National E-Health Transition Authoritywww.nehta.gov.au

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eHealth and Practice Nurses: ‘Using eHealth to improve outcomes for your chronic disease patients.

6th December 2014

Heather McDonald - National E-Health Transition Authority

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1. Introduction to eHealth

2. What is eHealth and how does it relate to Practice Nurses?

3. Current state within Australia

4. Using Clinical documents for patients with Chronic Disease

5. How to use of clinical software to upload and view patient records

Overview

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The overwhelming belief of nearly all

the respondents is that an electronic

health record is a critical investment

for Australia that we should support.

PCEHR Review

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What is eHealth?In

form

ation

Sha

ring While our healthcare

system is among the best in the world, some of our ways of collecting and sharing healthcare information — such as medical history, test results, scans, or hospital discharge reports can be improved. Many clinical communications, are still completed on paper.

Stan

dard

s The healthcare software industry in Australia currently uses a number of different standards and formats for recording medical information that results in computer systems not being able to communicate with each other.

Patie

nt C

entr

ic The introduction of eHealth is helping to put the individual at the centre of their healthcare. In addition it reduces opportunities for errors and supports healthcare providers to share relevant patient information and make informed patient decisions.

eHealth is the collection, management, use, storage and sharing of healthcare information using information and communication technology.

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The eHealth Foundations combine the basic technologies of unique identification to provide a safe and secure method of exchanging healthcare information ie.( identification, authentication and encryption)

eHealth Foundations

Healthcare Identifiers (HI) Service

Operated by the Department of Human Services (Human Services) which allocates a unique 16-digit number (a Healthcare Identifier) to individuals using healthcare services and their practitioners and healthcare organisations.

The right health information associated with the right individual at the point of care

For more information on the HI Service visit: www.humanservices.gov.au/hiservice

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Information in an eHealth Record comes from 3 main sources

Patient Health Professional Medicare

Personal medications and allergies summary (can be viewed by healthcare professionals)

Personal health notes (can not be view by providers)

Child development information

Advance care directive custodian contact details

Shared Health Summary

Event Summary

eDischarge Summary

eReferrals and Specialist letters

Prescription and dispense records

Coming in 2014: eDiagnostic Imaging and Pathology reports

Medicare claims data

Pharmaceutical Benefits Scheme

Australian Childhood Immunisation Register

Australian Organ Donor Register

DVA claiming events

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How do I access the eHealth Record?

Individuals can access their health record via the consumer portal. Consumers are able to contribute to their health record by inputting personal health notes, medications and allergies.

Consumer Portal

The Provider Portal is view only. Healthcare providers can view and download a patient’s health information but cannot contribute to it.

Provider Portal

Healthcare providers with access to PCEHR conformant software are able to contribute to the patient’s eHealth record by uploading clinical documents via their software.

Conformant Clinical Software

The my child’s eHealth record app is for consumers with children under the age of 14 years. It allows parents and authorised representatives to access the child’s eHealth record and and view information about the child’s development.

Mobile ApplicationCons

umer

sPr

ovid

ers

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How does the eHealth record benefit Nurses?

Some of the key benefits for Practice Nurses and their organisations are:

Better access to health information

Health Information around your patient’s

current conditions and past records like diabetes,

heart disease, medications or past

surgeries.

Improved Continuity of Care

Continuity of care through accurate and timely communication and clinical hand over

across health professionals utilising

eHealth products.

Informed decisions on patient’s medical needs

Informed decisions on patient’s medical needs

through access to a health history that is shared rather than

recalled by the patient.

• Less time finding & calling other providers for information

• More efficient consultations

• Less duplication

• Provide efficient access to health information that you didn’t already have

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• Health information will travel with the individual

• Care not affected by the individual’s ability to remember their medical history

• Individuals have the ability to update personal data and view their health information online

• Better quality, safer and more efficient care for individuals (information availability & less time wastage)

• Reduction in duplications (tests, information, etc.)

How does the eHealth record benefit Individuals?

• Discharge Summaries available within 24 hours of discharge

• Linking e-Health communities

• Exchanging information• 2-way communication

flow• Hospitals sending

discharge summaries & Practices uploading SHS

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Adoption of eHealth in Australia

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Where are we now ?

Readiness Adoption Meaningful Use

Benefits Realised

Health Outcomes

Capabilities exist and ready to adopt

Engaging various parts of the health sector

eHealth interactions across sectors

Evidence of benefits and disbenefits

Evidence of improvements in long term health and economic outcomes

2012 – 14 Focus

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7,445 healthcare organisations (HPI-Os) registered in the PCEHR System.

Public Hospitals and Health Centres connected to the PCEHR

As at 5 September 2014

Healthcare Providers

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Targeting the Chronic Disease Patients.

• Information regarding uptake and registration numbers • How to engage and register appropriate patients• Using clinical software to register patients in the practice• When to upload clinical documents

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Impact to workflow

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eHealth Workflow Impact

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The duration of eHealth record activities is highly variable depending on the surrounding circumstances of the practitioner and the consumer. Examples include:

• Providers competence to efficiently use CIS (computer literacy)

• Cleanliness of existing clinical data

• Registration status of the consumer

• Ability for the consumer to comprehend the implications of a shared record

• Assisted registration model used by the practice – is it in your CIS?

• Support by practice staff to undertake eHealth activities prior to the consultation - registering patients at the front desk

• eHealth record knowledge of both the GP/Nurse and consumer

eHealth Workflow Impact (con’t)

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Three factors:• Widespread population registration i.e. the level of registration where

a provider will find a record more often than not when they look• Extensive adoption and use by healthcare providers across more

sectors• A large and compelling volume of content, presented in a way that

adds value to clinical workflow and decision making.

Are we reaching a tipping point of consumers, providers, content?

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What information is in an eHealth record?

Shared Health Summary Prepared by a health professional in consultation with the individual, is a summary of the individual's health at a point in time. It could include medical history, allergies and adverse reactions, medications the individual may be taking and any immunisations they have had.

Event Summary A clinical document used to capture health information about significant healthcare events from a healthcare professional. Information may include clinical synopsis, and medications.

Discharge Summary Created for an individual when associated with an event/hospital admission. May include diagnosis, key dates, clinical synopsis, diagnostic investigations and medications upon discharge, improving the continuity of care between healthcare professionals.

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How does a Shared Health Summary look?

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What does an Event Summary look like?

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What does a Discharge Summary look like?

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What does a Discharge Summary look like? (Cont)

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View of National Prescribe & Dispense Repository (NPDR)

JIM CITIZEN

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Adoption of eHealth has not yet translated to use that delivers anticipated

value

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Proportion of organisations registered in the eHealth Record System who are using the system, per week

Sep-12

Oct-12

Oct-12

Nov-12

Dec-12

Dec-12Jan

-13

Feb-13

Feb-13

Mar-13

Apr-13

Apr-13

May-13

Jun-13

Jun-13Jul-1

3

Aug-13

Aug-13

Sep-13

Sep-13

Oct-13

Nov-13

Nov-13

Dec-13Jan

-14Jan

-14

Feb-14

Mar-14

Mar-14

Apr-14

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

-5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Total organisations registeredPercentage accessing (all transactions)Percentage uploading documents

Tota

l org

anis

ation

s re

gist

ered

Est.

% u

niqu

e or

gs a

cces

sing

/upl

oadi

ng p

er w

eek

Limited use

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Factors affecting momentum of eHealth use

For you as the Practice Nurse and as a consumer – identify some of the factors that are affecting your use of eHealth

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Where are we heading?

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Transforming Adoption into Use

Adoption: ready and available

Adoption has occurred at a faster rate than any other country rolling out a national eHealth infrastructure.

In targeted areas (general practice, public hospitals and community pharmacy) registration numbers exceed the most optimistic projections made.

Overall, an estimated 70% of general practices; 20% of community pharmacies and 100% of public acute facilities in ACT, NT, QLD, Tas are registered in the eHealth Record System and have enabled software. Private acute facilities are now planning to connect.

Almost 2 million people have eHealth Records.

Use: improving patient outcomes

We now need to shift gear and focus on use.

This means:

Focusing on patients who have the greatest need.

Supporting those enabled healthcare providers who care for these patients to make use of the system.

Championing the system to users as being critical infrastructure that’s needed, wanted and here to stay.

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• Think about your practice – • Were there any barriers to

registration? • Barriers to increased Use ?

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• What strategies do we need to apply to overcome the barriers to use

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Practical ways to get the best out of your eHealth record system

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Preparation - Why is it important?• To access a Patient’s eHealth record:

• Correct Patient’s demographic details need to be within your Clinical Information System (CIS) (family name, given name, sex, DOB and Medicare / DVA number) – helpful tips at end of presentation

• Ensure the Patient’s demographics in the CIS match with Medicare and Patient

• Validate the Patient’s IHI which requires up-to-date demographic data

• Implication of “unclean” or incorrect demographic data means you won’t get a match from the HI Service and you will receive an error message

The role you can play

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Data quality and cleansing is so important

• archiving inactive patients

• removing sample patients

• merging duplicate patient records

• maintaining recall lists

• updating medications

• completing and clearing outstanding ‘actions’ or ‘requests’ etc.

• ensure consistent clinical terminology by utilising drop down menus where possible – minimising free text entries

How to Prepare – Step One

Data cleansing good practices• Reconfirm patients

demographics data every visit

• Ensure all of Practice are aware to avoid duplications

• Work with Practice Health Team to define a policy of active versus inactive patients

• eg - if patients hasn’t visited practice twice in the past 3 years

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Learn how to use your tools to help with data cleansing:• Your Clinical Software search tool• Pen Clinical Audit Tool – www.pencs.com.au• Canning Tool

RACGP - Quality health records in Australian primary healthcarehttp://www.racgp.org.au/download/Documents/PracticeSupport/2013qualityhealthrecords.pdf

RACGP - Sample compliance checklist for quality health recordshttp://www.racgp.org.au/your-practice/business/tools/support/qualityhealthrecords/sample-checklist/

 

 

Prepare & Plan – Step Two

Links to assist with data cleansing RACGP Electronic health records Health Summary Fact Sheets http://www.racgp.org.au/ehealth/summary

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Troubleshooting

• Record the error message

• Screenshot error message (make sure image is de-identified) and contact your software vendor – helpful links at end of presentation

• Use Snipping Tool – NEHTA Customer Care team can guide you through this

• If you have an issue validating IHI it most likely is a mismatch with Medicare – get patient to call Medicare to validate demographic details

• Call NEHTA Customer Care team on 1300 901 001 – we can determine your issue and triage your call

What to do if you encounter an issue

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For Providers

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Software Demonstrations

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Training Environment

The eHealth Training Environment is a simulated environment demonstrating the interaction between the PCEHR and respective desktop applications. It is designed to be used by Practitioners who already have an understanding of the eHealth functionalities within their Software.

You can demonstrate: • Interacting with the Healthcare Identifiers Service (HI Service)

• Uploading clinical documents to the PCEHR

• Viewing and downloading clinical documents from the PCEHR

• Performing assisted registration

• Or a sand box to play around in

The eHealth Training Environment has 12 test patients populated so you can manipulate test patient information in order to simulate changes to a patient’s eHealth Record.

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Where to next?

• Start data cleansing• Familiarise yourself with your own eHealth record• Select patients for pilot • Start your Pilot on 5 patients

• Try uploading a Shared Health Summary without cleansing the data

• Data cleanse and then upload again – note the difference in speed• Start Assisted Registration – http://

www.nehta.gov.au/for-providers/ehealth-support-tools/software-demonstrations/provide-assisted-registration

• Start looking up and validating IHI’s• Start creating Shared Health Summaries & Event Summaries• Review software demonstrations on the NEHTA website - http://

www.nehta.gov.au/for-providers/ehealth-support-tools/software-demonstrations

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Call NEHTA help centre on 1300 901 001 or email help@nehta.gov.au

eHealth registration resources available at www.nehta.gov.au/for-providers

Visit www.ehealth.gov.au for information on the eHealth Record System and promotional resources.

Contact your Software Vendor

Where to get help?

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Questions?