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Clinical Handover 2011(Rmcg)

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Transcript

  • 1.
    • Consumers and clinical handover
    • How consumers can
    • participate in
    • GP/Hospital handover
    • Russell McGowan
    • 15 April 2011
  • 2.
    • My story
    • Same GP in Canberra since 1981
    • Diagnosis at WVH - 1991
    • Surgery - 2002
    • Inpatient blood transfusions – 1992
    • BMT in Royal Adelaide - 1993
    • Re-admissions TCH 1993, 1994, 2006
    • Referal to Westmead - 2003
  • 3.
    • Specialists - within hospitals
    • Haematologist
    • Infectious disease specialist
    • Cardiologist
    • Thoracic physician
    • Gastroenterologist
    • Oral physician
  • 4.
    • Specialists – outside hospitals
    • Ophthalmologist(s)
    • Dermatologist(s)
    • Neurologist
    • Dentist(s)
    • Physiotherapist(s)
  • 5.
    • Formal discharge summaries issued to GP
    • ZIP
  • 6.
    • Formal referal letters from GP
    • 10% of occasions
  • 7.
    • Formal feedback from specialists
    • 10 -20% of the time
  • 8.
    • The Answer?
    • The personally controlled electronic health record (pcehr)
  • 9.
    • Personally Controlled E-Health Records
    • Safer healthcare
      • Improving direct patient care by more timely access to clinical information
      • Capacity to share information more readily
      • Clinical decision support systems
    • Higher quality healthcare
      • Supports and enables better team base care
      • Supports chronic disease management initiatives
      • Shares knowledge amongst health professionals
    Page
  • 10.
    • E-Health more generally
    • Direct patient care: better, more timely & accurate - Transfer of clinical information
    • Better patient care: Safety & Quality:- Clinical decision support
    • Cost savings in terms of less “re-do” of tests and better safety and quality so potentially less unplanned re-admissions
    • Support for chronic condition management
    • Support for team based care / engaging health professions in health care delivery:- Improved sharing of clinical information
    • Management and planning of healthcare services:- improved, accurate, relevant and up to date information.
    Page
  • 11.
    • Foundations for e-health
    • Healthcare Identifiers – IHI, HPI-I, HPI-O
    • National Authentication Service for Health (NASH)
    • Secure Messaging
    • Clinical Terminology
    • National Product Catalogue
    • Compliance, Certification & Accreditation
    Page
  • 12.
    • Healthcare Identifiers
    • • Individual Healthcare Identifier (IHI) – for individuals receiving healthcare services.
    • • Healthcare Provider Identifier – Individual (HPI-I) – for healthcare professionals and other health personnel involved in providing patient care.
    • • Healthcare Provider Identifier – Organisation (HPI-O) – for organisations (such as the hospital or health clinic) where healthcare is provided.
    Page
  • 13.
    • Secure messaging
    • Enables connectivity for e-health solutions
    • Needs to form part of contractual arrangements for IT products
    • Hospitals must have contracts with vendors meet NeHTA standards
    • Vendors must be compliance checked by NATA accredited laboratories
    • Staff must understand what the secure messaging delivers
    • IT breaches must be identified and remediated
    Page
  • 14.
    • Clinical terminology AMT
    • AMT – Australian Medicines terminology
    • Provides a unique identification regime for medicines in clinical systems to support prescribing, recording, reviewing, supply and administration of medications
    • Extension of SNOMED-CT-AU
    • Works on a relational model for medications/ingredients
    • Covers all listed TGA products & items listed by the PBS
    • Focus is to define & codify the information care providers need to prescribe medications
    • It does not cover- devices, special access products, over the counter medications, dietary supplements, alternative medicines, blood products & onsite manufactured medicines
    Page
  • 15. Medications
    • Current NEHTA work focusing on Electronic Transfer of Prescriptions (ETP)
    • Significant progress in hospitals on e-medication management – decision support
    • Utilisation of National Medication chart in paper form and electronically
    • Medications must be transferred and displayed in the discharge summary
    • Issues for divisions of general practice accreditation
    Page
  • 16.
    • Diagnostic Imaging
    • Radiological images are not strictly part of the medical record, only the report.
    • Access to images are an essential part of care delivery.
    • Where the images are stored in a PACS system it is important that they are accessible for patient care at all hours.
    • Staff need to be trained on access and retrieval of images from the system, including those from the current episode of care and those from previous episodes of care
    Page
  • 17.
    • Pathology
    • Improvement issues
    • Better clinical decision making – complete information at point of care
    • Efficient practices – tests not needing repeating
    • Improved consumer satisfaction
    • Standardised test names and result formats
    • Collation of appropriate data into meaningful cumulative reports
    • Consumer choice of provider
    Page
  • 18.
    • Benefits of eHealth
    • Safe clinical handover
    • Clinical decision support
    • Improved medication management
    • Minimisation of duplicated tests
    Page
  • 19. Risks of eHealth
    • Automated duplication of errors
    • Unauthorised disclosures
    • Vendor capture of function
    • Minimal early efficiencies
    Page
  • 20.
    • Challenges
    • Consent
    • Privacy
    • Waste
    • Slow uptake
    Page
  • 21.
    • What consumers say they want
    Page
    • • eHealth should improve health outcomes by partnerships between consumers and health professionals
    • Consumers should be informed about eHealth initiatives, including information contained in electronic health records
    • • Consumers should have access to their own health information
    • • Consumers should be able to decide who accesses their health information.
    • • Health information should be held and transferred securely.
  • 22.
    • Governance that consumers expect
    Page
    • Governance of eHealth systems and networks should be transparent and accountable
    • • Audit and monitoring systems must be in place to protect against privacy breaches, and consumers must be fully informed about any privacy breaches that occur in relation to their information
    • • Consumers should be able to access independent complaints handling.
    • • There should be strong penalties for the misuse of consumer information
    • • Development and operation of eHealth systems must be evaluated – including the impact on consumers .
  • 23.
    • ACSQHC
    • Commission Programs
    • Australian Charter of Healthcare Rights
    • Open Disclosure
    • Basic Care Issues
          • Healthcare Associated Infection
          • Patient Identification
          • Medication Safety
          • Clinical Handover
          • Patient at risk
          • Falls Guidelines
    • Tools
          • Accreditation and credentialing
          • Information Strategy
  • 24.
    • The National Safety and Quality Framework
    • - Consumer centred
    • - Organised for Safety
    • Driven by information