“There’s a lot of up-skilling to do, in particular at the home end or recipient end of healthcare. There’s a notion of build it and they will come: If you don’t have the NBN, you won’t generate the digital literacy to maximise the use of it. So it’s a little like chicken and egg,” said Professor Colin Carati, associate head of ICT at Flinders University.
Roy Monaghan, national telehealth delivery officer at the National Aboriginal Community Controlled Health Organisation (NACCHO), agreed, saying the lack of reliable broadband in remote and rural Australia has contributed to a digital divide.
“It’s like having a bike: you don’t really learn what the bike can do until you get on it. You may make a few mistakes, but essentially you have a vehicle that can take you faster than you can with your legs. If people don’t have the ability to jump onto a system and make those mistakes, adjust and learn on how to do things a bit better, we are not going to go places.”
Carati pointed to issues around the NBN rollout schedule not going according to plan, saying it has made the process of providing adequate teleheatlh services difficult.
A NACCHO survey showed that only 30 of about 100 members were actually engaging in telehealth services, with the lack of an effective Internet connection being the main reason why many weren’t engaging in telehealth, said Monaghan.
He added that the new government’s fibre-to-the-node broadband policy is “an incomplete solution”, but it could offer some flexibility in being able to make changes to the network as technology continues evolves over time.
“It could be that wireless technology does evolve and you may be able to [leverage] it at these nodes, and maybe there will be a Wi-Fi tower that can shoot out the information at a very high speed.”
A telehealth project that Carati is working on in South Australia is providing people at home with particular health conditions to have their health status monitored remotely on a regular basis through an iPad app and through video conferencing.
He said he was able to provide this without the need for a large amount of bandwidth; less than 1Mbps per video conference. However, he said he is still limited in the quality of service he can provide due to poor reliability of Internet.
“There are occasions, especially when you are using non NBN related technologies, where you are getting poor quality and reliability of service, primarily though the contention of those technologies where you are getting too many people trying to jump on the bandwidth.
“The NBN will improve access, especially pushing out to the home and the bandwidth demands are likely to increase.”
States commit to rapid eHealth integration project
Written by Kate McDonald on 10 October 2013., Pulse IT magazine
The majority of states and territories will have the ability to begin allowing acute care clinicians to view clinical documents and send discharge summaries to the PCEHR system by the end of the year.
In a panel discussion at a recent ICT forum organised by the Department of Health and NEHTA, jurisdictional representatives provided an update on their respective eHealth strategies and how they planned to connect acute care to the PCEHR.
No representatives from South Australia and Western Australia were on the panel, although SA has already begun sending discharge summaries from nine public hospitals and has developed software called Healthcare Information and PCEHR Services (HIPS) that is being used by other states as part of NEHTA’s unfortunately named rapid integration project (RIP).
Paul McRae, the principal enterprise architect with Queensland Health, told the forum that the jurisdictions were all members of a RIP steering committee that he chairs. Mr McRae said the committee had agreed that the first steps to integrating with the PCEHR was to enable discharge summaries to be uploaded and to allow clinicians to view clinical documents.
Mr McRae said Queensland Health had linked with the HI Service in January this year, and those using it were achieving an 85 per cent match rate when pulling in batches of Individual Healthcare Identifiers (IHIs).
He said NASH certificates and HPI-Os were recently acquired for healthcare organisations to support the rapid integration program.
“We are looking to roll out statewide the ability to send discharge summaries to the PCEHR from all facilities that use our enterprise discharge summary application, which is all bar about three,” he said.
“And we are going to provide the ability to view PCEHR information from our clinical portal, which is called The Viewer . That will be available in around 200-plus facilities and that will all happen early in November.
“At the same time, discharge summaries in CDA format level 2 will be able to be sent point to point as well.”
Yin Man, manager of NSW Health’s RIP program – better known as HealtheNet – said CDA discharge summaries and event summaries had been able to be sent to GPs and the NSW clinical repository from within the Greater Western Sydney lead site since August last year.
Clinicians in Greater Western Sydney are now able to access the national system through a clinical portal , which Ms Man said would be rolled out to all public hospitals in the state over the next two years.
“Our clinicians in hospitals within Greater Western Sydney have been viewing CDA discharges since last August and this year we have been integrating with the national,” she said.
“All hospitals will be connected to this one portal. Things have been going quite well and we already have half a million CDA documents within our clinical repository, and we pretty much generate about 6000 a month. As soon as we connect, we will be sending a lot of documents to the national.”
Victoria’s representative on the panel, the Victorian Department of Health’s advisor on eHealth policy and engagement, Peter Williams, did not go into much detail on his state’s plans for integrating with the PCEHR as a review of the state’s health IT sector is currently with the health minister.
It is understood that some local health districts – particularly those that took part in the Wave 1 and 2 lead site projects – are soon to begin sending discharge summaries to the national system, but Victoria does not have the centralised approach that the other states are taking.
Mr Williams said Victoria had put a proposal to NEHTA to look at how to expand the viewing capacity of hospitals outside of the lead sites. “Once you have done it for some, you can extend it to others … using common software, and we have licences across Victoria,” he said.
“With the secure messaging project that is being done in SA, while they are using different technology, the design approach is adaptable in Victoria very quickly. That is absolutely the core of what the RIP project is about – fast-tracking some of those things.”
The Northern Territory is currently working through a major project that it is calling the M2N , in which it is transitioning its successful My eHealth Record (MeHR) system over to the national PCEHR. For that reason, it will not go live with full discharge summary and viewing capability until March or April next year.
Robert Whitehead, director of eHealth policy and strategy with the NT Department of Health, said the territory was probably going to follow Queensland and provide a combined view of both the MeHR and the PCEHR for its departmental staff.
The PCEHR will become the primary record for all new information, but the MeHR will also be accessible for historical documents.
The NT is also holding off until next year as the national PCEHR cannot yet receive pathology and diagnostic imaging reports, which the MeHR can. The NT is planning to go live just after the major upgrade of the PCEHR planned for April, when pathology reports are expected to be available.
“We have a unique set of circumstances in that we’ve been operating [the MeHR] now for eight years,” Mr Whitehead said. “We’ve got an established community of consumers and providers who have expectations about usability.
“We needed … for our clinicians in particular to be confident that what they see in [the PCEHR] matched what they currently are able to see. That has been the driver for asking DoHA and NEHTA to advance some aspects of PCEHR work in terms of a view that would support an aggregation of some key pieces of primary care information and event summaries.
“Our clinicians at the moment have access to a document that aggregates information … and that gives them a bit of a context about what has been going on with that patient in the last little while.
“The other thing is around pathology and diagnostic imaging reports in that our clinicians are used to being able to seeing pathology results that were ordered in a primary care context. Hospital stuff at the moment appears in the discharge summary and we are not arguing that should be changed.
“So our go live is a little later in that we are targeting around March-April next year as the go live date because of this need to do a hard transition from one to the other. We will still do a dual view of MeHR for people who are registered so that historical information is still accessible to our current participating healthcare providers.”
Like Victoria, Tasmania is also currently undertaking a review of its eHealth strategy. Tim Blake, deputy chief information officer with the Tasmanian Department of Health and Human Services, said Tasmania was “on the cusp” of releasing its updated eHealth strategy, which is expected to include more details about connecting to the national system.
Pulse+IT understands that Tasmania will adopt the South Australian technology to begin allowing discharge summaries to be sent and clinical documents to be viewed within its public hospitals.
The ACT has been very active in eHealth, with Calvary Hospital playing a large role in one of the Wave 2 projects and already having the ability to send CDA discharge summaries to the PCEHR and to GPs.
The ACT Health Directorate’s manager for the national eHealth project, Ian Bull, said the territory had been investigating how to quickly verify IHIs for newborn babies, so their parents can register them for a PCEHR from birth.
“Within our jurisdiction we are building a consumer portal , so consumers can log in and look at their appointments for outpatients services,” Mr Bull said.“We are also building a provider portal for clinicians in the region to be able to submit referrals and get bookings.”
He said the ACT was also in discussions with the federal Department of Human Services to investigate using Medicare’s Health Professional Online Services (HPOS) system more widely in the hospital environment.
Update 1.00 pm October 16
UGPA calls on Government to address clinical utility of the PCEHR as an urgent priority
Australia’s general practice (GP) leaders are calling on the Government to heed concerns raised by GPs regarding the significant clinical utility issues associated with the Personally Controlled eHealth Record (PCEHR) system and address them as an urgent priority.
At a recent United General Practice Australia (UGPA) meeting in Canberra, representatives of the GP sector unanimously agreed that the focus of the PCEHR needs to be redirected to clinical utility and standardisation to ensure seamless clinical adoption.
Significant issues have been identified and currently there is no alignment between consumer registration and meaningful use through engagement of the clinical community and assurance of improvement of patient health outcomes.
In August 2013 a number of key clinical leads resigned from National E-Health Transition Authority (NEHTA). This was amidst ongoing concerns and requests for NEHTA and the Department of Health and Ageing (DoHA) to review the PCEHR development cycle and re-establish meaningful clinical l input.
Since August, DoHA has become the PCEHR system operator and opportunities for clinical engagement have been less clear.
UGPA is calling on Government to implement strategies to ensure the PCEHR is best structured to improve the health outcomes of all Australians. The process should be profession led and include:
• GP input at every level of the PCEHR development life cycle; including planning through to implementation
• Ensuring the system is clinically safe, usable and fit for purpose
• Supported by an acceptable, and robust legal and privacy framework
• Secure messaging interoperability is a critical dependency priority.
E-health and the PCEHR have the potential to transform Australia’s health system and provide superior, safer and more efficient healthcare to all Australian patients. UGPA members believe that this potential will only be fully realised if there is meaningful clinical engagement at a grassroots level.
The Government has announced it will review implementation of the PCEHR. UGPA supports the review and look forward to contributing to the review and expect that the clinical voice and the concerns raised will be heard.
UGPA comprises the Royal Australian College of General Practitioners (RACGP), the Australian Medical Association (AMA), the Australian Medicare Local Alliance (AMLA), the Australian General 2
Practice Network (AGPN), General Practice Registrars Australia (GPRA), the Australian College of Rural and Remote Medicine (ACRRM), and the Rural Doctors Association of Australia (RDAA).
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