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Dr. Ralph Hanson - NEHTA: Electronic Health Records
1. Perspectives on eHealth and the
Personally Controlled Electronic Health
Record (PCEHR)
Dr Ralph Hanson FRACP
Clinical Lead
The National E-Health Transition Authority
23rd October 2012
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
4. Health system faces a significant challenge
in providing future health services
CHALLENGES
• 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?
6. Building a case for eHealth
Healthcare 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. 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.
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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. Translating reform into the National
eHealth Strategy
eHealth is one of the most important opportunities to:
o Improve the quality and safety of healthcare
o Reduce waste and inefficiency
o Improve continuity and health outcomes for patients
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. Where does NEHTA fit in?
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.
eHealth Foundation Services Priority eHealth Solutions
Secure
Identifiers Authentication Terminology Messaging eDiagnostics eDischarge eReferral eMedications
12. Who is delivering the eHealth records
system?
DOHA
Benefits National External
National Department
And Change and Delivery
Infrastructure 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. What is an eHealth record – the National
eHealth 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.
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14.
15. 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
16. 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 healthcare
organisations 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 accordingly
www.ehealth.gov.au
17. National eHealth Record Rollout
Timeline Functionality
July 2012 Consumers started registering for an eHealth record, setting their access controls
and creating their own consumer health summary record
Next 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
18. Are consumers ready?
o High technology take-up rate
o Four in five Australians want to move from paper based
records
o 77% support eHealth record system once explained
o Most consumers believe they have knowledge required
to use eHealth records
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19. Are healthcare professionals ready?
o 96% + GPs have access to computer and internet in offices
o 95% of GPs use electronic patient medical records
o Most GPs have access to patient information required to
create eHealth record
o 38% of GPs agree they would encourage their patients to
register for an eHealth record
o Allied health professionals and medical specialists still
face a fragmented software vendor landscape
o Likely long lead time in moving to universal hospital
access to eHealth record
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20. Specific issues for children, young
people and families
Challenges 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
21. 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
22. The reality check :……eHealth improving the patient
experience?
Change is about people not the technology!
23. Thank you and Questions
www.ehealth.gov.au
www.nehta.gov.au
23 National E-Health Transition Authority
www.nehta.gov.au
Notes de l'éditeur
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