><li>www.nehta.gov.au </li></ul>Questions

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