Clinical Handover 2011(Rmcg)

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Clinical Handover 2011(Rmcg)

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

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