National E-Health Transition Authority 1 eHealth and Practice Nurses: ‘ Using eHealth to improve outcomes for your chronic disease patients. 6 th December 2014 Heather McDonald - National E-Health Transition Authority

2 National E-Health Transition Authority Draft – Not for distribution 1.Introduction to eHealth 2.What is eHealth and how does it relate to Practice Nurses? 3.Current state within Australia 4.Using Clinical documents for patients with Chronic Disease 5.How to use of clinical software to upload and view patient records Overview

3 National E-Health Transition Authority Draft – Not for distribution The overwhelming belief of nearly all the respondents is that an electronic health record is a critical investment for Australia that we should support. PCEHR Review

4 National E-Health Transition Authority Draft – Not for distribution What is eHealth? Information Sharing While our healthcare system is among the best in the world, some of our ways of collecting and sharing healthcare information — such as medical history, test results, scans, or hospital discharge reports can be improved. Many clinical communications, are still completed on paper. Standards The healthcare software industry in Australia currently uses a number of different standards and formats for recording medical information that results in computer systems not being able to communicate with each other. Patient Centric The introduction of eHealth is helping to put the individual at the centre of their healthcare. In addition it reduces opportunities for errors and supports healthcare providers to share relevant patient information and make informed patient decisions. eHealth is the collection, management, use, storage and sharing of healthcare information using information and communication technology.

5 National E-Health Transition Authority Draft – Not for distribution The eHealth Foundations combine the basic technologies of unique identification to provide a safe and secure method of exchanging healthcare information ie.( identification, authentication and encryption) eHealth Foundations Healthcare Identifiers (HI) Service Operated by the Department of Human Services (Human Services) which allocates a unique 16-digit number (a Healthcare Identifier) to individuals using healthcare services and their practitioners and healthcare organisations. The right health information associated with the right individual at the point of care For more information on the HI Service visit:

6 National E-Health Transition Authority Draft – Not for distribution Information in an eHealth Record comes from 3 main sources PatientHealth ProfessionalMedicare  Personal medications and allergies summary (can be viewed by healthcare professionals)  Personal health notes (can not be view by providers)  Child development information  Advance care directive custodian contact details  Shared Health Summary  Event Summary  eDischarge Summary  eReferrals and Specialist letters  Prescription and dispense records  Coming in 2014: eDiagnostic Imaging and Pathology reports  Medicare claims data  Pharmaceutical Benefits Scheme  Australian Childhood Immunisation Register  Australian Organ Donor Register  DVA claiming events

7 National E-Health Transition Authority Draft – Not for distribution How do I access the eHealth Record? Individuals can access their health record via the consumer portal. Consumers are able to contribute to their health record by inputting personal health notes, medications and allergies. Consumer Portal The Provider Portal is view only. Healthcare providers can view and download a patient’s health information but cannot contribute to it. Provider Portal Healthcare providers with access to PCEHR conformant software are able to contribute to the patient’s eHealth record by uploading clinical documents via their software. Conformant Clinical Software The my child’s eHealth record app is for consumers with children under the age of 14 years. It allows parents and authorised representatives to access the child’s eHealth record and and view information about the child’s development. Mobile Application Consumers Providers

8 National E-Health Transition Authority Draft – Not for distribution How does the eHealth record benefit Nurses? Some of the key benefits for Practice Nurses and their organisations are: Better access to health information Health Information around your patient’s current conditions and past records like diabetes, heart disease, medications or past surgeries. Improved Continuity of Care Continuity of care through accurate and timely communication and clinical hand over across health professionals utilising eHealth products. Informed decisions on patient’s medical needs Informed decisions on patient’s medical needs through access to a health history that is shared rather than recalled by the patient. Less time finding & calling other providers for information More efficient consultations Less duplication Provide efficient access to health information that you didn’t already have

9 National E-Health Transition Authority Draft – Not for distribution Health information will travel with the individual Care not affected by the individual’s ability to remember their medical history Individuals have the ability to update personal data and view their health information online Better quality, safer and more efficient care for individuals (information availability & less time wastage) Reduction in duplications (tests, information, etc.) How does the eHealth record benefit Individuals? Discharge Summaries available within 24 hours of discharge Linking e-Health communities Exchanging information 2-way communication flow Hospitals sending discharge summaries & Practices uploading SHS

10 National E-Health Transition Authority Draft – Not for distribution Adoption of eHealth in Australia

11 National E-Health Transition Authority Draft – Not for distribution Where are we now ? Capabilities exist and ready to adopt Engaging various parts of the health sector eHealth interactions across sectors Evidence of benefits and disbenefits Evidence of improvements in long term health and economic outcomes 2012 – 14 Focus

12 National E-Health Transition Authority Draft – Not for distribution 7,445 healthcare organisations (HPI-Os) registered in the PCEHR System. Public Hospitals and Health Centres connected to the PCEHR As at 5 September 2014 Healthcare Providers

13 National E-Health Transition Authority Draft – Not for distribution Targeting the Chronic Disease Patients. Information regarding uptake and registration numbers How to engage and register appropriate patients Using clinical software to register patients in the practice When to upload clinical documents

14 National E-Health Transition Authority Draft – Not for distribution Impact to workflow

15 National E-Health Transition Authority Draft – Not for distribution eHealth Workflow Impact

16 National E-Health Transition Authority Draft – Not for distribution The duration of eHealth record activities is highly variable depending on the surrounding circumstances of the practitioner and the consumer. Examples include: Providers competence to efficiently use CIS (computer literacy) Cleanliness of existing clinical data Registration status of the consumer Ability for the consumer to comprehend the implications of a shared record Assisted registration model used by the practice – is it in your CIS? Support by practice staff to undertake eHealth activities prior to the consultation - registering patients at the front desk eHealth record knowledge of both the GP/Nurse and consumer eHealth Workflow Impact (con’t)

17 National E-Health Transition Authority Draft – Not for distribution Three factors: Widespread population registration i.e. the level of registration where a provider will find a record more often than not when they look Extensive adoption and use by healthcare providers across more sectors A large and compelling volume of content, presented in a way that adds value to clinical workflow and decision making. Are we reaching a tipping point of consumers, providers, content?

18 National E-Health Transition Authority Draft – Not for distribution What information is in an eHealth record? Shared Health Summary Prepared by a health professional in consultation with the individual, is a summary of the individual's health at a point in time. It could include medical history, allergies and adverse reactions, medications the individual may be taking and any immunisations they have had. Event Summary A clinical document used to capture health information about significant healthcare events from a healthcare professional. Information may include clinical synopsis, and medications. Discharge Summary Created for an individual when associated with an event/hospital admission. May include diagnosis, key dates, clinical synopsis, diagnostic investigations and medications upon discharge, improving the continuity of care between healthcare professionals.

19 National E-Health Transition Authority Draft – Not for distribution How does a Shared Health Summary look?

20 National E-Health Transition Authority Draft – Not for distribution What does an Event Summary look like?

21 National E-Health Transition Authority Draft – Not for distribution What does a Discharge Summary look like?

22 National E-Health Transition Authority Draft – Not for distribution What does a Discharge Summary look like? (Cont)

23 National E-Health Transition Authority Draft – Not for distribution View of National Prescribe & Dispense Repository (NPDR) JIM CITIZEN

24 National E-Health Transition Authority Draft – Not for distribution Adoption of eHealth has not yet translated to use that delivers anticipated value

25 National E-Health Transition Authority Draft – Not for distribution Proportion of organisations registered in the eHealth Record System who are using the system, per week Limited use

26 National E-Health Transition Authority Draft – Not for distribution Factors affecting momentum of eHealth use For you as the Practice Nurse and as a consumer – identify some of the factors that are affecting your use of eHealth

27 National E-Health Transition Authority Draft – Not for distribution Where are we heading?

28 National E-Health Transition Authority Draft – Not for distribution Transforming Adoption into Use Adoption: ready and available  Adoption has occurred at a faster rate than any other country rolling out a national eHealth infrastructure.  In targeted areas (general practice, public hospitals and community pharmacy) registration numbers exceed the most optimistic projections made.  Overall, an estimated 70% of general practices; 20% of community pharmacies and 100% of public acute facilities in ACT, NT, QLD, Tas are registered in the eHealth Record System and have enabled software. Private acute facilities are now planning to connect.  Almost 2 million people have eHealth Records. Use: improving patient outcomes  We now need to shift gear and focus on use.  This means:  Focusing on patients who have the greatest need.  Supporting those enabled healthcare providers who care for these patients to make use of the system.  Championing the system to users as being critical infrastructure that’s needed, wanted and here to stay.

29 National E-Health Transition Authority Draft – Not for distribution Think about your practice – Were there any barriers to registration? Barriers to increased Use?

30 National E-Health Transition Authority Draft – Not for distribution What strategies do we need to apply to overcome the barriers to use

31 National E-Health Transition Authority Draft – Not for distribution Practical ways to get the best out of your eHealth record system

32 National E-Health Transition Authority Draft – Not for distribution Preparation - Why is it important? To access a Patient’s eHealth record: Correct Patient’s demographic details need to be within your Clinical Information System (CIS) ( family name, given name, sex, DOB and Medicare / DVA number) – helpful tips at end of presentation Ensure the Patient’s demographics in the CIS match with Medicare and Patient Validate the Patient’s IHI which requires up-to-date demographic data Implication of “unclean” or incorrect demographic data means you won’t get a match from the HI Service and you will receive an error message The role you can play

33 National E-Health Transition Authority Draft – Not for distribution Data quality and cleansing is so important archiving inactive patients removing sample patients merging duplicate patient records maintaining recall lists updating medications completing and clearing outstanding ‘actions’ or ‘requests’ etc. ensure consistent clinical terminology by utilising drop down menus where possible – minimising free text entries How to Prepare – Step One Data cleansing good practices Reconfirm patients demographics data every visit Ensure all of Practice are aware to avoid duplications Work with Practice Health Team to define a policy of active versus inactive patients eg - if patients hasn’t visited practice twice in the past 3 years

34 National E-Health Transition Authority Draft – Not for distribution Learn how to use your tools to help with data cleansing: Your Clinical Software search tool Pen Clinical Audit Tool – Canning Tool RACGP - Quality health records in Australian primary healthcare ityhealthrecords.pdf RACGP - Sample compliance checklist for quality health records practice/business/tools/support/qualityhealthrecords/sample-checklist/ Prepare & Plan – Step Two Links to assist with data cleansing RACGP Electronic health records Health Summary Fact Sheets

35 National E-Health Transition Authority Draft – Not for distribution Troubleshooting Record the error message Screenshot error message (make sure image is de- identified ) and contact your software vendor – helpful links at end of presentation Use Snipping Tool – NEHTA Customer Care team can guide you through this If you have an issue validating IHI it most likely is a mismatch with Medicare – get patient to call Medicare to validate demographic details Call NEHTA Customer Care team on – we can determine your issue and triage your call What to do if you encounter an issue

36 National E-Health Transition Authority Draft – Not for distribution For Providers

37 National E-Health Transition Authority Draft – Not for distribution Software Demonstrations

38 National E-Health Transition Authority Draft – Not for distribution Training Environment The eHealth Training Environment is a simulated environment demonstrating the interaction between the PCEHR and respective desktop applications. It is designed to be used by Practitioners who already have an understanding of the eHealth functionalities within their Software. You can demonstrate: Interacting with the Healthcare Identifiers Service (HI Service) Uploading clinical documents to the PCEHR Viewing and downloading clinical documents from the PCEHR Performing assisted registration Or a sand box to play around in The eHealth Training Environment has 12 test patients populated so you can manipulate test patient information in order to simulate changes to a patient’s eHealth Record.

39 National E-Health Transition Authority Draft – Not for distribution Where to next? Start data cleansing Familiarise yourself with your own eHealth record Select patients for pilot Start your Pilot on 5 patients Try uploading a Shared Health Summary without cleansing the data Data cleanse and then upload again – note the difference in speed Start Assisted Registration – providers/ehealth-support-tools/software-demonstrations/provide- assisted-registrationhttp:// providers/ehealth-support-tools/software-demonstrations/provide- assisted-registration Start looking up and validating IHI’s Start creating Shared Health Summaries & Event Summaries Review software demonstrations on the NEHTA website - demonstrations demonstrations

40 National E-Health Transition Authority Draft – Not for distribution Call NEHTA help centre on or eHealth registration resources available at providers Visit for information on the eHealth Record System and promotional resources. Contact your Software Vendor Where to get help?

41 National E-Health Transition Authority Draft – Not for distribution Questions?