Involving aged care in eHealth - A natural fit

Each individual Australian has been issued a health identifier (HI) number. This number will be able to be attached to every electronically held healthcare record made about a citizen over the coming months/years, including information held by Medicare. The inclusion of the HI in software programs across the country will form the cornerstone of the nation’s e-health project and the implementation of each citizen’s Personally Controlled E-Health Record (PCEHR).

The Aged Care IT Vendor Association along with the Aged Care Industry IT Council have been heavily involved in discussions with the Department of Health and Ageing and the National E-Health Transition Authority regarding the e-health process. These departments have released funds to support ‘Wave 2’ e-health projects which at present don’t include the aged care sector but it is expected that a near future project will address this gap.

The current Wave 1 and 2 projects traverse various Australian population cohorts and various health care settings including acute care, pharmacy services, GPs and diagnostic services. But to integrate the PCEHR into aged care organisations, aged care providers will have to see quality clinical outcomes from their software programs’ integration with the various ‘clouds’ which will hold vital clinical information regarding the clients and residents in their care.

By July 2012, some medical, pharmaceutical, diagnostic and other health information stored about an individual citizen, by software programs used by aged care providers, GP’s, pharmacists, hospitals, Medicare, diagnostic laboratories and others, can be made available to other healthcare providers through the sending of the stored health information, to secure internet based repositories. 

The information sent by software programs to secured repositories across the country will be attached to an individual via their HI number and will form the person’s personally controlled e-health record. Citizens will have control regarding what information is held about them in what is commonly called ‘the cloud’ and what is made available to healthcare providers. But before an individual citizen’s e-health information is made available to healthcare providers, they will have to opt-into this system and provide their HI number to healthcare providers.

In aged care, the benefits of accessing such information is clear. If every aged care client/resident has a history of health service usage, prescribed medicines and other diagnostic results, securely built in the ‘cloud’, this can be made available to aged care staff to review as necessary but most importantly, on admission. Aged care providers will have to have an accredited aged care clinical software program installed to access this information, but if prescribed medicines and past medical history details can be sourced instantly from the ‘cloud’, it would be expected that clinical misadventures can be avoided.

ACIVA has determined that aged care organisations can potentially lessen the number of hospitalisations and adverse medication events if they can access individual client/resident Personally Controlled E-Health Records upon admission and during their residence within the organisation. Access to healthcare knowledge built over years regarding individual clients/residents, can also assist the industry utilise limited Pharmaceutical Benefit Schedule (PBS) and Medical Benefits Schedule (MBS) resources in a judicious manner. Access to this knowledge can assist in making good healthcare management decisions.

To truly test and demonstrate benefits, the aged care industry needs to be able to access quality health and medication information held electronically in the various internet based repositories. This information will have been sent to these repositories by the various software programs used by health professionals across the country who have serviced individual clients/residents and which are linked to an individual client / resident’s HI number. Some of the information the accredited software programs will be able to access is held by Medicare.

Health professionals or organisations will need to be provided a person’s HI number and given approval to access these e-health information repositories on admission to realise clinical benefits. Aged care organisations are perfectly positioned as they already obtain an older person’s approval to access their health information on admission.

When the Commonwealth Privacy Act changed in 2001 to improve the confidentiality of information held by healthcare (and aged care) organisations, systems were developed by the industry to ensure compliance with the National Privacy Principles (NPP) related to accessing personal health information. These systems had to also address circumstances where client / residents or their authorised representatives wished to limit the information made available, i.e. where no information is to be provided to certain individuals. This well established process undertaken during the admission of every aged care recipient (and subsequently should client / resident personal circumstances change) ensures aged care is the best positioned industry in the country to implement and benefit from the e-health initiative.

The National Privacy Principle, ‘NPP 1 – Collection’ required aged care organisations to explain fully to clients /residents why information is collected, i.e. to develop appropriate care and activities plans, and to monitor and evaluate the effectiveness of care provided, so that changes to care are made as necessary. ‘NPP 2 – Use and Disclosure’ and ‘NPP 10 – Sensitive Information’ required aged care organisations to ensure only staff involved in care and Commonwealth or State Department officials could view health and other details. These systems can be easily enhanced to establish whether the aged care organisation healthcare staff and other professionals can access PCEHR internet based information stored about clients / residents.

There are over 180,000 residential aged care clients and over 40,000 community care clients receiving Commonwealth funding at present. For each resident or client, there are numerous family members and staff who will be able to see the benefits related to healthcare staff accessing ‘cloud’ health information to improve the health knowledge about and therefore care of their loved one.

ACIVA members through their client base, understand that the aged care industry need to be involved in projects demonstrating valuable and positive outcomes before the industry can commit funds (and the commensurate change management activities) to implementing projects such as the PCEHR initiative.

ACIVA has communicated this understanding to both Ministers and the commitment that ACIVA members have made to the HI and PCEHR initiatives so far. ACIVA actively encourages its members to understand the various secure messaging Standards and Compliance, Conformance and Accreditation (CCA) processes which need to be undertaken before being involved in any e-health project involving the Department of Health and Ageing, Medicare or NEHTA. And ACIVA members will variously develop components that will access the HI service over the coming year/s.

To access this information, the aged care industry will have to use accredited software programs that can access these repositories and send the HI number into ‘the cloud’ and bring back this information onto the screen. The software accreditation process (CCA) is only just now being developed and trialled, and will be made available for software programs to utilise in the coming months.

If the aged care industry is not involved in trialling and testing access to these health repositories, this could significantly reduce the uptake of any PCEHR related features across the sector. This will also reduce the significant ‘onsell-benefits’ which can be realised if families and staf f see firsthand, the great healthcare benefits that are achieved when healthcare providers have access to an individual citizen’s PCEHR.

Aged care will be a major user of the PCEHR. Building confidence in the PCEHR process via the aged care industry can assist the country to realise the benefits of the PCEHR system, which will in turn support the uptake of this initiative and citizens ‘opting into’ the process. ACIVA supports the initiative originally proposed with the Aged Care Industry IT Council and any other projects that truly involve aged care organisations across the nation.

Dr Caroline Lee

Dr Caroline Lee (RN) is the national President of the Australian Aged Care IT Vendors Association (ACIVA) and the Principal and CEO of Leecare software installed in over 250 aged care facilities across Australia. She is on the national Compliance Certification and Accreditation e-health Governance Committee monitoring the implementation of the Australian Healthcare Identifiers (HI) program (personal care e-health record across the nation and unique health identifiers) which will determine health records held for individuals in all health care settings. She works with various committees for the National e-Health Transitional Authority (NeHTA), is on the internationally renowned Joanna Briggs Institute Aged Care Advisory Committee and the Australian Aged Care Quality Association Committee. Her IT and aged care knowledge is a result of 20 years aged care management consulting, 12 years working with health software and her role as a Commonwealth Nurse Advisor for organisations under sanctions for the past 13 years. Her clinical knowledge was enhanced via her PhD thesis researching the Role of the Gerontological Nurse Practitioner in Australia, and the outcomes the role had on the physical, psychosocial and quality life of residents in residential aged care.