Transcript National Health IM&ICT Entity Business Case 26 October 2004

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HIMAA Symposium 2006
The EHR in Australia
Dr Bridget Bainbridge
General Manager, E-Health Policy
National E-Health Transition Authority
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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
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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
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Nationally agreed work plan to develop the e-health building
blocks
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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
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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
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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
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NEHTA’s Work Program
Interoperability Framework
eHealth Policy Framework
Benefits Realisation
Clinical
Information
Clinical
Terminologies
Medical Product
Directory
Hospitals And
Other Providers
Shared EHR
Specifications
Administrators &
Funders
Request
lab tests
Health IT
Vendors
Supply Chain
Health record
Consumers
Event summary
Results of
lab tests
Clinicians
Longitudinal
Health Record
Individual Healthcare
Identifier
Healthcare Provider
Identifier
Secure Messaging
Researchers
User Authentication
Standards Implementation
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COAG-funded initiatives #1 - terminologies

National commitment to SNOMED CT as core clinical
terminology – free access via NEHTA
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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
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COAG-funded initiatives #2 – Unique identifiers

National commitment to Individual and Healthcare Provider
identification systems

Individual Healthcare Identifier (IHI) $45m

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Healthcare Provider Identifier (HPI) $54m

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Aim = accurate identification of healthcare individuals across all
healthcare settings
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

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Ongoing Work Program 2006-7
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Further Development of Interoperability Framework
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Secure Messaging Migration Path
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User Authentication Services Model
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Supply Chain Reform - National Product Catalogue
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E-Health Policy including Privacy, Consent, Regulatory
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Collaborative Standards Development and Implementation
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National Shared Electronic Health Record Design
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Benefits Realisation to support COAG business case
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NEHTA & privacy
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Privacy = critical aspect of NEHTA’s work program
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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
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NEHTA’s privacy program
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Commitment to Privacy Impact Assessment (PIA) process
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Preliminary PIAs conducted on UHI and Shared EHR initiatives
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NEHTA’s Approach to Privacy published online July 2006
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Identifiers’ Privacy Blueprint currently being finalised;
publication date November 2006; feedback welcome
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Shared EHR Privacy Blueprint under development; publication
date early 2007; feedback welcome

Privacy Roundtable – targeting privacy experts
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Ultimate goal: working towards full PIA process:
Identifiers – early 2006
 Shared EHR – late 2007

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Key privacy & legal policy issues

Consent/privacy
Fragmentation of privacy laws
 Difficulties in meeting informed consent requirements; impact on
adoption rates

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Governance arrangements
Key dependency for privacy and other legal requirements &
relationships
 Protection against potential for function creep

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Access policies; security & identity management
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Authorised representatives
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Audit functionality
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Potential need for legislative support?
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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.pdf (p.32)
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Shared Electronic Health Record
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NEHTA funded to design national system of Shared EHRs
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Evolutionary: hospital discharge summaries, referrals, populate
the shared health profile …
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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
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National approach to Shared EHRs
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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

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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.

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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

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The timetable
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Three major COAG projects to be completed by end of FY
2008-9
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Current work program funded through to end of FY 2007-8
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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
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Concluding comments
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National approach to Shared EHR is visionary in nature

Key to delivering Shared EHR is ensuring that relevant
infrastructure is in place
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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
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Thank you
www.nehta.gov.au
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Focus for (US) health information efforts
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In October 2006 David Brailer, former US healthcare IT chief
told AHIMA audience to concentrate of four key factors:
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Health information makes healthcare safer
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Health information addresses affordability
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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
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