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Shared Electronic Health Record Service (SEHR)

Archived document

HCNT Implementation

Provider Engagement and Participation

System Capability (SEHR)

Privacy

HCNT Trial

The HealthConnect research and development trial commenced in Katherine in the Northern Territory in June 2002. The Trial was established to help determine whether HealthConnect could improve continuity of care by enabling health care providers timely access to vital health information.

The Trial centered on the development and utilisation of a secure HealthConnect repository.

With a registered consumer's consent, health service providers participating in the Trial were able to send event summaries of health events including medical summaries and hospital discharge summaries via a secure network to the repository. Once in secure storage, other authorised health care providers involved in the Trial were able to access consumer medical summaries with consumer consent.

Enduring partnerships were established with the participants involved in the Trial;

• Sunrise Health Service delivering health services to the predominately Indigenous population east of Katherine;
• Katherine West Health Board delivering health services to the predominately Indigenous population west of Katherine;
• The Wurli Wurlinjang Aboriginal Health Service servicing the Aboriginal population of Katherine Town and surrounding communities;
• The Binjari Health Service providing services to the Aboriginal population of Binjari, and;
• The Katherine District Hospital servicing the Katherine Region.

Evaluation

The phase 2 evaluation conducted during 2004 found that the HealthConnect concept was unanimously supported by providers, health care managers and consumers involved in the Trial and that providers and consumers strongly supported the implementation of HealthConnect across the Katherine Region and the Northern Territory. There was a strong belief among providers and consumers that HealthConnect would provide major benefits in the delivery of coordinated health care across the Territory. There were also a number of lessons learnt from the evaluation, which are included in the "Lessons Learned from the MediConnect and HealthConnect Field Test and Trials" Report.

HCNT Implementation

Following the success of the Trial and the enthusiastic support of consumers, providers and other major stakeholders, the Territory decided to implement the HealthConnect NT (HCNT) SEHR and P2P services Territory wide and to investigate the possibility of expanding the SEHR to cross border regions in South Australia and Western Australia.

Planning for the phased implementation of the HealthConnect NT SEHR and P2P services commenced in the latter part of 2004/2005 and initial implementation of the SEHR across the Katherine Region and P2P in Darwin on 1 July 2005.

Consumer Registration (SEHR)

Vast distances complicate the registration of consumers to participate in the HealthConnect NT SEHR, remoteness of communities, climate (in particular wet season access) and cultural diversity. This provides significant challenges in terms of engaging with, and gaining the informed consent of, consumers particularly with Territorians for whom English is a second language and where there is a range of cultural considerations.

New marketing and promotional materials have been developed, tailored to communicate with, and educate consumers from diverse cultural backgrounds and language groups.

A partnership with Medicare Australia has been negotiated and new registration forms for implementation developed to register consumers to participate in the SEHR service, to confirm Medicare registration details and facilitate new Medicare registrations. A detailed registration process has been established with data compatibility checks undertaken to a strict criteria – data compatibility at time of registration is checked to ensure consumer demographic details are a complete match with home health centre CIS, Medicare and CMI (Hospital) data prior to information being entered into the SEHR.

New pamphlets informing consumers of consent, privacy, provider access to records etc have been prepared and are issued to consumers at time of registration.

A Consumer Advisory Group (CAG) has been established. The Chair of the CAG and Indigenous cultural representatives are represented on the HCNT Implementation Steering Committee.

A dedicated Consumer Services team has been established to focus on consumer registration and provide secretarial support and information to the CAG.

Consumer registration involves community and stakeholder promotion and the appointment of casual Local Project Officers to assist with registration and consumer identification. This creates some employment and skills development opportunities in areas of high unemployment and community ownership in the program.

Consumers to date have embraced the concept of HealthConnect and readily commit to register to participate. A 90% uptake has been realized in remote communities. Over 10,000 consumers had registered to participate in the SEHR service by the end of February 2007.

Consumer registration is an ongoing process. The bulk of consumers registered have come from the Katherine Region, with registrations progressing at Gunbalanya, Jabiru & Outstations, Elliot, Tenant Creek and the Barkly, at Bagot community and registration has commenced in the wider Darwin area, and the Tiwi Islands.

Provider Engagement and Participation

Providers have enthusiastically supported the implementation of the HCNT SEHR and P2P services, believing it would assist greatly in delivering health services to their clients across the continuum of care. 320 providers had registered to participate in the SEHR by the end of February 2007.

Medical Providers currently participating in the SEHR service are:

• Katherine Hospital;
• Wurli Wurlinjang Medical Service;
• Binjari Community Health Centre;
• All of the Sunrise Health Service Centres located East and Southeast of Katherine which includes health centres at Mataranka, Jilkminggan, Ngukurr, Minyeri, Barunga, Wugularr, Bulman and Manyallaluk;
• All of the Katherine West Health Service Health Centres to the west of Katherine which include health centres at Timber Creek, Lajamanu, Kalkaringi, Bulla, Mialuni, Yarralin and Pigeon Hole;
• Anyinginyi Health Aboriginal Corporation;
• Kintore Clinic presently has capacity for viewing of patients records only ;
• Tennant Creek, Royal Darwin, Alice Springs and Nhulunbuy Hospitals;
• Bagot Community Health Centre.

A Clinical Advisory Committee (CAC) has been established and meets monthly. Representation on the CAC includes Doctors, Nurses, Aboriginal Health Workers, Allied Health Professionals and the Top End Division of General Practice (TEDGP). The CAC informs HCNT management and the HCNT Implementation Steering Committee on issues including: protocols, privacy, change management / provider engagement and training, QA and system requirements, capability, user friendliness, and has a major influence in the system enhancement development program.

Provider protocols (SEHR) are implemented and provider agreements at organizational level are agreed to. All providers apply to register, are trained in HealthConnect and are provided with user ID and Password access.

HCNT hotlines (SEHR) have been established to enable providers to obtain HCNT HCIDs for consumers visiting their health service from another location, to address user ID password / access issues and to report system faults.

Quality Assurance procedures in conjunction with providers were established to monitor data quality and audit provider access.

Considerable effort is undertaken in engaging providers and influencing change management to enable providers to incorporate utilization of the HCNT SEHR within normal work practice when utilizing feeder system clinical information systems. A joint Communicare / HCNT SEHR user manual was developed by HCNT with input from participating providers and “how to” sheets prepared for users of all participating CIS’s.

Provider participation increased markedly during 2005/2006 as a result of the increase in the number of registered consumers, efficient provider engagement practices, system reliability / major decrease in system failure and faults, system enhancements, data quality and the SEHR began delivering real service outcomes.

System Capability (SEHR)

The current HCNT SEHR system is designed around a central server sending and receiving medical information from numerous clinical information systems. The HCNT SEHR system receives secured medical summary messages (called event summaries) from feeder systems and stores them in the HCNT SEHR Repository database. Medical providers via the Internet can view these event summaries.

The HCNT SEHR system uses an Argus messaging tool to generate HL7 messages, containing the event summary, and attaches them to HeSA PKI encrypted message sent to the Repository Database via a Big Pond email account. Medical providers using their clinical information system can securely view, using SSL, via the Internet the medical information stored in the SEHR Repository for a specified consumer.
System features via seamless integration into participating feeder systems include:

• automatic flagging notifying of consumer registration status;
• notification (prompt) to send event summaries including inpatient and emergency discharge summaries in hospital systems;
• viewing features of event summaries;
• sending of initial health profiles (IHPS);
• sending of pathology results.

Participating providers are able to create and view initial health profiles, medical event summaries and pathology results and view hospitals inpatient discharge and emergency event summaries for consumers who have registered to participate.

Participating hospitals generate inpatient discharge and emergency event summaries to participating providers automatically for consumers who have registered to participate.

Daily notification to providers of inpatient and emergency discharge summaries for their clients is provided.

Medical summaries generated by the HCNT SEHR Service include:

Medical Summary of a consultation/encounter with Individual - includes current Diagnosis, Medications, Immunisations, Observations, Risk Factors, Allergies, Adverse Reactions, Progress Notes and Presenting Problems.

Hospital Discharge Summaries (ED and Inpatient) - includes Diagnosis, Procedures, Medications, Observations, Pathology Results and ongoing care instructions.

Initial Health Profile - 2-year history of patient from their home Health Centre. Includes Diagnosis, Medications, Immunisations, Observations, Pathology Results, Risk Factors, Allergies, Adverse Reactions, Progress Notes and Presenting Problems.

Current Health Profile – Will replace Initial Health Profile in 2007 and be updated at each occasion of service.

A new robust repository is being built during 2007 and will incorporate new features including the Current Health Profile.

Privacy

HealthConnect complies with the highest national standards for privacy and security.

At registration for the SEHR written consent is obtained from Consumers (or where the person is not legally competent, from a person who is capable of giving consent on their behalf), which

• permits registered health care providers who are registered to participate in the SEHR service to provide health care to their clients, to provide and retrieve the Consumer’s Health Information from the Repository, except where the Consumer requests information not to be sent, or not to be accessed, at the point of care and;
• limits the use of Health Information in the Repository to that needed for the provision of health care to the Consumer and for purposes concerned with the maintenance of the SEHR and its evaluation. (For evaluation purposes, the use of identifiable medical information is excluded).

Provider registration to participate in the SEHR service is available to registered providers who work for organisations participating in the SEHR service. It involves adhering to the HCNT privacy protocol, obtaining approval to register / participate in the SEHR from their supervisor / manager of the participating service. Once registration is approved by a provider’s organisation and HCNT the provider is issued with individual pin access to the SEHR.

An audit log records all transactions and access to consumer records. Access is monitored as part of QA processes and consumers are advised at time of registration that they can view a record of access to their records if they wish.