1. nehta HIMAA Symposium 2006 The EHR in Australia Dr Bridget Bainbridge General Manager, E-Health Policy National E-Health Transition Authority

2. nehta 1 Executive summary Overview of NEHTA & NEHTA’s work program Further information about NEHTA’s COAG-funded initiatives (February 2006)  Terminologies $32m  Individual Healthcare Identifier (IHI) $45m  Healthcare Provider Identifier (HPI) $54m Overview of NEHTA’s privacy program Overview of NEHTA’s Shared EHR initiative Concluding comments

3. National E-Health Transition Authority nehta 2 National Collaboration in E-health National E-Health Transition Authority Ltd (NEHTA) established to meet the requirements of a federation of nine governments Built on existing mechanisms for collaboration by Health Ministers and CEOs Set up as an entity independent of any one government but owned by all A company limited by guarantee; Directors from all jurisdictions Nationally agreed work plan to develop the e-health building blocks

4. National E-Health Transition Authority nehta 3 What is NEHTA’s mission? To develop better ways of electronically collecting and securely exchanging health information Electronic health information (e-health) systems that can securely and efficiently exchange data can significantly improve how important clinical and administrative information is communicated between healthcare professionals E-health systems have the potential to unlock substantially greater quality, safety and efficiency benefits

5. National E-Health Transition Authority nehta 4 What are the potential benefits? Improving the quality of healthcare services Streamlining multi-disciplinary care management Improving clinical and administrative efficiency  by standardising certain types of healthcare information to be recorded in e-health systems; uniquely identifying patients, healthcare providers and medical products; and reforming the purchasing process for medical products Maintaining high standards of patient privacy and information security

6. National E-Health Transition Authority nehta 5 Developing the e-health foundations Electronic transfer of clinical information using a common language of consistent terms, descriptions and formats National directories that accurately identify medicines, medical products, devices and consumables Information systems that uniquely identify individuals and healthcare providers are across Australia Agreed specifications and standards for authenticating users and exchanging messages across the health sector Policies and processes that ensure that privacy is protected Design of a national system of shared electronic health records accessible to authorised clinicians and consumers

7. National E-Health Transition Authority nehta 6 Shared EHR Specifications User Authentication NEHTA’s Work Program Secure Messaging Hospitals And Other Providers Administrators & Funders Researchers Results of lab tests Request lab tests Health record Event summary Consumers Longitudinal Health Record Health IT Vendors Supply Chain Clinicians Interoperability Framework Clinical Terminologies Medical Product Directory Clinical Information Individual Healthcare Identifier Healthcare Provider Identifier Standards Implementation eHealth Policy Framework Benefits Realisation

8. National E-Health Transition Authority nehta 7 COAG-funded initiatives #1 - terminologies National commitment to SNOMED CT as core clinical terminology – free access via NEHTA NEHTA building national capability to develop, maintain, distribute and support SNOMED International collaboration through SNOMED Standards Development Organisation Medicines Terminology- uniquely identify medicines with common descriptors; ACOM implementation Nationally agreed priorities for clinical communications COAG funding: $32m

9. National E-Health Transition Authority nehta 8 COAG-funded initiatives #2 – Unique identifiers National commitment to Individual and Healthcare Provider identification systems Individual Healthcare Identifier (IHI) $45m  Aim = accurate identification of healthcare individuals across all healthcare settings Healthcare Provider Identifier (HPI) $54m  Aim = accurate identification and authentication of healthcare providers & organisations across all healthcare settings Timings:  Detailed Design Phase commenced Requirements review completed  Project Planning and Procurement Strategy Under development in 2006 Procurement planned for 2007

10. National E-Health Transition Authority nehta 9 Ongoing Work Program 2006-7 Further Development of Interoperability Framework Secure Messaging Migration Path User Authentication Services Model Supply Chain Reform - National Product Catalogue E-Health Policy including Privacy, Consent, Regulatory Collaborative Standards Development and Implementation National Shared Electronic Health Record Design Benefits Realisation to support COAG business case

11. National E-Health Transition Authority nehta 10 NEHTA & privacy Privacy = critical aspect of NEHTA’s work program NEHTA supports the view that modern healthcare demands the confident exchange of information IHI, HPI and Shared EHR will support national healthcare system’s ability to electronically exchange health-related information Three key initiatives involving the collection & handling of personal (incl. health) information NEHTA’s view: success of these initiatives = dependent on both achieving privacy compliance & meeting community expectations around privacy

12. National E-Health Transition Authority nehta 11 NEHTA’s privacy program Commitment to Privacy Impact Assessment (PIA) process Preliminary PIAs conducted on UHI and Shared EHR initiatives NEHTA’s Approach to Privacy published online July 2006 Identifiers’ Privacy Blueprint currently being finalised; publication date November 2006; feedback welcome Shared EHR Privacy Blueprint under development; publication date early 2007; feedback welcome Privacy Roundtable – targeting privacy experts Ultimate goal: working towards full PIA process:  Identifiers – early 2006  Shared EHR – late 2007

13. National E-Health Transition Authority nehta 12 Key privacy & legal policy issues Consent/privacy  Fragmentation of privacy laws  Difficulties in meeting informed consent requirements; impact on adoption rates Governance arrangements  Key dependency for privacy and other legal requirements & relationships  Protection against potential for function creep Access policies; security & identity management Authorised representatives Audit functionality Potential need for legislative support?

14. National E-Health Transition Authority nehta 13 New patient consent statement? “WARNING: our physicians and nurses are attempting to use antiquated manual records keeping systems and their own limited memories in an often futile attempt to deliver a complex set of services without error. The logic of these human beings has been tested incompletely at some point in the past, but we offer no warranty expressed or implied that any individual decisions made or action taken will be provably correct. Moreover, we do not know the effect of ageing, distractions, overwork, and failure to communicate on the overall care you will receive. Because we do not take a systems approach to health care services, by signing this consent you agree to participate in this admittedly error prone and potentially life threatening activity” http://hinf.uvic.ca/archives/Protti.pdfhttp://hinf.uvic.ca/archives/Protti.pdf (p.32)

15. National E-Health Transition Authority nehta 14 Shared Electronic Health Record NEHTA funded to design national system of Shared EHRs Evolutionary: hospital discharge summaries, referrals, populate the shared health profile … Shared health profile = core of Shared EHR= better decision support Benefits of Shared EHR to health consumers:  supported self management of chronic conditions in community  shared care planning for multiple, complex chronic illnesses  reduced reliance upon acute care services

16. National E-Health Transition Authority nehta 15 National approach to Shared EHRs Goals  Enhance quality of care (from a safety, effectiveness, timeliness, health consumer centredness and equitable point of view)  Ensure privacy & other legal obligations are met  Provide pragmatic solution Purposes  Primary: to improve the availability of selected health information about participating individuals, for the purpose of their healthcare, while providing strong & effective privacy protection  Secondary: to support improved public health & policy planning, safety initiatives, disease detection, research & education etc. Objectives  To make selected health information available to the right people at the right time and place and in an appropriate form, targeting the needs of providers  To maintain participant confidence in Shared EHRs from a trust, privacy and governance viewpoint  To improve the quality (scope and nature) of health data holdings

17. National E-Health Transition Authority nehta 16 The timetable Three major COAG projects to be completed by end of FY 2008-9 Current work program funded through to end of FY 2007-8 Review of NEHTA’s progress to be conducted mid-2007 Health Ministers to report back to COAG no later than 2008 on:  progress & next steps towards a national electronic health record system  appropriate cost sharing arrangements

18. National E-Health Transition Authority nehta 17 Concluding comments National approach to Shared EHR is visionary in nature Key to delivering Shared EHR is ensuring that relevant infrastructure is in place Majority of NEHTA work program is about putting e-health infrastructure into place in a way that is interoperable, has capacity to produce tangible benefits for consumers & providers & provides strong foundation for Shared EHR Infrastructure is an enabling mechanism – pieces of infrastructure may produce little direct benefit; direct benefits increase as other systems use e-health infrastructure to provide additional applications & services

19. nehta Thank you www.nehta.gov.au

20. National E-Health Transition Authority nehta 19 Focus for (US) health information efforts In October 2006 David Brailer, former US healthcare IT chief told AHIMA audience to concentrate of four key factors:  Health information makes healthcare safer  Health information addresses affordability  Health information is portable  Health information is protected Based on recognition that technology alone is an insufficient condition of an improved healthcare system, it will require all relevant parties working together