Turning revolution into evolution

Turning revolution into evolution

Julie Roediger

Deputy Director, Australian Institute of Health and Welfare

Julie Roediger

Deputy Director, Australian Institute of Health and Welfare

Australian Institute of Health and Welfare

OutlineOutlineThe coming world

The existing world

The hybrid world

Enduring tensions

Australian Institute of Health and Welfare

E-Health activitiesE-Health activities

InteroperabilityClinical communicationsUnique health identificationIdentity managementSecure messagingIndividual electronic health recordSupply chainEngagement and adoption

Australian Institute of Health and Welfare

ImplicationsImplicationsStandards, standards, standards

– IHI-I, IHI-O, IPI– Identification service– Messaging– Terminology– Authentication

Structure, structure, structure– Generation of messages– Pull and push of data– Essential data and its meaning

Australian Institute of Health and Welfare

Functions of existing-healthFunctions of existing-health

Reimbursement

Evidence based medicine

Bench-marking and improvement

Post-market evaluation

Population health monitoring

Policy development and program management

Public Health Surveillance - Pandemic, Biosurveillance, Prevention

Biomedical Research

Australian Institute of Health and Welfare

Supporting infrastructureSupporting infrastructure

Wide variety of identifiers

No identification service

Data definitions– National Minimum Data Sets – Data Set Specifications

Searchable stores for collected NMDS & DSS and other administrative data sets

Australian Institute of Health and Welfare

Existing data standards: exampleExisting data standards: example

Australian Institute of Health and Welfare

Unit records withcoded values

Clinician raises a natural language and/or form-based record

Human coding assisted by guidelines

Aggregate reportseg. national minimum data sets, registries,

linked data sets,

Patient interacts with clinician

Information for research and analysis: Existing health

Australian Institute of Health and Welfare

Clinician raises a terminology or rule-based record

Machine coding according to maps

Unit records withcoded values

Aggregate reportseg. NMDS,

device registry,patient records

linked by IHI

Patient (IHI) interacts with clinician

Information for research and analysis: e- health

Map

Classifications

Terminology

Australian Institute of Health and Welfare

Clinician or coder raises a terminology or rule-based record

Machine coding according to maps

Unit records withcoded values

Clinician raises a natural language and/or form-based record

Human coding assisted by guidelines

Aggregate reportseg. NMDS,

device registry,patient records

linked by IHI

Patient (IHI) interacts with clinician

Information for research and analysis: hybrid

Map

Classifications

Terminology

Paper-based systems

Australian Institute of Health and Welfare

Clinician or coder raises a terminology or rule-based record

Machine coding according to maps

Unit records withcoded values

Clinician raises a natural language and/or form-based record

Human coding assisted by guidelines

Aggregate reportseg. NMDS,

device registry,patient records

possibly linked by IHI with consent

Patient (IHI) interacts with clinician

Information for research and analysis: hybrid

Map

Map

Classifications

Terminology

Australian Institute of Health and Welfare

Proposed governance — data supply chainProposed governance — data supply chain

Process

FUTURESTORE?

ProcessDevelop &

designBuild Collect Analyse

Dissemin-ate

Archive Evaluate

Collect AnalyseDissemin-

ateArchive Evaluate

CLINICAL INFORMATION PROCESS: collects, shares and uses information about individuals, also produces statistical information at local level for local use (e.g. in practice or hospital)

STATISTICAL INFORMATION PROCESS: creates and disseminates information about groups of people, events or other things such as diseases, for policy or research use

Other clinical users e.g. referrals

STANDARDSAPPROVALFOR NEEDS

AND MEANING

STANDARDS APPROVAL FOR DEVELOP, DESIGN

AND BUILD

Specify clinical needs

Specify statistical

needs

Specify other needs

COMPLEMENTARY RE-USE GOVERNANCE

CLINICAL RE-USE GOVERNANCE

TRUSTED RE-USE

FACILITATOR

Australian Institute of Health and Welfare

Useful concepts for secondary useUseful concepts for secondary use

Population-centred

De-identified or pseudonymised data (consent

models)

Program managment

Epidemiological studies

Point-of-service

Identified data

GP Hospital Pathologist

Patient-centred

Identifieddata

IEHRDischarge summary

Referral

Public accountability

All

Billing

Australian Institute of Health and Welfare

Enduring tensionsEnduring tensionsEnduring tensionsEnduring tensions

Appetite for information vs costAppetite for information vs costResponsiveness vs qualityResponsiveness vs qualityNew requirements vs time seriesNew requirements vs time seriesPrivacy vs accessPrivacy vs accessCompeting array of use casesCompeting array of use cases

Thank youThank you