clinical handover 2011(rmcg)
DESCRIPTION
TRANSCRIPT
Consumers and clinical handoverConsumers and clinical handover
How consumers can
participate in
GP/Hospital handover
Russell McGowan
15 April 2011
My storyMy story
Same GP in Canberra since 1981
Diagnosis at WVH - 1991
Surgery - 2002
Inpatient blood transfusions – 1992
BMT in Royal Adelaide - 1993
Re-admissions TCH 1993, 1994, 2006
Referal to Westmead - 2003
Specialists - within hospitalsSpecialists - within hospitals
Haematologist
Infectious disease specialist
Cardiologist
Thoracic physician
Gastroenterologist
Oral physician
Specialists – outside hospitalsSpecialists – outside hospitals
Ophthalmologist(s)
Dermatologist(s)
Neurologist
Dentist(s)
Physiotherapist(s)
Formal discharge summaries issued Formal discharge summaries issued to GPto GP
ZIP
Formal referal letters from GPFormal referal letters from GP
10% of occasions
Formal feedback from specialistsFormal feedback from specialists
10 -20% of the time
The Answer?The Answer?
The personally controlled electronic health record (pcehr)
Personally Controlled E-Health Personally Controlled E-Health RecordsRecords
• Safer healthcare• Improving direct patient care by more timely access to
clinical information
• Capacity to share information more readily
• Clinical decision support systems
• Higher quality healthcare• Supports and enables better team base care
• Supports chronic disease management initiatives
• Shares knowledge amongst health professionals
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E-Health more generallyE-Health more generally
• Direct patient care: better, more timely & accurate -Transfer of clinical information
• Better patient care: Safety & Quality:- Clinical decision support
• Cost savings in terms of less “re-do” of tests and better safety and quality so potentially less unplanned re-
admissions
• Support for chronic condition management
• Support for team based care / engaging health professions in health care delivery:- Improved sharing of clinical information
• Management and planning of healthcare services:- improved, accurate, relevant and up to date information.
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Foundations for e-healthFoundations for e-health
1. Healthcare Identifiers – IHI, HPI-I, HPI-O
2. National Authentication Service for Health (NASH)
3. Secure Messaging
4. Clinical Terminology
5. National Product Catalogue
6. Compliance, Certification & Accreditation
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Healthcare IdentifiersHealthcare Identifiers
• Individual Healthcare Identifier (IHI) – for individuals receiving healthcare services.
• Healthcare Provider Identifier – Individual (HPI-I) – for healthcare professionals and other health personnel
involved in providing patient care.
• Healthcare Provider Identifier – Organisation (HPI-O) – for organisations (such as the hospital or health clinic)
where healthcare is provided.
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Secure messagingSecure messaging
Enables connectivity for e-health solutions
• Needs to form part of contractual arrangements for IT products
• Hospitals must have contracts with vendors meet NeHTA standards
• Vendors must be compliance checked by NATA accredited laboratories
• Staff must understand what the secure messaging delivers
• IT breaches must be identified and remediated
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Clinical terminology AMT Clinical terminology AMT
AMT – Australian Medicines terminology
• Provides a unique identification regime for medicines in clinical systems to support prescribing, recording, reviewing, supply and administration of medications
• Extension of SNOMED-CT-AU
• Works on a relational model for medications/ingredients
• Covers all listed TGA products & items listed by the PBS
• Focus is to define & codify the information care providers need to prescribe medications
• It does not cover- devices, special access products, over the counter medications, dietary supplements, alternative medicines, blood products & onsite manufactured medicines
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Medications Medications
• Current NEHTA work focusing on Electronic Transfer of Prescriptions (ETP)
• Significant progress in hospitals on e-medication management – decision support
• Utilisation of National Medication chart in paper form and electronically
• Medications must be transferred and displayed in the discharge summary
• Issues for divisions of general practice accreditation
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Diagnostic ImagingDiagnostic Imaging
• Radiological images are not strictly part of the medical record, only the report.
• Access to images are an essential part of care delivery.
• Where the images are stored in a PACS system it is important that they are accessible for patient care at
all hours.
• Staff need to be trained on access and retrieval of images from the system, including those from the current episode of care and those from previous
episodes of care
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Pathology Pathology
Improvement issues
• Better clinical decision making – complete information at point of care
• Efficient practices – tests not needing repeating
• Improved consumer satisfaction
• Standardised test names and result formats
• Collation of appropriate data into meaningful cumulative reports
• Consumer choice of provider
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Benefits of eHealthBenefits of eHealth
Safe clinical handover
Clinical decision support
Improved medication management
Minimisation of duplicated testsPage 18
Risks of eHealthRisks of eHealth
Automated duplication of errors
Unauthorised disclosures
Vendor capture of function
Minimal early efficiencies
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ChallengesChallenges
Consent
Privacy
Waste
Slow uptake
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What consumers say they wantWhat consumers say they want
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• eHealth should improve health outcomes by partnerships between consumers and health
professionals• Consumers should be informed about
eHealth initiatives, including information contained in electronic health records
• Consumers should have access to their own health information
• Consumers should be able to decide who accesses their health information.
• Health information should be held and transferred securely.
Governance that consumers Governance that consumers expectexpect
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•Governance of eHealth systems and networks should be transparent and accountable
• Audit and monitoring systems must be in place to protect against privacy breaches, and consumers must be fully
informed about any privacy breaches that occur in relation to their information
• Consumers should be able to access independent complaints handling.
• There should be strong penalties for the misuse of consumer information
• Development and operation of eHealth systems must be evaluated – including the impact on consumers.
ACSQHCACSQHC
Commission Programs1. Australian Charter of Healthcare Rights
2. Open Disclosure
3. Basic Care Issues
Healthcare Associated Infection
Patient Identification
Medication Safety
Clinical Handover
Patient at risk Falls Guidelines
4. Tools
Accreditation and credentialing
Information Strategy
The National Safety and Quality The National Safety and Quality FrameworkFramework
- Consumer centred
- Organised for Safety
- Driven by information