eHealth: What it means foryouPresenters: Michelle McClure and Kathy RainbirdMarch 2013
Connecting health careIntroducing eHealth• Better decisions• Better access to information• Better co-ordination• Better ca...
What is eHealth?e-health is the electronic collection,management, use, storage and sharing ofhealthcare information.
eHealth Records     Secure messagingeHe         Telehealthal        ePrescribingth     eSpecialist Letters          eRefer...
Extrapolating ehealth evidence• Clinicians spend around a quarter of their time  collecting information rather than treati...
Benefits of eHealth• Improvements to patient care• Access to patient history: administrative &  clinical efficiencies• Bet...
eHealth RecordIn July 2012 the Australian Governmentintroduced a personally controlled electronichealth (eHealth) record s...
Benefits of the eHealth Record• Reducing unnecessary tests, hospitalisations  & follow-up specialist visits• Better access...
What will eHealth records include?Two set of information – clinical and personalAs the system grows, an eHealth record may...
What will an eHealth record look like?
How it works…
Common misconceptionsProgress notes will be sharedPatients can change the recordIt will take too much time for little reward
Common misconceptionsProgress notes will be shared Patients can change the recordIt will take too much time for little re...
Common misconceptionsProgress notes will be shared Patients can change the record It will take too much time for little ...
Common misconceptionsProgress notes will be shared Patients can change the record It will take too much time for little ...
Does it replace existing records?eHealth records don’t replace existing medicalrecordsHealthcare professionals will contin...
Who will have access to a patients eHealthrecord?Healthcare professionals working for aregistered healthcare organisation ...
What about in an emergency?Healthcare professionals may access a patient’seHealth record in an emergency, where patientcon...
What can patients enter?                       Personal Health                         Information        Personal health ...
What are the next steps for eHealth?People seeking healthcare in Australia can nowregister for an eHealth recordThe eHealt...
How can patients register for an eHealthrecord  • Online: www.ehealth.gov.au  • Over the phone: 1800 723 471  • In person:...
What can I do to prepare to access theeHealth record system?Your organisation will need a HealthcareProvider Identifier – ...
How do I access the eHealth recordsystem?To access the eHealth record system via clinicalsoftware, and be able to add to a...
In SummaryeHealth records will allow you to access asummary of your patients’ important information,assisting you to…• Sav...
eHealth Records     Secure messagingeHe         Telehealthal        ePrescribingth     eSpecialist Letters          eRefer...
ePrescribing
What is ePrescribing?ePrescribing is the secure transfer ofprescription information between prescribersand dispensers.Pres...
GP             2. Provides                  Patient                    prescription with                    barcode based ...
ePrescribing softwareThere are 2 approved ePrescribing products:–eRx–MediSecureThese are interoperable through the prescri...
But… why?ePrescribing is easyePrescriptions mean:• No more illegible handwritten prescriptions• Fewer transcription errors...
Benefits• Widespread use of ePrescribing will make it  easier to implement more sophisticated  systems •   eg to share med...
And remember….• It’s not mandatory, and for some practices and  pharmacies it might not be viable• However, NPS encourages...
Future BenefitsMay be one day we will no longer need paperscripts • No more rewriting lost scripts!
eHealth Records     Secure messagingeHe         Telehealthal        ePrescribingth     eSpecialist Letters          eRefer...
Further information• Visit www.ehealth.gov.au or call the Helpline:  1800 723 471• RACGP http://www.racgp.org.au/your-  pr...
ReferencesAustralia Audit Commission, Canberra, 1995 5. Karl A Stroetmann KA, Jones T, Dobrev A,      Stoetmann VN, ‘An Ev...
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  • While our healthcare system is among the best in the world, some of our ways of collecting and sharing health information—such as medications, test results, scans, or hospital discharge reports—can be improved. Many clinical communications, such as referrals and prescriptions, are still completed on paper.eHealth aims to introduce electronic services to improve upon some paper-based systems. With the right protections in place, the electronic management of your health information has the potential to transform the way we do things and improve the quality and safety of our healthcare system.It’s been estimated that for every dollar invested in eHealth in Australia, we’ll see more than two dollars back. Australia is not alone among OECD countries in projecting unsustainable growth in expenditure on health services. So it’s essential that we find ways to make our health dollars stretch further without compromising the quality of healthcare.
  • There are already good components to eHealth available. If you think of it like a cake, with many layers, then the eHealth record is the icing. Don’t throw out the cake because you don’t like icing. I will be mainly focusing on the eHealth record tonight.ePrescribing is easy and a good starting point and this will be discussed later in the presentation as will telehealth.
  • You will be able to have information about medications, allergies, PMH etc to help with making clinical decisionsNot have to wait for information to arrive but all sorts of means. Imagine no more having to scan documents on to your system.Also think of the time wasted following up on clinical documentation that some fax has apparently eaten.This will evolve and we will have more improved tools to support best practice.Good data helps to evaluate care and its effectiveness.
  • As the eHealth record system develops over time it will allow more information to be linked, helping build a more extensive overview of your patients’ healthAs more patients, healthcare professionals and organisations register and use the system and more information is added, the system will become more effectivePressure on Australia’s healthcare system and healthcare professionals is increasing due to a number of factors including:A growing and ageing populationMore patients with complex and chronic care needsIncreasing expectations and demands from consumers and health professionalsMore effective and innovative approaches, including those that harness the power of technology such as eHealth, are needed to sustain the quality of our health system – this is exciting as we are able to use eHealth to look at ways of developing improved models of care.
  • You will no longer have to rely solely on patient recall of their medical informationInformation will be linked, helping build a more extensive overview of your patients’ healthLess time chasing patient information and more time seeing patientsGreater access and sharing of information across the health system. This will assist in making good clinical decisions. There will be improved understanding of information around allergies, previous adverse drug events and medications and that can lead to enhanced patient safety – think of the grey nomads….’I think I normally take a little pink pill’Accessing important health information more efficiently will help to provide safer and more effect care. Less time delays and greater continuity of care with less duplications. Eg repeat tests.I like this one - Encouraging patients to take more control/responsibility for their own health and their own health information.
  • An eHealth record will contain two sets of information – clinical, and personal Only authorised healthcare professionals can enter information into the clinical record, ensuring it is clinically relevant and accurateAs the system grows, an eHealth record may contain standardised versions of the following:A shared health summary: This will include information about a patient’s medical conditions and medications they are currently taking, allergies they may have, or immunisations they have received. It will not include clinical notes. The shared health summary is prepared by a patient’s nominated provider who can be a medical practitioner, registered nurse or Aboriginal health practitioner. Event summary: This is a summary of a clinically significant event. It can be uploaded by a healthcare professional at any participating healthcare organisation that is authorised to use the eHealth record system – such as an after-hours GP clinic, hospital or allied health clinicHospital discharge summaries: Over time, it can be uploaded by healthcare professionals who have access to the eHealth record and were involved in the patient’s care
  • Progress notes will not be shared. They will remain within the health record of the health professional/organisation. This will be discussed further during the presentation.
  • As discussed the record has 2 parts and patients are unable to change clinical notes. They may choose not to share them will all health professionals and this is what currently happens. A patient may choose to disclose what they want during a consult.
  • It will save time but initially this may not be seen as a eHealth record will take time to set up. Tell patients they will need to book in for a separate long appointment if necessary for creating their shared health summary. Remember we are just embarking on this journey and we will not be able to fully appreciate the benefits at this stage.
  • Healthcare professionals will continue to take and review clinical notes. More detailed patient information will be available on local clinical information systems, as per current practiceThe eHealth record system provides an active online record that follows patients as they move through Australia’s health systemIn the future, the availability of eHealth records could save healthcare professionals valuable time
  • An eHealth record contains two sets of information – clinical and personal. Only authorised healthcare professionals can enter information into the clinical record.Patients have their own section in the eHealth record, separate from the clinical record. In this section, they are able to enter basic health information which you can see. They are also able to enter their own private notes for their own use which are not accessible to you or other healthcare professionals
  • Healthcare professionals participating in the eHealth record system may access a patient’s eHealth record in an emergency, where patient consent is not possible. This is consistent with existing privacy laws. In life-threatening cases where it is unreasonable or impracticable to obtain a patient’s consent to access their eHealth record, healthcare professionals may assert emergency access. This will override any access controls that have been set and provide your organisation with unrestricted access to a patient’s eHealth record for five days. Your use of the emergency access function will be logged in the audit log and may be notified to the patient if they requested notifications. Asserting emergency access is warranted where you believe that access to the information is necessary to lessen or prevent a serious threat to:an individual’s life, health or safety and the patient’s consent cannot be obtained. This might occur for example, if the patient is unconscious; or public health or public safety.
  • In the person health summary a consumer can enter summary information that can be viewed by healthcare professionals in the eHealth record system.Allergies, including the name and reaction.Medications, including the branded name of the productContact detailsCustodian of your advance care directive
  • People seeking healthcare in Australia can now register for an eHealth recordThe focus is initially on those who have the most to gain from eHealth records such as new mothers, older Australians and those with chronic conditions, and those who care for them, such as GPs, specialists and other allied health professionalsFor the South West WA Medicare Local this information session is just the beginning. From here we will be:holding workshops for ePIP readinessEncouraging the uptake/use amongst other health professionals and organisationsPromoting the eHealth record to key consumer groups – target populationsAnd investigating the potential gains of using eHealth in models of care eg. Chronic disease management.
  • Work is under way to provide the necessary information, training and education tools to help encourage people to register for Australia’s eHealth record systemFor more information call 1800 723 471 or visit www.ehealth.gov.au for regular updates
  • You can obtain both a HPI-I and HPI-O now. Healthcare professionals who are registered with the Australian Health Practitioner Regulation Agency (AHPRA) will have been assigned a HPI-I and AHPRA will have advised them of this number. Healthcare professionals in a field of practice not covered by AHPRA must apply for a HPI-I via the Department of Human Services.
  • Access is via a Clinical Information System (CIS) will only be possible as updated software becomes availableeHealth site vendors are expected to have upgraded software by May 2013. You can access a list from NeHTA with the current conformant software. Your conformant Clinical Information System (CIS) will identify you when you access the national eHealth record system. Healthcare professionals who meet the requirements willbe able to access the provider portal to view the patient’s eHealth record.
  • So if we go back to the eHealth cake – another layer is ePrescribing. And that’s what I’ll talk about briefly now.
  • In a nutshell ePrescribing is the secure (and reliable) transfer of prescription information between prescribers (GPs)and dispensers (pharmacists).
  • Just a matter of activating the systems at both ends. Who has the software?? If you are not sure we have a list which shows the practice software systems that have it in place.No more illegible handwritten prescriptions – think of the grey nomadsFewer transcribing and dispensing errorsFaster dispensing with no manual transfer of prescription dataFewer faxes and pharmacy call backs to doctors.
  • No more illegible handwritten prescriptions – think of the grey nomadsFewer transcribing and dispensing errorsFaster dispensing with no manual transfer of prescription dataSecure prescriptions sent to the right people with fewer lost or misplaced prescriptionsFewer faxes and pharmacy call backs to doctors.
  • Easy win – Come on – lets get this happeningIs available on most clinical software – just needs to be activated.eHealth PIP (ePIP) - Incentivises general practices to adopt eTP CIS = Clinical Information System PES = Prescription Exchange ServicePKI = Public Key Infrastructure Under the 5th Community Pharmacy Agreement (5CPA), 15c is paid for every electronic prescription that is drawn down. -Cost neutral to pharmacists, free to GPs -eRx and MediSecure will need to comply with Australian Technical Specifications to continue their access to the 5CPA.
  • Example of the grey nomads
  • So – back to our eHealth layers. Another part of eHealth is Telehealth, and I’ll hand over to Tom…
  • E health what it means for you

    1. 1. eHealth: What it means foryouPresenters: Michelle McClure and Kathy RainbirdMarch 2013
    2. 2. Connecting health careIntroducing eHealth• Better decisions• Better access to information• Better co-ordination• Better care for individuals Better health
    3. 3. What is eHealth?e-health is the electronic collection,management, use, storage and sharing ofhealthcare information.
    4. 4. eHealth Records Secure messagingeHe Telehealthal ePrescribingth eSpecialist Letters eReferrals Electronically received results
    5. 5. Extrapolating ehealth evidence• Clinicians spend around a quarter of their time collecting information rather than treating patients.• ePrescription systems in Sweden, the US and Denmark increased health provider productivity per prescription by over 50%.• eReferrals in Europe reduced the average time spent on referrals by 97%.• For Your Information, Australia Audit Commission, Canberra, 1995 5. Karl A Stroetmann KA, Jones T, Dobrev A, Stoetmann VN, ‘An Evaluation of the Economic Impact of Ten European E-Health Applications’, 2007 6. Ibid
    6. 6. Benefits of eHealth• Improvements to patient care• Access to patient history: administrative & clinical efficiencies• Better communications with other health care providers: leading to better coordinated care• Efficiency: time saved by not searching for clinical documentation• Innovations: clinical support tools that make work easier• Data cleansing tools: better quality data results in better practice management and clinical care
    7. 7. eHealth RecordIn July 2012 the Australian Governmentintroduced a personally controlled electronichealth (eHealth) record systemPeople seeking health care in Australia can nowchoose to register for an eHealth recordHealthcare organisations that choose toparticipate will, over time, have access toimportant health information, helping providesafer, more efficient care for consumers
    8. 8. Benefits of the eHealth Record• Reducing unnecessary tests, hospitalisations & follow-up specialist visits• Better access to patient data• Allow more time for treating patients• Patients with chronic conditions can better monitor their healthcare• Secure, online access to patient information can improve patient safety• Better access to hospital information
    9. 9. What will eHealth records include?Two set of information – clinical and personalAs the system grows, an eHealth record maycontain the following:• A shared health summary – including medical conditions, medications, allergies, previous adverse reactions and immunisations• Event summaries• Hospital discharge summaries
    10. 10. What will an eHealth record look like?
    11. 11. How it works…
    12. 12. Common misconceptionsProgress notes will be sharedPatients can change the recordIt will take too much time for little reward
    13. 13. Common misconceptionsProgress notes will be shared Patients can change the recordIt will take too much time for little reward
    14. 14. Common misconceptionsProgress notes will be shared Patients can change the record It will take too much time for little reward
    15. 15. Common misconceptionsProgress notes will be shared Patients can change the record It will take too much time for little reward 
    16. 16. Does it replace existing records?eHealth records don’t replace existing medicalrecordsHealthcare professionals will continue to takeand review clinical notes – the eHealth recordsystem provides a summary of key healthinformation, so other healthcare professionalscan see relevant information
    17. 17. Who will have access to a patients eHealthrecord?Healthcare professionals working for aregistered healthcare organisation can enterinformation into the clinical record, ensuring it isclinically relevant and accuratePatients can enter their own information as anaide-memoire for their own use and a summaryof information including demographics and basichealth information.
    18. 18. What about in an emergency?Healthcare professionals may access a patient’seHealth record in an emergency, where patientconsent is not possible but the person’s life orsafety may be at riskThis is consistent with existing privacy laws
    19. 19. What can patients enter? Personal Health Information Personal health summary Personal health notes Viewable by healthcare Private use. Not professionals viewable by healthcare professionals
    20. 20. What are the next steps for eHealth?People seeking healthcare in Australia can nowregister for an eHealth recordThe eHealth system will grow, as will thebenefits, as more Australians and healthcareprofessionals register
    21. 21. How can patients register for an eHealthrecord • Online: www.ehealth.gov.au • Over the phone: 1800 723 471 • In person: at a Department of Human Services service centre offering Medicare services • In writing: by completing a registration form from a service centre offering Medicare services, or downloading it from www.ehealth.gov.au
    22. 22. What can I do to prepare to access theeHealth record system?Your organisation will need a HealthcareProvider Identifier – Organisation (HPI-O) and tobe registered for eHealthTo participate in the eHealth record system as ahealthcare professional you will need aHealthcare Provider Identifier – Individual (HPI-I)
    23. 23. How do I access the eHealth recordsystem?To access the eHealth record system via clinicalsoftware, and be able to add to a patient’s eHealthrecord, you will need conformant Clinical InformationSystem (CIS) desktop softwareAccess via Clinical Information System will only bepossible as updated software becomes availableIf you don’t have CIS desktop software, you’ll be ableto view records as read only via the Provider Portal
    24. 24. In SummaryeHealth records will allow you to access asummary of your patients’ important information,assisting you to…• Save time• Allow for more coordinated care• Reduce possibility of adverse events• Provide better health outcomes for patients
    25. 25. eHealth Records Secure messagingeHe Telehealthal ePrescribingth eSpecialist Letters eReferrals Electronically received results
    26. 26. ePrescribing
    27. 27. What is ePrescribing?ePrescribing is the secure transfer ofprescription information between prescribersand dispensers.Prescriptions are transferred electronically viathe Prescription Exchange Service.
    28. 28. GP 2. Provides Patient prescription with barcode based 1. Submits ‘access key’ 3. Chooses prescription pharmacy and presents script 6. Dispense with ‘access key’ notification 4. Scans barcode barcode (optional) to retrieve ePrescriptionPrescription Exchange Pharmacist 5. Submits dispense record Diagram adapted from NEHTA ePrescriptions Overview, May 2012
    29. 29. ePrescribing softwareThere are 2 approved ePrescribing products:–eRx–MediSecureThese are interoperable through the prescribingexchange service
    30. 30. But… why?ePrescribing is easyePrescriptions mean:• No more illegible handwritten prescriptions• Fewer transcription errors• Faster dispensing with no manual transfer of prescription data • This allows more time for patient engagement if needed• Fewer pharmacy call backs to GPs
    31. 31. Benefits• Widespread use of ePrescribing will make it easier to implement more sophisticated systems • eg to share medicines information and improve medication management• Dispense notifications (optional)• Improved work flow for pharmacies
    32. 32. And remember….• It’s not mandatory, and for some practices and pharmacies it might not be viable• However, NPS encourages all general practices and pharmacies to seriously consider ePrescribing, and to implement it if possible• It’s a small, but crucial step towards improved quality and safety
    33. 33. Future BenefitsMay be one day we will no longer need paperscripts • No more rewriting lost scripts!
    34. 34. eHealth Records Secure messagingeHe Telehealthal ePrescribingth eSpecialist Letters eReferrals Electronically received results
    35. 35. Further information• Visit www.ehealth.gov.au or call the Helpline: 1800 723 471• RACGP http://www.racgp.org.au/your- practice/e-health/ehealthrecords/epip/• South West WA Medicare Local http://www.sw- medicarelocal.com.au/ or email Michelle McClure mmcclure@sw-medicarelocal.com.au
    36. 36. ReferencesAustralia Audit Commission, Canberra, 1995 5. Karl A Stroetmann KA, Jones T, Dobrev A, Stoetmann VN, ‘An Evaluation of the Economic Impact of Ten European E-Health Applications’, 2007 6. IbidNational E-Health Transition Authority. Retrieved January 2013, from www.ehealthinfo.gov.au.Otto, K. (2012, December 18). Callenges with eHealth adoption. Retrieved from www.trainitmedical.com.au.
    37. 37. eHealth

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