clinical handover 2011(rmcg)

Consumers and clinical handoverConsumers and clinical handover

How consumers can

participate in

GP/Hospital handover

Russell McGowan

15 April 2011

My storyMy story

Same GP in Canberra since 1981

Diagnosis at WVH - 1991

Surgery - 2002

Inpatient blood transfusions – 1992

BMT in Royal Adelaide - 1993

Re-admissions TCH 1993, 1994, 2006

Referal to Westmead - 2003

Specialists - within hospitalsSpecialists - within hospitals

Haematologist

Infectious disease specialist

Cardiologist

Thoracic physician

Gastroenterologist

Oral physician

Specialists – outside hospitalsSpecialists – outside hospitals

Ophthalmologist(s)

Dermatologist(s)

Neurologist

Dentist(s)

Physiotherapist(s)

Formal discharge summaries issued Formal discharge summaries issued to GPto GP

ZIP

Formal referal letters from GPFormal referal letters from GP

10% of occasions

Formal feedback from specialistsFormal feedback from specialists

10 -20% of the time

The Answer?The Answer?

The personally controlled electronic health record (pcehr)

Personally Controlled E-Health Personally Controlled E-Health RecordsRecords

• Safer healthcare• Improving direct patient care by more timely access to

clinical information

• Capacity to share information more readily

• Clinical decision support systems

• Higher quality healthcare• Supports and enables better team base care

• Supports chronic disease management initiatives

• Shares knowledge amongst health professionals

E-Health more generallyE-Health more generally

• Direct patient care: better, more timely & accurate -Transfer of clinical information

• Better patient care: Safety & Quality:- Clinical decision support

• Cost savings in terms of less “re-do” of tests and better safety and quality so potentially less unplanned re-

admissions

• Support for chronic condition management

• Support for team based care / engaging health professions in health care delivery:- Improved sharing of clinical information

• Management and planning of healthcare services:- improved, accurate, relevant and up to date information.

Foundations for e-healthFoundations for e-health

1. Healthcare Identifiers – IHI, HPI-I, HPI-O

2. National Authentication Service for Health (NASH)

3. Secure Messaging

4. Clinical Terminology

5. National Product Catalogue

6. Compliance, Certification & Accreditation

Healthcare IdentifiersHealthcare Identifiers

• Individual Healthcare Identifier (IHI) – for individuals receiving healthcare services.

• Healthcare Provider Identifier – Individual (HPI-I) – for healthcare professionals and other health personnel

involved in providing patient care.

• Healthcare Provider Identifier – Organisation (HPI-O) – for organisations (such as the hospital or health clinic)

where healthcare is provided.

Secure messagingSecure messaging

Enables connectivity for e-health solutions

• Needs to form part of contractual arrangements for IT products

• Hospitals must have contracts with vendors meet NeHTA standards

• Vendors must be compliance checked by NATA accredited laboratories

• Staff must understand what the secure messaging delivers

• IT breaches must be identified and remediated

Clinical terminology AMT Clinical terminology AMT

AMT – Australian Medicines terminology

• Provides a unique identification regime for medicines in clinical systems to support prescribing, recording, reviewing, supply and administration of medications

• Extension of SNOMED-CT-AU

• Works on a relational model for medications/ingredients

• Covers all listed TGA products & items listed by the PBS

• Focus is to define & codify the information care providers need to prescribe medications

• It does not cover- devices, special access products, over the counter medications, dietary supplements, alternative medicines, blood products & onsite manufactured medicines

Medications Medications

• Current NEHTA work focusing on Electronic Transfer of Prescriptions (ETP)

• Significant progress in hospitals on e-medication management – decision support

• Utilisation of National Medication chart in paper form and electronically

• Medications must be transferred and displayed in the discharge summary

• Issues for divisions of general practice accreditation

Diagnostic ImagingDiagnostic Imaging

• Radiological images are not strictly part of the medical record, only the report.

• Access to images are an essential part of care delivery.

• Where the images are stored in a PACS system it is important that they are accessible for patient care at

all hours.

• Staff need to be trained on access and retrieval of images from the system, including those from the current episode of care and those from previous

episodes of care

Pathology Pathology

Improvement issues

• Better clinical decision making – complete information at point of care

• Efficient practices – tests not needing repeating

• Improved consumer satisfaction

• Standardised test names and result formats

• Collation of appropriate data into meaningful cumulative reports

• Consumer choice of provider

Benefits of eHealthBenefits of eHealth

Safe clinical handover

Clinical decision support

Improved medication management

Minimisation of duplicated tests

Risks of eHealthRisks of eHealth

Automated duplication of errors

Unauthorised disclosures

Vendor capture of function

Minimal early efficiencies

ChallengesChallenges

Consent

Privacy

Waste

Slow uptake

What consumers say they wantWhat consumers say they want

• eHealth should improve health outcomes by partnerships between consumers and health

professionals• Consumers should be informed about

eHealth initiatives, including information contained in electronic health records

• Consumers should have access to their own health information

• Consumers should be able to decide who accesses their health information.

• Health information should be held and transferred securely.

Governance that consumers Governance that consumers expectexpect

•Governance of eHealth systems and networks should be transparent and accountable

• Audit and monitoring systems must be in place to protect against privacy breaches, and consumers must be fully

informed about any privacy breaches that occur in relation to their information

• Consumers should be able to access independent complaints handling.

• There should be strong penalties for the misuse of consumer information

• Development and operation of eHealth systems must be evaluated – including the impact on consumers.

ACSQHCACSQHC

Commission Programs1. Australian Charter of Healthcare Rights

2. Open Disclosure

3. Basic Care Issues

Healthcare Associated Infection

Patient Identification

Medication Safety

Clinical Handover

Patient at risk Falls Guidelines

4. Tools

Accreditation and credentialing

Information Strategy

The National Safety and Quality The National Safety and Quality FrameworkFramework

- Consumer centred

- Organised for Safety

- Driven by information

clinical handover 2011(rmcg)

Documents