Dr. Ralph Hanson - NEHTA: Electronic Health Records


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A presentation given by Dr Ralph Hanson on Electronic Health Records at the CHA Conference The Journey, in October 2012.

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  • eHealth records will enable easier, more accurate sharing of information within all parts of the health system, including between GPs, specialists, pharmacists and hospitals. For example, eHealth records will help minimise unnecessary repeat tests, manage medication better and improve continuity of care.Healthcare organisations that choose to participate can, over time, access important health information more effectively, helping to provide safer, more efficient, and more effective care. SOURCE: ABS 2010a; 2010b, AIHW 2011, AIHW 2011; 2010a; 2010b, PHIAC 2011, MBS 2010
  • The National E-Health Strategy commissioned by Australian Health Ministers in 2008 defines the transformation of the Australian healthcare system from a ‘paper-based’ records system that limits access to a patient’s critical healthcare information to an electronic system that ensures the right information at the right place, at the right time.
  • NEHTA was established by The Council of Australian Governments to lead the uptake of eHealth systems of national significance; and coordinate the progression and accelerate the adoption of eHealth by delivering urgently needed integration infrastructure and standards for health information.
  • An eHealth record is a secure electronic summary of a patient’s health records. A national system has the potential to deliver better care for patients, save money and make the health system more efficient.eHealth records will not replace existing medical records. 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 practice. The eHealth record system provides an active online record that over time will follow patients as they move through Australia’s health system, including important clinical and treatment information at different points in time.All those seeking care in Australia will be eligible for an eHealth record. Registration for an eHealth record is voluntary and will not be required in order to receive health care.
  • Building on these foundations, from 1 July 2012, Australians will be able to register online for a Personally Controlled Electronic Health Record (PCEHR). This is a major focus of our attention, while we also continue to develop and launch improvements to our eHealth foundations and eHealth solutions for health professionals.With the Personally Controlled Electronic Health Record:For the first time Australians will be able to choose to have password controlled access to summary information about their medical history - including some of their medications, test results and allergies - allowing them to make better informed health decisions and have more informed conversations with their healthcare providers. They will choose who sees it, by setting access controls.For one in seven Australians suffering from a chronic illness, it gives them the ability to manage their illness more effectively, regardless of age or physical location. They will experience the freedom of enhanced shared care, improved decision support, and be more involved in the management of their own health. For mothers with young children, keeping track of immunisations, treatment and drug allergies will be much easier. Their data will be private, they will choose who accesses it and they will be able see who has viewed it.The frustration of repeating a full medical history, from memory, to several different doctors will be replaced by the doctor first double checking information held on the summary record. For doctors and nurses, there will be less trawling through lengthy paper records and quicker access to key and current issues. It will not replace the information held in health organisation’s own patient management systems, but will provide a standardised summary and access to some types of reports, to assist providers as the patient moves through different parts of the health system. Australians are used to the ease and efficiency that technology brings to banking travel and other services and they will soon realise similar benefits in managing their health. The PCEHR and other platforms we are building are the start of the story. They will be the base on which, in coming years, developers will create new and innovative health applications, which you can expect to experience the benefits of in your organisation. NETHA is the Managing AgentNEHTA is developing the architecture and system designThe Concept of Operations was released on Monday 12 September and from this the final product will be developedNEHTA will deliver it by June 2012 so that on 1 July 2012 all Australians will be able to register for oneIn the meantime, 12 eHealth lead sites are live examples of some of the elements in action and what we learn from these will be applied nationally.
  • July 2012 is just the starting point for the eHealth record system. Over time, a comprehensive national system can enable better access to a patient’s current health summary, updated medications, tests, results and treatment plans.The approach will be a staged implementation which will grow as more individuals and healthcare professionals become a part of itWhen Australians register for an eHealth record they will able to:Add their own personal health notes, emergency contact details and location of their advance care directiveSet privacy controls Register their children for an eHealth record
  • Dr. Ralph Hanson - NEHTA: Electronic Health Records

    1. 1. Perspectives on eHealth and the Personally Controlled Electronic Health Record (PCEHR)Dr Ralph Hanson FRACPClinical LeadThe National E-Health Transition Authority23rd October 2012
    2. 2. Objectives• Set the scene• Strategic context• Build the case for eHealth• Brief introduction to the National eHealth Record System (PCEHR)• Start a conversation on the opportunities and benefits for Child Health• A reality check
    3. 3. What eHealth could look like today
    4. 4. Health system faces a significant challenge in providing future health servicesCHALLENGES • Rapidly increasing demand for high quality, safe health services in an environment of constrained financial and human resources. • Key demand drivers include: – Ageing population – Increased prevalence of chronic diseases – New diagnosis and treatment technologies – Rising consumer expectations • Current workforce, service delivery methods and models of care will not be able to cope with this rising demand. • Can eHealth make a difference?
    5. 5. Strategic context
    6. 6. Building a case for eHealthHealthcare in Australia albeit of reasonably high quality faces some challenges:• Care is fragmented.• Inefficiencies abound.• Stakeholders don’t communicate effectively.• Tasks better suited to technology are completed manually.• Design, build and technology opportunities out of synch with models of care.• Clinicians have little time and incentive to adopt new technologies, many of which significantly change established workflows for which they may not be reimbursed.
    7. 7. The need to share health information• Every year Australians have an average of 22 interactions with the health system, including: Approximately 13% of health provider  4 visits to a GP consultations have missing information  12 prescriptions  3 visits to a specialist.• Most of the information from these visits is currently held in paper-based records in separate locations. Most of these records are not shared electronically. 7
    8. 8. The health care we provide is not always safe or efficient Some facts… • It is estimated 5,000 patients die each year due to adverse medical events •Up to one in six (18%) medical errors are due to inadequate patient information •Almost two million Australians experience an adverse drug event each year and approximately 138,000 of these end up in hospital. •53% of medication mistakes are considered ‘definitely preventable’ •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 average time spent on referrals by 97%
    9. 9. Translating reform into the National eHealth StrategyeHealth is one of the most important opportunities to:o Improve the quality and safety of healthcareo Reduce waste and inefficiencyo Improve continuity and health outcomes for patients
    10. 10. What is happening in eHealth in Australia?• eHealth is an all encompassing term• Being pursued at a National and Jurisdictional level• In all health care settings private and public• Varying stages of maturity• Progress often slow but getting there.....
    11. 11. Where does NEHTA fit in? Lead the uptake of eHealth systems of national significance; and coordinate the progression andaccelerate the adoption of eHealth by delivering urgently needed integration infrastructure and standards for health information. eHealth Foundation Services Priority eHealth Solutions Secure Identifiers Authentication Terminology Messaging eDiagnostics eDischarge eReferral eMedications
    12. 12. Who is delivering the eHealth records system? DOHA Benefits National External National Department And Change and DeliveryInfrastructure of Human Partner NEHTA Evaluation Adoption Assurance Services Partner Partner Advisor (NIP) (DHS) (BEP) (NCAP) (EDAA) eHealth record system implementation is a partnership between governments, NEHTA and the market.
    13. 13. What is an eHealth record – the NationaleHealth Record System(PCEHR)?• An eHealth record is a secure electronic summary of a patient’s health records.• eHealth records will not replace existing medical records.• The eHealth record system provides an active online record that over time will follow patients as they move through Australia’s health system• All those seeking care in Australia will be eligible for an eHealth record. Registration for an eHealth record is voluntary and will not be required in order to receive health care. 13
    14. 14. The Personally Controlled Electronic Health Record Key Principles o Participation is voluntary (Opt-in) o Provider access is under consumer control o The PCEHR is not a replacement for organisational clinical records o The clinical component contains copies, not originals o The ‘Source of truth’ remains where it is today – in local clinical records
    15. 15. From 1 July 2012, Australians have been able to register online for an eHealth record & Health Care Organisations are able to register to participate in the system• National infrastructure in place• A starting point• Value of the system will grow gradually over time• A guide is available to help healthcareorganisations register• As more consumers and healthcare providers join up, the system’s functionality will expand, more features will become available, and the benefits will grow accordinglywww.ehealth.gov.au
    16. 16. National eHealth Record RolloutTimeline FunctionalityJuly 2012 Consumers started registering for an eHealth record, setting their access controls and creating their own consumer health summary recordNext Steps As providers become ready the eHealth record system will include the sharing of:  Shared health summaries  Health overview  Event summaries  Discharge summaries  Specialist letters  eReferrals  Medicare data, including child immunisation data, organ donor register data, DHS data and PBS and RPBS data Healthcare professionals can, with patient consent, access the above information through:  Conformant clinical information systems
    17. 17. Are consumers ready?o High technology take-up rateo Four in five Australians want to move from paper based recordso 77% support eHealth record system once explainedo Most consumers believe they have knowledge required to use eHealth records 18
    18. 18. Are healthcare professionals ready?o 96% + GPs have access to computer and internet in officeso 95% of GPs use electronic patient medical recordso Most GPs have access to patient information required to create eHealth recordo 38% of GPs agree they would encourage their patients to register for an eHealth recordo Allied health professionals and medical specialists still face a fragmented software vendor landscapeo Likely long lead time in moving to universal hospital access to eHealth record 19
    19. 19. Specific issues for children, young people and familiesChallenges Opportunities• Delayed registration • Lifelong record• Personal control • Shared / Integrated care • Child • Greater involvement in care • Adolescent / Young person • Move to an Electronic Child From 14 Health Record From 18 • Enhance benefits of CHR eg• Representatives Improve immunisation • Authorised status • Nominated
    20. 20. Where to from here?• Significant opportunities for healthcare organisations to improve efficiency and effectiveness through eHealth• Immediate need to get eHealth ready to support clinical care and facilitate participation in the National electronic health record system
    21. 21. The reality check :……eHealth improving the patient experience? Change is about people not the technology!
    22. 22. Thank you and Questions www.ehealth.gov.au www.nehta.gov.au23 National E-Health Transition Authority www.nehta.gov.au