Delivering E-Health's Foundations

For some years now, there has been more promise from e-health than results on the ground and one of the reasons has been that the foundations of a linked, efficiently communicating healthcare system have not been put in place in a coordinated fashion on a national scale. The barriers to developing these building blocks have been many, which is why Australian Health Ministers agreed to give the task to an organisation designed and funded to do so. The National E-Health Transition Authority Limited (NEHTA) was established on July 5th, 2005 as a collaborative enterprise by the Australian Federal, State and Territory governments, to identify and develop the necessary foundations for e-health.

With these building blocks in place, healthcare professionals will be well on the way to quickly and securely exchanging standard clinical information - information such as hospital discharge summaries, referrals and other priority communications - using standardised data formats and terminologies, so that there is no room for ambiguity or misinterpretation. These foundations will also ensure that information exchange can occur regardless of the software used by either the sending or receiving clinician. Ultimately, clinicians will also be able to access any participating individual's integrated health record.

The potential benefits of e-health systems across the national health sector are enormous and include:

  • Improving the quality of healthcare services, allowing clinicians to more easily access accurate and complete information about their patients
  • Streamlining the care of people with long term illness, who need to be looked after by many different health professionals, by enabling seamless handovers of care through for example electronic referrals and discharge summaries
  • Improving clinical and administrative efficiency, by standardising certain types of healthcare information to be recorded in electronic systems; uniquely identifying patients, healthcare providers and medical products; and reforming the purchasing process for medical products

all while maintaining high standards of patient privacy and information security.

NEHTA has a comprehensive and interrelated program of initiatives underway to deliver these critical elements of e-health, with the agreement of all Australian governments, by July 2008. These elements are outlined below, along with the work completed to date and the next steps.

A framework for interoperability
A key task for NEHTA is to develop a shared understanding of what an e-health environment means for all stakeholders.

Currently, common complaints about e-health include standards that are unclear, unaligned and uncoordinated; and software products that are not interoperable because they are not standards-based. Therefore, NEHTA is developing an overarching e-health framework, to be agreed to by all Australian governments. In August 2005, NEHTA produced Towards a Health Interoperability Framework, a discussion document outlining the direction being taken by NEHTA in the development of the framework. The framework itself will be released in 2006, with guidelines for its use.

In 2006 NEHTA will also pursue the development of methods by which health IT systems that claim to be interoperable can be tested and certified.

Standard clinical information
Australia's priorities for electronic health communications are:

  • Hospital Discharge Summaries - both Inpatient and Emergency. These are produced for the patient's GP by a hospital clinician at, or soon after, the discharge of the patient.
  • Referrals - particularly from GPs to specialists.
  • Event Notifications. These notify healthcare providers of significant planned or unplanned health events such as a hospital admission.
  • Initial Health Profile. This contains pertinent historical and current information about the patient, such as adverse reactions, family clinical history and current medications.
  • Medical Consultation ¬ both General Practitioner and Specialist. This record contains the summary of a patient's visit to a GP or specialist.
  • Diagnostic Investigation ¬ both Imaging and Pathology. Reports on requested imaging and pathology investigations performed on a patient.
  • Pharmacy Provision. A summary of the provision of medication by a pharmacist to a patient.
  • Community Based Health Consultation. This records clinical information relevant to a consultation between a patient and community health provider, such as a nursing practitioner, community nurse or aboriginal health worker.
  • Allied Health Consultation. A summary of clinical information relevant to allied health practitioners such as audiologists, physiotherapists, etc.

During 2005 NEHTA worked extensively with clinicians to specify the clinical data to appear in the electronic version of these communications, and in early 2006 NEHTA will deliver templates for Hospital Discharge Summaries and Referrals to be trialled throughout 2006. NEHTA will also progress work on developing templates for the remaining priorities.

Standard terms and names
NEHTA is also standardising clinical languages used by computers, so that the terms clinicians use in their records - for diagnoses, medicines names and ingredients, therapies etc - are consistent across all healthcare professions. To date, NEHTA has evaluated various options and determined that SNOMED Clinical Terms, an internationally available standard - should be adopted nationally.

In 2005 NEHTA announced its intention to become a Charter Member of the proposed SNOMED Standards Development Organisation (SDO). Once a Member, the advantages are many. It means that software developers will have a standard language they can use in their products - free. The computer of one health care practitioner will then be able to easily interpret information sent from another practitioner.

During 2006 NEHTA will assess the specific terminologies used in SNOMED to ensure that they adequately describe Australian pathology scenarios, medicines, adverse reactions and diagnostic testing.

Secure electronic transmissions
NEHTA is defining the standards for how clinical information can be securely exchanged electronically between healthcare providers. In 2005 an evaluation of the various secure electronic messaging models, and the experiences of other countries in meeting this goal, was undertaken.

In early 2006 NEHTA will release for discussion a transition strategy that outlines how this might be achieved in Australia.

Identifying healthcare providers
To significantly reduce the possibility of clinical documents being sent to the wrong health practitioner, a means of identifying the 400,000 healthcare providers in Australia must be established. In 2005 NEHTA assessed the existing sources of healthcare provider information; and during 2006 NEHTA will pursue the creation of a national healthcare provider identification system based upon the most trusted of these sources, and will complete a privacy assessment of this system.

Accurately identifying individuals
Similarly, a means of accurately identifying individual patients will significantly reduce the possibility of clinical information being assigned to the wrong patient. In 2005 NEHTA identified a means of leveraging existing health identification data, and during 2006 will progress work on creating a national individual health identification system, and will complete a further privacy assessment.

Authenticating electronic access
Once healthcare providers and individuals are identified, a process of authenticating this identity must be established. This authentication process will control who can access sensitive health information, and so therefore must be of a high standard. NEHTA therefore is developing the national standard for authentication processes used in e-health systems, and guidelines will be developed by mid 2006.

Shared electronic health records
Ultimately, NEHTA's work will lay the foundations for individuals to share selected health information with clinicians wherever/whenever required and in way that is secure and maintains privacy.

During 2006, NEHTA will identify how health records would be shared electronically and will assess the relevant privacy aspects of this. These health records will enable authorised healthcare providers to access an individual's health history. Individuals will also be able to access their own shared health record.

Supporting standards implementation
NEHTA has been, and will continue to, develop processes for obtaining the involvement of local and international standards organisations, to support the implementation of NEHTA's standards.

During 2006 this will include the development of a NEHTA Resource Centre, to ensure NEHTA's work outputs are readily accessible online.

Healthcare products supply chain
NEHTA's work creates opportunities for reforming the process of purchasing of medicines and medical products across the health sector. In 2005 NEHTA obtained the agreement of all Australian governments to a National Product Catalogue - a single, central repository of key products such as pharmaceutical, medical device and retail products, for use by all government health services.

In 2006, NEHTA will work with the States and Territories as well as healthcare product suppliers to ensure that they have the capability to use the National Product Catalogue.

Consultation
The input of stakeholders into NEHTA's work is critical. During 2006, NEHTA will continue to undertake extensive consultation with a range of stakeholders, including healthcare practitioners and consumers, the medical software industry, and government agencies.

In addition, NEHTA will regularly publish information ranging from discussion documents, strategies and technical specifications to more general NEHTA news and progress updates.

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