Concept of Operations: Relating to the introduction of a Personally Controlled Electronic Health Record System
D.2 Frank Harding
Frank is a 62-year-old retired schoolteacher, who has decided to travel around Australia. Frank and his wife Daphne have just purchased a 4WD and campervan and have headed north from their home in Croydon in Victoria. He had been diagnosed with Type II Diabetes (Non-Insulin Dependent Diabetes) and moderate depression. Both conditions require monitoring and treatment modification. His initial anti-depressant (Prozac) was ineffective and resulted in a rash and vomiting. He is now on Metformin to manage his diabetes.
Frank has consented to have a PCEHR and has opted to use ‘basic access controls’.
Scene 1: Frank visits the Emergency Department in CairnsWhile on his holiday in Cairns, Frank presents to the Cairns Emergency Department (ED) complaining of chest pain and presenting with shortness of breath and cough.
In the current system, the Cairns ED would need to rely on Frank’s memory for his medical history. At best, if the ED had time and Frank’s GP was contactable, the ED would phone Frank’s GP to find out his medical history.
With access to the range of new eHealth capabilities, the Cairns ED can use the healthcare identifiers service to quickly locate Frank’s IHI by using Frank's Medicare Card and other identifying details (name and date of birth).
After locating Frank’s IHI, the local clinical system also identifies that Frank has a PCEHR. As Frank’s access controls permit any healthcare provider involved in his care to have access to his PCEHR, the Cairns hospital adds itself to his ‘access list’.
From now on, the Cairns Hospital can use the PCEHR System to locate Frank’s health information in a range of different repositories. This authorisation will remain in place until Frank revokes it (or for 3 years).
When the doctor is able to see Frank, he/she can view a copy of Frank’s Consolidated View. The Consolidated View includes the Shared Health Summary from his regular GP in Croydon and also shows any new information about Frank’s allergies/adverse reactions, medicines and medical history that may have been collected in his PCEHR on his travels (e.g. Event Summaries from visits to walk in GP practices).
At the conclusion of Frank’s consultation in the ED, the emergency physician diagnoses Frank with pneumonia and prescribes a course of antibiotics. Frank’s Liver Function Test (LFT) performed at the hospital showed a mild out of range result. The LFT results were explained to Frank by the ED physician and Frank was advised to have a follow up LFT in 2 weeks. Frank’s Discharge Summary is sent to Frank’s regular GP in Croydon and a copy is uploaded to Frank’s PCEHR.
Scene 2: Frank in Port DouglasTwo weeks later while in Port Douglas, Frank is feeling better and remembers that he needs to have a pathology test done. Frank attends a walk-in GP clinic in Port Douglas to have his pathology test organised.
In the current situation, Frank would need to remember the name of the pathology test and the details of his episode of care within Cairns for the Port Douglas GP to undertake the right course of action.
With access to the range of new eHealth capabilities, the Port Douglas GP can access Frank’s PCEHR to locate the Discharge Summary from the Cairns ED. Then using the information from Frank’s Discharge Summary, the Port Douglas GP can request a LFT for Frank electronically.
At the conclusion of this consultation, an Event Summary is sent by the GP to Frank’s PCEHR.
Scene 3: Coffs HarbourAfter a day in Port Douglas, Frank is not feeling up to doing the full lap of Australia, so he and Daphne head home to Croydon. While in Coffs Harbour, the GP office in Port Douglas calls Frank requesting him to come back for a follow up visit to review his results. The GP has also released the pathology results to Frank’s PCEHR.
Frank is now too far away from Port Douglas to return for his follow up appointment, so the practice recommends that he should see his GP back in Croydon as soon as he returns.
Ordinarily in this case Frank would not have direct knowledge of his health records. Using the PCEHR System, Frank is able to become more involved in his own care. Frank is able to use the consumer portal to view his health information and then look up online resources such as HealthInsite and LabTestsOnline to help him understand his condition and lab test results.
Scene 4: CroydonOn return to Croydon, Frank books an appointment with his regular GP to review his results.
Ordinarily, Frank’s GP would need to request a copy of Frank’s results from the pathology laboratory in North Queensland or have the pathology test repeated. In this case, by using the PCEHR System, Frank’s GP is able to locate Frank’s results quickly. Frank’s GP can also easily see the entire medical history of his journey from the PCEHR index view, including visits to other healthcare providers.
Frank’s GP recommends that Frank undertake a new course of antibiotics and gets some rest before heading west to Broome and the Kimberly.
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