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eHealth in Australia
Transcript of eHealth in Australia
Dr. Noha Elkholy
A higher quality and safer healthcare system
The E-Health Strategy will enhance the quality and safety of care through improved decision support for care providers and consumers, and improved patient information leading to a reduction in adverse events and improved treatment effectiveness.
A more accessible and equitable healthcare system
The E-Health Strategy will enhance the provision of more accessible and equitable delivery of healthcare services, irrespective of a consumers’ demographic, socioeconomic or geographic profile.
A more efficient healthcare system
The E-Health Strategy will improve the efficiency and cost effectiveness of the health care system.
Estimating the size of efficiency benefits in dollar terms is very challenging and the subject of considerable international debate due to a range of factors including the lack of reliable data across the health system, the difficulties in isolating the benefits associated with specific eHealth solutions and the divergent approaches to determining the economic value of the quality of life.
E-Health implementations overseas demonstrate significant direct productivity improvements for specialists, GP and pharmacists by helping to automate routine interactions between care providers such as referrals, prescriptions, and image processing.
Barriers to Adoption
Dr. Amira Ismail
Despite the significant amount of E-Health activity across the country and the strong emerging consensus for action, Australia has historically struggled to meaningfully progress with a national E-Health agenda.
The reasons for this are varied but at the core is the fact that Australia’s health system is not a single, cohesive entity.
It is inherently fragmented with disjointed service delivery processes as a consequence of the wide range of largely autonomous public and private sector parties involved in health care delivery across Australia.
This fragmentation, which spans dimensions such as Australian, State and Territory Governments, the public and private sectors, and primary, acute and community health providers, has made it very difficult to effectively coordinate and align E-Health activities at a national level and will continue to be a significant challenge going forward.
1- An inability to effectively justify the spend on E-Health to financial and political decision makers who have traditionally prioritized investments in more tangible physical infrastructure, medical equipment and workforce matters ahead of IT. The weaknesses associated with a traditional return on investment E-Health business case model are primarily due to the difficulty in clearly isolating the benefits that will be realized by the E-Health component of a change program.
2- The lack of continuity of key political and bureaucratic health sector leaders across Australian, State and Territory Governments.
3- An inability to effectively leverage the many disparate E-Health initiatives being undertaken around the country. Most successful E-Health projects across the Australian health sector been implemented on a small, local scale due to a lack of funding or understanding of how they could be leveraged within a broader strategic framework.
4-The lack of engagement of key stakeholders in the design and implementation of E-Health strategies and solutions. Up until very recently Australian consumers have not been meaningfully engaged in the E-Health debate and there has been consequent lack of pressure for action from this critical stakeholder group.
5-A shortage of health IT skills within the sector required to deliver large scale E-Health programs of work. The combination and depth of skills required to effectively implement E-Health should not be underestimated given the complexity of the workplace and technological challenges involved.
6- The poor state of underlying health IT systems and infrastructure due to a combination of historic underinvestment and the relative immaturity of the health IT vendor marketplace.
Standards in eHealth Australia
Dr. Shirin Zolfakar
American National Standards Institute(ANSI)
European Committee for Standardization(CEN)
Health Level 7(HL7)
Health Level 7 Australia(HL7 Australia)
International Organization for Standardization(ISO)
National E-Health Transition Authority(NEHTA)
Standards Australia (SA)
American National Standards Institute (ANSI)
It provides an open, public forum for the voluntary coordination of healthcare informatics standards among all United States standards developing organizations.
Every major developer of healthcare informatics standards in the United States participates in ANSI HISB (Healthcare Informatics Standard Board).
European Committee for Standardization (CEN)
CEN contributes to the objectives of the European Union and European Economic Area with voluntary standards which promotes several aspects among which is the interoperability of networks.
Health Level 7 (HL7) &Health Level 7 Australia
HL7 is an international organization which originates in the USA. HL7.org provides international standards for inter-system and inter-organization messaging, for decision support, clinical text document mark-up, user interface integration as well as a health data model and message development methodology. It produces global health informatics standards through a process of collaboration, which involves HL7 Australia.
HL7 Australia is the local affiliate of the international HL7 organization and is an open, volunteer-based, not-for-profit organization that supports the needs of HL7 users in Australia.
International Organization for Standardization (ISO)
ISO is the world's largest developer of standards.
Although ISO's principal activity is the development of technical standards, ISO standards also have important economic and social repercussions.
ISO is a network of the national standards institutes of 148 countries, on the basis of one member per country, with a Central Secretariat in Geneva, Switzerland, that coordinates the system.
The National E-Health Transition Authority (NEHTA)
It was established by the Australian, State and Territory governments to develop better ways of electronically collecting and exchanging health information.
NEHTA's mission is to set the standards, specifications and infrastructure requirements for secure and interoperable e-health systems, while maintaining high standards of privacy.
SNOMED Clinical Terms® (SNOMED CT), the internationally pre-eminent clinical terminology, has been identified by NEHTA as the preferred terminology for Australia. SNOMED CT is now freely available for use in Australia, under NEHTA's licensing arrangements with the International Health Terminology Standards Development Organisation (IHTSDO).
Standards Australia is the nexus for Australian industry.
Standards Australia ensures the effective development of standards and recognition of other standardization bodies by providing an active forum for discussion, debate and consensus.
Vision of eHealth Australia
Dr. Khaled Elsadi
The vision includes 3 sectors
Health care managers.
Allow care providers to access their medical information to know more about their health details.
Give consumers ability to access their own record & have control on it.
Consumers trust that their records are secure.
Depend on health system to coordinate there medical care & treatment.
Consumers will have many accredited sources for health.
Consumers in rural areas will have better health services.
Support consumers to monitor their health & access to risk assessment & care plans.
They will have complete health information about individual at time of care.
Connect multiple providers electronically to deliver an effective care to consumers.
Share health information with other providers securely in no time.
They will have access to data to monitor & evaluate service outcomes.
They will have the ability to order test, prescribe medications & refer to other provider
Providers decisions will be supported by access to appropriate information source & decision support tools.
Providers will be have the ability to interact with consumers electronically wherever they are.
Providers will have the ability to monitor consumer care plans and health status.
Providers will have easy access to clinical knowledge and evidence sources.
Providers will collaborate with other professionals to share their experience.
Health care managers
They will have access to timely and complete information about health system activities and outcomes.
Health Care Managers will have a reliable and comprehensive evidence base to monitor
Health Care Managers will be able to better respond in the case of emergencies.
Health Care Managers will be able to rapidly assess the national impact of particular treatment regimes.
Data collection and reporting will occur in a streamlined and automated fashion.
Health Care Managers will be able to improve health care service quality by access to reliable datasets of population health and treatment effectiveness.
Privacy Guidelines for the Medicare Benefits & Pharmaceutical Benefits Programs
Dr. Manal Abou Taleb
The Australian Government issued laws to ensure the privacy of handling information within the healthcare system. The privacy law reform process began in 2006, almost 20 years after the Privacy Act was first introduced in 1988.On 1 November 2010 the Office of the Privacy Commissioner was integrated into the Office of the Australian Information Commissioner and a new website established at www.oaic.gov.au.Major changes to the Privacy Act 1988 will come into effect in March 2014.
The National Privacy Principles
The Privacy Act creates a single, nationally consistent framework for protecting privacy. It complements existing codes of practice and ethics in the health sector and has been amended to cover most private sector organizations, including all health service providers in Australia regardless of size.
Health Information and the Privacy Act 1988, the NPPs cover the whole information life cycle from collecting health information, to its storage and maintenance, and including its use and disclosure for a wide range of purposes.
The legislation delivers 10 items which are:
NPP1: Collection &
NPP2: Use and Disclosure
NPP3: Data Quality &
NPP 4: Data Security which sets standards
NPP6: Access & Correction
NPP7 : Identifiers
NPP8 : Anonymity
NPP9: Transborder data flows
NPP10: Sensitive Information
Medicare Australia established detailed technical standards which:
(a) specify access controls applying to each database;
(b) limit access to each database;
(c) specify the security procedures;
(d) identify how any linkages conducted can be traced;
(e) describe the special arrangements for the security of claims information; and
(f) specify the destruction schedule for records created.
Medicare Australia Personal Identification Number
Medicare Australia may only maintain a personal identification number (''Medicare Australia PIN') to the extent necessary to assist that agency in identifying individuals included in the Medicare Benefits Program and the Pharmaceutical Benefits Program. A Medicare Australia PIN must not: (a) be based on or derived from a person's name, date of birth, address, telephone number or Medicare card number; (b) enable an individual's identity to be determined from the Medicare Australia PIN alone; or (c) reveal any health related or other personal information of the individual.
Disclosures and Linkages
Disclosure of information is regulated so that the privacy is preserved, secured, recorded and audited. Medicare Australia may only link claims information relating to the same individual in very strict circumstances, whether internal or external or even for disclosure to an individual where that individual has given their consent. Medicare Australia must destroy that linked claims information as soon as practicable after meeting the purpose for which it was linked.
Personally Controlled Electronic Health Records Act 2012 (PCEHR Act)
From July 2012, Australians can choose to register for their own personally controlled electronic health (eHealth) record.
The PCEHR Act limits when and how health information included in an eHealth record can be collected, used and disclosed .
The OAIC’s role includes investigating complaints about the mishandling of health information in an individual’s eHealth record. The OAIC can also conduct ‘own motion investigations’..
The purpose of the PCEHR (Participation Agreements) Rules is to prescribe a requirement that healthcare provider organisations, repository operators, portal operators and contracted service providers enter into a participation agreement in order to be, and remain, registered as a participant in the PCEHR system.
The OAIC’s role in the eHealth record system
The functions and enforcement powers available to the OAIC include:
* Seeking a civil penalty from the Courts seeking an injunction to prohibit or require particular conduct accepting enforceable undertakings using existing Privacy Act investigative and enforcement mechanisms, including conciliation of complaints and formal determinations accepting data breach notifications from the System Operator, repository operators and portal operators.
* The OAIC will issue Enforcement Guidelines which will outline the Commissioner’s approach to enforcement issues under the legislation.
* The OAIC uses different methods to reach the people and clarify the different rules and acts,including the official website and YouTube channels.
Leadership should encourage the endorsement of a law of privacy of information, especially electronic information.
A legislation specific to electronic information should be affected.
Standards should be used within the same sector to enable interoperability among the different entities.
Public awareness is essential.
Thank You For Your Time
The Video: www.youtube.com/watch?v=ODgjGfC4opE
Key Strategic Principles
Recognizing different starting point.
Balancing alignment & independence.
1- Integrate private & public hospitals as a single entity.
2- Don’t follow personal interest for special leadership but follow public interest.
3- Make a strategic plan for implementation of the system by following international standard.
4- Must be present a qualified staff and have excellent knowledge & experiences for success.
5- Suitable budget for purchasing all supplies and equipment.
Implementation of Australia eHealth
Dr. Jina Awad
The implementation took 10 years divided into 3 stages:
Stage 1: connect and communicate (1st 3 years ): establish foundation for E-health and provide basic connections between care providers.
Stage 2: collaborate (2nd 3 years): shift from basic communication to collaboration.
Stage 3: consolidate (last 4 years): E-health becomes part of business.
E-health implementation targets:
2) Care Providers.
3) Healthcare Managers.
The vision must come from higher authority.
The strategy must be include multiple organizational (Ministries).
Setup new organizations that are principle of foundations, standards & privacy.
Recommendations for application of EHR in Egypt
There are several issues that need to be fulfilled in order to reach our target.
First, healthcare providers need to be prepared to shift from paper to electronic records.
Secondly, a good plan need to be introduced for proper implementation depending upon our needs and goals we want to achieve.
Third, we have to select a suitable system depending upon our demands.
Last but not least we need to achieve proper training for our providers and adopt an efficient maintenance policy for the system to carry on the work without flaws.