Perspectives on eHealth and the Personally Controlled Electronic Health

Record (PCEHR)

23rd October 2012

Dr Ralph Hanson FRACPClinical LeadThe National E-Health Transition Authority

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

What eHealth could look like today

Health system faces a significant challenge in providing future health services

• 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?

CHALLENGES

Strategic context

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

• Every year Australians have an average of 22 interactions with the health system, including:

4 visits to a GP

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.

The need to share health information

Approximately 13% of health provider consultations have missing information

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%

.

Translating reform into the National eHealth Strategy

eHealth is one of the most important opportunities to:o Improve the quality and safety of healthcareo Reduce waste and inefficiencyo Improve continuity and health outcomes for patients

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.....

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.

eDiagnostics

eDischarge

eReferral

eMedications

TerminologySecure

MessagingIdentifiers Authentication

Priority eHealth Solutions eHealth Foundation Services

National Infrastructure

Partner(NIP)

NEHTA

NationalChange and

AdoptionPartner(NCAP)

External Delivery

AssuranceAdvisor(EDAA)

DOHA

Benefits And

EvaluationPartner(BEP)

Departmentof HumanServices

(DHS)

eHealth record system implementation is a partnership between governments, NEHTA and the market.

Who is delivering the eHealth records system?

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.

13

Date Document05-Dec-2008 Event Summary General Practitioner, Medihome Croydon03-Dec-2008 Event Summary General Practitioner, Medihome Croydon03-Dec-2008 Event Summary General Practitioner, Medihome Croydon02-Dec-2008 Event Summary General Practitioner, 25 Hour After Hours Clinic, Croydon06-Nov-2008 Specialist Letter Cardiologist, Bay Hill Consulting Room25-Sep-2008 Specialist Letter Cardiologist, Bay Hill Consulting Room21-Aug-2008 Event Summary RN, Blackthorne Community Centre14-Aug-2008 Specialist Letter Cardiologist, Bay Hill Consulting Room30-Jun-2008 Discharge Summary Cardiologist, Bay Hill Consulting Room

9 New Documents sent to the PCEHR since the Shared Health Summary

Date Document05-Dec-2008 Event Summary General Practitioner, Medihome Croydon03-Dec-2008 Event Summary General Practitioner, Medihome Croydon03-Dec-2008 Event Summary General Practitioner, Medihome Croydon02-Dec-2008 Event Summary General Practitioner, 25 Hour After Hours Clinic, Croydon06-Nov-2008 Specialist Letter Cardiologist, Bay Hill Consulting Room25-Sep-2008 Specialist Letter Cardiologist, Bay Hill Consulting Room21-Aug-2008 Event Summary RN, Blackthorne Community Centre14-Aug-2008 Specialist Letter Cardiologist, Bay Hill Consulting Room30-Jun-2008 Discharge Summary Cardiologist, Bay Hill Consulting Room

9 New Documents sent to the PCEHR since the Shared Health Summary

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

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

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 dataHealthcare professionals can, with patient consent, access the above information through: Conformant clinical information systems

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

18

Are consumers 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

19

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

Are healthcare professionals ready?

Specific issues for children, young people and families

Challenges• Delayed registration• Personal control

• Child• Adolescent / Young person

From 14From 18

• Representatives• Authorised • Nominated

Opportunities• Lifelong record• Shared / Integrated care• Greater involvement in care• Move to an Electronic Child

Health Record• Enhance benefits of CHR eg

Improve immunisation status

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

The reality check :……eHealth improving the patient experience?

Change is about people not the technology!

23 National E-Health Transition Authoritywww.nehta.gov.au

Thank you and Questions

www.ehealth.gov.au

www.nehta.gov.au