Sharon McAnelly interoperability in the northern territory - using ehealth to support quality patient care
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Sharon McAnelly interoperability in the northern territory - using ehealth to support quality patient care

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Sharon McAnelly delivered the presentation at the 2013 eHealth Interoperability Conference. ...

Sharon McAnelly delivered the presentation at the 2013 eHealth Interoperability Conference.

The 2013 eHealth Interoperability Conference program is a balance between updates on state-wide interoperability projects, health service eHealth project case studies, and discussions of overarching principles such as information governance, data standardisation, and the future direction of eHealth in Australasia.

For more information about the event, please visit: http://www.informa.com.au/eHealth13

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  • 1. Department of Health is a Smoke Free Workplace Interoperability In The Northern Territory: Using eHealth To Support Quality Patient Care
  • 2. 2 Interoperability in NT Recent History Outcomes for clinicians, patients and organisations across NT and remote SA & WA Current challenges Handling data across repositories Approaches to integrating more systems into health care provision Future development and integration of technology: collaboration and the future
  • 3. 3 Exchange of clinical information MeHR P2P Since 2005 2004 Evolution Health Connect SeHR MeHR Email SMD via intermediaries Clinical Documents 1. Health Profile 2. Event Summary 3. Discharge Summary 4. Pathology Results Report 5. Diagnostic Imaging Report 6. Specialist Letter 7. Other Hospital Docs 8. Antenatal Report IN 1. Discharge Summary 2. Pathology Results Report 3. Diagnostic Imaging Report 4. Specialist Letter 5. Notification OUT 1. eReferrals Coverage Acute Care Primary Care - Remote health centres both DoH and ACCHOs Cross-sectorial
  • 4. Department of Health is a Smoke Free Workplace MeHR - Usage
  • 5. 5 MeHR statistics - 2013 60,000 mainly Indigenous consumers for the consortium across NT, northern SA and the Kimberley region of WA 9,000 authorised clinical users 130 sites 1,000 clinicians accessing pm 154,000 clinical documents sent pm 42,400 views pm
  • 6. 6 2012-13 Monthly av. = 35,919 Mean: 35,636 Range: 32,356 to 38,729 2011-12 Monthly av. = 27,570 Mean: 28,702 Range: 18,683 to 34,068 Views of MeHR Records - 2013
  • 7. 7 Sends of MeHR Records 2012-13 Monthly av. = 145,436 Mean: 145,812 Range: 131,433 to 162,065 2011-12 Monthly av. = 114,614 Mean: 109,084 Range: 85,572 to 154,138
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  • 13. 13
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  • 15. 15
  • 16. Department of Health is a Smoke Free Workplace M2N Transition Project
  • 17. 17 Controlled transition from the MeHR to the National eHR Clean cut-over Combined view of MeHR & PCEHR clinical docs PCEHR can act as primary record: 8 of 10 MeHR docs Deepen Sectoral Coverage spanning acute care, remote primary care, urban general practice, residential aged care, private specialists and allied health professionals Informed and Participative Transition MeHR has a well-earned reputation for security and reliability Participants understand the outcomes of transition to the National eHR are and willingly participate
  • 18. 18 Partner Health Services DoH 65 AMSANT 59 ACHSA 33 NTML 58 WACHS 16 M2N Transition Project
  • 19. 19 M2N Transition Project Clinical Information Systems ACCHO Communicare Urban Healthcare Facilities Genie Medical Practice-MD3 Best Practice NT DoH ACIS & PCIS Combined Viewer PCEHR Dashboard
  • 20. 20 Transition Principles 1. Where a consumer has a PCEHR, this will be their primary eHealth record 2. MeHR consumers who register for the PCEHR should continue to receive the same quality of service 3. The preferred option must minimise clinical risk 4. To ensure ongoing alignment with the PCEHR information model, data should be as close to the NeHTA specification, and as possible as atomised as possible Harmonise PHCS and MES data items Use the opportunity of the national standards to help bring clarity to making documents sourced from PCIS and Communicare consistent
  • 21. 21 Design Principles 1. Ensure that clinical documents are as informative as possible 2. Minimise workload of clinician 3. Ensure any automated functions have clear business rules that are known and understood: Clinically safe – understand the impact of our actions Simplest solution is usually the best (KISS) 4. Balance pertinence and succinctness of information versus “information overload”
  • 22. 22 Engagement Principles 1. Long-time, expert users on current practices and usage 2. Governance of all decisions about Workflow Data mapping Viewing Changes to existing systems Retrofitting MeHR Pragmatic, practical, forward-thinking Challenge: PD CRG CAC convince the clinical cohort Product Development Clinical Reference Group
  • 23. 23 Document Mapping MeHR Source PCEHR Phase * ED Discharge Summary ACIS Discharge Summary * Inpatient Discharge Summary ACIS Discharge Summary * Outpatient Letter ACIS Specialist Letter Current Health Profile PCIS C’Care Shared Health Summary * Medical Event Summary/ Primary Health Centre Summary PCIS C’Care Event Summary Pathology Results Report PCIS C’Care Pathology Result Report Medical Imaging Report ACIS Medical Imaging Report Antenatal Report C’Care N/A Other Hospital Docs ACIS N/A 2a 2 2a 2 1 2 2
  • 24. 24 Consistency between eHRs CIS MeHR 1. Shared Health Summary 2. Event Summary 3. Discharge Summary ED 4. Discharge Summary Inpatient 5. Pathology Results Report 6. Diagnostic Imaging Report 7. Specialist Letter PCEHR 1. Shared Health Summary 2. Event Summary 3. Discharge Summary ED 4. Discharge Summary Inpatient 5. Pathology Results Report 6. Diagnostic Imaging Report 7. Specialist Letter Send Document Lists • All • SHS • ES • DS ED • DS In • Results • SpL Clinical Synopsis View Latest SHS View MeHR Link for DoH access: • RHD • Immunisation • Synapse Combined Viewer
  • 25. 25 Clinical Synopsis View Event Date Progress Notes 12/09/2012 Dr. Jo Wright General Practitioner Organisation: Wadeye Clinic S: Coughing since yest afternoon. O: Exacerbation asthma; presents with husband this am from outstation; In Wadeye for funeral; Obs as charted; Febrile with moist chest; IMP: possible chest infection; For GP r/v Friday Observations: Weight: 60kg; BMI: 25; BP: 120/60mm 11/09/2012 Peter John Registered Nurse Organisation: Barunga Clinic. Family concerned with Bessie’s chest/cough; they have encouraged her to come to clinic for review but declining at present. Family given ventolin puffer for her as per script and encouraged to reinforce that she should attend clinic for review. Observations: Weight: 60kg; BMI: 25; BP: 120/60mm 24/08/2012 Dr. Sandy Fish General Practitioner Organisation: Barunga Clinic. Bessie presented to clinic requesting 3/52 medications for herself and partner. They are going to Wadeye for 3/52. Observations: Weight: 60kg; BMI: 25; BP: 120/60mm 15/07/2012 Peter John Registered Nurse Organisation: Barunga Clinic. Review key observations and current medications Observations: Weight: 60kg; BMI: 25; BP: 120/60mm Example from previous 4 events
  • 26. 26 Viewing Document Lists
  • 27. 27 Viewing Documents
  • 28. 28 All views are audited
  • 29. 29 Timing • Expected Go-Live date delayed to allow for Phase 2A: earliest possible date is Monday April 28 2014 Content • PCEHR will have sufficient information to act as primary eHealth Record for patients previously registered for MeHR Send • At M2N Go-Live only NeHTA standard Clinical Documents will be sent to PCEHR or MeHR, depending on PCEHR registration View • NeHTA standard views of PCEHR - document lists • Latest SHS View • Clinical Synopsis View • Plus MeHR document list views (as now), either via • separate buttons (Communicare) or • as Combined Viewer (NT DoH) Assisted Registration • PCEHR Assisted Registration available in Communicare 13.4 (September); • At M2N Go-Live, PCEHR Assisted Registration available in both NT DoH and Communicare; MeHR Registration is decommissioned Go-Live Switch • Both NT DoH and Communicare will have “M2N Go-Live Configuration Flag” to enable synchronous Go-Live (decoupled from version deployment) • Communicare 14.2 will have the full suite of primary care clinical documents for PCEHR registered consumers.
  • 30. 30 M2N Schedule
  • 31. 31 PCEHR Dashboard IHI reconciliation search for an IHI and store it; adjust demographics; report PCEHR Participation Status identify the “current patients” who are registered for the PCEHR Remove a PCEHR document - remove a clinical document previously submitted to the PCEHR, either because it has been posted in error, or on patient request Assisted PCEHR registration HPI validation – validate an HPI-I or to search for an HPI-I and store it PCEHR Submission Error Report - provide queries or regular reports on any problems or delays in submitting clinical documents to the PCEHR KPI Reports on HI Service and PCEHR System - provide performance statistics on the quality of service provided by HI Service and PCEHR System
  • 32. Department of Health is a Smoke Free Workplace Future Directions
  • 33. 33 Current Interoperability Projects iCareNet – ACCHO & DoH Decision support based on shared clinical data Care Plans Antenatal pilot for consent patients Client Centric View (CCV) – DoH only Allow a point-in-time, read-only view from 6 source systems Full consent model – opt out; push & pull models MedChart & LabTrack CCIS – Community Care & Welfare Services PCIS - Primary Care ACIS: CareSys – PAS plus and Clinical Workstation (CWS) CoC – improving management of P2P delivery errors Strategic Information Plan - underway Foundations: LDAP/Single Sign-on/Provider Index
  • 34. 34 Collaboration Projects Partnering with SA on P2P Infrastructure project • Deliver point to point conformant Secure Message Delivery (SMD) in the HIPS product • Provide a set of architectural and design artefacts that can be leveraged by all other state and territories looking to implement a similar secure messaging solution.