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PCeHR Lessons Learnt and the Future of E-Health

PCeHR Lessons Learnt and the Future of E-Health. Presenter: Dr Greg Wyatt. Welcome. This presentation is based on RACGP’s eHealth record system – Adding value to clinical consultations This seminar is designed and delivered by GPs for GPs and practice teams

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PCeHR Lessons Learnt and the Future of E-Health

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  1. PCeHR Lessons Learnt and the Future of E-Health Presenter: Dr Greg Wyatt

  2. Welcome • This presentation is based on RACGP’s eHealth record system – Adding value to clinical consultations • This seminar is designed and delivered by GPs for GPs and practice teams • Seminar is not designed to teach you how to: • set up your GP desktop system to interact with the national eHealth record system (I actually will do some of this) • register to participate in the national eHealth record system • meet ePIP requirements • For assistance with registration and set up, contact your Medicare Local • I wish to formally acknowledge the RACGP’s consent to use these slides Bp Sunshine Summit 2014

  3. Where are you? Bp Sunshine Summit 2014

  4. What are we learning today? By the end of this session, you should be able to do the following: • recognise the purpose, scope and benefits of the eHealth record system to clinicians • identify patient groups that would benefit most from the eHealth record system • create shared health summaries with high quality data aiming to improve patient outcomes • identify precautions to be taken when using the eHealth record system • integrate the eHealth record system into routine practice workflow. Bp Sunshine Summit 2014

  5. Agenda • The national eHealth record system • What is it and what does it do? • What information does it contain? • What are the benefits? • What are the limitations and precautions? • Putting national electronic health records into practice • What are shared health summaries and event summaries? • What, when and who of uploading? • Who and how to engage? • What does the future hold? Bp Sunshine Summit 2014

  6. What is the PCEHR? • An important piece in the national e-health agenda • A document store • A new way for patients to share: • key pieces of their health information • with providers of their choice Bp Sunshine Summit 2014

  7. What it is not • A replacement of local clinical records • A replacement of current standard point-to-point communications Bp Sunshine Summit 2014

  8. Patients decide … • Whether or not they have a national electronic health record – it is opt-in • Who can access it (record control and organisational control) • What information is displayed (document control) Patients can also view an audit trail showing who has accessed their record and when. Bp Sunshine Summit 2014

  9. Hippos, Hippies and IHIs80036XXXXXXXXXXX • HPI-O 8003620123456789 • Healthcare Practitioner Identifier – Organisation • Your practice should have one (or apply for one) • HPI-I 8003610123456789 • Healthcare Practitioner Identifier – Individual • You should have one – all AHPRA registered practitioners have one • Non-AHPRA (eg Speech Pathologist) can apply for one • IHI 8003600123456789 • Individual Healthcare Identifier • All Medicare and DVA eligible persons and a few others Bp Sunshine Summit 2014

  10. Hands up… • Does the idea of patients controlling what information they share with you worry you? However • Patients cannot modify clinical documents • Less than 1% of patients restrict access • Emergency access overrides any access controls Think about • How is this different from the situation now? Bp Sunshine Summit 2014

  11. Types of information available • Shared health summary • Event summary • Discharge summary • Specialist letter • Referral Healthcare professional or organisation • Medicare services (MBS & DVA) • Prescription information (PBS & RPBS) • Immunisations (ACIR) • Donor details (AODR) • Medication record (NPDR) new • Test results future • Advance care directive future Other data sources (e.g. Medicare) • Personal health summary • Personal health notes (not available to providers) • Advance care directive custodian • Emergency contact • Child eHealth record new Patient

  12. Clinical scenarios • DAVID • Single 40-something FIFO mining engineer with MS • BILL • 50-something indigenous Australian with diabetes • NELLIE • 75+ who lives in granny flat attached to son’s house • DES • Grey nomad Bp Sunshine Summit 2014

  13. Meet David • Age 42 • Single • Fly-in fly-out worker • Multiple sclerosis • Seeing his usual GP for checkup • Couple of months ago fell and lacerated chin (while away) • Doctor was spooked by MS tried to contact GP (but after hours) • Doctor gave letter for GP but David “lost it” • Nurse suggested he set up PCEHR • Has done so but needs SHS • Is it the “right” David Zeigler? • GP cleans data, creates SHS and discussed it • Uploads SHS to PCEHR with David’s consent Bp Sunshine Summit 2014

  14. Thoughts? • What was different? • David has a new way to share information • A shared health summary (SHS) was uploaded • What stayed the same? • Current standard records • Current standard clinical communications • Current standard patient–doctor communications Bp Sunshine Summit 2014

  15. Meet Bill • Age 53, married, Indigenous • Lives in Rural area • Type 2 diabetes • He and his wife have come to the city to help daughter (injured in MCA) look after grandaughter • Forgot his medication • Sore foot – getting worse • Visits daughter’s GP and can’t remember his usual medications • Mentions he has one of those “eHealth thingies” • GP able to open his PCEHR and ascertain his medications • Antibiotics for infected foot, scripts for forgotten medications (CTG) • Creates ES and uploads • Stays for week or so then travels to visit another relative on way home • Drops into AMS to have foot checked - doctor can view PCEHR Bp Sunshine Summit 2014

  16. Thoughts? • What did this scenario highlight? • The national eHealth record system can provide efficient access to health information that you didn’t already have • Valuable information can be obtained via the provider portal • The national eHealth record system is valuable in out of context visits • And again, the eHealth record system does not replace: • Local GP records • Current standard clinical communications • Normal patient–doctor communication but it can mean you don’t have to rely solely on patient memory Bp Sunshine Summit 2014

  17. Meet Nellie • Aged 90, widowed • Lives in granny flat at son’s house • Son is her authorised representative and has set up her PCEHR • Recently visited at home by community pharmacist and practice nurse • Seeing GP to complete 75+ health check and HMR • Been seeing GP for years – knows her well • Goes thru report from pharmacist and amends medication list • Discusses notes from nurse – floor mats are trip hazard • Opportunity to clean data and create updated summary • Creates SHS and uploads it with Nellie’s consent (herein lies a problem) Bp Sunshine Summit 2014

  18. Authorised representative and Nominated representative • Authorised representative • Applies where person cannot make his/her own decisions • Parent or formal carer of child under 18 • A child over 14 may administer his/her own PCEHR if he/she wishes and is capable of making his/her own decisions (so no authorised representative applies) • For an adult, a person who is legally authorised to act on behalf of a consumer • Consumer cannot control PCEHR if an authorised representative is appointed • Nominated representative • May be nominated by a consumer to assist in the management of their PCEHR • Both consumer and nominated representative may control PCEHR • Both authorised and nominated representatives must act in consumer’s best interests Bp Sunshine Summit 2014

  19. Thoughts? • What does the scenario with Nellie highlight? • National electronic health records can be valuable for older Australians • Patients can have a nominated or authorised representative(s) • A shared health summary (SHS) can be uploaded when local records are being updated • The clinician and patient (or authorised representative) confirm the content of the SHS before it is uploaded Bp Sunshine Summit 2014

  20. Meet Des • Aged 74, married to Grace • Heart attack 2 yrs ago • Grey nomads, travelling around Australia in campervan • Chest pain while changing flat tyre, settled quickly • At next town, attends hospital (after nagging by Grace) and seen by on-call GP • GP checks his PCEHR • ECG and serial enzymes normal • Dx – chest muscle strain • Rx – Rest, stretching • Will send letter to usual GP • Uploads ES Bp Sunshine Summit 2014

  21. Thoughts • What was different? • The GP had access to health information that she wouldn’t normally have had • The GP could upload an event summary that could accessed by future out of context healthcare providers • What stayed the same? • Current standard practice – clinical judgement and decision making • Current local record keeping practices • Current point-to-point communications back to the usual GP Bp Sunshine Summit 2014

  22. The national eHealth record system … is: • a digital record of your patient’s key health information • opt-in • a potential enhancement of medical information • a source of information to assist information sharing and decision making • multiple sources of health information accessed through a central point • personally controlled is not: • a replacement for existing practice clinical records • compulsory • a requirement for medical treatment • a replacement for current standard information sharing and clinical decision making • a single government store of personal information • going to look the same in 5 years time Bp Sunshine Summit 2014

  23. What are some limitations and precautions? • National electronic health records are personally controlled • The system is voluntary • The national eHealth record system contains summary information Bp Sunshine Summit 2014

  24. What about privacy & security? • Security and privacy of the national eHealthrecord system is protected by: • Secure technology (similar to banking) • New and existing legislation • Design principles allowing only authorised participating organisations access to patient information. • Security and privacy of your local data is protected by: • Your normal practice policies to keep patients’ health information confidential and secure • Your compliance with RACGP Computer and Information Security Standards. Bp Sunshine Summit 2014

  25. Any questions to date? Bp Sunshine Summit 2014

  26. Putting the national eHealth record system into practice Bp Sunshine Summit 2014

  27. Conformant software – Best Practice Bp Sunshine Summit 2014

  28. More on Healthcare Identifiers • Practice must be registered (and thus have HPI-O) • NASH certificate must be loaded on server (see Bp FAQs) • Users must be registered (and thus have HPI-I) • Individual NASH certs only used for web based access to PCEHR (Provider portal) • Need to know patient’s IHI • Consent implicit and may legally be collected if related to current or planned healthcare • “Live” demo Bp Sunshine Summit 2014

  29. PCEHR Patient Registration • Assisted Registration • Phone • Mail • On-line • Medicare shopfront Bp Sunshine Summit 2014

  30. Assisted Registration 1 • Practice needs to have HPI-O and be registered to participate in eHealth system • Obtain ART or compliant practice software (Bp is compliant) • New in Bp (Summit 2014 edition – 1.8.4.640+) • Bp tool much easier that the PCEHR supplied software • Develop and implement Assisted Registration policies (in P&P manual) • Can be done by any authorised practice staff member • No additional registration process to provide Assisted Registration to your patients Bp Sunshine Summit 2014

  31. Assisted Registration 2 • Only takes a few minutes • Patient reads 2 page info sheet from www.ehealth.gov.au (I have some printed laminated copies at my clinic) • Patient signs and reads application form (template in Bp) • Staff asserts ID • visited 3 times (incl today) and MC or DVA card sighted or • registering as new patient and 100 points ID (ie passport/birth cert + licence etc) • Use ART to upload patient details (upload or file application form) • IVC sent to patient by SMS, email or on screen if successful • Can upload SHS to PCEHR immediately Bp Sunshine Summit 2014

  32. What’s in a shared health summary? • Allergies and adverse reactions • Current and past medical history • Medicines • Immunisations • It is just like the summary that Bp already produces Bp Sunshine Summit 2014

  33. Developing a shared health summary Think about: • who might read it • what information they need • ‘what would I want to see if this patient was new to me?’ Bp Sunshine Summit 2014

  34. Uploading a Shared Health Summary • Doesn’t take long – good opportunity to clean up your data • Note PCEHR column in Past History screen • Can only be uploaded with patient’s (or parent’s or authorised representative’s) consent – only needs to be verbal and GP ticks box • “Live” demo Bp Sunshine Summit 2014

  35. Event Summaries • Are for a defined ‘event of care’ • Stand alone • Are not progress notes • Are for ‘clinically significant’ events • Don’t replace normal clinical communications • Can be created by any participating healthcare provider • Content is flexible and are going to be used in a number of ways… Bp Sunshine Summit 2014

  36. What events need an event summary? • Useful • Medication dose change • Adverse reaction to medication • First time UTI in a male • Immunisation • Less useful • Repeat prescription • Mild, resolving sporting injury • Recurrent UTI in a female • Not useful • Consultation with no change in status or management Bp Sunshine Summit 2014

  37. Will national electronic health records impact my workflow? • Time spent uploading and viewing • Time saved looking for information Bp Sunshine Summit 2014

  38. Audit trail • Bp maintains an audit trail of all PCEHR activity • Main screen → View → PCEHR Audit • Shows • Date & time • Patient, IHI (& Authorised representative IHI if applicable) • User, HPI-I & HPI-O • Operation & Result Bp Sunshine Summit 2014

  39. Who should we engage? • The national target groups are: • Patients living with chronic and complex conditions • Older patients • Parents with newborn babies (and the babies) • Aboriginal and Torres Strait Islander peoples • People with mental health conditions • Which of your patient groups would benefit the most? • E.g. carers – 55+ people with parent in a nursing home • People with disabilities (herein lies a problem) Bp Sunshine Summit 2014

  40. How might we engage them? • At reception • In the waiting room • In the consultation • On your website • In your newsletters Bp Sunshine Summit 2014

  41. Key messages • The national eHealth record system: • is a shared clinical document and data repository • is an opt-in system for GPs and their patients • does not replace existing communications between healthcare providers • does not replace your practice’s clinical record system. • Patients decide what information they share with which providers. • There is no obligation for healthcare providers using the national eHealth record system to do so outside a clinical consultation • Implementation of the national eHealth record system is expected to drive other e-health initiatives which will improve the efficacy and safety of clinical practice. Bp Sunshine Summit 2014

  42. Where to from here? • More information can be found at: • your Medicare Local • http://publiclearning.ehealth.gov.au • www.ehealth.gov.au • www.medicareaustralia.gov.au • https://ama.com.au/getting-ready-pip-ehealth-incentive-and-pcehr • For a comprehensive look at the eHealth record system, download a copy of the Clinicians Desktop User Guide at: • www.nehta.gov.au/publications/nehta-publications • For more information about security and privacy, see: • the RACGP Computer and Information Security Standards (CISS) Bp Sunshine Summit 2014

  43. Computer and information security standards • Risk assessment • Staff roles and responsibilities • Access control and management • Business continuity and disaster recovery plans • Back, malware, viruses and email threats • Network perimeter controls • Asset registers • Portable devices and wireless networks • Physical, system and software protection • Governance processes • 2nd edition - June 2013 Bp Sunshine Summit 2014

  44. The future… What have we learned so far? What does the future hold for the PCEHR? Bp Sunshine Summit 2014

  45. Thank-you!Any questions? Bp Sunshine Summit 2014

  46. For assistance, please visit www.bpsoftware.com.au You can contact our Customer Support Team on: (07) 4155 8800 (07) 4153 2093 support@bpsoftware.com.au This session’s over. (But we’re still here for you) Bp Sunshine Summit 2014

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