Concept of Operations: Relating to the introduction of a Personally Controlled Electronic Health Record System
B.2 The National E-Health Strategy
Australian governments have recognised, consistent with the experience of many other countries, that moving from a paper-based system to an electronic one requires a long-term plan with multiple staged goals that are linked to the experiences of patients as they journey through the health system.
The key lesson from analysis of comparable developed countries is that the success of an eHealth implementation depends on focused strategic plans [ECIS2007, DHC2004, MHSA2006]. These plans have been implemented with strong leadership by government and supported by appropriate investment over long lead times.
Australia has acknowledged this need for leadership through its collaborative approach between governments to address eHealth and through the development and public release by all Health Ministers of a National E-Health Strategy in 2008 [AHMC2008]. The Strategy provides a guide for the further implementation and adoption of eHealth in Australia.
The National E-Health Strategy proposes an incremental and staged approach to developing eHealth capabilities and supports the existing collaboration of Commonwealth, State and Territory governments. The Strategy also provides sufficient flexibility for individual jurisdictions and health sector participants to determine how they implement eHealth solutions within a common framework and set of priorities. It recognises the current eHealth work program to be delivered through NEHTA and the need for other investments over a ten-year timeframe to deliver a full national eHealth capability. It also recognises the significant role of the market in delivering eHealth solutions that will respond to a dynamic health sector.
The key principles that underpin the Strategy’s approach to deliver Australia’s national approach to eHealth are around creating the necessary national infrastructure; using an approach heavily informed by stakeholder engagement; an incremental approach to implementation and adoption; recognising that different stakeholders will have different starting points; leveraging existing systems where appropriate; striking a balance in national alignment and local independence; and fostering relevant skills in the community.
In order to deliver the vision for eHealth, the Strategy recommends work be conducted in four major work streams: Governance; Foundations; eHealth Solutions; and Change and Adoption.
The Strategy focuses on the development of eHealth solutions in priority health areas that will provide the greatest tangible benefit to all Australians and their healthcare providers. The three categories of solutions identified as high priority by the Strategy are:
- Electronic information sharing.
- Service delivery tools.
- Health information resources.
Much of the Strategy’s foundation work for information exchange is funded and delivery is underway. The NEHTA work program funded to June 2012 is focused on achieving the foundations for information exchange to support eHealth solutions.
The foundations for a National eHealth system include:
- A system for uniquely identifying individuals, healthcare providers and the organisations in which they work.
- Authentication services to ensure that transactions are private, traceable and only conducted by known identities.
- Healthcare providers using computer software that meets common standards for communicating information such as Prescriptions, Referrals, Discharge Summaries, Pathology Result Reports and Diagnostic Imaging Result Reports.
- A robust privacy framework for the handling of personal health information.
The Strategy identified a national Individual Electronic Health Record (IEHR) System as a high priority. The Strategy envisaged the IEHR as:
A secure, private electronic record of an individual’s key health history and care information. The record would provide a consolidated and summarised record of an individual’s health information for consumers to access and for use as a mechanism for improving care coordination between care provider teams. [AHMC2008]
Since the Strategy was originally developed, the term ‘PCEHR’ is now preferred as it better aligns with the recommendations from the National Health and Hospitals Reform Commission which recommended that a national approach to electronic health records should be driven by ‘the principle of striving to achieve a person-centred health system.’ [NHRR2009].
In 2010, the Government has invested 466.7 million in the first release of a PCEHR System.