Landmark time for e-health in Australia

A national e-health system is well on its way and seamless alignment is now within our reach, writes Dr Chris Mitchell.

As a rural GP every day I see the challenges faced by my patients as they experience the health system and the challenges of creating a health system that connects primary care, the hospital, and aged care facilities.

In September I had the honour of accompanying the Minister for Health and Ageing Nicola Roxon at Parliament House as she viewed how e-health will work in practice – through a real-world walk through example of a patient journey from the medical centre, to the specialist, to the hospital, the pharmacist, the pathology lab, and back home. As we followed the patient journey at each stop, we saw how the relevant clinical information follows the patient, improves decision making, and with patient consent, can be uploaded to their e-health record.

It was just a few years ago that e-health was spoken about as something that was going to happen in the future. As the Lead of Change and Adoption for the Personally Controlled Electronic Health Record (PCEHR) programme at the National E-Health Transitional Authority (NEHTA) I’m pleased to say that e-health is here now!

The establishment of NEHTA six years ago marked a new Federal, State and Territory government collaboration to help drive a new era of health reform, connecting and streamlining the way Australians receive healthcare.

Our mandate was to establish the foundations or building blocks, to enable a national e-health infrastructure.

A national e-health system needs all parties involved in healthcare to be accurately identified – the patient, the healthcare provider, and the healthcare organisation – and an authentication process to prove organisations and people are who they say they are. You need a common language or terminology across the multitude of healthcare systems and a secure way for information and messages to be transmitted between them.

And on that journey, people’s information can’t just sit in one siloed healthcare setting; it needs to connect the system as people move from one care provider to the next. To do this we need templates and standards, so information recorded on their hospital discharge summary can be used by, for example, their GP and pharmacist.

There have been many e-health systems operating in Australia but we have not had the benefit of a nationally aligned e-health system.

A national e-health system is well on its way and seamless alignment is now within our reach.

The foundations we have built are now in place and many of these systems are in action or ready to go soon. Here are just a few examples:

• We can now correctly identify individuals in the system and make sure the right information is attached to their health records: Since July 2010, when the Healthcare Identifiers Service began, the Australian public has been allocated around 23 million individual healthcare identifiers. The lead e-health sites have downloaded more than one million of these in Brisbane, Melbourne and Newcastle to support more accurate patient administration. •
  


• We can now conformance test new types of medical software systems that use Healthcare Identifiers: In June 2011 the National Association of Testing Authorities accredited the first two laboratories to test conformance of both secure messaging services and software systems that will access the Healthcare Identifier Service, paving the way for a new generation of software to support healthcare professionals in their day-to-day practice.
  


• We now have a standard clinical language for Australian health professionals and its being put into action. SNOMED CT-AU (a clinical terminology adapted for Australia) is updated every six months and the Australian Medicines Terminology, a standard national approach to identify and name medicines is now released monthly as new medicines are released. Australian Medicine Terminology is now used in several clinical environments, after starting last year with Box Hill Hospital, part of one of Melbourne’s largest metropolitan health service. They use it to generate prescriptions for outpatients and discharge through their HealthSMART Clinical System.
  


• We now have standards that enable health professionals to securely communicate with each other: NEHTA’s conformance test specification and automated open-source test tools help software developers implement new Australian standards for secure message delivery. For the first time, there are now standards for software vendors to securely transmit key healthcare information.
  


• The Electronic Transfer of Prescriptions specifications being developed will support national standards for clinical information, terminology and secure communications between prescribing and dispensing organisations.
  


• We can ensure the right communication gets to the right person: Health professionals who use e-health systems need to be confident in systems they use to send information electronically. The National Authentication Service for Health does this and will support strong access control mechanisms for the personally controlled electronic health record, so patients can choose who to give access to their health records and have the opportunity to track if they wish who has looked at their records.

These are just some of the foundations which support e-health across Australia.

Personally controlled electronic health records for all Australians
From 1 July 2012 Australians will see a major milestone for e-health: all Australians will be able to register for a personally controlled electronic health record— enabling more accurate, better informed health decisions as people move around the health system - and giving Australians unprecedented access to a summary of their own health information.

The Concept of Operations document describes how the system will work. The document is based on an initial draft concept of operations developed with stakeholders in early 2011, followed by an extensive public consultation process.

E-health across Australia
Twelve e-health lead sites across Australia are also putting new types of e-health systems into action and what we learn from them at a local level will be applied progressively across our national rollout.

Almost everyone has a story about something that would be better with e-health. Mothers keeping track of the health of their newborn babies and their young families, Australians suffering from chronic disease who need to visit different health providers, patients in aged and palliative care, Aboriginal and Torres Strait Islanders and people living in rural and remote areas are just some of the groups set to benefit in the short term from the work now underway in the lead e-health sites and the progressive national e-health rollout that will follow soon after.

National change and adoption
Critical to the success of e-health in Australia is how we help educate and support the training and information needs of the health workforce who will use the system.

Australia’s health workforce will interact with the personally controlled electronic health record system in different ways.

For some, such as GPs, specialists, hospital-based care providers, pharmacists, pathologists, community health workers, and aged care providers, the new system will become a highly-integrated part of the regular way they provide care to their patients. For other parts of the health workforce, it will still play a role in helping them deliver care (for example, by viewing health records of their patients), but their interactions will be fewer and it will be less ingrained in their daily workflows. Therefore, the national change and adoption approach needs to be grounded in how care is actually being delivered, and an understanding of how the personally controlled electronic health record will enhance existing clinical workflows. The health workforce will not be uniformly ready to adopt the personally controlled electronic health record, and starting with an understanding of how it can help them – and then equipping them with the capabilities to use it – will be critical.

Consultation
The development and uptake of e-health in Australia does not happen in isolation. It is through the active debate between our stakeholders that we have been able to challenge and test the approaches we are taking.

We actively consult with consumers, the ICT industry, healthcare providers, and policy makers. NEHTA has a number of Stakeholder Reference Groups, with members from peak bodies and industry associations. These members are involved with every aspect of NEHTA’s work program. NEHTA’s Clinical Leads (comprising over 60 clinicians across multiple disciplines) are involved with all aspects of NEHTA’s work.

During March 2011 a series of forums were held with a number of key stakeholder groups including medical and practice managers, nursing, aged care, allied health, pharmacy, dentistry and optometry and the ICT industry. A larger forum was held with 200 representatives from four key stakeholder groups (consumers, ICT, healthcare providers, policy makers).

The objectives of these meetings were to inform stakeholders about the key elements of the draft PCEHR Concept of Operations (prior to its public release), to better understand any issues they may have with the proposed system design, and to seek their input on their requirements for successful delivery of a change and adoption strategy. The specific aim of the larger forum was also to enable cross-sector dialogue across the four key stakeholder groups, as had been requested by the Consumer Reference Group.

We also held a number of PCEHR workshops with target groups in the community likely to receive the most immediate benefit including people with chronic and mental health conditions, older Australians, people with disabilities, their families and carers, people living  in rural and remote areas, Aboriginal and Torres Strait Islanders, parents and babies and youth.

National health reform is all about improving health outcomes for all Australians. After years of conversation and consultation (which will continue) I am confident that the work being undertaken will shape the way healthcare is delivered for generations to come.

Dr Chris Mitchell

B.Med, FRACGP, FACRRM, Grad.Dip.Rural, FARGP, FAICD

Chris is a GP on the North Coast of New South Wales. He is the immediate past President of the RACGP. He leads the Change and Adoption Team for the Personally Controlled Electronic Health Record at the National E-Health Transition Authority (NEHTA) and began his work with NEHTA in February 2011. Chris is also a Board Member of the NPS (formerly the National Prescribing Service), Therapeutic Guidelines Limited and the Northern Rivers GP Network. Chris is a clinical professor at the University of Wollongong and holds a Fellowship of the Australian Institute of Company Directors. NEHTA has been tasked by the governments of Australia to develop better ways of electronically collecting and securely exchanging health information and is the lead organisation supporting the national vision for e-health in Australia. Visit www.nehta.gov.au for further information on NEHTAs work. Visit www.ehealthinfo.gov.au to keep up to date with e-health developments across Australia.