Recommendations For Unique Health Identifiers - Tracy O'Carroll


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  • 11/28/11 Good afternoon. My name is … and I led out on the project to recommend.. For the health information and quality authority This presentation should take approximately 15mins, leaving a few mins or so for questions at the end.
  • Before we look at this project in greater detail, let me provide an overview on who the Health Information and Quality Authority are.
  • We are governed by the health act.. Independent body Reporting to the minister We have established We strongly believe in a person centred ethos..
  • We have 4 functional directorates, I work in the health information directorate along with my colleagues clare Harney and Linda Weir who will be presenting Privacy Impact Assessments in the next segment Our directorate is currently working on technical standards..
  • This afternoon, I hope to… Introduce.. Look at the rationale and objectives of the project Highlight the benefits of introducing the unique identifiers Outline what is currently happening nationally and what is in place internationally Present our vision for a central registry and the most appropriate order to phase in unique identifiers And finally look at the recommendations the Authority put forward to the Minister
  • I am not talking about Individual Health Identifiers today, but the Authority did publish a in March 2009 recommending introduction of IHIs
  • Why are we doing this project.. There is a clear need for unique identifiers for healthcare practitioners and orgs which is articulated in the NHIS, Health Act, Commission… NHIS 2004 The Authority in conjunction with the DOHC and working in partnership with health agencies, will have responsibility for setting the standards including " The range of health service staff/agencies where unique identification is required, " Whether identification will be at institutional or individual level or both, " HA2007 - In accordance with the Health Act 2007, section 8 (1) (j) having regard to section 8 (2) (d), one of the Authority’s functions is to provide advice to the Minister for Health and the Health Service Executive (HSE) about deficiencies identified in the area of health information. The Authority has identified that the absence of a national system of uniquely identifying healthcare practitioners and organisations is an important deficiency in the health information infrastructure in Ireland. PSC2008- Commission states that the Health system must commit itself to appropriate standards based on EHR
  • The objective of this project is to…
  • The benefits to the groups of people that use the healthcare service are quite significant Benefits for the people who use health and social care services include: Service Users will benefit greatly from having the HPI and HOI in place, for a number of reasons, including improved communication, greater accountability, improved audit and traceability, and being able to take advantage of e-health initiatives such as eprescribing. All leading to better quality and safer care for the patient. Healthcare Practitioners Improved communication, timely access to information and reduction in administrative effort Service Planners Accurate, timely data available at one central source reduction in effort to collect information on the health and social care sector, authoritative source of information as a first point of contact, . Benefits for Healthcare Organisations The Government has proposed the introduction of a statutory licensing system that applies to both publicly and privately funded healthcare services. The HOI will be of enormous benefit towards assisting the realisation of this recommendation. Benefits for Prof Reg Authorities Having a HPI in place will improve tracking of healthcare practitioners across regulatory authorities and internationall borders. Benefits for the Healthcare Sector 1) decrease admin burden (2) facilitate greater interoperability (will improve audit, identification, security, addressing of healthcare information)
  • Nationally – there are a number of professional regulatory authorities in place currently regulating their group of health care practitioners including, the medical council of Ireland, An Bord Altranias (Nursing Board), Pharmaceutical Society of Ireland, Dental Council of Ireland and the Health and Social Care Professional Counci, SSI in HIQA – all doing an fantastic job, but working in silos, the HPI and HOI will be able to overcome this and amalgamate the data into a single trusted source of healthcare practitioner and organisation data.
  • Undertook an international review – Countries chosen as a result of: Geographic spread Access to personnel in each jurisdiction Availability of information in english As we can see from slide all of the countries have unique identification in place for their healthcare practitioners and organisations – the only exception is Canada…who are currently in the process of a readiness assessment. Found that Intl. jurisdicitons have implemented unique identifiers in a phased manner. Studies by New Zealand, Finland, Sweden, Norway, England and Australia identified the benefits of implementing UHIs enable administrative efficiencies by reducing the need to capture the same information numerous times take full advantage of the uniformity of the data in the central directory to leverage and integrate the information systems that are currently in place Act as a fundamental building block for eHealth and EHR initiatives It is reasonable to expect that Ireland could also expect similar benefits. HPRO Card … European health professional card
  • The Authority recommends that a central directory is in place, which will be the single up to date authorative source of information regarding healthcare professionals and healthcare organisations offering services in the health and social care sector. The sources are professional regulatory authorities and other ICT systems which maintain data on professionals and organisations. The consumers of the central directory include those who require an element of the UHI for Healthcare Practitioners or Organisations data for identification, publication, research or other such purposes. These include National Health Information sources, ICT projects, Service planners The agency responsible for the central directory will be responsible for: management of issuing and assigning HPIs and HOIs management of access to and use/disclosure of HPIs and HOIs and the related datasets management of relationships with the professional regulatory authorities and other relevant stakeholders provision of all necessary training and education for the healthcare community to ensure that the directory and identifiers are appropriately used.
  • How is this going to look. We decided the most appropriate standard to adapt is ISO TS 27527 as it outlines the data items that should be collected for each healthcare practitioner and organisation for instance, dob, street address, phone number etc. As we can see from the slide it is….a technical spec. which was developed as a result of the health industry need for a common best practice approach for the way data is captured, stored and managed for the purpose of identifying providers. ISO TS/27527 ISO TS/27527 progressed from a draft to a full standard over the lifetime of this project, the Authority fed back our requirements into the development of this standard.. The Authority conducted a survey and worked with our advisory group members to assess the impact of adopting the standard. We recommended three national adaptations. The first…deals with healthcare practitioners, there is a section that requires the field of practice start date and end date to be recorded, the regulatory bodies do not collect this information. The Authority recommended to instead track the data that is currently collected which is the date on which the healthcare practitioner registers with their professional regulatory authority not the date on which they began to practice in a certain field. ISO/TS 27527 requires individual biometric identifiers. Biometric identification is only in its infancy in Ireland, and therefore we changed the biometric identification data field as optional. And finally.. looking at healthcare organisations, the Irish adaptation will include an additional directory record, which will include the services and functions that healthcare organisation provide.
  • The proposed structure for the HPI and HOI comprises of an: Identification Number Identification Record And Directory Record In the case of the HPI: The identification number will be unique and the format will be the same for all healthcare practitioners. The identification record will be made up of the healthcare practitioner’s name, address and communication details. Finally the directory record will identify the healthcare practitioner’s registration body and qualification details and place of employment. And for the HOI: The identification number will be unique and the format will be the same for all healthcare organisations. The Identification record contains the organisation name, address information, communication and site details. The directory record identifies the services and functions for the organisation
  • The Authority recommends that the HPI and HOI is phased in. The recommended order to phase in the HPI is: Groups of healthcare practitioners….Medical Council, An Board Altranis, Dental Council of Ireland, Pharmacists. Pre-Hospital Emergency Care Council (PHECC), which regulates Emergency Medical Technicians, Paramedics and Advanced Paramedics, and the Opticians Board, which registers Optometrists and Dispensing Opticians. 3) Coru plan to introduce the registers on a phased basis, they have started with the social workers register which is up and running and intend to move on to Clinical Biochemists, Physiotherapists, Dieticians, Psychologists, Medical Scientists, Radiographers, Occupational Therapists, Social Care Workers, Orthoptists, Social Workers, Podiatrists & Speech and Language Therapists Hospital CEO and responsible persons as designated by the SSI Longer term goal, need to be assessed as needs be in the context of national eHealth initiatives
  • In terms of phasing in the healthcare organisations, the Authority recommends: 1. The groups of healthcare organisations….Pharmacies: Pharmaceutical Council of Ireland, Residential Services for Older People, SSI 2. All units that will be obliged to attain licensing in the future 3. All remaining healthcare orgs.
  • The recommendations that we put forward to the Minister are.. 3. As mentioned an agency will be responsible for Governance, implementation and maintenance of the central directory. We have recommended that the HI Bill should designate this task as an added function to an existing agency or a new agency will be established.
  • If you would like more indepth information on this project, it can be found on website. We have both a summary and full report.
  • Recommendations For Unique Health Identifiers - Tracy O'Carroll

    1. 1. Recommendations for Unique Health Identifiers for Healthcare Practitioners and Organisations Tracy O’Carroll 17 November 2011
    2. 2. Remit <ul><li>To drive continuous improvements in the quality and safety of health and social care in Ireland </li></ul>
    3. 3. Background <ul><li>Health Act 2007, establishment 15 May 2007 </li></ul><ul><li>independent - reporting to Minister for Health and Children </li></ul><ul><li>close relationship with people using the service, professionals, providers, public, communities, media, stakeholders </li></ul><ul><li>person-centred ethos of “working with” not “doing to” </li></ul>
    4. 4. Functions <ul><li>Social Services Inspectorate (SSI) – residences for older people, people with disabilities, children, etc </li></ul><ul><li>Health Technology Assessment (HTA) - colorectal cancer, HPV in cervical screening, prion filtration of red cell concentrates </li></ul><ul><li>Healthcare Quality and Safety (HQS) – standard setting and monitoring function in acute hospital setting </li></ul><ul><li>Health Information (HI) - Technical Standards, Information Governance Standards, Standards for National Health Information Sources, Health Identifiers – IHI, HPI, HOI </li></ul>
    5. 5. Agenda <ul><li>introduce the Healthcare Practitioner Identifier (HPI) and Healthcare Organisation Identifier (HOI) concepts </li></ul><ul><li>rationale for project </li></ul><ul><li>objective of project </li></ul><ul><li>benefits of HPI/HOI </li></ul><ul><li>national and international </li></ul><ul><li>vision for a central registry & proposed data structure </li></ul><ul><li>phasing </li></ul><ul><li>overall recommendations </li></ul>
    6. 6. Concepts <ul><li>Healthcare Practitioners identifier (HPI) </li></ul><ul><li>A unique, non-transferable lifetime number assigned to a healthcare practitioner. Its purpose is to identify the individual as one and the same person and to allow the “attaching” of other information, for instance address and contact details. </li></ul><ul><li>Healthcare Organisation Identifier (HOI) </li></ul><ul><li>A HOI uniquely identifies all healthcare organisations in Ireland. It will </li></ul><ul><li>allow the attaching of a set dataset for example location, contact details and site details. </li></ul><ul><li>Individual Health Identifier (IHI)*** </li></ul>
    7. 7. Rationale for project <ul><li>National Health Information Strategy (2004) </li></ul><ul><li>Health Act 2007 </li></ul><ul><li>Commission on Patient Safety and Quality Assurance (2008) </li></ul><ul><li>Health Information Bill </li></ul>
    8. 8. Objective <ul><li>identify benefits of HPI and HOI </li></ul><ul><li>identify what is in place nationally and in international jurisdictions </li></ul><ul><li>recommend a model to implement the HPI and HOI in Ireland </li></ul><ul><li>advise on the most appropriate order to phase in HPI and HOI </li></ul>
    9. 9. Benefits Benefits Healthcare Sector Professional Regulatory Authorities Healthcare Organisations Service Planners Healthcare Practitioners Service Users Benefits
    10. 10. National <ul><li>Medical Council of Ireland </li></ul><ul><li>Pharmaceutical Society of Ireland </li></ul><ul><li>The Nursing Board (An Bord Altranais) </li></ul><ul><li>Dental Council of Ireland </li></ul><ul><li>Health and Social Care Professional Council (CORU) </li></ul><ul><li>SSI – Health Information and Quality Authority </li></ul><ul><li>Opticians Board </li></ul><ul><li>Pre-Hospital Emergency Care Council (PHECC) </li></ul>
    11. 11. International <ul><li>Australia </li></ul><ul><li>Australian Healthcare Practitioner Registration Authority – HPI-I </li></ul><ul><li>Medicare Australia – HPI-O </li></ul><ul><li>New Zealand </li></ul><ul><li>Ministry for Health maintains a central registry - Health Provider Identifier for Organisations (HPI-ORG), Facilities (HPI-FAC) and Common Person Number (HPI-CPN) </li></ul><ul><li>England </li></ul><ul><li>The spine directory service (SDS) consists of a National Register of Healthcare Professionals and a Register of Healthcare Organisations </li></ul><ul><li>Norway </li></ul><ul><li>Registration Authority for Health Professionals maintains the Health Personnel Number (HPR) </li></ul><ul><li>Companies and business office maintains healthcare registry (public and private) - Business Enterprise Organisation Number </li></ul><ul><li>Sweden </li></ul><ul><li>The National Board of Healthcare Professions issues a unique identifier (förskrivarkod) to healthcare professionals. </li></ul><ul><li>The Centre of Epidemiology within the National Board of Health and Welfare issues the registreringsnummer to hospitals and healthcare units </li></ul><ul><li>Canada </li></ul><ul><li>Canadian Institute for Health Information (CIHI ) feasibility assessment of the National Unique Identifier (NUI) for all healthcare providers </li></ul><ul><li>Western Health Information Collaborative (WHIC) - issues identifier to healthcare organisations </li></ul>
    12. 12. Vision for a central directory
    13. 13. International Standards Organisation Technical Standard 27527 (ISO TS 27527) <ul><li>This technical specification is the result of a </li></ul><ul><li>recognised need within the health industry need for </li></ul><ul><li>a common, best practice approach to the way data </li></ul><ul><li>is captured, stored and managed for the purpose of </li></ul><ul><li>identifying providers. </li></ul>
    14. 14. Proposed data structure for identifiers
    15. 15. HPI phasing
    16. 16. HOI phasing
    17. 17. Recommendations <ul><li>Unique identifiers for healthcare practitioners and organisations should be introduced in Ireland. </li></ul><ul><li>A central directory should be established that contains unique identifiers for healthcare practitioners and organisations and should be established as the primary trusted source of core identity information in relation to healthcare practitioners and organisations. </li></ul><ul><li>The Health Information Bill should assign a designated agency with the task of governance, implementation and maintenance of a central directory. </li></ul>
    18. 18. Overall Recommendations <ul><li>The HPI and HOI should be phased in </li></ul><ul><li>The dataset to be associated with the identifiers for practitioners and organisations should be based on the international standard ISO/TS 27527, adapted for use in Ireland. </li></ul><ul><li>Each professional regulatory authority should upload the standard dataset at set intervals to the central directory. </li></ul>
    19. 19. Next Steps <ul><li>If approved by the Minister: </li></ul><ul><li>the Authority will work with the DOHC through the Health Identifiers Group to ensure that the implementation of the recommendations are progressed. </li></ul><ul><li>the Authority will work with the designated agency to ensure that the development of a practitioners and organisations registry is compliant with our recommendations. </li></ul>
    20. 20. The full and summary report <ul><li>Recommendations for Unique Health Identifiers for </li></ul><ul><li>Healthcare Practitioners and Organisations </li></ul><ul><li> </li></ul>
    21. 21. <ul><li>THANK YOU </li></ul>